IRVINE, Calif. More than eight years after, as he described it, My brain went ... Whats the word? ... Foggy, Jack Sage said finally, four years after he was diagnosed with Alzheimers disease and two years since he began an innovative and extremely invasive therapy, Sage said he is being flooded by memories that seem new, or, at the very least, feel easier to retrieve.
His daughter, Kate, thought Sage suddenly had begun to open up about his past because he knew his time was growing short.
He should not know who I am at this point, Kate said.
His doctor, Christopher Duma, hopes Jack Sage goes down in history as the one-man turning point in the treatment of Alzheimers disease, while others are skeptical about what Duma has done to Sages brain.
The Alzheimers Association reported that 610,000 Californians 65 or older had the disease in 2016, and it estimated increases to 690,000 by 2020 and 840,000 by 2025.
On a cool recent night, Sage, a fit 82-year-old, sat next to his wife Gloria talking about his children (It is significant that Sage remembers their names James, 46, Kate, 50, and Kelly, 56), recalling when he and Gloria moved into their Newport Beach house (1990), their first date (1979), his years as a labor negotiator and executive (1970s and '60s) and the jack hammering he did in the nickel mines (mid-1950s) in Northern Ontario, Canada.
At this point in his illness, his doctor said he should be having more trouble remembering the mine. Sages series of recollections represent the three main components of long-term memory: semantic (recalling the meaning of words), episodic (recalling autobiographic milestones) and procedural (recalling how to accomplish tasks) prompted a grin from Duma, the brain surgeon who, for $10,000 per treatment and without insurance coverage, cut a hole in the back of Sages head and injected a stem cell serum that had been sucked out of Sages love handles.
Is this the Alzheimers breakthrough the world has been waiting for? Or, is this unproven medical procedure what University of Minnesota bioethicist Leigh Turner calls quackery and flimflam? Is this an unsafe, money-grab being conducted outside the approval process of the Food and Drug Administration preying on the most vulnerable among us?
Turner has written extensively and critically about the Cell Surgical Network (CSN), for which Duma, whose home hospital is Hoag in Newport Beach, is listed as a network physician. The CSN promotes the stem cell revolution, which its literature claims, is an appropriate treatment for people suffering from a variety of inflammatory and degenerative conditions, such as cancer, diabetes, bad knees and hips as well as multiple uses in cosmetic surgery.
You dont just start dumping things into peoples brains, Turner said. People may spend a lot of money and find there is no benefit. He (Duma) is exposing people to serious harm. Fat cells dont belong in peoples brains.
Sage is the first patient in Phase I of a clinical study officially called Intracerebroventricular injection of autologous abdominal fat-derived, non-genetically altered stem cells. Sage was the first Alzheimers patient anywhere to have his own liposuctioned cells injected directly into his brain. He has received eight injections (about two months apart) since November 2014.
Duma quickly offers a qualifier. It is far too early to tell if what he has done to Sage will indeed change the world. He said Sage and, later, 19 other patients have not been harmed by the procedure, and that safety is the only criteria in Phase I. Whether the treatment is effective is a question for Phase II, for which Duma is hoping to attract private funding. Also, he wrote a letter to the national Alzheimers Association asking for $700,000 to continue his work. He was instructed to apply officially later this year. If he gets the grant, the fees for his patients would be waived.
So far, Duma is excited by Sages results. Sages most recent cognition scores have risen from 45 on the 100-point Memory Performance Index in March 2015 to 54 in September 2015. The volume of his hippocampus the memory center of the brain has grown from the fifth percentile before his first treatment to the 28th percentile after his fourth treatment to the 48th percentile after his eighth treatment.
Sages brain isnt his only problem. He has a long history of heart ailments that have required the insertion of 12 stents to keep his arteries open.
You cant make a global conclusion based on one patient, but its a huge turning point, Duma said, with the confidence of someone who probes brains for a living.
Duma is somewhat of a maverick in the medical world, a brain surgeon who regularly shuns a scalpel for the gamma knife, a futuristic laser for removing brain tumors.
Duma realizes he will face opposition to his stem cell/brain injection therapy. But, as in all breakthroughs, someone has to be first.
I could have harmed people, he said. I took an enormous leap.
Duma said he is nearly finished writing a paper about his work that he hopes will be published in a peer-reviewed journal.
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