Alzheimer Therapy: Oment please!

5. September 2011

Seriously ill people often grasp at any straw which offers hope. And there always are people who will hand you a straw. One such example is an operation for Alzheimer's disease sufferers, in support of which a US surgeon for years has campaigned. He probably doesn't have many supporters. (though)

The operation at issue is the so-called Omental Transposition. In this type of operation, fat-rich tissue of the omentum in the abdomen is connected directly to the brain of a patient with Alzheimer’s disease through a channel in the subcutaneous abdominal and chest area. The surgeon who has advocated this method as a treatment option is U.S. medical professor Harry S. Goldsmith of Glenbrook, Nevada. As recently as early July he has, in the prestigious “Journal of Alzheimer’s Disease” made a summation for the operative procedure. The time has come to test the new method on severe Alzheimer’s patients in a clinical trial, Goldsmith says.

Not the very freshest method

The procedure is not, however, new. Already fifteen years ago, Goldsmith reported on an Alzheimer’s disease patient for whom, even two and a half years after the operation, things went better than expected. In 2003 he then presented in the same journal the results for ten patients who’d undergone the operation. Additionally, from among these Alzheimer’s patients, many were said to have improved a lot after the operation, in both subjective and objective terms. Goldsmith first reported on his own animal experiments in 1973 in the Archives of Surgery. In 1985, he then reported in the journal Paraplegia on successes with the so-called omental transposition in cats with spinal cord injury. Since then, Goldsmith has repeatedly campaigned for the procedure which, in his view, is an appropriate treatment option for patients with traumatic spinal cord injury and, equally, also for Alzheimer’s patients. His argument is based on few experimental observations and theoretical considerations. His main argument: In Alzheimer’s disease, cerebral hypoperfusion is the cause of neurodegenerative processes and not, as is overwhelmingly assumed, the consequence of neurodegeneration.

Decreased blood flow to play a key role

Evidence for the argument that there is some truth in this blood-circulation thesis is, according to the surgeon, the increasing findings that, in addition to aging, diseases such as diabetes mellitus and hypertension, which may be associated with cerebral hypoperfusion, are risk factors for Alzheimer’s disease. The efficacy of omental transposition, says Goldsmith, as understood at the moment arises from the way that it promotes angiogenesis and vascularisation, improves cerebral blood flow and also provides the brain with neurotransmitters and, potentially, also with stem cells. His own studies, among others, have proven this, he suggests.

With his ideas on the pathogenesis of the disease Goldsmith is not totally amiss. It is well known that, in most patients with Alzheimer’s dementia, fMRI or PET scans reveal decreased perfusion in regions of the brain, and that histological examinations also show vascular damage. In 60 to 90 percent of Alzheimer’s disease cases a cerebral ischemia is detectable, the two U.S. neurologists Henry W. Querfurth and Frank M. Laferla, in an article on Alzheimer’s pathogenesis (New England Journal of Medicine), explain. In about one third of patients with vascular dementia, Alzheimer-typical findings were able to be ascertained.

Operation “lacks any scientific basis”

That we can extract something from these well-known facts, however, and get to the point of reasoning, wherein a possible improvement in perfusion via omental transposition has the effect of slowing the cognitive decline in Alzheimer’s disease and thus justifies the surgery, is one which Goldsmith holds probably alone. Very brief is the response statement, for example, from Professor Wolfgang H. Oertel, chairman of the German Society of Neurology, given to the query from DocCheck on the value of omental transposition in Alzheimer’s patients: “The surgical treatment of Alzheimer’s,” says Oertel, “lacks any scientific basis.”

Negative operation outcomes in spinal cord injury

Most of the positive reports on the procedure come from Goldsmith in any case, as the result of a search engine research shows. They also occupy the spaces in his current list of scientific papers, with which he is attempting to support his thesis. Scarce, on the other hand, are studies from other researchers which indicate a possible benefit of surgery for Alzheimer’s sufferers or lend medically or ethically justified credence to such a traumatising method being used on seriously ill patients.
Added to this is that clinical studies of omental transposition in spinal-cord injury have gone poorly. Already in 1996 neurosurgeon Professor Guy L. Clifton from the University of Texas at Galveston published the results of this procedure used on 160 patients with complete or incomplete sensitive paraplegia. His conclusion in the journal Spinal Cord was clearly negative. Further clinical studies, says Clifton, are not justified. Extreme reservations made up also a large part of of the conclusion of British scientists after they had tested the method on seventeen paraplegic patients.

Only in acute trauma situation might omentum transposition have a role, they write in Journal of Neurology, Neurosurgery & Psychiatry. The U.S. neuroscientist Professor Wise Young of WM Keck Center for Collaborative Neuroscience at Rutgers University in Piscataway, who runs a website for patients, also arrives at, after an analysis of published studies, a clear conclusion: There is no evidence of a benefit of the surgery for traumatic paraplegia. Whether the meagre body of data will prevent, however, that omentum transposition be offered to Alzheimer’s patients (and their relatives) as a therapy, is an entirely different matter.

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