Tuesday October 15, 2002
The Guardian
Lorenzo Odone was only five years old when his parents noticed that he kept
bumping into the furniture. A horrifying diagnosis followed: Lorenzo had a
rare, incurable genetic disorder that affects only boys, known as
adrenoleukodystrophy (ALD). He would lose all his bodily functions and die
within two to three years. If you've seen the 1992 Hollywood film Lorenzo's
Oil, you'll know what happened next.
The Odones, neither of whom had medical training, were not going to sit
around and watch their son deteriorate. "We were not prepared to believe
that there wasn't a cure," says Augusto Odone. So they set out to find one,
ignoring doctors who said the literature would be too "complex" for them to
understand. The result was, says Odone "a case of man bites dog": after two
years immersed in medical texts and journals, badgering specialists across
the globe and wrestling with neurogenetic theories, they discovered a blend
of plant oils that they believed would delay their son's disease. On May 29
this year, Lorenzo, now severely disabled, turned 24.
To say there has been scepticism among doctors, scientists and support
groups about the efficacy of "Lorenzo's Oil" would be an understatement.
They scoffed at the idea that an oil invented by novices could halt the
disease. They put the boy's survival down to a combination of superlative
care and luck. Parents of ALD boys who found that the oil did not save their
sons accused the family of offering false hope. But now the Odones, who have
been called anything from quacks to prophets, finally seem to have been
vindicated. A clinical trial of the oil led by a world authority on ALD has
just been published. It shows that Lorenzo's oil works.
Dr Hugo Moser, a leading expert in ALD and director of neurogenetics at
Baltimore's Kennedy Krieger Institute conducted the 10-year-long trial, set
partly in the US and partly in Europe. It followed 104 boys with the ALD
gene, all less than six years old and symptom-free when the trial began. The
results were dramatic: the boys who were not scrupulously given the oil were
nearly three times as likely to develop symptoms as boys who were given the
oil without fail. As Moser puts it, Lorenzo's oil may not be "an absolute
preventive" but it certainly "reduces the chances of developing the
symptoms".
The oil is a combination of two fats extracted from olive oil and
rapeseed oil. It works, it is thought, because of the way it affects the
"very long chain fatty acids" in the boys' bodies. In boys with ALD, the
enzyme that breaks down these fatty acids is impaired. They can't properly
metabolise these acids, which then build up and begin to damage the central
nervous system. Specifically, they destroy myelin - the white matter that
insulates the nerves and allows impulses to be conducted from one part of
the body to another. This is why some of the early signs of ALD include
memory loss, emotional instability, difficulty with vision, hearing and
motor function. This devastating process of gradual brain damage is known by
specialists as demyelination. Usually, boys who have the childhood form of
ALD will be bedridden, blind and unable to swallow by the age of 10. They
will die soon after.
Sadly, Michaela Odone is not here to see these results. Having given up
work, social life, entertaining and all other interests to care for her son,
she died of cancer in June 2000. Augusto Odone, though, sounds
matter-of-fact about their public vindication. "For me, this isn't
ground-breaking," he says. "I already knew it worked." He describes how, at
the end of the film about his family, there is a shot of some young boys
"jumping up and down". These are all boys with the ALD gene "I knew those
children," Odone tells me, "I put them on Lorenzo's oil. I have followed
those children as they are growing up. None that I know of have got the
disease".
That the oil came too late to stop his son from developing the symptoms
must be hard to bear. Lorenzo lost most of his bodily functions and has been
bedridden for 18 years. His mind, however, is "still there" - his father
says he communicates by blinking and raising his fingers; he loves music,
and being read to. "If I'd invented Lorenzo's oil two years before, it would
have been different. Most probably he would not have got the disease," says
Odone. "Still, it will save the lives of many children who are destined to
have the childhood form of ALD".
Until now, the main treatment for childhood ALD has been a bone marrow
transplant. Many specialists believe this still offers the best hope of
survival. Some are saying that the trial only proves that Lorenzo's oil
delays the symptoms and none are saying that Lorenzo's oil should now be
used to the exclusion of all other treatments. Moser's trial was, after all,
relatively small, and for obvious ethical reasons there could be no placebo
group. None the less, says Dr Ian Duncan, professor of neurology at the
University of Wisconsin, the consensus among specialists is that "this is an
extremely important finding". Most, he says, now "acknowledge that this
therapy can work". Moser, who was a doubter in the beginning is now
recommending that every presymptomatic boy with ALD is given it.
It's not yet clear what will happen to the boys who have taken the oil
and reached the age of 10 (by which time the disease has normally shown
itself) without symptoms. ALD comes in two main forms - Lorenzo's kind and
an adult type, which shows up in the late teens or early 20s and acts more
slowly ("you can," says Duncan, "live for long periods" with the adult
form). The boys studied are still teenagers, so nobody knows yet whether
they will develop the adult type. Indeed, says Duncan, we don't even know
whether these boys will be at a higher risk of developing the adult form of
the disease.
Sadly, for the boys who did develop symptoms, there is still no cure
(though Odone certainly believes the oil has played a part in his son's
survival this far). In a message to parents of boys with ALD, Odone told the
New Scientist: "Give the oil as soon as you know your son carries the
genetic defect. If you wait, the symptoms might come and then you are in a
different ballpark." Duncan, who specialises in "re-myelination" in
childhood disorders, confirms this: "The oil does not promote myelin
regeneration." This, for Odone, is the next challenge.
'What I want to do," he tells me, "is to restore functions in Lorenzo."
He now runs an organisation called the Myelin Project which funds research
that will "increase the odds that a way will be found to bring back myelin".
If this were to happen, the implications would go far beyond ALD boys.
Several other diseases destroy myelin - multiple sclerosis (MS) is perhaps
the best known. About 85,000 people in the UK suffer from MS, and the Myelin
Project estimates that "demyelinating" diseases affect about a million
people in industrialised countries alone.
The Myelin Project is currently financing Yale University doctors to do
pioneering surgery that will see whether it is possible to rebuild myelin.
Three MS patients so far have had myelin producing cells taken from their
ankles and transplanted into the right frontal lobe of the brain. This,
Duncan explains, will eventually show whether you can "promote the brain to
repair itself".
It is too early to tell whether these cell transplants will work -
whether they will multiply so that the patient begins to regain lost bodily
functions. But for many people who hope desperately for a cure for diseases
like ALD and MS, the very fact that such experiments are under way is
positive. "The drive and determination behind the Myelin Project is our best
and brightest hope for the future," says Diana McGovern, who has multiple
sclerosis, and is honorary secretary of the British Trust for the Myelin
Project. Odone is certainly a tireless ally to have. His favourite aphorisms
are "Fortune favours the brave" and "You never know until you try." He will,
he says, repeat these to the doctors he works with until the Myelin Project
has put itself out of business.
· The Myelin Project is at
www.myelin.org To contact
the British Trust for the Myelin Project, call 0131 339 8424.