A controversial Alzheimer’s surgery is said to reverse symptoms — here’s what scientists know | Nature
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Illustration: Simbie Yau
The video opens with a man in his 80s slumped in a hospital bed, his face hollow as he scrunches his eyes. A jump cut advances the scene three days: the man is alert now, words gathering as he identifies his son.<br>Six months later, he is pictured sitting upright, engaged in conversation. His gaze is animated. At eight months, the man walks briskly down a hospital corridor. He recites a near-century-old Maoist military anthem from memory. He is practically unrecognizable from the withered figure in the opening frame.<br>China is waging war on Alzheimer’s. What can its approach teach the rest of the world?
The footage records the recovery of a man who, in September 2020, became the first person in the world to undergo a surgery known as deep cervical lymphatic-venous anastomosis (dcLVA) to treat Alzheimer’s disease. The procedure involves connecting tiny lymphatic vessels in the neck — part of the drainage system that carries waste away from the brain — to nearby veins, creating a route that, in theory, allows fluid and waste proteins to flow more easily into the bloodstream.<br>The treatment was first reported1 in 2022 in a Chinese-language journal by microsurgeon Qingping Xie, president of the Qiushi Hospital in Hangzhou, China. At the time, it drew little notice. But that changed the following year, when Wei Chen, a lymphatic microsurgeon at the Cleveland Clinic in Ohio, began showing the footage (with consent from Xie and the man’s family) at surgical meetings around the world.<br>“A lot of jaws dropped,” recalls Chen. “It basically started a frenzy of this surgery being performed left and right.”<br>Almost all of the surgeries took place in China, where hundreds of hospitals were soon offering the experimental procedure. Propelled by viral testimonial videos and aggressive marketing campaigns on social-media platforms such as Douyin and WeChat, it was sought out by thousands — with many people paying more than 200,000 yuan (US$30,000) for a chance of recovery.<br>The rapid adoption, in the absence of hard evidence, prompted Chinese regulators to intervene. Last year, they restricted the procedure to more-formalized clinical research settings, rather than the ad hoc use that had proliferated previously. And Xie, the pioneer of the technique, has been in detention since September for undisclosed reasons.<br>The great brain clearance and dementia debate
Now, as controlled studies get under way around the world, the scientific community remains divided over whether or not the procedure actually alters the course of the disease. Mechanistic explanations for why the surgery might work remain hard to square with how quickly some individuals seem to improve, clinicians say. And many researchers remain concerned about the risks, including infection, bleeding and injury to nearby nerves.<br>Nature spoke to more than two dozen researchers in the field, revealing a mix of qualified enthusiasm and deep scepticism.<br>“The concept is scientifically valid and biologically plausible,” says Young-Kwon Hong, a lymphatics researcher at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. But he worries that the excitement has outpaced the evidence. “The hope is high,” he says, “and whenever hope is high, the hype also follows.”<br>Medical maverick<br>Xie did not set out to reinvent Alzheimer’s treatment. He trained as a reconstructive microsurgeon, and is more at home with reconnecting severed vessels than with troubleshooting brain drainage. But according to interviews Xie gave before his detention, and corroborated by his daughter Angela, who spoke to Nature, a stray case of tinnitus set him on a different path.<br>In 2019, while performing surgery to relieve pressure on nerves that carry sound signals to the brain, Xie noticed abnormalities in lymphatic structures deep in the neck of a middle-aged woman with persistent ringing in her ears. To bypass the problem area, he connected lymph vessels to nearby veins, adapting a technique first developed in the 1960s to treat painful swelling in the arms and legs that can happen when lymph nodes are removed or damaged during cancer treatment.<br>After the surgery, the woman reported not only that her tinnitus improved, but so had her mental acuity. Intrigued, Xie dug into the literature and found research that seemed to explain the phenomenon. In 2015, a team led by neuroimmunologist Jonathan Kipnis identified a...