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A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease

INTRODUCTION: There is an urgent need to develop effective interventional treatments for people with Alzheimer's disease (AD). AD results from a complex multi‐decade interplay of multiple interacting dysfunctional biological systems that have not yet been fully elucidated. Epidemiological studi...

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Autores principales: McEwen, Sarah C., Merrill, David A., Bramen, Jennifer, Porter, Verna, Panos, Stella, Kaiser, Scott, Hodes, John, Ganapathi, Aarthi, Bell, Lesley, Bookheimer, Tess, Glatt, Ryan, Rapozo, Molly, Ross, Mary Kay, Price, Nathan D., Kelly, Daniel, Funk, Cory C., Hood, Leroy, Roach, Jared C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8290633/
https://www.ncbi.nlm.nih.gov/pubmed/34295960
http://dx.doi.org/10.1002/trc2.12191
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author McEwen, Sarah C.
Merrill, David A.
Bramen, Jennifer
Porter, Verna
Panos, Stella
Kaiser, Scott
Hodes, John
Ganapathi, Aarthi
Bell, Lesley
Bookheimer, Tess
Glatt, Ryan
Rapozo, Molly
Ross, Mary Kay
Price, Nathan D.
Kelly, Daniel
Funk, Cory C.
Hood, Leroy
Roach, Jared C.
author_facet McEwen, Sarah C.
Merrill, David A.
Bramen, Jennifer
Porter, Verna
Panos, Stella
Kaiser, Scott
Hodes, John
Ganapathi, Aarthi
Bell, Lesley
Bookheimer, Tess
Glatt, Ryan
Rapozo, Molly
Ross, Mary Kay
Price, Nathan D.
Kelly, Daniel
Funk, Cory C.
Hood, Leroy
Roach, Jared C.
author_sort McEwen, Sarah C.
collection PubMed
description INTRODUCTION: There is an urgent need to develop effective interventional treatments for people with Alzheimer's disease (AD). AD results from a complex multi‐decade interplay of multiple interacting dysfunctional biological systems that have not yet been fully elucidated. Epidemiological studies have linked several modifiable lifestyle factors with increased incidence for AD. Because monotherapies have failed to prevent or ameliorate AD, interventional studies should deploy multiple, targeted interventions that address the dysfunctional systems that give rise to AD. METHODS: This randomized controlled trial (RCT) will examine the efficacy of a 12‐month personalized, multimodal, lifestyle intervention in 60 mild cognitive impairment (MCI) and early stage AD patients (aged 50+, amyloid positivity). Both groups receive data‐driven, lifestyle recommendations designed to target multiple systemic pathways implicated in AD. One group receives these personalized recommendations without coaching. The other group receives personalized recommendations with health coaching, dietary counseling, exercise training, cognitive stimulation, and nutritional supplements. We collect clinical, proteomic, metabolomic, neuroimaging, and genetic data to fuel systems‐biology analyses. We will examine effects on cognition and hippocampal volume. The overarching goal of the study is to longitudinally track biological systems implicated in AD to reveal the dynamics between these systems during the intervention to understand differences in treatment response. RESULTS: We have developed and implemented a protocol for a personalized, multimodal intervention program for early AD patients. We began enrollment in September 2019; we have enrolled a third of our target (20 of 60) with a 95% retention and 86% compliance rate. DISCUSSION: This study presents a paradigm shift in designing multimodal, lifestyle interventions to reduce cognitive decline, and how to elucidate the biological systems being targeted. Analytical efforts to explain mechanistic or causal underpinnings of individual trajectories and the interplay between multi‐omic variables will inform the design of future hypotheses and development of effective precision medicine trials.
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spelling pubmed-82906332021-07-21 A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease McEwen, Sarah C. Merrill, David A. Bramen, Jennifer Porter, Verna Panos, Stella Kaiser, Scott Hodes, John Ganapathi, Aarthi Bell, Lesley Bookheimer, Tess Glatt, Ryan Rapozo, Molly Ross, Mary Kay Price, Nathan D. Kelly, Daniel Funk, Cory C. Hood, Leroy Roach, Jared C. Alzheimers Dement (N Y) Research Articles INTRODUCTION: There is an urgent need to develop effective interventional treatments for people with Alzheimer's disease (AD). AD results from a complex multi‐decade interplay of multiple interacting dysfunctional biological systems that have not yet been fully elucidated. Epidemiological studies have linked several modifiable lifestyle factors with increased incidence for AD. Because monotherapies have failed to prevent or ameliorate AD, interventional studies should deploy multiple, targeted interventions that address the dysfunctional systems that give rise to AD. METHODS: This randomized controlled trial (RCT) will examine the efficacy of a 12‐month personalized, multimodal, lifestyle intervention in 60 mild cognitive impairment (MCI) and early stage AD patients (aged 50+, amyloid positivity). Both groups receive data‐driven, lifestyle recommendations designed to target multiple systemic pathways implicated in AD. One group receives these personalized recommendations without coaching. The other group receives personalized recommendations with health coaching, dietary counseling, exercise training, cognitive stimulation, and nutritional supplements. We collect clinical, proteomic, metabolomic, neuroimaging, and genetic data to fuel systems‐biology analyses. We will examine effects on cognition and hippocampal volume. The overarching goal of the study is to longitudinally track biological systems implicated in AD to reveal the dynamics between these systems during the intervention to understand differences in treatment response. RESULTS: We have developed and implemented a protocol for a personalized, multimodal intervention program for early AD patients. We began enrollment in September 2019; we have enrolled a third of our target (20 of 60) with a 95% retention and 86% compliance rate. DISCUSSION: This study presents a paradigm shift in designing multimodal, lifestyle interventions to reduce cognitive decline, and how to elucidate the biological systems being targeted. Analytical efforts to explain mechanistic or causal underpinnings of individual trajectories and the interplay between multi‐omic variables will inform the design of future hypotheses and development of effective precision medicine trials. John Wiley and Sons Inc. 2021-07-20 /pmc/articles/PMC8290633/ /pubmed/34295960 http://dx.doi.org/10.1002/trc2.12191 Text en © 2021 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Research Articles
McEwen, Sarah C.
Merrill, David A.
Bramen, Jennifer
Porter, Verna
Panos, Stella
Kaiser, Scott
Hodes, John
Ganapathi, Aarthi
Bell, Lesley
Bookheimer, Tess
Glatt, Ryan
Rapozo, Molly
Ross, Mary Kay
Price, Nathan D.
Kelly, Daniel
Funk, Cory C.
Hood, Leroy
Roach, Jared C.
A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease
title A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease
title_full A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease
title_fullStr A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease
title_full_unstemmed A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease
title_short A systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early Alzheimer's disease
title_sort systems‐biology clinical trial of a personalized multimodal lifestyle intervention for early alzheimer's disease
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8290633/
https://www.ncbi.nlm.nih.gov/pubmed/34295960
http://dx.doi.org/10.1002/trc2.12191
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