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Huang Q, Hu Z, Zheng Q, Mao X, Lv W, Wu F, Fu D, Lu C, Zeng C, Wang F, Zeng Q, Fang Q, Hood L. A Proactive Intervention Study in Metabolic Syndrome High-Risk Populations Using Phenome-Based Actionable P4 Medicine Strategy. PHENOMICS (CHAM, SWITZERLAND) 2024; 4:91-108. [PMID: 38884061 PMCID: PMC11169348 DOI: 10.1007/s43657-023-00115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/18/2024]
Abstract
The integration of predictive, preventive, personalized, and participatory (P4) healthcare advocates proactive intervention, including dietary supplements and lifestyle interventions for chronic disease. Personal profiles include deep phenotypic data and genetic information, which are associated with chronic diseases, can guide proactive intervention. However, little is known about how to design an appropriate intervention mode to precisely intervene with personalized phenome-based data. Here, we report the results of a 3-month study on 350 individuals with metabolic syndrome high-risk that we named the Pioneer 350 Wellness project (P350). We examined: (1) longitudinal (two times) phenotypes covering blood lipids, blood glucose, homocysteine (HCY), and vitamin D3 (VD3), and (2) polymorphism of genes related to folic acid metabolism. Based on personalized data and questionnaires including demographics, diet and exercise habits information, coaches identified 'actionable possibilities', which combined exercise, diet, and dietary supplements. After a 3-month proactive intervention, two-thirds of the phenotypic markers were significantly improved in the P350 cohort. Specifically, we found that dietary supplements and lifestyle interventions have different effects on phenotypic improvement. For example, dietary supplements can result in a rapid recovery of abnormal HCY and VD3 levels, while lifestyle interventions are more suitable for those with high body mass index (BMI), but almost do not help the recovery of HCY. Furthermore, although people who implemented only one of the exercise or diet interventions also benefited, the effect was not as good as the combined exercise and diet interventions. In a subgroup of 226 people, we examined the association between the polymorphism of genes related to folic acid metabolism and the benefits of folate supplementation to restore a normal HCY level. We found people with folic acid metabolism deficiency genes are more likely to benefit from folate supplementation to restore a normal HCY level. Overall, these results suggest: (1) phenome-based data can guide the formulation of more precise and comprehensive interventions, and (2) genetic polymorphism impacts clinical responses to interventions. Notably, we provide a proactive intervention example that is operable in daily life, allowing people with different phenome-based data to design the appropriate intervention protocol including dietary supplements and lifestyle interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-023-00115-z.
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Affiliation(s)
- Qiongrong Huang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nanoscience and Technology, CAS Center for Excellence in Nanoscience, Beijing, 100190 China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049 China
| | - Zhiyuan Hu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nanoscience and Technology, CAS Center for Excellence in Nanoscience, Beijing, 100190 China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049 China
- Beijing P4 Healthcare Institute, 316 Wanfeng Road, Beijing, 100161 China
- Health Management Institute, The Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853 China
- School of Nanoscience and Technology, Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100049 China
- Fujian Provincial Key Laboratory of Brain Aging and Neurodegenerative Diseases, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350108 Fujian China
- School of Chemical Engineering and Pharmacy, Wuhan Institute of Technology, Wuhan, 430205 Hubei China
| | - Qiwen Zheng
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101 China
| | - Xuemei Mao
- Beijing P4 Healthcare Institute, 316 Wanfeng Road, Beijing, 100161 China
| | - Wenxi Lv
- Beijing P4 Healthcare Institute, 316 Wanfeng Road, Beijing, 100161 China
| | - Fei Wu
- Beijing P4 Healthcare Institute, 316 Wanfeng Road, Beijing, 100161 China
| | - Dapeng Fu
- Beijing Zhongguancun Hospital, No. 12, Zhongguancun South Road, Haidian District, Beijing, 100190 China
| | - Cuihong Lu
- Beijing Zhongguancun Hospital, No. 12, Zhongguancun South Road, Haidian District, Beijing, 100190 China
| | - Changqing Zeng
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, 100101 China
| | - Fei Wang
- Health Management Institute, The Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853 China
| | - Qiaojun Fang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Key Laboratory of Standardization and Measurement for Nanotechnology, National Center for Nanoscience and Technology, CAS Center for Excellence in Nanoscience, Beijing, 100190 China
- University of Chinese Academy of Sciences, No. 19A Yuquan Road, Beijing, 100049 China
- School of Nanoscience and Technology, Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Leroy Hood
- Health Management Institute, The Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853 China
- Institute for Systems Biology, Seattle, WA 98109 USA
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Ziegler DA, Anguera JA, Gallen CL, Hsu WY, Wais PE, Gazzaley A. Leveraging technology to personalize cognitive enhancement methods in aging. NATURE AGING 2022; 2:475-483. [PMID: 35873177 PMCID: PMC9302894 DOI: 10.1038/s43587-022-00237-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
As population aging advances at an increasing rate, efforts to help people maintain or improve cognitive function late in life are critical. Although some studies have shown promise, the question of whether cognitive training is an effective tool for improving general cognitive ability remains incompletely explored, and study results to date have been inconsistent. Most approaches to cognitive enhancement in older adults have taken a 'one size fits all' tack, as opposed to tailoring interventions to the specific needs of individuals. In this Perspective, we argue that modern technology has the potential to enable large-scale trials of public health interventions to enhance cognition in older adults in a personalized manner. Technology-based cognitive interventions that rely on closed-loop systems can be tailored to individuals in real time and have the potential for global testing, extending their reach to large and diverse populations of older adults. We propose that the future of cognitive enhancement in older adults will rely on harnessing new technologies in scientifically informed ways.
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Affiliation(s)
- David A. Ziegler
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Neuroscape, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Correspondence should be addressed to David A. Ziegler or Adam Gazzaley. ;
| | - Joaquin A. Anguera
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Neuroscape, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Courtney L. Gallen
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Neuroscape, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Wan-Yu Hsu
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Peter E. Wais
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Neuroscape, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Adam Gazzaley
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- Neuroscape, University of California San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
- Department of Physiology, University of California San Francisco, San Francisco, CA, USA
- Correspondence should be addressed to David A. Ziegler or Adam Gazzaley. ;
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ReCODE: A Personalized, Targeted, Multi-Factorial Therapeutic Program for Reversal of Cognitive Decline. Biomedicines 2021; 9:biomedicines9101348. [PMID: 34680464 PMCID: PMC8533598 DOI: 10.3390/biomedicines9101348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Alzheimer’s disease (AD) is the major cause of age-associated cognitive decline, and in the absence of effective therapeutics is progressive and ultimately fatal, creating a dire need for successful prevention and treatment strategies. We recently reported results of a successful proof-of-concept trial, using a personalized, precision medicine protocol, but whether such an approach is readily scalable is unknown. Objective: In the case of AD, there is not a single therapeutic that exerts anything beyond a marginal, unsustained, symptomatic effect. This suggests that the monotherapeutic approach of drug development for AD may not be an optimal one, at least when used alone. Using a novel, comprehensive, and personalized therapeutic system called ReCODE (reversal of cognitive decline), which proved successful in a small, proof-of-concept trial, we sought to determine whether the program could be scaled to improve cognitive and metabolic function in individuals diagnosed with subjective cognitive impairment, mild cognitive impairment, and early-stage AD. Methods: 255 individuals submitted blood samples, took the Montreal Cognitive Assessment (MoCA) test, and answered intake questions. Individuals who enrolled in the ReCODE program had consultations with clinical practitioners, and explanations of the program were provided. Participants had follow-up visits that included education regarding diet, lifestyle choices, medications, supplements, repeat blood sample analysis, and MoCA testing between 2 and 12 months after participating in the ReCODE program. Pre- and post-treatment measures were compared using the non-parametric Wilcoxon signed rank test. Results and Conclusions: By comparing baseline to follow-up testing, we observed that MoCA scores either significantly improved or stabilized in the entire participant pool—results that were not as successful as those in the proof-of-concept trial, but more successful than anti-amyloid therapies—and other risk factors including blood glucose, high-sensitivity C-reactive protein, HOMA-IR, and vitamin D significantly improved in the participant pool. Our findings provide evidence that a multi-factorial, comprehensive, and personalized therapeutic program designed to mitigate AD risk factors can improve risk factor scores and stabilize or reverse the decline in cognitive function. Since superior results were obtained in the proof-of-concept trial, which was conducted by a small group of highly trained and experienced physicians, it is possible that results from the use of this personalized approach would be enhanced by further training and experience of the practicing physicians. Nonetheless, the current results provide further support indicating the potential of such an approach for the prevention and reversal of cognitive decline.
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Mohd Safien A, Ibrahim N, Subramaniam P, Shahar S, Din NC, Ismail A, Singh DKA, Mat Ludin AF. Randomized Controlled Trials of a Psychosocial Intervention for Improving the Cognitive Function among Older Adults: A Scoping Review. Gerontol Geriatr Med 2021; 7:23337214211025167. [PMID: 34395815 PMCID: PMC8361523 DOI: 10.1177/23337214211025167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
Aim: The goal is to explore available evidence and provide greater clarity to what is described as psychosocial intervention to improve cognitive function among older population with MCI as well as identifying areas for future research. Methods: An electronic literature search of PubMed, Cochrane, Ebscohost, Medline, Scopus, and gray resource was conducted to find articles published in English language between 2010 and September 2020. This review focused on research undertaken using randomized clinical trials study design. We extracted information regarding the publication date, geographical location, study setting, intervention mechanism, type of cognitive measurement used, and outcome of the studies. References of this literature were also reviewed to ensure comprehensive search. Result: Out of 240 potential records found, a total of 27 articles were identified following the first round of screening and deletion of duplicates. Full-text article reviews and analysis in the second round of screening narrowed the selection down to four articles. Another three relevant articles obtained from references were also included making a total of seven articles in the final analysis. Findings: Psychosocial intervention strategies for improvement of cognitive function, done in various setting all over the globe, covered a range of approaches including art therapy, visual art therapy, therapeutic writing therapy, reminiscence activity, and cognitive behavioral approach. Most were conducted in weekly basis within 1-to-2-hour duration of session. Cognitive function of older adult in psychosocial intervention group was significantly improved in two studies. Three studies showed no significant improvement at all in the cognitive function, and another one reported success in improving cognitive function over time in the intervention group than in control group. One study did not describe the interaction effect. Different types of cognitive measurement also were used to quantify different domains of cognitive function in the reviewed studies. Conclusion: The idea of using psychosocial intervention for improving cognitive function has begun to increasingly accepted recently. Findings from the limited studies are encouraging, although the outcome of the cognitive function was mixed. Large-scale and longer duration of psychosocial intervention with bigger sample size is warranted for future studies.
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Affiliation(s)
| | | | | | | | | | - Aniza Ismail
- Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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