Although researchers have conducted more than 400 human trials for potential treatments of Alzheimer?s disease (AD) in the last two decades, the attrition rate is estimated at over 99%. Furthermore, the ?one gene, one drug, one disease? reductionism-informed paradigm overlooks the inherent complexity of the disease and continues to challenge drug discovery for AD. The predisposition to AD involves a complex, polygenic, and pleiotropic genetic architecture. Recent studies have suggested that AD often has common underlying mechanisms, sharing intermediate endophenotypes with many other complex diseases. These endophenotypes, such as amyloidosis and tauopathy, have essential roles in many neurodegenerative diseases. Systematic identification and characterization of novel underlying pathogenesis and disease modules, more so than mutated genes, will serve as a foundation for generating actionable targets as input for drug repurposing and rational design of combination therapy in AD. Integration of the genome, transcriptome, proteome, and the human interactome are essential for such identification. Given our preliminary results, we posit that network- based identification of novel risk genes and endophenotype modules that share degree between amyloid and tau offer unexpected opportunities for drug therapy in AD comparing to targeting amyloid and tau separately. To address the underlying hypothesis, we propose to establish an integrated interdisciplinary research plan with three specific aims.
Aim 1 will explore amyloid and tau-mediated endophenotype modules for AD -- We will test the network module hypothesis for amyloid and tau using our recently developed Bayesian framework that integrates multi-omics data (i.e., genome-wide association studies [GWAS] loci, single cell sequencing, and human brain Hi-C data) and the human interactome.
Aim 2 will be capable of searching existing drugs and combination therapies for AD using network proximity approaches -- We will emphasize the uses of network proximity approaches (i.e., Genome-wide Positioning Systems network [GPSnet]) to identify repurposable drugs and efficacious combination regimens. This will be accomplished by integrating AD endophenotype module findings, public drug-target databases, the human interactome, and the large-scale patient longitudinal Claims- Electronic Medical Record data (over 200 million patients from the MarketScan database).
Aim 3 will evaluate brain penetration and target network engagement for repurposable drugs -- We will use the humanized in vitro blood-brain barrier, resected brain tissues (ex vivo/in situ), and transgenic AD models (i.e., TgF344-AD rats) to experimentally evaluate brain penetration and target network engagement. Evaluation will be based upon network proximity to the AD-related endophenotype modules that are relevant to maximizing efficacy and to minimizing side effects. The successful completion of this project will offer powerful network methodologies and bioinformatics tools for prediction and population-based validation of in silico drug repurposing. It will also allow for the identification of novel repurposable drugs and clinically relevant combination therapies toward AD trials.

Public Health Relevance

Alzheimer's disease (AD) is the leading cause of dementia and the sixth leading cause of death in the United States, while the current disease incidence indicates approximately 16 million Americans will be affected by 2050 without an effective treatment. This proposal will develop intelligent computer-based network medicine and systems pharmacology tools, capable of searching human genome sequencing findings and existing drug-target databases, while also testing the most promising network-predicted repurposable drugs and drug combinations using large-scale patient longitudinal data complemented by in vitro and in vivo mechanistic observations. The innovative network methodologies and potential prevention/therapeutic approaches developed in this proposal will prove to be novel and effective ways to improve outcomes in long-term dementia care and quality of life for the rapidly growing AD population.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Special Emphasis Panel (ZAG1)
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Yuan, Jean
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Cleveland Clinic Lerner
Other Basic Sciences
Schools of Medicine
United States
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