Latest news with #ADAPT
Yahoo
4 days ago
- Health
- Yahoo
City of Hope Awarded $23.7 Million to Map Biomarkers Linked to Treatment Resistance in Patients With Common Lung Cancer
Clinical Trial Will Lead to Personalized Immunotherapies That Adapt to Evolving Tumors LOS ANGELES, June 17, 2025--(BUSINESS WIRE)--City of Hope®, one of the largest and most advanced cancer research and treatment organizations in the United States with its National Medical Center named a Top 5 "Best Hospital" in the nation for cancer care by U.S. News & World Report, has been awarded an up to $23.7 million contract from the Advanced Research Projects Agency for Health (ARPA-H) within the U.S. Department of Health and Human Services. The grant will help City of Hope create a bio map of tumor changes that cause immunotherapy resistance in advanced or metastatic non-small cell lung cancer (NSCLC). City of Hope's Beckman Research Institute researchers will also test new biomarker-guided therapies in near real time NSCLC, which accounts for 87% of all lung cancer cases. By shaping physicians' management of the disease, the new findings offer promise for improving treatment success and extending the lives of the 200,000 patients diagnosed each year in the United States. A six-year clinical trial, enrolling 535 patients, will provide the cornerstone for the City of Hope project, which is part of ARPA-H's Advanced Analysis for Precision Cancer Therapy (ADAPT) program. The up to $142 million initiative combines the latest technologies with the nation's top expertise in tumor biology to deliver customized cancer care that adapts to a patient's disease as it evolves. "Changes in cancer may occur over time, creating resistance to immunotherapy and complicating oncologists' ability to identify the next best treatment approach," said Ravi Salgia, M.D., Ph.D., professor and chair of City of Hope's Department of Medical Oncology & Therapeutics Research, the Arthur & Rosalie Kaplan Chair in Medical Oncology, principal investigator with City of Hope's Aritro Nath, Ph.D., and Jyoti Malhotra, M.D., M.P.H. "Developing a biomap that detects mutations and other alterations early and predicts a patient's cancer trajectory will enable us to match treatments to evolving tumor biology and improve our patients' long-term survival." Until now, cancer studies have focused on first-line therapy and lacked the flexibility to modify treatments as tumors grow. City of Hope will design its clinical trial to adjust treatment as resistance arises, with the goal of increasing progression-free survival by 50% in at least one patient group. "Doctors have historically treated advanced non-small cell lung cancer with immune checkpoint inhibitors, sometimes combined with chemotherapy," explained Dr. Nath, City of Hope assistant professor with the Division of Molecular Pharmacology, Department of Medical Oncology & Therapeutics Research. "The main biomarker used to select immunotherapy, however, is not very reliable, with a patient response rate of less than 40%. We don't know why some patients become resistant to checkpoint inhibitors, and we have no good biomarkers to guide the choice of secondary treatments." City of Hope intends to change that through meticulous monitoring and measurement of tumor changes in near real time. Dr. Salgia and his colleagues will collect samples and detailed data at regular intervals from patients throughout the course of treatment. The researchers will monitor tumor trajectory and patients' response to treatment using state-of-the-art diagnostic techniques like liquid biopsies, single cell sequencing and radio imaging, relying on rapid turnaround times for comprehensive tumor measurements. Instead of measuring a few data types at a single timepoint with limited predictive ability, the ADAPT program will take many measurements of diverse data over time and through multiple lines of treatments. The insights gleaned will help identify newly acquired resistant traits in tumors, predict the right therapies at each point in a patient's treatment and identify strategies that provide better long-term prognoses. "We expect our collaboration with ADAPT will uncover predictive biomarkers that will enhance patient treatment and boost immunotherapy responses in non-small cell lung cancer," said Dr. Malhotra, associate professor with the Department of Medical Oncology & Therapeutics Research and interim division chief of Thoracic Medical Oncology, City of Hope, Los Angeles. "The information we gather will allow for informed adjustments in treatments and improve patient outcomes." Equally important, the trial will leverage City of Hope's network of more than 35 clinical sites whose populations reflect the nation's lung cancer patients. The research team anticipates enrolling its first patients within 12 months. With over 30 years of experience spearheading clinical trials and translational research, Dr. Salgia's leadership has been instrumental in uncovering key variants in lung cancer. He oversees more than 130 medical oncologists, including a nationwide team of 30 clinicians dedicated to lung cancer. City of Hope investigators will fund the development, testing and matching of new biomarkers with therapeutic options that are now available or in a clinical trial. Algorithms and aggregate datasets developed under the program will be made publicly available, allowing scientists around the world to visualize trends and evaluate their implications and insights in near real time. "We are incredibly excited to launch this ambitious project," said Dr. Salgia. "Our analysis of host and tumor biology will help clinicians counter the limits of current treatment choices and lead to better patient management strategies for advanced and metastatic non-small cell lung cancer." About City of Hope City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the United States, and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked a Top 5 "Best Hospital" in the nation for cancer care by U.S. News & World Report at its core, City of Hope's uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas. City of Hope's affiliated group of organizations includes Translational Genomics Research Institute and AccessHopeTM. For more information about City of Hope, follow us on Facebook, X, YouTube, Instagram and LinkedIn. View source version on Contacts Letisia Marquez626-476-7593lemarquez@
Yahoo
4 days ago
- Health
- Yahoo
City of Hope Awarded $23.7 Million to Map Biomarkers Linked to Treatment Resistance in Patients With Common Lung Cancer
Clinical Trial Will Lead to Personalized Immunotherapies That Adapt to Evolving Tumors LOS ANGELES, June 17, 2025--(BUSINESS WIRE)--City of Hope®, one of the largest and most advanced cancer research and treatment organizations in the United States with its National Medical Center named a Top 5 "Best Hospital" in the nation for cancer care by U.S. News & World Report, has been awarded an up to $23.7 million contract from the Advanced Research Projects Agency for Health (ARPA-H) within the U.S. Department of Health and Human Services. The grant will help City of Hope create a bio map of tumor changes that cause immunotherapy resistance in advanced or metastatic non-small cell lung cancer (NSCLC). City of Hope's Beckman Research Institute researchers will also test new biomarker-guided therapies in near real time NSCLC, which accounts for 87% of all lung cancer cases. By shaping physicians' management of the disease, the new findings offer promise for improving treatment success and extending the lives of the 200,000 patients diagnosed each year in the United States. A six-year clinical trial, enrolling 535 patients, will provide the cornerstone for the City of Hope project, which is part of ARPA-H's Advanced Analysis for Precision Cancer Therapy (ADAPT) program. The up to $142 million initiative combines the latest technologies with the nation's top expertise in tumor biology to deliver customized cancer care that adapts to a patient's disease as it evolves. "Changes in cancer may occur over time, creating resistance to immunotherapy and complicating oncologists' ability to identify the next best treatment approach," said Ravi Salgia, M.D., Ph.D., professor and chair of City of Hope's Department of Medical Oncology & Therapeutics Research, the Arthur & Rosalie Kaplan Chair in Medical Oncology, principal investigator with City of Hope's Aritro Nath, Ph.D., and Jyoti Malhotra, M.D., M.P.H. "Developing a biomap that detects mutations and other alterations early and predicts a patient's cancer trajectory will enable us to match treatments to evolving tumor biology and improve our patients' long-term survival." Until now, cancer studies have focused on first-line therapy and lacked the flexibility to modify treatments as tumors grow. City of Hope will design its clinical trial to adjust treatment as resistance arises, with the goal of increasing progression-free survival by 50% in at least one patient group. "Doctors have historically treated advanced non-small cell lung cancer with immune checkpoint inhibitors, sometimes combined with chemotherapy," explained Dr. Nath, City of Hope assistant professor with the Division of Molecular Pharmacology, Department of Medical Oncology & Therapeutics Research. "The main biomarker used to select immunotherapy, however, is not very reliable, with a patient response rate of less than 40%. We don't know why some patients become resistant to checkpoint inhibitors, and we have no good biomarkers to guide the choice of secondary treatments." City of Hope intends to change that through meticulous monitoring and measurement of tumor changes in near real time. Dr. Salgia and his colleagues will collect samples and detailed data at regular intervals from patients throughout the course of treatment. The researchers will monitor tumor trajectory and patients' response to treatment using state-of-the-art diagnostic techniques like liquid biopsies, single cell sequencing and radio imaging, relying on rapid turnaround times for comprehensive tumor measurements. Instead of measuring a few data types at a single timepoint with limited predictive ability, the ADAPT program will take many measurements of diverse data over time and through multiple lines of treatments. The insights gleaned will help identify newly acquired resistant traits in tumors, predict the right therapies at each point in a patient's treatment and identify strategies that provide better long-term prognoses. "We expect our collaboration with ADAPT will uncover predictive biomarkers that will enhance patient treatment and boost immunotherapy responses in non-small cell lung cancer," said Dr. Malhotra, associate professor with the Department of Medical Oncology & Therapeutics Research and interim division chief of Thoracic Medical Oncology, City of Hope, Los Angeles. "The information we gather will allow for informed adjustments in treatments and improve patient outcomes." Equally important, the trial will leverage City of Hope's network of more than 35 clinical sites whose populations reflect the nation's lung cancer patients. The research team anticipates enrolling its first patients within 12 months. With over 30 years of experience spearheading clinical trials and translational research, Dr. Salgia's leadership has been instrumental in uncovering key variants in lung cancer. He oversees more than 130 medical oncologists, including a nationwide team of 30 clinicians dedicated to lung cancer. City of Hope investigators will fund the development, testing and matching of new biomarkers with therapeutic options that are now available or in a clinical trial. Algorithms and aggregate datasets developed under the program will be made publicly available, allowing scientists around the world to visualize trends and evaluate their implications and insights in near real time. "We are incredibly excited to launch this ambitious project," said Dr. Salgia. "Our analysis of host and tumor biology will help clinicians counter the limits of current treatment choices and lead to better patient management strategies for advanced and metastatic non-small cell lung cancer." About City of Hope City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the United States, and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked a Top 5 "Best Hospital" in the nation for cancer care by U.S. News & World Report at its core, City of Hope's uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas. City of Hope's affiliated group of organizations includes Translational Genomics Research Institute and AccessHopeTM. For more information about City of Hope, follow us on Facebook, X, YouTube, Instagram and LinkedIn. View source version on Contacts Letisia Marquez626-476-7593lemarquez@ Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Business Wire
4 days ago
- Health
- Business Wire
City of Hope Awarded $23.7 Million to Map Biomarkers Linked to Treatment Resistance in Patients With Common Lung Cancer
LOS ANGELES--(BUSINESS WIRE)--City of Hope ®, one of the largest and most advanced cancer research and treatment organizations in the United States with its National Medical Center named a Top 5 'Best Hospital' in the nation for cancer care by U.S. News & World Report, has been awarded an up to $23.7 million contract from the Advanced Research Projects Agency for Health (ARPA-H) within the U.S. Department of Health and Human Services. The grant will help City of Hope create a bio map of tumor changes that cause immunotherapy resistance in advanced or metastatic non-small cell lung cancer (NSCLC). 'Changes in cancer may occur over time, creating resistance to immunotherapy and complicating oncologists' ability to identify the next best treatment approach,' said City of Hope's Ravi Salgia, M.D., Ph.D. City of Hope's Beckman Research Institute researchers will also test new biomarker-guided therapies in near real time NSCLC, which accounts for 87% of all lung cancer cases. By shaping physicians' management of the disease, the new findings offer promise for improving treatment success and extending the lives of the 200,000 patients diagnosed each year in the United States. A six-year clinical trial, enrolling 535 patients, will provide the cornerstone for the City of Hope project, which is part of ARPA-H's Advanced Analysis for Precision Cancer Therapy (ADAPT) program. The up to $142 million initiative combines the latest technologies with the nation's top expertise in tumor biology to deliver customized cancer care that adapts to a patient's disease as it evolves. 'Changes in cancer may occur over time, creating resistance to immunotherapy and complicating oncologists' ability to identify the next best treatment approach,' said Ravi Salgia, M.D., Ph.D., professor and chair of City of Hope's Department of Medical Oncology & Therapeutics Research, the Arthur & Rosalie Kaplan Chair in Medical Oncology, principal investigator with City of Hope's Aritro Nath, Ph.D., and Jyoti Malhotra, M.D., M.P.H. 'Developing a biomap that detects mutations and other alterations early and predicts a patient's cancer trajectory will enable us to match treatments to evolving tumor biology and improve our patients' long-term survival.' Until now, cancer studies have focused on first-line therapy and lacked the flexibility to modify treatments as tumors grow. City of Hope will design its clinical trial to adjust treatment as resistance arises, with the goal of increasing progression-free survival by 50% in at least one patient group. 'Doctors have historically treated advanced non-small cell lung cancer with immune checkpoint inhibitors, sometimes combined with chemotherapy,' explained Dr. Nath, City of Hope assistant professor with the Division of Molecular Pharmacology, Department of Medical Oncology & Therapeutics Research. 'The main biomarker used to select immunotherapy, however, is not very reliable, with a patient response rate of less than 40%. We don't know why some patients become resistant to checkpoint inhibitors, and we have no good biomarkers to guide the choice of secondary treatments.' City of Hope intends to change that through meticulous monitoring and measurement of tumor changes in near real time. Dr. Salgia and his colleagues will collect samples and detailed data at regular intervals from patients throughout the course of treatment. The researchers will monitor tumor trajectory and patients' response to treatment using state-of-the-art diagnostic techniques like liquid biopsies, single cell sequencing and radio imaging, relying on rapid turnaround times for comprehensive tumor measurements. Instead of measuring a few data types at a single timepoint with limited predictive ability, the ADAPT program will take many measurements of diverse data over time and through multiple lines of treatments. The insights gleaned will help identify newly acquired resistant traits in tumors, predict the right therapies at each point in a patient's treatment and identify strategies that provide better long-term prognoses. 'We expect our collaboration with ADAPT will uncover predictive biomarkers that will enhance patient treatment and boost immunotherapy responses in non-small cell lung cancer,' said Dr. Malhotra, associate professor with the Department of Medical Oncology & Therapeutics Research and interim division chief of Thoracic Medical Oncology, City of Hope, Los Angeles. 'The information we gather will allow for informed adjustments in treatments and improve patient outcomes.' Equally important, the trial will leverage City of Hope's network of more than 35 clinical sites whose populations reflect the nation's lung cancer patients. The research team anticipates enrolling its first patients within 12 months. With over 30 years of experience spearheading clinical trials and translational research, Dr. Salgia's leadership has been instrumental in uncovering key variants in lung cancer. He oversees more than 130 medical oncologists, including a nationwide team of 30 clinicians dedicated to lung cancer. City of Hope investigators will fund the development, testing and matching of new biomarkers with therapeutic options that are now available or in a clinical trial. Algorithms and aggregate datasets developed under the program will be made publicly available, allowing scientists around the world to visualize trends and evaluate their implications and insights in near real time. 'We are incredibly excited to launch this ambitious project,' said Dr. Salgia. 'Our analysis of host and tumor biology will help clinicians counter the limits of current treatment choices and lead to better patient management strategies for advanced and metastatic non-small cell lung cancer.' About City of Hope City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the United States, and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked a Top 5 'Best Hospital' in the nation for cancer care by U.S. News & World Report at its core, City of Hope's uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas. City of Hope's affiliated group of organizations includes Translational Genomics Research Institute and AccessHope TM. For more information about City of Hope, follow us on Facebook, X, YouTube, Instagram and LinkedIn.
Techday NZ
04-06-2025
- Business
- Techday NZ
Agentic accounting the next frontier for CFOs
Australian CFOs and their teams are now caught in a perfect storm as they navigate global and local economic uncertainties, mounting pressure to adopt AI-driven solutions across the enterprise, ESG compliance and finance reforms. These challenges highlight the urgent need for sustained business efficiencies throughout organisations by ensuring streamlined finance and accounting processes from procurement, invoicing and expense management through to tax compliance and financial reporting. Ironically, even though AI is a challenge for Australian CFOs as illustrated in a recent ADAPT survey, fast tracking its adoption is likely to be the silver bullet to resolving many of the issues that finance teams are facing, with the next generation of agentic automation technology providing a new frontier for finance operations. What is agentic automation? Agentic automation brings together proven robotic process automation, AI models and human expertise into cohesive workflows where people, robots and AI agents work synergistically to optimise processes and drive enterprise efficiency. These agentic workflows are intelligent, adaptive and governed — enabling automation that is not only powerful but trusted. More simply, AI agents think with human-like reasoning and learning, the robots conduct tasks with precision and tireless consistency, and people provide the strategic direction, creativity and human judgement that machines can't match. For finance teams, an agentic automation platform creates reliable workflows whereby AI agents operate within clearly defined guardrails to ensure security, predictability, and performance. The platform should deliver robust governance, real-time vulnerability assessments, and stringent data access controls to protect enterprise environments, while at the same time enhancing efficiencies and streamlining operations on a cycle of continuous sustained improvement. This provides significant benefits for day-to-day finance processes, while also helping to ensure compliance is maintained even in a dynamic regulatory environment. The shift to agentic automation in finance processes Mirvac is among many Australian enterprises that are already reaping the benefits of agentic automation across core finance and operations processes, from procurement to employee support. Currently, Mirvac is using agentic automation to route invoices for complex and changing utilities needs, which are beyond the capabilities of robotic processes that require a strict script of instructions. Instead, agentic automation directs utilities invoices to the right Mirvac development or construction site with high accuracy. Mirvac's procurement teams have also realised significant advantages in the company's request for proposal process, which involves stripping out data and conducting side-by-side comparisons of responses from vendors. To address a time-consuming manual process, Mirvac has been using agentic automaton to read a Request for Proposal response, extract key data, and pre-populate evaluation sheets so that employees spend less time copying and pasting and more time on decision-making. Fiserv is another early adopter and is already achieving 98 percent end-to-end process automation for its merchant category codes process through agentic automation. The future of the finance team in an AI world While most financial processes can now be done by agentic automation, it still requires human intelligence and oversight to ensure the data fed into the AI model is clean and fit for purpose, and the results are analysed in a way that drives a sustained positive return on investment for businesses. One significant benefit that comes from agentic automation is the ability to quickly upskill and reskill finance teams in the use of AI tools to drive faster decision making, compliant and accurate reporting, and a much stronger focus on strategic planning that truly shifts the needle for an organisation. In these turbulent times, it is clear that finance teams take the brunt of the impact when it comes to financial and regulatory changes. While it can be tricky to continually anticipate market shifts and their business impact, agentic automation enables finance teams to get ahead of the game by alleviating them from the burden of processes to focus more on corporate strategy. Even a small step toward agentic automation is likely to deliver big gains for CFOs and their teams. UiPath is hosting Agentic Automation Summit events in Melbourne, Sydney and Auckland this month. To register visit: agentic-automation-summit- roadshow
The Guardian
23-02-2025
- Health
- The Guardian
When is the correct time to diagnose dementia?
It's difficult to say when he first began noticing the signs, says Chris. He was living abroad and communicated with his parents on Skype. During these calls, his mother would sometimes repeat herself, asking the same question just minutes later. 'We didn't think much of it, we assumed it was due to technical problems.' Then his father mentioned that there was something wrong with her memory. 'Mum being only 63, I didn't believe him.' But two years later, during a Christmas break abroad, when his mother went upstairs to use the toilet and couldn't find her way back down, they knew there was something up. Shirley was diagnosed with Alzheimer's disease at the age of 67 by a GP using a cognitive test that includes drawing a clock with a certain time on a piece of paper. She received the diagnosis via a letter that consisted of only one line. 'I look at that letter and I am appalled by it,' says Chris. 'My mother never saw a neurologist. It was such a thin diagnosis. We thought this can't be right, she's too young.' Shirley is now 75 and living with advanced-stage Alzheimer's, the most common form of dementia, which affects memory, language and behaviour. The gold standard for diagnosing Alzheimer's involves cognitive tests plus either a brain scan or cerebrospinal fluid sampling that reveal abnormal levels of the proteins amyloid and tau. But testing for these biomarkers is costly, and until recently there has been little incentive to diagnose the disease due to the lack of effective medication. 'Only about 2% of individuals in the UK are being diagnosed using these methods,' says David Thomas of Alzheimer's Research UK. Very soon, it may be possible to determine whether someone has Alzheimer's using a simple drop of blood. In recent years, blood tests have been developed that are just as good at detecting Alzheimer's biomarkers as expensive brain scans and painful lumbar punctures, where cerebrospinal fluid is drawn from the base of the spine. 'There is a lot of excitement in the field,' says Thomas. 'Blood tests would be a huge benefit to clinical practice if we could use them as a standard.' They are cheap, scalable and equitable. Last month, the first patients received blood tests as part of two trials backed by Alzheimer's Research UK and Alzheimer's Society aiming to introduce blood tests in the UK within five years. The ADAPT (Alzheimer's disease anti-inflammatory prevention trial) study is assessing a protein called p-tau217, which is specific for Alzheimer's disease. 'The trial will provide evidence on how to deploy blood tests in clinical practice,' says Thomas. 'Who do you test and when do you test them?' The need for simple diagnosis of Alzheimer's disease has become more pressing with the approval of the amyloid-lowering drugs lecanemab and donanemab, which have been shown to have a modest effect in early stages of the disease. The drugs have been licensed in Britain but are not currently funded by the NHS because the benefits are too small to justify the costs. Although they reduce levels of amyloidosis in the brain, their effect on cognition is marginal. Some researchers suspect that this is because patients are treated too late, years after amyloid begins to accumulate in the brain. Given earlier, before symptoms arise, the drugs could prevent the buildup of amyloid and delay the onset of disease. Whether this is true is still an open question. The results of continuing clinical trials are expected in the next years. However, accurately diagnosing Alzheimer's will be essential for eligibility for clinical trials, regardless of the drug. And this is where blood tests have a huge potential. 'They could provide results much faster and accelerate the introduction of new drugs that rely on early diagnosis,' says Thomas. 'The conversation around the blood biomarkers and new therapies are very interconnected.' But blood-based biomarkers are also leading to profound changes in the way we think about Alzheimer's disease. Last year, controversy erupted among researchers after the US Alzheimer's Association published guidelines proposing that individuals with abnormal biomarkers should be given a diagnosis of Alzheimer's even if they have no clinical symptoms. According to this 'biological definition', Alzheimer's begins when amyloid first accumulates in the brain, which may be decades before symptoms arise. These amyloid-positive individuals are considered to be in a 'preclinical' stage of the disease. Sign up to Observed Analysis and opinion on the week's news and culture brought to you by the best Observer writers after newsletter promotion A few months later, the predominantly European International Working Group published a rebuttal postulating that Alzheimer's should only be diagnosed in symptomatic individuals. In their view, cognitively unimpaired individuals with abnormal biomarkers are considered 'at risk' of developing the disease. 'The vast majority of amyloid-positive individuals will never develop symptoms in their lifetime,' says Nicolas Villain, a neurology professor at Sorbonne University in Paris and an author of the critique. 'Labelling people who will never have symptoms with Alzheimer's is deleterious.' Identifying risk factors that allow for early intervention is common in other areas of medicine. Early detection and treatment of hypertension, for instance, helps prevent cardiovascular disease. In Alzheimer's, however, the roles that amyloid and tau play in the progression of the disease have not been fully elucidated. The idea of Alzheimer's being one single continuum, dependent only on amyloid and tau biomarkers, is overly simplistic, writes Maartje Schermer, professor in the philosophy of medicine at Erasmus University Rotterdam. Narrowing the scope of diagnosis to amyloid and tau alone risks missing factors that could play a previously unknown role. Labelling biomarker-positive individuals as 'preclinical' or 'at risk' may seem like no big deal. 'But semantics matter,' says Villain. 'The difference is more crucial than it might initially appear.' For one, a biological definition would lead to a fourfold increase in 'patient' cases. Moreover, a biological definition of Alzheimer's changes the meaning of the disease that exists in popular discourse. 'The idea we have now is that Alzheimer's is an irreversible and fatal disease,' says Timothy Daly, a bioethicist at the University of Bordeaux. 'The biological entity without symptoms is almost banal: you have disease biomarkers, but you're not guaranteed to develop dementia.' Using risk factors to define disease will create confusion among patients, physicians and public health experts, he says. 'There is no justification to test asymptomatic people outside clinical trials at the moment,' says Jonathan Schott, chief medical officer at Alzheimer's Research UK and neurology professor at University College London, who co-wrote the critique and is running the ADAPT study. He adds: 'Though I fear that with the availability of blood tests, some people will be self-testing against medical advice.' For now, according to Schott, having a biomarker-positive test is better thought of as an indication of risk rather than proof of the disease. 'The challenge will be to work out which of these biomarker-positive individuals are at imminent risk of developing symptoms within a few years and offering them treatment,' he says. 'But a simple blood test at the moment is insufficient for that.'
