Human Practices

Before initiating our project, we had never anticipated the extent of complexity nor the profound significance inherent in “Human practice”. We have exerted every effort to engage with various stakeholder groups, articulating our vision while endeavoring even more diligently to listen to their voices. This process of active listening has prompted us to reflect upon and refine our project and its intricate details. “Human practice” serves as a guiding thread throughout our project. It steers us in defining our theme at its inception, offering corrections during its progression, and providing a directional compass for us and future iGEMers who may delve deeper into this subject.

“Treat with the reverence due to age the elders in your own family, so that the elders in the families of others shall be similarly treated.” This quote is from Mencius: king Hui of Liang, Chapter 1.

The aging of the population has become an inevitable trend in China’s future, and the uniqueness in China lies in:

1.The traditional Chinese virtue of “filial piety” dictates the obligation of children to support their parents. This may be a concept that is difficult to understand for those outside the Confucian cultural circle. For instance, the majority of elderly people in China are reluctant to leave their children, or what they consider their “home,” to spend their remaining years in a nursing home unless it is out of absolute necessity.

2.Due to historical reasons, most adult children in the current era do not have siblings. It means that in every traditional Chinese family, couples need to take care of not only their minor children but also four elderly parents simultaneously.

For patients with Alzheimer’s disease, from early memory decline to complete loss of self-care ability, and even to the emergence of hallucinations, mood swings, and aggressive/self-harming behavior in the middle to late stages, this is undoubtedly a disaster for any family.

Although we are merely a group of high school students and aging seems far removed from us. The principle of “Treat with the reverence due to age the elders in your own family, so that the elders in the families of others shall be similarly treated” resonates with us deeply. Through online research, we delved into people’s awareness and perceptions of anti-aging and Alzheimer’s disease. We discovered that the public lacks sufficient understanding of Alzheimer’s, and there are even misconceptions. For instance, many people view Alzheimer’s solely as memory decline or dementia. The feedback from nearly a thousand questionnaires collected nationwide has made us realize the significance of initiating this project on Alzheimer’s disease.

Interviewee: Chen Xinping, Associate Chief Physician in the Neurology Department of Haidian Hospital, Peking University Third Hospital

Interviewer: Jiang Chengjun, SRE-CHINA iGEMer

Among Dr. Chen Xinping's patients, the prevalence of Alzheimer’s disease is around 5%.

[The current drugs for Alzheimer’s disease have limited effects]

In the opinion of Dr. Chen Xinping, the greatest challenge in the diagnosis and treatment of Alzheimer’s disease is regardless of whether the current Alzheimer’s medications focus on symptomatic treatment or supplementary therapy, they can only serve to delay the degeneration and necrosis of nerve cells and mitigate the worsening of symptoms. In other words, the damage caused by Alzheimer’s to the brain is irreversible. The existing treatment methods can only slow down the progression of the disease, but cannot stop or cure it.

[New drug development is hindered by clinical trials]

Despite the continuous efforts and experiments conducted by relevant professionals worldwide, most of the promising solutions identified in basic experiments have faced challenges. Even drugs that have shown effectiveness in animal tests for Alzheimer’s ultimately prove to be ineffective in clinical trials.

[Sorting: efficacy, cost, safety]

Based on Dr. Chen Xinping’s years of medical experience, the current expectations of patients and their families for Alzheimer’s medications are ranked in the following order: efficacy, cost, and side effects/safety.

[Reflection]

The interview with Dr. Xinping Chen enlightened our experimental thinking. Whether it is possible to rapidly screen drug components that are compatible with the treatment of Alzheimer’s in a cost-effective, yet safe and stable manner.

Interviewee: Professor Wang Wenzhao, Chief Physician in the Neurology Department of Changzheng Hospital, Second Military Medical University, Shanghai.

Interviewer: Cui Jinming, SRE-CHINA iGEMer

Dr. Wang Wenzhao provided us with an official statistic. The morbidity of Alzheimer’s disease among people aged 65 and above doubles every 5 years globally.

[The use of medications is limited by the cause of the disease and the characteristics of the patient population]

The causes of Alzheimer’s disease are relatively complex, with patients often presenting multiple causes. As China has a high incidence of cerebrovascular diseases, a significant portion of Alzheimer’s cases in China can be attributed to cerebrovascular conditions. Taking the new drug Lecanemab as an example, its side effects include cerebral edema, cerebral hemorrhage, etc. These are particularly unfavorable for Alzheimer’s patients in a country like China with a high incidence of cerebrovascular diseases. For elderly patient groups such as those with Alzheimer’s, combination therapy in a state of multiple diseases has its limitations. It is more difficult to assess the safety and efficacy of medications over a long period as well.

[High treatment costs]

Due to the irreversible nature of Alzheimer’s disease, long-term medication is required to delay the worsening of symptoms. Therefore, for Alzheimer’s patients and their families, treatment costs are also a major concern. Taking Lecanemab as an example, the annual cost of the drug alone is nearly 200,000 yuan. Alzheimer’s patients need to take medication constantly throughout the year just to maintain their current state. This is an unbearable financial burden for most families in China.

[Under the dual pressure of efficacy and cost, patients in the middle and late stages of the disease become more radical]

Therefore, the acceptance of treatment among Alzheimer’s patients varies from person to person. Patients in the middle and late stages of the disease tend to be more radical in their acceptance of medications. They are more likely to accept new drugs that are still in the clinical validation stage and not yet marketed. One mainstream hypothesis of Alzheimer’s disease pathogenesis is that the therapeutic target lies in Aβ. However, clinical research on interventions targeting Aβ, including interventions for oxidative stress and inflammation, is scarce and mostly remains at the basic research level. For synthetically biological preparation, more evidence is needed to prove their safety. Overall, doctors do not reject the use of synthetic biology to alleviate the suffering of patients and their families. The key is to look at the clinical effectiveness.

[Reflection]

From a professional perspective as a clinician, Dr. Wang Wenzhao affirmed the application of synthetic biology in Alzheimer’s disease. However, he also reminded us that efforts are still needed to prove safety. Drug development cannot rely solely on basic experiments, clinical trial results are the most crucial.

Interviewee: Professor Sun Jing, Chief Physician of the Geriatric Department, The Second Affiliated Hospital of Wenzhou Medical University.

Interviewer: Jin Ziqing, SRE-CHINA iGEMer

Among Dr. Sun Jing’s patients, the incidence rate of Alzheimer’s disease among individuals aged 65 and above is 4%-5%, and the incidence rate is higher in females than in males.

[Optimal treatment with current medications is in the early stages of symptoms]

From the perspective of current Alzheimer’s treatment drugs, neither the new monoclonal antibody drugs nor traditional drugs can completely cure Alzheimer’s. They can only delay the deterioration of the disease or are relatively effective in treating mild cognitive impairment in the early stages of Alzheimer’s.

[The majority of patients miss the optimal timing for treatment]

For Alzheimer’s patients and their families, the primary issue is the inability to accurately distinguish between normal age-related memory decline and early symptoms of Alzheimer’s. The result is that when families bring patients to seek medical attention, the patients are already in the middle or late stages of Alzheimer’s. They have missed the optimal timing for treatment.

[The irreversibility of Alzheimer’s disease makes patients doubt the efficacy of medications]

Secondly, due to the overlap of Alzheimer’s with normal age-related memory decline in the elderly, patients' families may have the illusion that the medication is ineffective and stop taking it on their own. This is not conducive to maintaining the patient in a relatively good state for a long time, leading to a steep worsening of the disease.

[Reflection]

Dr. Sun Jing provided a crucial suggestion for our research direction. Given the specificity of Alzheimer’s disease and the anti-aging properties of WGX-50, in practical application, it can be formulated into a health product that prevents Alzheimer’s through mechanisms such as antioxidation, anti-inflammation, and anti-aging. When combined with other non-pharmacological daily preventive health measures, it can achieve twice the result with half the effort. This also aligns with the traditional theory of Chinese medicine, “The sage does not treat existing illnesses, but prevents them from occurring” as stated in The Inner Canon of Huangdi.

Interviewee: Professor Zuo Fan, Human behavior research expert and data scientist at New York University, USA.

Interviewer: Chen Junqiao, SRE-CHINA iGEMer

[Alzheimer’s is one of the symptoms that emerge during the aging process]

Alzheimer’s disease, which emerges during the human aging process. It is a progressive neurodegenerative disorder that has profound impacts on patients and their families. The impacts encompass not only physical suffering but also economic and emotional burdens. Currently, there are misconceptions among the public regarding anti-aging and Alzheimer’s disease. We should enhance public awareness through education and promotional activities, emphasizing the importance of prevention and potential intervention measures.

[Preventing Alzheimer’s through anti-aging measures is one of the effective pathways]

Professor Zuo Fan believes that the biggest challenge currently is how to translate laboratory findings into clinical applications. The current trends in anti-aging research focus on understanding the molecular mechanisms of aging and how to intervene in these mechanisms to delay the aging process. The integration of anti-aging research with the treatment of Alzheimer’s disease primarily involves seeking methods that can slow or halt neurodegenerative changes. This includes research on compounds beneficial to brain health and studies on lifestyle interventions.

[In the research against Alzheimer’s, it is not limited to Alzheimer’s itself]

At the end of this interview, Professor Zuo Fan expressed his insights regarding the research on WGX-50. “I believe this is a very promising field. WGX-50 has demonstrated antioxidant and anti-inflammatory properties in some studies. Utilizing synthetic biology technology to synthesize anti-aging health products. Preventing Alzheimer’s through anti-aging may be a new preferred approach. I also suggest considering issues such as the bioavailability, safety, and interactions with other drugs of WGX-50 in research.”

[Reflection]

Professor Zuo Fan’s interview echoes that of Dr. Sun Jing, highlighting that in the fight against Alzheimer’s, we can understand the core issues from a higher dimension. Early intervention should not be limited to combating Alzheimer’s itself. Instead, it should aim at the public’s pursuit of a healthy later life, with anti-aging serving as a precursor to preventing Alzheimer’s.

Interviewee: Zhuoran Yin, Researcher at Harvard University, Neurology Expert

Interviewer: Peng Huier, SRE-CHINA iGEMer

[The early intervention for Alzheimer’s overlaps with anti-aging on the timeline]

Through the conversation with Zhuoran Yin, we learned that cellular aging is a complex process in which cells stop dividing and enter a state of permanent growth arrest. This is primarily triggered by DNA damage, telomere shortening, oxidative stress, and the activation of certain oncogenes. Senescent cells accumulate with age and secrete pro-inflammatory factors, leading to organizational dysfunction and age-related diseases. Alzheimer’s is characterized by the accumulation of β-amyloid plaques and tau tangles in the brain, which cause neuronal dysfunction and death. Evidence suggests that Alzheimer’s results in neuroinflammation, vascular changes, and mitochondrial dysfunction. Recent studies have shown that the disease begins to lurk decades before symptoms appear, highlighting the importance of early intervention.

[There is feasibility in conducting parallel research on anti-aging and the treatment of Alzheimer’s]

Research on anti-aging and Alzheimer’s treatment share certain similarities, with both fields focusing on addressing the issue of cellular aging. Methods to combat cellular aging, reduce oxidative stress, and improve mitochondrial function are closely linked to the prevention of Alzheimer’s. Future research directions in Alzheimer’s include the development of more targeted therapies based on individual genetic and biological characteristics. As well as the exploration of comprehensive therapies that can simultaneously address multiple aspects of aging and neurodegeneration. However, translating research findings from animal models to humans remains a significant challenge. We still need to address the issue of inter-individual variability in aging and Alzheimer’s.

[The Prospects of Synthetic Biology in Anti-Aging and Alzheimer’s Disease]

Professor Zhuoran Yin believes that the contributions of synthetic biology to combating Alzheimer’s lie in two aspects: firstly, targeting the elimination of senescent cells in the brain, thereby slowing down or even halting the deterioration of Alzheimer’s symptoms. Secondly, regarding personalized therapies that are particularly concerned in current medical research, synthetic biology presents an opportunity to develop highly specific and customizable treatment plans. Additionally, synthetic biology can also facilitate the development of disease diagnostics and prevention measures, thereby for interventions to be implemented before symptoms manifest.

[Reflection]

Zhuoran Yin's interview painted a picture of the prospects and directions for utilizing synthetic biology in combating Alzheimer’s. It also once again confirmed the correlation between anti-aging and Alzheimer’s. Meanwhile, it hinted at the key of experimental research, which is to demonstrate whether WGX-50 possesses efficacy in combating cellular aging, reducing oxidative stress, and fighting neuroinflammation.

Interviewee: Dai Xianyong, Associate Chief Physician, Neurology Department, Linhai Second People’s Hospital

Interviewer: Jin Chenming, SRE-CHINA iGEMer

[Limited Awareness of Alzheimer’s Disease: A Major Barrier to Treatment]

Dr. Dai Xianyong expressed that, according to public data, the prevalence of Alzheimer’s disease among individuals aged 65 and above stands at approximately 5%. However, at the grassroots hospital in the prefecture-level city where he practices, the actual number of patients seeking medical attention is much lower. Given that Linhai primarily serves its own prefecture as well as the vast rural areas surrounding it, patients and their families have limited ability to recognize Alzheimer’s disease. As a result, most patients only seek medical treatment when the condition has progressed to a severe stage. Consequently, at Dr. Dai’s hospital, the number of Alzheimer’s patients is low, but the majority of them are in the late stages of the disease.

[The Paradox Between Drug Effects on Early Symptoms and Patient Awareness]

Dr. Dai Xianyong believes that currently, the medications available for treating Alzheimer’s disease are in a stagnant state, with none of them being considered a “miracle drug” that can instantly cure the condition. Furthermore, these medications are primarily targeted at patients in the early stages of Alzheimer’s, and their effectiveness is significantly reduced for those in the mid-to-late stages, especially in the late stages. However, the reality is that few individuals are willing to acknowledge that they are in the early stages of dementia or have a tendency towards dementia, thereby reluctance to undergo MCI (Mild Cognitive Impairment) screening or take the prescribed medications.

[Early Intervention, Screening, and Treatment]

Therefore, the optimal strategy for Alzheimer’s disease is to intervene at the MCI (Mild Cognitive Impairment) stage. This involves comprehensive measures such as MCI screening, follow-up, monitoring, and early intervention, particularly targeting interventions when Aβ (amyloid-beta) has not yet aggregated or deposited significantly.

[Reflection]

Dr. Dai Xianyong’s experience has pointed us towards an important direction beyond experimentation for our team: prevention of Alzheimer’s disease is more crucial than its treatment. Thus, the key to preventing Alzheimer’s lies in educating the public about the disease, enhancing their understanding and recognition capabilities. 

Interviewee: Le Jianhua, Psychotherapist, Alzheimer’s Diagnosis and Treatment Center, Shanghai Jiao Tong University

Interviewer: Bai Zikuan, SRE-CHINA iGEMer

[Addressing Socio-Ethical Aspects of Alzheimer’s Disease: A Crucial Step Towards Early Intervention]

Ms. Le Jianhua, not only serves as a Psychotherapist at the Alzheimer’s Diagnosis and Treatment Center, Shanghai Jiao Tong University, but also holds positions as a faculty member in the “Intelligent Health Care and Elderly Service Management” program at Shanghai Open University, an expert with the Shanghai Elderly Service Industry Association, and a monitoring expert for cognitive impairment care units in Shanghai. With years of professional experience working with Alzheimer’s patients and their families, Ms. Le recommends that we pay greater attention to the ethical implications of Alzheimer’s treatment, particularly addressing the societal issue of ageism.

As society progresses, there is a growing call for the public to refrain from using stigmatizing terms such as “senile dementia” or “dementia” and instead adopt the term “cognitive impairment.” This shift in terminology aims to mitigate the sense of shame that can deter patients from seeking timely medical attention, which is particularly critical for individuals in the early stages of cognitive impairment.

[The Guiding Significance of Healthcare Policies Amidst Population Aging]

Economically, the cost of caring for the elderly population and Alzheimer’s patients poses a significant challenge, necessitating sustainable healthcare policies for guidance. Furthermore, fostering collaboration among communities, hospitals, and nursing homes to provide systematic and coherent healthcare services for the elderly is an effective pathway to prevent and treat Alzheimer’s disease, thereby safeguarding the healthy lives of seniors.

[Fighting Alzheimer’s Should Go Beyond the Disease Itself and Emphasize Advocating for a Healthy Elderly Life]

Given the unique characteristics of Alzheimer’s disease, drug therapy must be complemented by a healthy lifestyle and habits, forming the cornerstone for maintaining a good condition. This includes the combined use of medications for multiple comorbidities, daily dietary habits, social activities, and more. For Alzheimer’s, Ms. Le Jianhua believes that advocacy should precede prevention, and prevention is superior to treatment. The scope should not be limited to the elderly; instead, both young and middle-aged individuals should be exposed to more information about Alzheimer’s, fostering an earlier and broader awareness among the population.

[Reflection]

Drawing from her extensive experience in elderly care, Ms. Le Jianhua guides us to not limit ourselves in public outreach due to the themes of Alzheimer’s or anti-aging. Instead, we should leverage our strengths, reach out to schools and communities, and fully exploit the advantages of the internet era. Our efforts should not solely target the elderly but also encompass youth and middle-aged individuals, broadening the scope of awareness for Alzheimer’s and even more broadly, anti-aging and healthy aging. As we embrace an aging society, this is a challenge that all sectors of society must jointly confront.

Interviewee: Pan Li, Director of Shanghai Qiutanyuan Nursing Home

Interviewer: Zhang Zhuxu, SRE-CHINA iGEMer

As the director of Shanghai Qiutanyuan Nursing Home, Ms. Pan Li has a wealth of experience in the eldercare industry, having held key management positions in several senior care facilities in Shanghai. With an extensive background in operations and management, she serves as a senior consultant for the Shanghai Elderly Service Industry Association, participates in the standardization of eldercare services in Shanghai, and advocates for the concept of “Healthy Aging,”dedicated to enhancing the quality of life for the elderly.

[Combining Medication with Healthy Lifestyles Enhances the Quality of Life for Alzheimer’s Patients]

Ms. Pan Li emphasizes that the nursing home she oversees adopts a comprehensive care model that integrates medication therapy with healthy lifestyle practices. In terms of medication, she acknowledges that it can bring about a degree of improvement for Alzheimer’s patients, especially during early intervention. For instance, medications can slow down the decline of cognitive functions and enhance patients' daily living abilities. However, she cautions that the effectiveness of medications varies among individuals, and they cannot cure the disease. Furthermore, the potential side effects must be closely monitored.

In caring for Alzheimer’s patients at the nursing home, Ms. Pan Li stresses that reliance on medications alone is insufficient. Instead, a holistic approach that incorporates adjusting the diet, improving sleep environments, incorporating physical activities, and fostering social interactions as part of a healthy lifestyle, can alleviate the discomfort caused by side effects and enhance the overall quality of life for the elderly.

[Anticipating New Hope for Alzheimer’s Patients through Synthetic Biology]

Nursing homes hold a positive outlook on the application of synthetic biology in the research of anti-Alzheimer’s drugs, particularly those focused on early intervention and slowing disease progression, which are expected to provide patients with more treatment options and renewed hope. It is hoped that these drugs will attain higher standards of safety and efficacy, leading to their widespread clinical application. Additionally, given national policies governing genome editing and genetically modified products, along with the varying production methods employed during experimental phases and commercialization, Ms. Pan Li underscores the critical importance of making the process more transparent and easily understandable to the public.

[Reflection]

Through interviews with various doctors, researchers, and elderly care professionals, we have learned that given the current status and challenges of Alzheimer’s disease, neither professionals nor patients and their families are averse to the involvement of synthetic biology in its prevention and treatment. In fact, there is significant anticipation. Despite the fact that a considerable portion of the population is unfamiliar with synthetic biology as an emerging field, this presents us with an opportunity to educate the public about it. As many professionals like Ms. Pan Li have pointed out, introducing synthetic biology into the prevention and treatment of Alzheimer’s disease, and even improving the quality of life for the elderly, necessitates disseminating knowledge and insights on synthetic biology and new technologies to the public, and communicating this information transparently. This is a chance for us to engage in educational interactions, which is equally crucial as conducting experiments.