Lithium as a Treatment for Alzheimer’s Disease: The Systems Pharmacology Perspective
Authors: Hampel Harald , Lista Simone , Mango Dalila , Nisticò Robert , Perry George , Avila Jesus , Hernandez Felix , Geerts Hugo , Vergallo Andrea ,   Alzheimer Precision Medicine Initiative (APMI), AFSHAR Mohammad , AGUILAR Lisi Flores , AKMAN-ANDERSON Leyla , ARENAS Joaquín , AVILA Jesus , BABILONI Claudio , BALDACCI Filippo , BATRLA Richard , BENDA Norbert , BLACK Keith L. , BOKDE Arun L.W. , BONUCCELLI Ubaldo , BROICH Karl , CACCIOLA Francesco , CARACI Filippo , CASTRILLO Juan , CAVEDO Enrica , CERAVOLO Roberto , CHIESA Patrizia A. , CORVOL Jean-Christophe , CUELLO Augusto Claudio , CUMMINGS Jeffrey L. , DEPYPERE Herman , DUBOIS Bruno , DUGGENTO Andrea , EMANUELE Enzo , ESCOTT-PRICE Valentina , FEDEROFF Howard , FERRETTI Maria Teresa , FIANDACA Massimo , FRANK Richard A. , GARACI Francesco , GEERTS Hugo , GIORGI Filippo S. , GOETZL Edward J. , GRAZIANI Manuela , HABERKAMP Marion , HABERT Marie-Odile , HAMPEL Harald , HERHOLZ Karl , HERNANDEZ Felix , KAPOGIANNIS Dimitrios , KARRAN Eric , KIDDLE Steven J. , KIM Seung H. , KORONYO Yosef , KORONYO-HAMAOUI Maya , LANGEVIN Todd , LEHÉRICY Stéphane , LUCÍA Alejandro , LISTA Simone , LORENCEAU Jean , MANGO Dalila , MAPSTONE Mark , NERI Christian , NISTICÓ Robert , O’BRYANT Sid E. , PALERMO Giovanni , PERRY George , RITCHIE Craig , ROSSI Simone , SAIDI Amira , SANTARNECCHI Emiliano , SCHNEIDER Lon S. , SPORNS Olaf , TOSCHI Nicola , VERDOONER Steven R. , VERGALLO Andrea , VILLAIN Nicolas , WELIKOVITCH Lindsay A. , WOODCOCK Janet , YOUNESI Erfan 
Published: May 2019

Systems pharmacology is a novel framework for drug research that models traditional and innovative pharmacological parameters and provides the overall efficacy and safety profile of a drug across body systems and complex, non-linear, molecular interactions. Lithium chloride, a pharmacological compound approved for the therapy of psychiatric disorders, represents a poorly explored compound for the treatment of Alzheimer’s disease (AD). Lithium has been shown to reduce downstream effects associated with the aberrant overactivation of certain molecular pathways, such as glycogen synthase kinase 3 subunit β (GSK3-β)-related pathways, involved in AD-related pathophysiology. It seems that overactivation and overexpression of GSK3-β lead to an impairment of long-term potentiation and amyloid-β induced neurotoxicity that can be normalized using lithium. Moreover, a growing body of evidence has demonstrated that lithium’s GSK3-β inhibitory effect prevents tau phosphorylation in mouse models of tauopathies. Clinical data have been inconclusive, partly due to methodological limitations. The lack of studies exploring the dynamics of protein misfolding in AD and investigating the specific tau-isoforms appearing prior to the accumulation of neurofibrillary tangles calls for new and optimized clinical trials. Advanced computer modeling based on a formal implementation of quantitative parameters and basic enzymatic insights into a mechanism-based model would present a good start to tackle these non-linear interactions. This innovative approach will pave the way for developing “molecularly” biomarker-guided targeted therapies, i.e., treatments specifically adapted (“tailored”) to the individual, consistently with the primary objectives and key conceptual points of precision medicine and precision pharmacology.