Andres J. Acosta, M.D., Ph.D.
- Consultant, Division of Gastroenterology and Hepatology, Department of Medicine
- Assistant Professor of Medicine, Mayo Clinic College of Medicine and Science
- Area of research: Obesity, food intake regulation
- Laboratory: Precision Medicine for Obesity
What sparked your interest in individualized medicine?
I am a passionate physician-scientist focused on understanding and curing obesity. My passion for obesity and metabolic diseases started during medical school. It led me to pursue and complete a Ph.D. and, subsequently, a gastroenterology fellowship combined with postdoctoral training in food intake regulation and obesity in the laboratory of Michael Camilleri, M.D., funded by a T32 training grant from the National Institutes of Health (NIH).
During my postdoctoral training, my most significant finding was the identification of obesity-related phenotypes. Identifying these phenotypes can conceivably lead to individualized obesity treatments tailored to the specific disturbances of function in individual patients — laying the groundwork for precision medicine for obesity.
What is your focus as a Gerstner Family Career Development Award recipient?
Weight-loss results with current treatments — including medications, endoscopy and surgery — are highly variable.
Patients who respond to each treatment achieve significant weight loss (more than 15% total-body weight loss); this degree of weight loss reduces cardiovascular mortality and other obesity-related comorbidities. However, it is unknown or unpredictable who will be the best responders to each treatment.
Thus, there is a critical need to individualize obesity management — that is, to identify the "responders" to each treatment — and move from a best-guess approach to the right intervention for the right patient.
Based on a study of more than 500 patients, my team recently subclassified obesity into different phenotypes based on dysfunctions in gastric motility, satiation, satiety, psychological, energy expenditure and other factors. We hypothesize that obesity-related phenotypes predict weight loss to pharmacotherapy and device interventions.
To test our hypothesis, my team has proposed three aims:
- Individualize obesity management. Individualized management will allow us to determine whether the obesity-related phenotypes predict weight loss to pharmacotherapy in obesity.
- Omics and obesity-related phenotypes. We're working to identify genetic variants, novel targets or pathways, pharmacogenomics, and metabolites associated with obesity-related phenotypes that may predict weight loss or side effects.
- Function of the gut-brain axis. Studying this axis will help us understand the differences in satiation and satiety in association with different obesity phenotypes.
How will your research improve patient care?
Individualized medicine initiatives are mainly focusing on rare diseases or cancer; very little has been attempted to individualize noncommunicable chronic diseases such as obesity and diabetes.
My team proposes an in-depth individualized medicine program for obesity that is supported by robust preliminary data and has a clear pathway to identify genotype and phenotype-based actionable biomarkers, or "companion diagnostics," as personalized medicine tests for obesity.
My research encompasses many key areas of individualized medicine. Additionally, my team applies pharmacogenomics principles in obesity to better understand the individual pathogenesis of each group within obesity, reduce treatment heterogeneity, and decrease the treatments' side effects.
Finally, my research goal of stratifying obesity will support the development of personalized drugs to treat obesity; this approach likely will generate safer and more efficacious medications.
All these benefits will improve the weight loss and comorbidities outcomes, increase treatment adherence and result in prevention of disease progression, consistent with the NIH's Precision Medicine Initiative.
How has the Gerstner Family Career Development Award helped advance your research?
The funding for this award has launched my career in individualized medicine as a unique physician-scientist in the field of obesity. It has supported the development of tailored obesity medicine. The award was critical to bridge the transition between my postdoctoral training and independence as a physician scientist, and allowed me to successfully compete and obtain an NIH K23 career development award.
Why did you choose Mayo Clinic to explore research?
Mayo Clinic's emphasis on the idea that the best interest of the patient is the only interest to be considered drives my research to be patient-centered. At Mayo, research and research translation are key, and I am delighted to have the opportunity to bring the questions from my patients to my lab and then from the lab back to the patients — real translational research to improve patient care. In my case, that means bringing precision medicine for obesity.