I am Diana Hengartner. I am a Medical Director in the Neuroscience team at Parexel, with a specialty in Parkinson's disease and movement disorders.

Before Parexel, I was an attending physician in movement disorders and Parkinson's disease. I faced the reality that, despite treatments, patients eventually continue to progress. When I encountered this as a physician, I knew I had to do something, which drove my passion for research. I felt that if we don't act now, using our knowledge and training to create better trials for disease-modifying solutions, there will be little progress.

At Parexel, I am the medical lead on clinical trials, guiding teams in the therapeutic indication of the trial. I keep up with trends and treatment options, which allows me to guide our teams effectively. I help sponsors to find solutions and mitigations, to make studies successful, and ultimately, I am going to help the patients who are going to be impacted by that study.

Why do you enjoy working at Parexel?

Parexel has enabled me to successfully transition from being an academic researcher and attending specialist into a lead of clinical trials teams, leading very important clinical trials in Parkinson's disease. I have been able to grow in my career, protect my goals and my niche as a professional, and focus on the area of my interest. And by doing so, I have grown tremendously as a professional in my knowledge of clinical trials.

If you had to describe the culture of Parexel in one word, what would it be and why?

Parexel’s culture is enabling. The work exposes you to different types of studies across indications and therapeutic strategies. It's an environment that allows professional growth and achievement of goals in your specific area of interest.

What inspires you to do what you do?

1. The ability to impact many patients and families by making clinical trials successful.
2. To contribute to finding therapeutic options for neurodegenerative diseases, specifically Parkinson's disease, where we need options to slow or halt disease progression.
3. Research is my passion. I discovered this early in my training, and it was nurtured by my mentors during my training and early academic career. I truly believe I'm doing what I love.

As a Medical Director, how does the use of insights fuel the advancement of clinical research?

When you are a medical lead on a clinical trial, you guide your team in the therapeutic indication of the trial. You have the invaluable knowledge of having treated patients in your specialty, and you know the patient's needs and struggles. With that knowledge, you can advise all teams—operational, data management, scientific, and regulatory—on what to do and what not to do. All of that brings the team together and makes the study successful.

What does that hands-on experience with patients mean to sponsors?

It's incredibly important. Sometimes a protocol looks good on paper, but when setting up the study, you realize it's not feasible as written. Patients might not tolerate long assessments, frequent visits, or multiple procedures like lumbar taps. Patients have their own needs and limitations, especially in my field of Parkinson's disease, where patients are debilitated with a progressive neurological disease and have unique needs.

Can you share a success story where your work directly impacted a customer or colleague's success?

We were setting up a very important trial for a scientific community. When we observed the design, we noticed that this study protocol might not be feasible. There was a very high risk for validation issues. Our team created a set of different scenarios and alternative designs and provided these to the sponsor. By working together, we were able to find a solution to make the study successful. Our experience with patients and previous clinical trials helped us foresee issues ahead of time and prevent potential pitfalls. It was a really rewarding experience for me.

What has been the progress in the space over the past few years?

Over the last years, specifically the last decade, there have been a lot of advances in our knowledge of the disease. We now have more knowledge from the genetic perspective of the disease, the molecular biology of the disease, and the technology has also progressed.

With that, we've identified something very important: we're now more conscious that the traditional outcome measures used in clinical trials for Parkinson's are not ideal. They have many limitations. Because of that, we've started to develop novel outcomes.

How have digital technologies advanced Parkinson's research?

During the production of novel outcomes and novel biomarkers, there has been a significant advance in digital healthcare technologies, which can quantify objectively the symptoms of a patient, hour by hour, day by day, in their home environment. That by itself, is a great advantage because a patient is not being observed. They're in their natural environment, enjoying life, and doing daily activities.

Digital health technologies have come in the form of wearable devices, applications for smartphones and smartwatches, and even devices you can place in your home to monitor the movements of patients without them wearing anything. This field is rapidly growing and developing.

What progress has been made with biomarkers?

We've seen progress in biomarkers for the actual pathology or biology of the disease, such as the alpha synuclein amplification assay, which showed very promising results in data published last year. Imaging biomarkers have also progressed significantly in the last 10 years.

With all of this, I hope that once we have validated these biomarkers, the scientific community will be able to put together a disease construct with the use of technology, and perhaps even AI, to better stage patients in clinical trials and evaluate their progression during a trial.

How can machine learning and AI be better utilized in the study of Parkinson's disease?

Artificial intelligence and machine learning are already being introduced into digital health technologies in order to help analyze motor behaviors of patients while they're in their home environment.

Artificial intelligence is being used to analyze patterns of movement in patients with Parkinson's disease without using any wearables on their bodies, which is an even more sophisticated way to monitor patients, as patients with Parkinson's might feel uncomfortable wearing any sort of device or cable on their bodies.

What specific tasks can AI perform in Parkinson's research?

AI can be used to help score motor tasks that we commonly use in Parkinson's disease trials, such as finger tapping or alternating movements on the body. There have been studies showing that artificial intelligence can score, almost with the same accuracy as a movement disorder specialist, these specific motor tasks during the application of clinical skills in Parkinson's disease trials.

Also, artificial intelligence has been used to help integrate data from different biomarkers or from different data sources, in order to help predict whether a patient with prodromal symptoms may or may not develop the disease in the future.

What is the future potential of AI in Parkinson's disease research?

I think in the future we may be able to create a disease construct based on validated biomarkers. Once they're validated and we have multiple of them, artificial intelligence can be used to create algorithms with the ability to predict whether a patient might develop Parkinson's disease in the future based on specific features a patient has.