Abstract
Recent advancements in large language models (LLMs) have demonstrated their potential in scientific reasoning, but their ability to open-ended hypotheses in data-scarce domains remains underexplored. Here, we introduce Combinatorial Alzheimer's Disease Therapeutic Efficacy Decision (Coated-LLM), an AI-driven framework that is inspired by scientific collaboration to predict efficacious combinatorial therapy when data-driven prediction is infeasible. Coated-LLM employs multiple specialized LLM agents-Researcher, Reviewer s, and Moderator-to systematically generate and evaluate hypotheses through several in-context learning techniques. Using Alzheimer's disease (AD) as a test case, Coated-LLM outperformed traditional knowledge-based methods (accuracy: 0.74 vs. 0.52), with external validation achieving an accuracy of 0.82. In addition, a drug combination predicted from Coated-LLM was experimentally validated to significantly reduce amyloid aggregation in vitro. These findings highlight the potential of our framework to augment human reasoning in complex scientific reasoning tasks, offering a scalable approach for hypothesis generation in biomedical research.