ASPIRE-MSA: Natural History and Disease Progression Biomarkers of Multiple System Atrophy

Sponsor

University Hospital, Toulouse (Other)

Overall Status

Active, not recruiting

CT.gov ID

NCT04229173

Collaborator

(none)

Enrollment

Locations

Arms

27.2

Anticipated Duration (Months)

Patients Per Site

0.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Multiple system atrophy (MSA) is a rare and fatal neurodegenerative disease characterised by a variable combination of parkinsonism, cerebellar impairment and autonomic dysfunction. The neuropathological hallmark is the accumulation of alpha-synuclein in oligodendrocytes. While some symptomatic treatments exist, neuroprotective treatments for MSA remain an urgent, unmet need. Moreover, at present there is not a single surrogate biomarker of MSA which could be used to inform clinical trials.

This study seeks to characterise the natural history of MSA on a panel of candidate biomarkers, pre-selected for being putative surrogates of the underlying neurodegenerative process

Condition or Disease	Intervention/Treatment	Phase
Multiple System Atrophy	Diagnostic Test: MRI acquisition Diagnostic Test: DAT-SPECT Diagnostic Test: blood sample, cerebrospinal fluid (optional) Behavioral: Evaluations about motor abilities, depression, cognition and lifestyle Behavioral: Evaluation about depression cognition	N/A

Detailed Description

Surrogate biomarkers are objectively measured characteristics of a disease which act as indicators of the underlying pathophysiological processes responsible for disease progression. Reduced grey matter volume in putamen, cerebellum and brainstem as measured with MRI have been consistently reported to differentiate MSA from other parkinsonian disorders. However, to date, there are no longitudinal studies examining the natural history of MSA on these structural neuroimaging markers over time. The magnitude of the abnormalities observed cross-sectionally in MSA compared to other parkinsonian disorders and the fast clinical progression of the disease make it very likely that structural changes can be observed even over short periods of time. There is also a strong scientific rationale for the potential of measures reflecting white matter integrity, cerebral iron deposition and presynaptic dopaminergic dysfunction, as well as levels of neurofilament light chain (NfL), alpha-synuclein and other proteins involved in the neurodegenerative process in MSA, to serve as progression biomarkers of the disease, although supporting evidence remains limited. A better understanding of the natural history of MSA over 6 and 12 months on a panel of candidate surrogate biomarkers is needed to better understand the disease, help optimise future trial designs in terms of patient selection, sample size and trial duration, and improve the ability to measure the therapeutic effects of novel treatments.

In evaluating potential progression markers of a neurodegenerative disease such as MSA, it is important to control for the normal effects of aging. Studies in healthy volunteers have shown regionally distinct effects of aging on both brain volume and dopamine transporter density, justifying the inclusion of healthy controls with a similar age and gender distribution than patients.

Study Design

Study Type:

Interventional

Actual Enrollment :

60 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Other

Official Title:

Natural History and Disease Progression Biomarkers of Multiple System Atrophy

Actual Study Start Date :

May 26, 2020

Anticipated Primary Completion Date :

May 30, 2022

Anticipated Study Completion Date :

Sep 1, 2022

Arms and Interventions

Arm	Intervention/Treatment
Other: MSA patients Patients with multiple system atrophy will be examined at baseline, 6 months and 12 months via the following procedures performed at all 3 visits: a clinical examination; blood and cerebrospinal fluid (CSF) (optional) sampling for the assessment of selected fluid biomarkers; MRI for the assessment of brain volume, white matter integrity and cerebral iron deposition; DAT-SPECT (Dopamine Transporter, Single Photon Emission Computed Tomography) for the assessment of presynaptic dopaminergic function	Diagnostic Test: MRI acquisition MRI acquisition Diagnostic Test: DAT-SPECT Imaging with DAT SPECT (Dopamine Transporter, Single Photon Emission Computed Tomography) Diagnostic Test: blood sample, cerebrospinal fluid (optional) blood sample, cerebrospinal fluid Behavioral: Evaluations about motor abilities, depression, cognition and lifestyle Evaluations about motor abilities (UMSAR scale), depression (BDI scale), cognition (MoCA scale) and lifestyle (MSA- QoL)
Other: Healthy volunteers healthy. Controls will undergo an MRI scan at baseline, 6 months and 12 months, and a DAT-SPECT(Dopamine Transporter, Single Photon Emission Computed Tomography) scan at baseline and 12 months.	Diagnostic Test: MRI acquisition MRI acquisition Behavioral: Evaluation about depression cognition Evaluations about depression (BDI scale), cognition (MoCA scale)

Arm

Intervention/Treatment

Other: MSA patients

Patients with multiple system atrophy will be examined at baseline, 6 months and 12 months via the following procedures performed at all 3 visits: a clinical examination; blood and cerebrospinal fluid (CSF) (optional) sampling for the assessment of selected fluid biomarkers; MRI for the assessment of brain volume, white matter integrity and cerebral iron deposition; DAT-SPECT (Dopamine Transporter, Single Photon Emission Computed Tomography) for the assessment of presynaptic dopaminergic function

Diagnostic Test: MRI acquisition

MRI acquisition

Diagnostic Test: DAT-SPECT

Imaging with DAT SPECT (Dopamine Transporter, Single Photon Emission Computed Tomography)

Diagnostic Test: blood sample, cerebrospinal fluid (optional)

blood sample, cerebrospinal fluid

Behavioral: Evaluations about motor abilities, depression, cognition and lifestyle

Evaluations about motor abilities (UMSAR scale), depression (BDI scale), cognition (MoCA scale) and lifestyle (MSA- QoL)

Other: Healthy volunteers

healthy. Controls will undergo an MRI scan at baseline, 6 months and 12 months, and a DAT-SPECT(Dopamine Transporter, Single Photon Emission Computed Tomography) scan at baseline and 12 months.

Diagnostic Test: MRI acquisition

MRI acquisition

Behavioral: Evaluation about depression cognition

Evaluations about depression (BDI scale), cognition (MoCA scale)

Outcome Measures

Primary Outcome Measures

Change putamen, cerebellum and brainstem volume measured on MRI [at 12 month]
volume measured with T1-3D MRI, unit : Volume (mm3), Fer: R2* (s-1), diffusion: mean diffusivity (mm2s-1)

Secondary Outcome Measures

Effect of disease progression on other measures of brain structural integrity and iron accumulation [6 month and 12 month]
volume measured with T1-3D MRI, unit : Volume (mm3), Fer: R2* (s-1), diffusion: mean diffusivity (mm2s-1)
Effect of disease progression on the loss of presynaptic dopaminergic terminals in the striatum integrity and iron accumulation [6 month and 12 month]
volume measured with DAT SPECT (Single Photon Emission Computed Tomography), unit : binding potential (e.g ratio striatum/brain activity)
Effect of disease progression on axonal damage as evidenced in biofluids [6 month and 12 month]
biomarkers dosages in blood and Cerebral Spinal Fluid total Concentration unit : pg/ml.

Eligibility Criteria

Criteria

Ages Eligible for Study:

30 Years to 80 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

INCLUSION CRITERIA:

Applicable to MSA patients:

Patients with possible or probable MSA according to consensus diagnosis criteria [Gilman et al., 2008]
Patients aged between 30 and 80 years
Patients at the early stages of the disease, defined as maximum 5 years since the onset of one of the following symptoms associated to MSA:

Parkinsonism Ataxia Orthostatic hypotension and/or urinary dysfunction - Patients with an anticipated survival of at least 3 years on the basis of Investigators' clinical judgment

Applicable to healthy controls:

Participants with a similar age (+/- 5 years) and gender distribution compared to MSA patients
Participants with absence of neurological pathology
Patients aged between 25 and < 80 years

Applicable to both patients and healthy controls:

Participants who voluntarily sign the written informed consent form, indicating that they understand the purpose of and procedures required for the study and are willing to participate in it Participants affiliated to the French social security health system

EXCLUSION CRITERIA:

Applicable to MSA patients:

Speech impairment (score of ≥3 on UMSARS (Unified Multiple System Atrophy Rating Scale) question 1);
Impairment in ambulation (score of ≥3 on UMSARS (Unified Multiple System Atrophy Rating Scale) question 7)
Falling more frequently than once per week (score of ≥3 on UMSARS (Unified Multiple System Atrophy Rating Scale) question 8)

Applicable to both MSA patients and healthy controls:

Participants with significant cognitive impairment (MoCA score <21)
Any major medical or psychiatric condition which may compromise participation in the study or the safety, at the discretion of the Investigator
Contraindications for MRI imaging, including claustrophobia and presence of metallic implants such as cardiac or auditory prostheses, pacemakers or cerebral clips
Contraindications to obtain a FP-CIT SPECT(Single Photon Emission Computed Tomography) (i.e. known hypersensitivity to the active substance or to any of the excipients, or to iodine)
Current pharmacological treatments that may alter the DAT(dopamine transporter ) SPECT (Single Photon Emission Computed Tomography) reading, including amphetamines, benzatropine, buproprion (amfebutamone), cocaine, mazindol, methylphenidate, phentermine or sertraline
Females who are pregnant, breast feeding or of child bearing age without effective contraception
Participants who lack the capacity to give informed consent
Participants taking any investigational products within 3 months before baseline assessment
Participant under adult autonomy protection system, legal guardianship or incapacitation.

Additional exclusion criteria concerning only patients consenting to the lumbar puncture:

Coagulopathy and/or anticoagulant treatment
Thrombocytopenia
Intracranial hypertension
Severe degenerative arthritis of the lumbar spine Patients failing to meet these criteria can still participate in the study and all other study assessments (with the exception of lumbar puncture) as appropriate.

Contacts and Locations

Locations

	Site	City	Country	Postal Code
1	CHU de Bordeaux	Bordeaux	France	33076
2	Hôpital Neurologique Pierre Wertheimer	Bron	France	69677
3	Chu Clermont Ferrand	Clermont Ferrand	France	63003
4	CHU Lille	Lille	France	59037
5	Hôpital de La Timone	Marseille	France	13000
6	CHU de Nancy	Nancy	France	54035
7	Clinique neurologique - Hôpital Laennec	Nantes	France	44093
8	Hôpital Pitié-Salpêtrière	Paris	France	75013
9	Hôpital de Hautepierre	Strasbourg	France	67098
10	CHU	Toulouse	France	31000