Plasma a-Synuclein Aggregation Seeding Activity as a Novel Biomarker for Neurodegeneration Disease

Overview

Synuclein disease, also known as Synucleinopathies, is a general term for a class of degenerative diseases. It mainly includes Parkinson's disease (PD), Dementia with lewy bodies (DLB), Multiple system atrophy (MSA) and so on. The disease is characterized by the abnormal folding of alpha-synuclein (α-syn) in the peripheral and central nervous system, resulting in the production of lewy bodies, lewy neurites, neurons, and glial cytoplasmic inclusion bodies in neurons or glial cells. The intracellular location and accumulation pattern of α-syn vary in different synuclein diseases. There are overlapping conditions between synuclein diseases, which also makes the accuracy of clinical diagnosis of synuclein diseases very low. A definitive diagnosis can be made only after the patient has died and brain samples are evaluated using immunohistochemical staining. Therefore, in order to intervene and save synuclein disease in advance, it is necessary to develop more accurate and less invasive diagnostic methods. Real-Time Quaking Induced Conversion (RT-QuIC) is a method for in vitro amplification of pathogenic protein seeds, which can enable seed proteins with in vitro amplification ability to transform substrates into misfolded seeds under specific conditions. RT-QuIC was originally used in the diagnosis of patients with prion protein. The technique can identify the prion protein in the misfolded form in the cerebrospinal fluid of patients with Creutzfeldt-Jakob disease with a specificity of 100% and a sensitivity of 95-98%, so it has been incorporated into the clinical diagnostic criteria for sporadic Creutzfeldt-Jakob disease. Studies have shown that pathogenic seeds extracted from patients' cerebrospinal fluid or other biological fluids or tissues are incubated with recombinant protein substrates, and the use of intermittent shaking to promote the interaction between the seed and substrate can force the substrate to transform into pathogenic protein seeds. The RT-QuIC reaction process is monitored in real time by a detector inside the machine for thioflavin, a fluorescent dye that fluoresces when bound to the beta lamellar layer, which is also typical of amyloid fibrils. Studies have shown that testing patients' cerebrospinal fluid with RT-QuIC can accurately distinguish lewy body dementia from non-Parkinson's dementia In this study, RT-QuIC technique was used to amplify the misfolded α-syn in clinical samples to explore the differences in protein characteristics among synuclein diseases, and to try to diagnose synuclein diseases by this method. Firstly, clinical cases of synucleoprotein disease were enrolled, and plasma of 100 control subjects, 221 cases of PD patients and 127 cases MSA patients, 10 cases of PSP patients, were established. Using RT-QuIC technology, we used aSyn (successfully prepared in our laboratory) to amplify the plasma of normal subjects and Synucleinopathies patients. It was found that the maximum fluorescence intensity (extreme value), peak time, K/2 (slope at extreme value/2) and Tmax/2 (time of reaching extreme value/2) can be used as diagnostic and differential diagnostic indicators for Synucleinopathies.

Primary outcome measures

• slope [Time frame: From enrollment to the end of treatment at 21 weeks]
• MAX [Time frame: From enrollment to the end of treatment at 21 weeks]

Eligibility criteria

Inclusion criteria

\- Grouping criteria for PD patients: All PD patients who join the group need to meet the following conditions at the same time: The diagnosis of primary PD patients is based on the 2015 International Association for Movement Disorders (MDS) Parkinson's disease diagnosis standard, and all patients need to meet the clinical diagnosis or likely Parkinson's disease diagnosis criteria. Quasi; All patients come from the outpatient clinic of Xuanwu Hospital Affiliated to Capital Medical University, and the clinical evaluation and disease diagnosis are completed by a movement disorder specialist. This project is approved by the Ethics Committee of Xuanwu Hospital Affiliated to Capital Medical University. The subjects who participated in the study signed the informed consent form. Fully improve the information of PD patients and form an NSFC 2024 clinical information database. Establish an evaluation scale based on various indicators such as basic demographic data, general disease status and past history and exercise symptom evaluation, including Hoehn \& Yahr staging, unified Parkinson's disease assessment scale (MDS- UPDRS), concise mental state examination (MMSE) examination, Monte Lear scale (MOCA), rapid eye movement sleep behavior disorder Hong Kong questionnaire (RBDQ-HK), Hamilton depression scale (HAMD) and anxiety scale (HAMA), integrating a number of sports and non-sports indicators, comprehensively considering and evaluating the patient's condition, for the follow-up relevant Sexual analysis provides accurate and complete clinical information.MSA patients need to meet the MSA clinical diagnosis criteria updated in 2008 by the Europe Multiple System Atrophy Study Group (EMSA-SG). For DLB patients, use the 2017 standard for diagnosis and grouping.

Exclusion criteria

• Patients with Parkinson's syndrome but not primary PD, patients with brain surgery/deep brain electrode stimulation, or patients diagnosed with dementia according to the Diagnostic and Statistical Manual of Mental Illness formulated by the American Association of Mental Illness. PD patients with mild cognitive dysfunction are not excluded.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Observational model

Cohort

Study locations

China · 2 centers

• Xuanwu Hospital — Beijing
• Xuanwu Hospital — Beijing

Identifiers

NCT: NCT07498686 · 115

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗