Brockmann Kathrin, Lerche Stefanie, Baiardi Simone, Rossi Marcello, Wurster Isabel, Quadalti Corinne, Roeben Benjamin, Mammana Angela, Zimmermann Milan, Hauser Ann-Kathrin, Deuschle Christian, Schulte Claudia, Liepelt-Scarfone Inga, Gasser Thomas, Parchi Piero
Department of Neurodegeneration, Center of Neurology, Hertie Institute for Clinical Brain Research, German Center for Neurodegenerative Diseases, University of Tuebingen, Hoppe Seyler‑Strasse 3, 72076, Tuebingen, Germany.
German Center for Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany.
NPJ Parkinsons Dis. 2024 Jan 20;10(1):24. doi: 10.1038/s41531-023-00627-5.
Seed amplification assays have been implemented in Parkinson's disease to reveal disease-specific misfolded alpha-synuclein aggregates in biospecimens. While the assays' qualitative dichotomous seeding response is valuable to stratify and enrich cohorts for alpha-synuclein pathology in general, more quantitative parameters that are associated with clinical dynamics of disease progression and that might potentially serve as exploratory outcome measures in clinical trials targeting alpha-synuclein would add important information. To evaluate whether the seeding kinetic parameters time required to reach the seeding threshold (LAG phase), the peak of fluorescence response (Imax), and the area under the curve (AUC) are associated with clinical trajectories, we analyzed LAG, Imax, and AUC in relation to the development of cognitive decline in a longitudinal cohort of 199 people with Parkinson's disease with positive CSF alpha-synuclein seeding status. Patients were stratified into tertiles based on their individual CSF alpha-synuclein seeding kinetic properties. The effect of the kinetic parameters on longitudinal development of cognitive impairment defined by MoCA ≤25 was analyzed by Cox-Regression. Patients with a higher number of positive seeding replicates and tertile groups of shorter LAG, higher Imax, and higher AUC showed a higher prevalence of and a shorter duration until cognitive impairment longitudinally (3, 6, and 3 years earlier with p ≤ 0.001, respectively). Results remained similar in separate subgroup analyses of patients with and without GBA mutation. We conclude that a more prominent alpha-synuclein seeding kinetic profile translates into a more rapid development of cognitive decline.
种子扩增检测已应用于帕金森病,以揭示生物样本中疾病特异性错误折叠的α-突触核蛋白聚集体。虽然该检测的定性二分法种子反应对于总体上对α-突触核蛋白病理学的队列进行分层和富集很有价值,但与疾病进展的临床动态相关且可能作为针对α-突触核蛋白的临床试验中的探索性结局指标的更多定量参数将增加重要信息。为了评估种子动力学参数达到种子阈值所需的时间(延迟期)、荧光反应峰值(Imax)和曲线下面积(AUC)是否与临床轨迹相关,我们分析了199名脑脊液α-突触核蛋白种子状态为阳性的帕金森病患者纵向队列中延迟期、Imax和AUC与认知衰退发展的关系。根据患者个体的脑脊液α-突触核蛋白种子动力学特性将其分为三分位数。通过Cox回归分析动力学参数对由蒙特利尔认知评估量表(MoCA)≤25定义的认知障碍纵向发展的影响。具有更多阳性种子重复数以及延迟期更短、Imax更高和AUC更高的三分位数组的患者纵向出现认知障碍的患病率更高且持续时间更短(分别提前3年、6年和3年,p≤0.001)。在有和没有GBA突变的患者的单独亚组分析中结果仍然相似。我们得出结论,更显著的α-突触核蛋白种子动力学特征转化为认知衰退的更快发展。