Discovery and Validation of Protein Structural Complexes in Circulating Biofluids As Novel Biomarkers for Early Diagnosis, Prognosis and Therapeutic Management of Patients Affected by Neurodegenerative Disorders

Neurodegenerative disorders (NDDs), such as Parkinson¿s disease (PD), Alzheimer¿s disease (AD), Frontotemporal dementia (FTD) and Amyotrophic Lateral Sclerosis (ALS) are characterized by aggregation and intracellular accumulation of misfolded proteins, which are believed to play a key role in synaptic dysfunction and neuronal death. Protein structural complexes in biofluids have been proposed to mirror pathological conditions suggesting their use as biomarkers for NDDs characterized by protein aggregation. In this framework, we plan to: i) collect a large cohort of NDD and prodromal patients and healthy subjects using standardized clinical and genetics procedures; ii) apply a novel method based on genomics, proteomics and bioinformatic analysis to map protein complexes in biofluids; iii) identify novel circulating biomarkers and correlate them to genetic profiling and disease endophenotypes, and; iv) validate the biological properties in human brain tissue and dopaminergic cultures.

Study Overview

• Status: Recruiting
• Conditions: Parkinson Disease; Amyotrophic Lateral Sclerosis (ALS); Frontotemporal Dementia (FTD); Alzheimer's Disease (AD)
• Intervention / Treatment: Genetic: Genetic: whole genome sequencing; Genetic: whole exome sequencing; Genetic: whole exome sequencing

Detailed Description

The project is a multicrentric observational study. Institutions involved are:

OU1 - IRCCS INM Neuromed OU2 -University of Piemonte Orientale The project takes advantage from the availability of a large collection of PD samples from familiar and sporadic cases, recruited at IRCCS Neuromed, for which we already collected and stored clinical information, genetic data as well as DNA, serum, plasma and peripheral blood mononuclear cells (PBMCs) for the entire study cohort. induced pluripotent stem cells (iPSC) are available for 6 PD patients and 5 healthy subjects.

The activities of the Operating Unit (OU1) are:

1. Stratification of NDD patients based on genetics and clinical records;
2. Recruitment of CSF sample of NDD patients;
3. Recruitment, WES and bioinformatic analysis of a selected cohort of NDD relatives (200 samples);
4. Bioinformatic analysis to identify protein structural alterations, candidate genes, genetic profiles and deregulatedpathways (OU1/ OU2);
5. Correlation of circulating complex with PD endophenotypes to identify disease biomarkers (OU1/ OU2);
6. Validation in RBD patients and PD relatives to identify early biomarkers for PD (OU1/ OU2);
7. Validation of the protein complexes in human brain slices and analysis of the biological activity of the most relevant CSF and plasmatic complexes in iPSC-derived mdDA neurons (OU1/ OU2).

The activities of the Operating Unit (OU2) are:

1. CSF and plasma sample collection and storage for patients with NDDs;
2. Stratification of patients based on genetics and clinical records (in collaboration with OU1);
3. Detect alterations in protein complexes in CSF samples (100 samples);
4. Identification and validation of CSF biomarkers for PD (100 samples) (in collaboration with OU1);
5. Validate complex biomarkers using immunochemical or targeted analysis on plasma samples (450 samples);
6. Identify potential drug targetable complexes (in collaboration with OU1);
7. Assess whether proteins with structural changes in the CSF/plasma have those changes in the brain as well;
8. Correlate protein structural information with genetics and clinical data (in collaboration with OU1).

• Study Type: Observational
• Enrollment (Estimated): 110

Contacts and Locations

• Study Contact: Name: Teresa Esposito, PhD; Phone Number: +39 0865915249; Email: teresa.esposito@igb.cnr.it

Study Locations

• Italy
  • Pozzilli, Italy, 86077
    • Recruiting
    • IRCCS INM Neuromed
    • Contact: Teresa Esposito, PhD; Phone Number: +30 0865915249; Email: teresa.esposito@igb.cnr.it

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

The study will be performed on a total population of 510 subjects (140 PD, 150 AD/ALS/FTD, 120 controls, 100 relatives of patients carrying mutations), of these, 90 patients with a clinical diagnosis of neurodegenerative disease (40 PD cases, 30 AD cases, 20 ALS/FTD cases) will be recruited in this study. The study also includes the recruitment and analysis of 20 control individuals selected among those who will undergo CSF sampling in a diagnostic regimen for non-inflammatory and non-neurodegenerative diseases. The validation cohort, partially already available at the Clinical Centers involved in the study, is composed of 400 subjects of which: 100 PD patients (UO1), 100 AD/FTD/ALS patients (UO2), 100 healthy family members of NDD patients carrying pathogenic mutations and who have not yet developed the disease (UO1) and 100 control individuals (UO1).

Description

• Inclusion Criteria:
• Inclusion criteria for PD patients.

For the IRCCS INM Neuromed, patients will be recruited from those affiliated with the Center for the Study and Treatment of Parkinson's Disease of the Neuromed Institute of Pozzilli. Affected subjects will be selected according to the criteria proposed by Gelb et al in 1999. This is a very pragmatic scheme based on the presence of four cardinal signs, the response to a test administration of Levodopa and the absence of atypical signs:

A) Presence of at least 2 of the 4 cardinal signs (tremor, rigidity, bradykinesia, asymmetric onset) one of which must be tremor or bradykinesia; B) Absence of atypical symptoms such as: i) early postural instability, freezing phenomena, cognitive deterioration, hallucinations, pathological involuntary movements, vertical gaze paralysis; ii) proven causes of secondary parkinsonism (focal lesions, drugs, toxic substances); C) Documented response to the use of L-dopa or dapamine agonists (or lack of an adequate therapeutic attempt with L-dopa or dopamine agonists).

• Inclusion criteria forAD patients. Patients will be selected at the Center for Cognitive Disorders and Dementias (CDCD) SCDU Neurology, AOU Maggiore della Carità, Novara. Patients with AD will be included after diagnosis of probable Alzheimer's disease according to the McKhann criteria (2011) and supported by positive biomarkers for amyloidopathy (PET with amyloid tracer or amyloid cerebrospinal fluid dosage).
• Inclusion criteria for FTD/ALS patients. For UPO, patients will be selected at the tertiary center Amyotrophic Lateral Sclerosis - SCDU Neurology, AOU Maggiore della Carità, Novara. Patients with amyotrophic lateral sclerosis will be included following a diagnosis according to the El Escorial criteria - revised (2015): in this regard, only patients with a definite or probable diagnosis supported by laboratory will be included. For patients with FTD, they will be selected at both centers mentioned above with a diagnosis according to the Rascovsky criteria (2011). In this group, the diagnosis will be supported by negative biomarkers for amyloidopathy (PET with amyloid tracer or amyloid cerebrospinal fluid dosage). For patients with concomitant ALS and FTD, the El Escorial criteria (2015) associated with the Strong criteria (2017) will be used.

Exclusion Criteria:

• PD PATIENTS

  • pre-existing psychiatric pathologies;
  • neurodegenerative neurological diseases such as multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's, neuromuscular diseases, epilepsy;
  • diagnosis of dementia;

• AD/FTD/ALS PATIENTS

  • pre-existing psychiatric pathologies;
  • previous diagnosis of other neurodegenerative neurological diseases;
  • patients unable to sign informed consent.

• CONTROLS

  • pre-existing psychiatric pathologies;
  • neurodegenerative neurological diseases such as Parkinson's, multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's, neuromuscular diseases, epilepsy;
  • diagnosis of dementia;
  • depression;
  • prolonged intake of anxiolytic, antidepressant, antipsychotic, sleep-inducing, cognitive stimulant drugs.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
motor symptoms of PD patients will be evaluated with Hoehn and Yahr (HY) score	The Hoehn and Yahr Scale will be used to measure how Parkinson's symptoms progress and the level of disability. Itincludes stages 1 through 5: Stage 1. Unilateral involvement only, usually with minimal or no functional impairment; Stage 2 = Bilateral disease, without impairment of balance; Stage 3 = Mild to moderate bilateral disease; some postural instability; physically independent. Stage 4 = Severe disability; still able to walk or stand unassisted. Stage 5 = Wheelchair bound or bedridden unless aided.	2 years
motor and non motor symptoms of PD patients will be evaluated with MDS-UPDRS	The MDS-UPDRS has four parts, namely, I: Non-motor Experiences of Daily Living; II: Motor Experiences of DailyLiving; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver	2 years
clinical evaluation of cognitive impairment of PD, AD, ALS/FTD patients	PD patients will be evaluated with the Montreal Cognitive Assessment (MoCA) test. This is a test used by healthcare providers to evaluate people with memory loss or other symptoms of cognitive decline. The MoCA contains 30 questions and checks different types of cognitive or thinking abilities. These include:orientation, short-term memory/delayed recall, executive function/visuospatial ability, clock-drawing test.- assessment of language disorders. ALS/FTD - assessment of cognitive disorders (and classification according to Strong criteria, 2017); - assessment of language disorders. AD patients: - assessment of cognitive disorders (MMSE, MOCA test, clock test); - assessment of language disorders.	2 years
clinical evaluation of ALS/FTD patients	Clinical classification according to El Escorial - revised	2 years
identification of variants/mutations	PD patients: the number of multiple rare (Minor allele frequency, MAF<0.01) deleterious (missense, non sense, frameshift and splicing) variants in PD genes will be counted in PD patients and unrelated healthy subjects. Case-control assoiciation study will evaluate the PD risk. AD, ALS/FTD: deleterious variants (missense, non sense, frameshift and splicing) in responsible genes will be considered.	2 years
Identification of protein complexes in CSF	Protein complexes present in the CSF of PD/AD/FTD/ALS patients and control subjects recruited in the two Clinical Centers participating in the study will be analyzed by size exclusion chromatography (SEC) and by label-free proteomic analysis. The complexes will be separated and fractionated by SEC and identified and quantified by mass spectrometers. Statistical analysis will allow to identify the presence/absence or the different abundance of protein complexes in patients compared to controls and therefore the identification of biomarkers and potential therapeutic targets.	2 years
Bioinformatic analysis for the identification of proteins and molecular pathways involved	Through advanced bioinformatics analysis, multivariate statistical analysis techniques and machine learning, proteins and molecular pathways involved in different neurodegenerative diseases and their development will be identified. This will allow us to understand and improve the knowledge of these pathologies and to identify potential therapeutic or diagnostic targets/pathways.	2 years
Validation of protein complexes in plasma	The key marker protein complexes identified in Phase 1 will be validated in plasma samples from PD/AD/FTD/ALS patients and control subjects through targeted mass spectrometry analyses and through immunochemical technical analyses such as ELISA, Western blot and immunoassays.	2 years
Association analysis with endophenotypes	Correlation analyses will be aimed at evaluating whether the presence of aggregates impacts on the age of onset (AAO), neurological symptoms, non-motor symptoms, as well as the response to L-dopa treatment. In addition, genetic data from PD patients will be integrated with biomolecular data to identify altered molecular pathways. ROC curves will be used to evaluate the diagnostic power of the test.	2 years
Analysis of the biological impact of protein complexes identified in CSF on the viability of mdDA dopaminergic neurons obtained from iPSCs of patients and controls	Patient and control iPSC lines will be differentiated into mesodiencephalic dopaminergic neurons using published protocols. Cells will be exposed to protein aggregates purified from patient CSF and the cells' vulnerability to neurodegeneration will be assessed.	2 years

Collaborators and Investigators

• Sponsor: Neuromed IRCCS
• Collaborators: Università del Piemonte Orientale AOU Maggiore della Carità - Novara
• Investigators: Principal Investigator: TERESA ESPOSITO, PhD, IRCCS INM Neuromed

Study record dates

Study Major Dates

• Study Start (Actual): February 4, 2025
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: January 27, 2025
• First Submitted That Met QC Criteria: January 27, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 17, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: protein structural complexes in Neurodegenerative diseases; circulating biomarkers for neurodegenerative diseases
• Additional Relevant MeSH Terms: Synucleinopathies; Neurologic Manifestations; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Neuromuscular Diseases; Metabolic Diseases; Neurobehavioral Manifestations; Neurocognitive Disorders; Dementia; Movement Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Spinal Cord Diseases; TDP-43 Proteinopathies; Proteostasis Deficiencies; Communication Disorders; Language Disorders; Aphasia; Speech Disorders; Frontotemporal Lobar Degeneration; Parkinson Disease; Motor Neuron Disease; Amyotrophic Lateral Sclerosis; Neurodegenerative Diseases; Frontotemporal Dementia; Aphasia, Primary Progressive; Pick Disease of the Brain
• Other Study ID Numbers: PNRR-MCNT2-2023-12377375

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No