Misfolded Proteins in the Skin of People With Parkinson's Disease and Other Parkinsonism

Recruiting

• Conditions: Dementia With Lewy Bodies; Multiple System Atrophy; Corticobasal Degeneration; Parkinsonism; Parkinson Disease; Progressive Supranuclear Palsy
• Interventions: Procedure: punch skin biopsy

• Registration Number: NCT04518059
• Lead Sponsor: University Hospitals Cleveland Medical Center

Brief Summary

The purpose of this study is to determine whether identification of misfolded proteins in the skin will help to determine what sort of parkinsonism someone has. We seek to demonstrate whether someone has a synucleinopathy such as Parkinson's disease (PD), multiple system atrophy (MSA), or dementia with Lewy bodies(DLB), as opposed to a tauopathy such as progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD) or no parkinsonism at all (control).

Detailed Description

This is a clinical research study for patients with parkinsonism, including Parkinson's disease, progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy, and dementia with Lewy bodies. Parkinsonism can be difficult to diagnose, especially in the early stages of the disease. Skin punch biopsy could be a useful and way to diagnose and measure the severity of these conditions. Given that there currently is no proven way to determine that someone has a synucleinopathy such as PD and not a tauopathy, this is a novel study that may lead to better ways to diagnose people with parkinsonism. The purpose of the study is to identify changes on a skin punch biopsy, in which small samples of skin are removed and sent to the laboratory for examination. We are seeking to measure the amount of misfolded alpha-synuclein in someone's skin. Participation will last between 1 and 2 years and will involve between 2 and 4 visits. Visits will include a physical examination, questionnaires, a memory test, blood draws and saliva collection, and a single visit for skin punch biopsies. We will also be looking to enroll volunteers to serve as "controls," who do not have any neurological illness.

Study Timeline

• Study Start: 2019-03-12
• Study First Submitted: 2020-07-31
• Study First Submitted QC: 2020-08-14
• Study First Posted: 2020-08-19
• Status Verified: 2024-06
• Last Update Submitted: 2024-06-20
• Last Update Posted: 2024-06-21
• Primary Completion: 2025-05-31
• Study Completion: 2025-05-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 250

Inclusion Criteria

• Age 21 years old and age <90 years of age at the time of the baseline visit 1
• Age of diagnosis at least 40 years old for PD, DLB, and PSP and at least 30 years old for MSA
• A confirmed diagnosis of PD, PSP, CBD, MSA, DLB, or healthy control
• Montreal Cognitive Assessment (MoCA) > 10 at the outset of the study

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Exclusion Criteria

• Age 90 or above
• Allergy to local anesthetic
• History of deep brain stimulation (DBS) or other brain surgery prior to Visit 1
• For PD or DLB diagnoses, any other neurodegenerative or central nervous system process that would interfere with examination
• For PD or DLB, history of negative DATscan
• Use of investigational drugs or devices within 60 days prior to baseline visit (except for dietary supplements)
• In control subjects, family history of a neurodegenerative disease in a first degree or second degree blood relative
• History of schizophrenia
• History of antipsychotic medication use or exposure in controls or history of antipsychotic medication leading to parkinsonism (drug induced parkinsonism) in the parkinsonism group
• Blood clotting disorder
• On multiple (more than one) antiplatelet and/or anticoagulant blood thinner medications in combination (except for aspirin if it can be safely held for 1 week)
• Any other medical, psychiatric, or cognitive illness that in the investigator's opinion would interfere with cooperation or ability to undergo the study procedures.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Control Group	punch skin biopsy	Participants without parkinsonism
Parkinsonism Group	punch skin biopsy	Participants with Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD)

Primary Outcome Measures

Name	Time	Method
Change in UMSARS measures of multiple system atrophy (MSA) severity in people with MSA	Baseline, 1 year, and optional 2 year assessment	Questionnaire and examination. Lower scores are better.
Change in Schwab and England (S&E) Score	Baseline, 1 year, and optional 2 year assessment	0% to 100% rating scale score. Higher score is better.
Amount of alpha-synuclein in the skin	Cross-sectional at baseline	Alpha-synuclein will be measured by RT-QuIC and sPMCA
Change in PSPRS measures of progressive supranuclear palsy (PSP) severity in people with PSP	Baseline, 1 year, and optional 2 year assessment	Questionnaire and examination. Lower scores are better.
Change in Hoehn and Yahr (H&Y) and modified H&Y Scores	Baseline, 1 year, and optional 2 year assessment	Zero to 5 parkinsonism rating scale score. Lower score is better.

Secondary Outcome Measures

Name	Time	Method
Change in REM Behavior Disorder Questionnaire	Baseline, 1 year, and optional 2 year assessment	10 item depression rating scale score. Lower score is better.
Change in blood pressure with orthostatic posture	Baseline, 1 year, and optional 2 year assessment	Blood pressure from lying down to sitting to standing. Smaller drop in blood pressure is better.
Change in Montreal Cognitive Assessment (MoCA)	Baseline, 1 year, and optional 2 year assessment	Zero to 30 cognitive rating scale score. Higher score is better.
Change in Epworth Sleepiness Scale (ESS)	Baseline, 1 year, and optional 2 year assessment	Zero to 24 sleepiness rating scale score. Lower score is better.
Change in Hamilton anxiety scale	Baseline, 1 year, and optional 2 year assessment	14 item depression rating scale score. Lower score is better.
Change in PDQ-39	Baseline, optional 1 year assessment, and optional 2 year assessment	39 item health status questionnaire. Lower is better.
Change in Hamilton depression scale	Baseline, 1 year, and optional 2 year assessment	17 item depression rating scale score. Lower score is better.
Amount of alpha-synuclein in the blood	Baseline, optional 1 year assessment, and optional 2 year assessment	Alpha-synuclein will be measured in the blood sample

Trial Locations

Locations (2)

University Hospitals Cleveland Medical Center; 🇺🇸 Cleveland, Ohio, United States

University Hospitals Suburban Health Center; 🇺🇸 South Euclid, Ohio, United States