Identifying Biomarkers in ALS Patients Using Neuronal Derived Extracellular Vesicles
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Enrollment
- 60
- Locations
- 1
- Primary Endpoint
- Identification by RNA-seq of biomarkers carried by neuron-derived extracellular vesicles (NVEC) present in the blood of ALS patients
Study Overview
Brief Summary
Rationale. ENGRAILED1 (EN1) is under consideration as a therapeutic approach for amyotrophic lateral sclerosis (ALS). To assess EN1 target engagement in patients, we aim to identify EN1-responsive biomarkers suitable as Prentice-style surrogate endpoints. We will discover candidates by RNA-seq of neuron-derived extracellular vesicles (NVEC) immuno-isolated from blood. Establishing such biomarkers would enable and de-risk early-phase (I/II) EN1 trials.
Primary endpoint. Discovery: RNA-seq identification of circulating NVEC-borne biomarkers that differ between sporadic ALS patients and healthy controls.
EN1 modulation: Demonstration that these biomarkers are modulated by EN1 in En1+/- mouse models and in ALS patient iPSC-derived motor neurons.
Design. Prospective cohort, N=60 (30 sporadic ALS; 30 healthy controls matched on age/sex).
Population. Adults undergoing diagnostic work-up for suspected sporadic ALS; healthy volunteers without neurological disease.
Key procedures and timeline. Baseline (M0, inpatient): ALSFRS-R, MRC, hand dynamometry, eye-movement recording (MOC); NCS/EMG (NUMIX), TMS/MEP with cortical excitability; neuropsychology; brain & spinal MRI; pulmonary function testing; CSF (10 mL) and blood (15 mL) for clinical labs and research (NVEC immunocapture → RNA-seq; proteomics).
Follow-up: M6 clinic visit (repeat clinical/electrophysiology/neuropsychology/PFTs as per care) with blood (15 mL); additional routine follow-ups at M12, M18, M24 (clinical; MOC at M12 and M24).
Controls: single visit with blood (3×5 mL EDTA) and cortical excitability; brain MRI for targeting.
Sample size. 60 participants total (30 ALS, 30 controls).
Study Design
- Study Type
- Observational
- Observational Model
- Cohort
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •For patients :
- •Age ≥ 18 years. Diagnostic suspicion of amyotrophic lateral sclerosis (ALS). Planned inpatient admission in the HFAR neurology department for the standard diagnostic work-up as part of routine care: clinical evaluation, neuropsychological assessment, nerve conduction studies/EMG, motor evoked potentials (TMS/MEP), brain and spinal MRI, pulmonary function testing, lumbar puncture, and standard blood tests.
- •Explicit written informed consent to participate in the study. Affiliation with or beneficiary of a social security system.
- •Non-inclusion criteria:
- •Patient under legal protection/guardianship. Pregnant or breastfeeding woman. Active infection within the 4 weeks preceding biological sampling. Ongoing diagnosis and management of cancer.
- •Secondary exclusion criterion:
- •ALS diagnosis not confirmed.
- •For Healthy Controls :
- •Age ≥ 18 years. Explicit written informed consent to participate in the study. Affiliation with or beneficiary of a social security system.
Exclusion Criteria
- •Patient under legal protection/guardianship.
- •Pregnant or breastfeeding woman.
- •Diagnosed neurological disease.
- •Self-reported cognitive impairment.
- •Active infection within the 4 weeks prior to biological sampling.
- •Current diagnosis and management of cancer.
Arms & Interventions
patients with ALS
controls without ALS
Outcomes
Primary Outcomes
Identification by RNA-seq of biomarkers carried by neuron-derived extracellular vesicles (NVEC) present in the blood of ALS patients
Time Frame: at inclusion visit, month 6
Identification by RNA-seq of biomarkers carried by neuron-derived extracellular vesicles (NVEC) present in the blood of ALS patients
Secondary Outcomes
No secondary outcomes reported