An industry wide survey performed by Dr. Lyle Ostrow at Johns Hopkins University indicated that longitudinal bio-fluids linked to detailed clinical information are critical to continued drug development for amyotrophic lateral sclerosis (ALS), with CSF being the top biofluid often lacking in longitudinal sample biorepositories. There have been prior efforts for longitudinal collection of biofluids matched to clinical information (see https://cdmrp.army.mil/alsrp/resources/Biorepositories_biofluids_celllines for a listing of ALS biorepositories), but those sample sets are limited in size and quickly utilized by the research community. Based upon input from industry leaders, we propose the creation of a Target ALS longitudinal biofluids biorepository linked to patient genetic and clinical information.

Given the heterogeneous clinical and biologic nature of ALS, a repository of longitudinal samples linked to clinical and genetic information is essential to help identify and verify ALS biomarkers. Recent studies to identify ALS biomarkers have used longitudinal samples from either the sporadic patient population or from those that harbor genetic mutations known to cause ALS but are not yet symptomatic. Beyond exploring the relationship between known causative genes and candidate biomarkers, the Target ALS Postmortem Core has collected postmortem ALS tissue samples linked to whole genome sequencing information that have been valuable at finding new subtypes of ALS linked to transcriptomics profiles from the tissue samples. The current study utilizes medical centers participating in the Target ALS Postmortem Core to create a longitudinal biofluids repository from living patients and healthy controls. Given the impact of COVID-19 on ALS clinical research studies and clinical trials, all participants will participate in at home speech measures on a weekly basis and we will also enroll 100 ALS and 30 healthy control participants for at home measures of vital capacity that are completed once every two weeks. The added feature of these at home measures is to further evaluate the potential for at home measures in future clinical trials and ability to obtain enriched speech and vital capacity measures to correlate to downstream biomarker studies using biofluid or genetic data. There is a growing interest in the use of at home speech analytics to classify and monitor ALS patients, with recent studies indicating the value for these at home measures in both clinical research and clinical trial settings. Our study will not only expand upon these early findings but also include at home spirometry measures of vital capacity to evaluate the ability to obtain reliable vital capacity measures at home.

Our proposed study will provide valuable longitudinal biofluids linked to clinical information, genetic data, at home speech and vital capacity measures for use in future research studies. These de-identified samples and clinical information will be available to investigators throughout the world to enhance ALS research and ultimately improved treatments for ALS. There is a long history of benefit for biorepositories with linked clinical data to be instrumental in research progress. Most studies that identify biomarkers or validate biomarkers for human diseases typically require banked samples that are linked to clinical information to determine sensitivity/specificity of the biomarker for that disease or to demonstrate change over course of disease.