Clinical trial NCT04101968: The GBA Multimodal Study in Parkinson's Disease
Official title: Multimodal Molecular Imaging and Biometric Analysis in GBA-PD and Asymptomatic GBA-mutation Carriers
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Parkinson Disease
GBA Gene Mutation
Gaucher Disease
Keywords: Parkinson
Lead sponsor: Pacific Parkinson's Research Centre
Sponsor class: OTHER
Collaborators: name: University of British Columbia
name: University of Washington
name: Oregon Health and Science University
name: Simon Fraser University
name: Michael J. Fox Foundation for Parkinson's Research
name: Silverstein Foundation
name: Weston Brain Institute
First posted: 2019-09-24
Enrollment: 25
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: CROSS_SECTIONAL
Sampling method: PROBABILITY_SAMPLE
Study population: People with a known pathogenic GBA gene mutation with or without PD.

Brief summary: This study plans to analyze the molecular and clinical mechanisms of the relationship between the GBA mutations and Parkinson's disease. This will be assessed through the use of advanced neuroimaging techniques called PET (positron emission tomography) to study the accumulation of the tau protein and the dysfunction of acetylcholine and dopamine in the brain of people with a mutation in the GBA gene, with and without Parkinson's disease. The ingestigators will also use a technology-based assessment to study the typing patterns as possible biomarkers of early motor dysfunctions.

Detailed description: Study Rationale: People who have a mutation in the GBA gene have a higher risk of developing Parkinson's disease (PD) and, if they have PD, are more likely to have cognitive decline and dementia. Cognitive problems in people with PD is related to dysfunction of the brain chemical acetylcholine and likely to the accumulation of the tau protein in the brain. Another observation in previous studies is that analyzing the patterns of typing into a computer can help differentiate healthy people from people with PD.

Hypothesis: The investigators hypothesize that people with GBA-related PD will have higher acetylcholine dysfunction and tau accumulation compared with non-GBA patients, and that these changes may start in the asymptomatic phase (i.e., people with the mutation but without symptoms of PD). The investigators also believe that the investigators will be able to detect subjects with higher degree of dopamine loss just by analyzing the way they type into a computer.

Study Design: The investigators will recruit 25 subjects with a GBA mutation (10 subjects with PD and 15 asymptomatic carriers). All the participants will have a clinical evaluation and a typing session, and subsequently will undergo a brain MRI and three PET scans with a tau tracer, an acetylcholine tracer, and a dopaminergic tracer. A blood sample will also be taken for the analysis of GCase (the enzyme related to the GBA mutation).

Impact on Diagnosis/Treatment of Parkinson's Disease: The results will help understand the changes that take place in the brain of people with GBA-related Parkinson's disease, and hopefully will shed light also on the pathophysiology of non-GBA-related Parkinson's, as well as on the molecular correlates of cognitive decline, especially in its early stage. The typing data along with dopaminergic imaging will clarify the possible role of using typing patterns to identify subjects with early stage Parkinson's disease.

Next Steps for Development: The findings of this study may help identify biomarkers for cognitive decline in early Parkinson's disease, with a potential role in clinical trials. Also, if the hypothesis on the typing is confirmed, this approach may be studied in larger cohorts for early diagnosis of Parkinson's in other at-risk populations.

Eligibility criteria: Inclusion Criteria:

* heterozygous for a pathogenic GBA mutation (e.g., p.L444P, p.N370S) or polymorphism;
* age 18 to 80 years.

Exclusion Criteria:

* co-occurrence of other neurological disorders;
* implants that contraindicate the MRI scanning (e.g. cardiac pacemaker, ferromagnetic implants or devices);
* severe claustrophobia;
* intolerance to antiparkinsonian drug withdrawal (for GBA-PD subjects);
* ongoing treatment with cholinergic drugs

Primary outcomes:
measure: Acetylcholinesterase activity
timeFrame: baseline
measure: Tau protein deposition
timeFrame: baseline
measure: Dopaminergic denervation
timeFrame: baseline
measure: neuroQWERTY index
timeFrame: baseline
Secondary outcomes:
Other outcomes:
Locations:
city: Portland
country: United States
facility: Oregon Health & Science University
state: Oregon
city: Seattle
country: United States
facility: University of Washington
state: Washington
city: Vancouver
country: Canada
facility: Pacific Parkinson's Research Centre | University of British Columbia
state: British Columbia
Study officials:
affiliation: Pacific Parkinson's Research Centre | University of British Columbia
name: Michele Matarazzo, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Pacific Parkinson's Research Centre | University of British Columbia
name: A. Jon Stoessl, CM, MD, FRCPC, FCAHS
role: PRINCIPAL_INVESTIGATOR
References: