Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2024 Sep 10:2024.02.14.24302818.
doi: 10.1101/2024.02.14.24302818.

Neuronal alpha-Synuclein Disease Integrated Staging System performance in PPMI, PASADENA, and SPARK baseline cohorts

Tien Dam  1 , Gennaro Pagano  2 , Michael C Brumm  3 , Caroline Gochanour  3 , Kathleen L Poston  4 , Daniel Weintraub  5 , Lana M Chahine  6 , Christopher Coffey  3 , Caroline M Tanner  7 , Catherine M Kopil  8 , Yuge Xiao  8 , Sohini Chowdhury  8 , Luis Concha-Marambio  9 , Peter DiBiaso  10   11 , Tatiana Foroud  12 , Mark Frasier  8 , Danna Jennings  13 , Karl Kieburtz  14 , Kalpana Merchant  15 , Brit Mollenhauer  16 , Thomas J Montine  17 , Kelly Nudelman  12 , John Seibyl  18 , Todd Sherer  8 , Andrew Singleton  19 , Diane Stephenson  20 , Matthew Stern  21 , Claudio Soto  9   22 , Eduardo Tolosa  23 , Andrew Siderowf  21 , Billy Dunn  24 , Tanya Simuni  15 , Kenneth Marek  18 ; Parkinson’s Progression Markers Initiative
Affiliations

Neuronal alpha-Synuclein Disease Integrated Staging System performance in PPMI, PASADENA, and SPARK baseline cohorts

Tien Dam et al. medRxiv. .

Update in

  • Neuronal alpha-Synuclein Disease integrated staging system performance in PPMI, PASADENA, and SPARK baseline cohorts.
    Dam T, Pagano G, Brumm MC, Gochanour C, Poston KL, Weintraub D, Chahine LM, Coffey C, Tanner CM, Kopil CM, Xiao Y, Chowdhury S, Concha-Marambio L, DiBiaso P, Foroud T, Frasier M, Jennings D, Kieburtz K, Merchant K, Mollenhauer B, Montine TJ, Nudelman K, Seibyl J, Sherer T, Singleton A, Stephenson D, Stern M, Soto C, Tolosa E, Siderowf A, Dunn B, Simuni T, Marek K; Parkinson’s Progression Markers Initiative. Dam T, et al. NPJ Parkinsons Dis. 2024 Sep 27;10(1):178. doi: 10.1038/s41531-024-00789-w. NPJ Parkinsons Dis. 2024. PMID: 39333167 Free PMC article.

Abstract

The Neuronal alpha-Synuclein Disease (NSD) biological definition and Integrated Staging System (NSD-ISS) provide a research framework to identify individuals with Lewy body pathology and stage them based on underlying biology and increasing degree of functional impairment. Utilizing data from the PPMI, PASADENA and SPARK studies, we developed and applied biologic and clinical data-informed definitions for the NSD-ISS across the disease continuum. Individuals enrolled as Parkinson's disease, Prodromal, or Healthy Controls were defined and staged based on biological, clinical, and functional anchors at baseline. Across the three studies 1,741 participants had SAA data and of these 1,030 (59%) were S+ consistent with NSD. Among sporadic PD, 683/736 (93%) were NSD, and the distribution for Stages 2B, 3, and 4 was 25%, 63%, and 9%, respectively. Median (95% CI) time to developing a clinically meaningful outcome was 8.3 (6.2, 10.1), 5.9 (4.1, 6.0), and 2.4 (1.0, 4.0) years for baseline stage 2B, 3, and 4, respectively. We propose pilot biologic and clinical anchors for NSD-ISS. Our results highlight the baseline heterogeneity of individuals currently defined as early PD. Baseline stage predicts time to progression to clinically meaningful milestones. Further research on validation of the anchors in longitudinal cohorts is necessary.

Keywords: Biological definition; Dementia with Lewy Bodies; Neuronal Alpha-Synuclein Disease; Parkinson’s disease.

PubMed Disclaimer

Conflict of interest statement

COMPETING INTERESTS TD declares former employment for and employee stock options in Biogen. GP declares employment for F. Hoffmann-La Roche Ltd. and stock ownership for F. Hoffmann-La Roche Ltd., Atea, Novartis and Eli Lilly. MB declares travel grants from The Michael J. Fox Foundation. CG declares employment for The Michael J. Fox Foundation. KP declares consultancies for Curasen; was on a scientific advisory board for Curasen and Amprion; honoraria from invited scientific presentations to universities and professional societies not exceeding $5000 per year from California Congress of Clinical Neurology, California Neurological Society, and Johns Hopkins University; and patents or patent applications numbers 17/314,979 and 63/377,293. KP also declares grants to her institution (Stanford University School of Medicine) from NIH/NINDS NS115114, NS062684, NS075097, NIH/NIA U19 AG065156, P30 AG066515, The Michael J. Fox Foundation, Lewy Body Dementia Association, Alzheimer’s Drug Discovery Foundation, Sue Berghoff LBD Research Fellowship and the Knight Initiative for Brain Resilience. DW declares salary support from The Michael J. Fox Foundation for serving on an Executive Steering Committee for the PPMI and consultancies for Roche Pharma. DW declares membership on the npj Parkinson’s Disease Editorial Board. LC declares grants to her institution from Biogen (clinical trial funding), MJFF, UPMC Competitive Medical Research Fund, National Institutes of Health, and University of Pittsburgh; grant and travel support from MJFF; royalties from Wolters Kluwel (for authorship); and in-kind donation by Advanced Brain Monitoring of equipment for research study to her institution. CC declares grants from The Michael J. Fox Foundation and NIH/NINDS. CT declares consultancies for CNS Ratings, Australian Parkinson’s Mission, Biogen, Evidera, Cadent (data safety monitoring board), Adamas (steering committee), Biogen (via the Parkinson Study Group steering committee), Kyowa Kirin (advisory board), Lundbeck (advisory board), Jazz/Cavion (steering committee), Acorda (advisory board), Bial (DMC) and Genentech. CT also declares grant support to her institution from The Michael J. Fox Foundation, National Institute of Health, Gateway LLC, Department of Defense, Roche Genentech, Biogen, Parkinson Foundation and Marcus Program in Precision Medicine. CT declares membership on the npj Parkinson’s Disease Editorial Board. CK declares employment for The Michael J. Fox Foundation. YX declares employment for and travel grants from The Michael J. Fox Foundation. SC declares employment for and travel grants from The Michael J. Fox Foundation. LC-M declares employment for and employee stock options in Amprion, grants 16712 and 21233 from The Michael J. Fox Foundation to his institution; grant U44NS111672 from NIH to his institution; and patents or patent application numbers US 20210277076A1, US 20210311077A1, US 20190353669A1 and US 20210223268A1. PD has no declarations. TF declares travel grants and grant payments to her institution (Indiana University) from The Michael J. Fox Foundation. MF declares employment for The Michael J. Fox Foundation and an unpaid advisory role at Vaxxinity. DJ declares employment for and employee stock options from Denali Therapeutics. KK declares support to his institution (University of Rochester Medical Center) from The Michael J. Fox Foundation. KMe declares consultancies for The Michael J. Fox Foundation, AcuRx, Caraway, Cerebral Therapeutics, NRG Therapeutics (scientific advisory board), Nitrase Therapeutics (scientific advisory board), Nurabio, Retromer Therapeutics (director on the board, part-time chief scientific officer), Schrodinger, Sinopia Biosciences (scientific advisory board), and Vanqua Biosciences (scientific advisory board); stock ownership for Cognition Therapeutics, Eli Lilly (retiree stock holder), Envisagenics, Nitrase Therapeutics, Sinopia Biosciences and Retromer Therapeutics; honoraria for the University of Utah; patents or patent applications for Retromer Therapeutics (planned patent); research grant from The Michael J. Fox Foundation and travel grants from the University of Utah. BM declares consultancies from Roche and Biogen; grants from The Michael J. Fox Foundation, ASAP and DFG; honoraria for Abbvie and Bial; leadership role for The Michael J. Fox Foundation and travel grants for Abbvie. TM declares support to his institution (Stanford University School of Medicine) from The Michael J. Fox Foundation. KN declares grant to her institution from The Michael J. Fox Foundation. JS declares consultancies from Invicro, Biogen, and Abbvie; and stock ownership from RealmIDX, MNI Holdings, and LikeMinds as well as grants from The Michael J. Fox Foundation. TSh declares employment for The Michael J. Fox Foundation. ASin declares employment for The National Institutes of Health who received grants from The Michael J. Fox Foundation and ASAP. ASin declares Diagnostic for Stroke royalties (unrelated to current work); honoraria from Movement Disorders Society and Nature Publishing Group; travel grants from Chan Zuckerberg Initiative, The Michael J. Fox Foundation and Weill Cornell. ASin’s spouse is an employee of GeneDx. ASin declares being an associate editor for the npj Parkinson’s Disease Editorial Board. DS has no declarations. MS declared consultancies for Mediflix, Inc., Health and Wellness Partners; honoraria from Atria Foundation, International Parkinson and Movement Disorder Society, Neurocrine, Luye Pharma and Acorda. MS serves on advisory board at Neuroderm, Alexza, Alexion and Biogen. CS declares employment for Amprion; stock ownership for Amprion; honoraria (will receive royalties for the sale of seed amplification assay [SAA]) from Amprion; and patents or patent applications, awarded and amplified in conjunction with Amprion for the SAA assay. ET has no declarations. ASid declares consultancies for SPARC Therapeutics, Capsida Therapeutics and Parkinson Study Group; honoraria from Bial; grants from The Michael J. Fox Foundation (member of PPMI Steering Committee); and participation on board at Wave Life Sciences, Inhibikase, Prevail, Huntington Study Group and Massachusetts General Hospital. BD declarations are TBD. TSi declares consultancies for AcureX, Adamas, AskBio, Amneal, Blue Rock Therapeutics, Critical Path for Parkinson’s Consortium, Denali, The Michael J. Fox Foundation, Neuroderm, Roche, Sanofi, Sinopia, Takeda, and Vanqua Bio; on advisory boards for AcureX, Adamas, AskBio, Biohaven, Denali, GAIN, Neuron23 and Roche; on scientific advisory boards for Koneksa, Neuroderm, Sanofi and UCB; and received research funding from Amneal, Biogen, Roche, Neuroderm, Sanofi, Prevail and UCB and an investigator for NINDS, MJFF, Parkinson’s Foundation. KMa declares support to his institution (Institute for Neurodegenerative Disorders) from The Michael J. Fox Foundation. KMa also declares consultancies for Invicro, The Michael J. Fox Foundation, Roche, Calico, Coave, Neuron23, Orbimed, Biohaven, Anofi, Koneksa, Merck, Lilly, Inhibikase, Neuramedy, IRLabs and Prothena and participates on DSMB at Biohaven.

Figures

Figure 1.
Figure 1.
Participant Flowchart 1 Not evaluable = CSF samples not available for alpha-synuclein aggregation testing 2 Evaluable = CSF samples analyzed for alpha-synuclein aggregation and results available 3 NSD = Individuals with positive alpha-synuclein aggregation tests (S+) 4 Not stageable = Missing DaT-SPECT or clinical data and unable to assess stages 5 Not NSD = Individuals with negative alpha-synuclein aggregation tests (S−) NSD= Neuronal Synuclein Disease
Figure 2.
Figure 2.
Time to reaching any progression milestone by stage at baseline among PPMI sporadic PD cohort Interval-censored survival curves of progression-free survival stratified by stage at baseline among PPMI sporadic PD participants. Progression was defined as reaching any clinically meaningful milestone across any of six clinical domains (walking and balance, motor complications, cognition, autonomic dysfunction, functional dependence, activities of daily living). Median (95% CI) progression-free survival equaled 8.3 (6.2, 10.1) years, 5.9 (4.1, 6.0) years, and 2.4 (1.0, 4.0) years among participants with a baseline stage of 2B, 3, and 4, respectively. A generalized log-rank test indicated a significant difference across the survival curves (P<0.0001).
See this image and copyright information in PMC

References

    1. Simuni T., et al. A biological definition of neuronal alpha-synuclein disease: towards an integrated staging system for research. Lancet neurology 23, 178–190 (2024). - PubMed
    1. Siderowf A., et al. Assessment of heterogeneity among participants in the Parkinson’s Progression Markers Initiative cohort using alpha-synuclein seed amplification: a cross-sectional study. Lancet neurology 22, 407–417 (2023). - PMC - PubMed
    1. Postuma R.B., et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 30, 1591–1601 (2015). - PubMed
    1. McKeith I.G., et al. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology 89, 88–100 (2017). - PMC - PubMed
    1. Marek K., et al. The Parkinson’s progression markers initiative (PPMI) - establishing a PD biomarker cohort. Ann Clin Transl Neurol 5, 1460–1477 (2018). - PMC - PubMed

Publication types

LinkOut - more resources