Insulin Resistance in Multiple System Atrophy (IRAMS)

University Hospital of Bordeaux

Status: Enrolling

Conditions: Multiple System Atrophy

Treatments: Biological: Homeostasis Model Assessment of insulin resistance (HOMA); Behavioral: Clinical characteristics of AMS patients; Behavioral: MOntreal Cognitive Assessment (MoCA); Procedure: Brain Magnetic Resonance Imaging (MRI); Biological: Blood sampling

Study type: Interventional

Funder types: Other

Identifiers

NCT04250493

CHUBX 2018/30

Details and patient eligibility

About

Multiple system atrophy (MSA) is a rare and fatal neurodegenerative disorder. The pathologic hallmark is the accumulation of aggregated alpha-synuclein in oligodendrocytes forming glial cytoplasmic inclusions. Some symptomatic treatments are available while disease-modification remains an unmet treatment need. Post-mortem findings suggest insulin resistance, i.e. reduced insulin signaling, in the brains of MSA patients. The aim of this study is to complete the target validation of insulin resistance for future treatment trials.

Full description

Multiple system atrophy (MSA) patients have a poor prognosis with a median survival ranging between 6 and 10 years. MSA belongs to the synucleinopathies, which are characterized by the abnormal accumulation of alpha-synuclein. We have recently shown brain insulin resistance (i.e. reduced insulin signaling) in post-mortem brain tissue of MSA patients and transgenic MSA mice, as illustrated by increased protein levels of insulin receptor substrate-1 phosphorylated at serine 312 (IRS-1pS312). Additionally, exendin-4, an approved anti-diabetic drug targeting glucagon-like peptide-1 (GLP-1) receptors, was capable of decreasing brain levels of IRS-1pS312 and preserving dopamine neurons in transgenic MSA mice. We further observed an inverse correlation between plasma neural-derived exosomal IRS-1pS312 levels and survival of dopamine neurons in transgenic MSA mice.

The aim of this study is to further characterize peripheral and central insulin resistance in MSA patients, thereby validating this target for future treatment trials. For this purpose, fasting blood glucose and insulin levels will be determined in samples of MSA patients and healthy controls for a homeostatic model assessment of insulin resistance (HOMA). Additionally, IRS-1pS312 will be measured in neural-derived plasma exosomes of MSA patients and healthy controls.

Enrollment: 124 estimated patients

Sex: All

Ages: 30+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

Patients :

• Patients suffering from "possible" or "probable" MSA according to clinical consensus criteria (Gilman et al., 2008).
• Age > 30
• Written informed consent
• Patient covered by the national health system

Controls:

• Patients not suffering from a neurologic disorder
• Age > 30
• Written informed consent
• Patient covered by the national health system

Exclusion criteria

For patients and controls:

• Presence of a diabetes
• Treatment with corticosteroids, estrogen, atypical antipsychotics, and anti-retroviral agents
• Patient under tutelage
• Patient unable to give consent
• Any other neurologic disorder
• Pregnancy and breastfeeding
• MOCA ≤21
• Contraindication to perform an MRI

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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124 participants in 2 patient groups

MSA patient

Experimental group

Description:

Patients will be recruited at the French Reference Center for MSA.

Treatment:

Biological: Blood sampling

Procedure: Brain Magnetic Resonance Imaging (MRI)

Behavioral: MOntreal Cognitive Assessment (MoCA)

Behavioral: Clinical characteristics of AMS patients

Biological: Homeostasis Model Assessment of insulin resistance (HOMA)

Control

Other group

Description:

Healthy volunteer matched for age (+/- 5years) and sex with MSA patient.

Treatment:

Biological: Blood sampling

Procedure: Brain Magnetic Resonance Imaging (MRI)

Behavioral: MOntreal Cognitive Assessment (MoCA)

Biological: Homeostasis Model Assessment of insulin resistance (HOMA)