The Fingerprinting of Inherited Leukoencephalopathies: A New Brain Imaging, Genetic and Clinical Assessment

NCT06332625 | Recruiting

• 1 other identifier: PNRR-MR1-2022-12375648
• Study Type: observational
• Target: 100
• Locations: 1 country
• Sites: 3

Brief Summary

Inherited leukoencephalopathies are a broad spectrum of genetically determined disorders, characterized by specific involvement of the white matter of the central nervous system. These pathologies are almost as common as other acquired white matter disorders, such as acute disseminated encephalomyelitis and multiple sclerosis. The onset can occur at any age, from prenatal life to adulthood, and the clinical picture is mostly progressive, but can also be non-evolving or, rarely, improve over time. Thanks to new diagnostic approaches, including next-generation genetic sequencing and recognition of magnetic resonance imaging patterns, in recent years the investigators have witnessed a significant increase in the number of genetically defined leukoencephalopathies. However, despite advances in genetic studies, inherited leukoencephalopathies include a large number of inherited white matter diseases in children and adults and remain of unknown cause in many patients (about 40%). This significant percentage of cases of unknown etiology represents a major challenge for public health, both in prognostic terms and, consequently, economically. However, even in leukoencephalopathies of genetically determined cause, the absence of specific biomarkers can be a limiting factor in the design and execution of clinical studies in search of promising therapies. As in other fields of neurology, the integration of clinical and genetic data with brain MRI data plays a fundamental role in the diagnostics of subjects affected by these pathologies. Currently, the methodologies commonly used in magnetic resonance imaging are qualitative, and evaluate brain lesions through the contrast between white and gray matter. The lack of specific biomarkers is therefore a limiting factor in the design of therapeutic challenges. In this regard, the development of new multiparametric quantitative magnetic resonance imaging (qMRI) methods could allow the investigators to identify new biomarkers to assess the etiology behind leukodystrophies, increasing diagnostic power and understanding the progression or improvement of leukoencephalopathy for both future trials and existing therapies. In this perspective, recent rapid "transient-state" magnetic resonance imaging methods, such as MR Fingerprinting (MRF), have proven effective in efficiently separating different components of brain tissue. These techniques consist of rapid and highly undersampled acquisitions performed by continuously changing the MR sequence parameters, thus obtaining a signal evolution that is unique for each combination of underlying tissue properties. Furthermore, if these techniques have already shown their validity at 3 Tesla, they could be even more informative in 7T MRI where the use of qMRI could provide more details thanks to the high image resolution. The project's objective is to evaluate and validate new and innovative quantitative magnetic resonance imaging (qMRI) methodologies at both clinical and ultra-high fields in inherited leukodystrophies and those of unknown etiology. This is a national, multi-institutional, multicenter exploratory study on the potential identification and predictability of early structural and metabolic markers in quantitative MRI at 3T and 7T in the diagnosis and follow-up of leukodystrophy and leukoencephalopathy in adults and during development. The study will include multiple sub-studies:

1. 1.A cross-sectional study in leukoencephalopathies at clinical fields.
2. 2.A longitudinal study in leukoencephalopathies at 3T: natural history and therapy outcomes.
3. 3.A cross-sectional and longitudinal study at 7T: The added value of ultra-high-field Magnetic Resonance Imaging in leukoencephalopathies.

Conditions

Leukoencephalopathies

Outcome Measures

Primary Outcomes (7)

• Quantitative Susceptibilty Mapping, QSM

  The Relative magnetic susceptibility values (in units of parts per billions \[ppb\], with respect to water magnetic susceptibility) registered in subcortical structures and nuclei

  every year for two years

• Fractional Anisotropy, FA

  FA values (a fractional number between 0 and 1), registered in lesioned white matter and normal-appearance white matter

  every year for two years

• Mean Diffusivity, MD

  MD values (in units of square millimeters per second \[mm²/s\]), registered in lesioned white matter and normal-appearance white matter

  every year for two years

• Relaxation times

  Values of longitudinal (T1) and transverse (T2) relaxation times (in units of milliseconds \[ms\]), registered in grey matter, lesioned white matter, normal-appearance white matter, and subcortical nuclei

  every year for two years

• Myelin water fraction, MWF

  MWF values (a fractional number between 0 and 1), registered in grey matter, lesioned white matter, normal-appearance white matter, and subcortical nuclei

  every year for two years

• Neuromotor skills

  Gross Motor Function Classification System (GMFCS) is a motor scale that categorizes patients' motor skills into 5 levels. Each level corresponds to a range of motor functions, with Level 1 representing mild symptoms and Level 5 being the most severe

  every year for two years

• Neuromotor skills

  Movement Disorders-Childhood Rating Scale Revised (MD-CRS R) has a score ranging from 0 and 100 with deficits below 70

  every year for two years

Secondary Outcomes (3)

• Epilepsy symptoms

  every year for two years

• Electroencephalography features

  every year for two years

• Neuro-psychological profile

  every year for two years

Interventions

Brain quantitative magnetic resonance imaging DIAGNOSTIC_TEST

Identification and predictability of early structural and metabolic markers from 3T and 7T quantitative magnetic resonance imaging (qMRI)

Eligibility Criteria

• Age: 0 Years - 30 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

100 subjects with leukoencephalopathy will undergo quantitative analysis at clinical field strengths, of which 20 will also be subjected to 7T MRI.

You may qualify if:

• For MRI examinations at clinical fields:
• Typical development patients under 30 years of age undergoing brain MRI for clinical reasons other than leukoencephalopathy (e.g., headache) with normal brain MRI results.
• For ultra-high field MRI (7T) examination:
• Patients with leukoencephalopathy aged between 8 and 30 years, who are capable of cooperating with an MRI examination.
• Patients suffering from leukoencephalopathy, who have already undergone a clinical field MRI (≤3T) as part of their diagnostic or research clinical pathway according to the diagnostic flowchart identified and shared with other institutes, and who present inconsistencies between clinical and imaging profiles or white matter patterns on clinical field imaging.

You may not qualify if:

• All subjects with absolute contraindications to undergoing an MRI exam, as determined by the medical history questionnaire.
• Patients with severe clinical conditions, such as the presence of a tracheostomy.
• Age under 8 years;
• Inability to cooperate with undergoing an MRI exam.

Sponsors & Collaborators

• IRCCS Fondazione Stella Maris: lead
• Oasi Research Institute-IRCCS: collaborator
• Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta: collaborator
• IRCCS Ospedale San Raffaele: collaborator

Study Sites (3)

IRCCS Associazione Oasi Maria SS Troina

Troina, Enna, 94018, Italy

RECRUITING

Ospedale San Raffaele

Milan, 20132, Italy

RECRUITING

Fondazione Istituto Neurologico Carlo Besta

Milan, 20133, Italy

RECRUITING

MeSH Terms

Conditions

Leukoencephalopathies

Condition Hierarchy (Ancestors)

Brain Diseases; Central Nervous System Diseases; Nervous System Diseases

Central Study Contacts

Roberta Battini

CONTACT

050886282; rbattini@fsm.unipi.it

Michela Tosetti

CONTACT

michela.tosetti@fsm.unipi.it

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 2 Years
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 23, 2024
• First Posted: March 27, 2024
• Study Start: May 22, 2023
• Primary Completion: February 5, 2024
• Study Completion: November 22, 2025
• Last Updated: March 27, 2024

Record last verified: 2024-03

Data Sharing

• IPD Sharing: Will not share

Locations

IT (3)