| Eligibility |
Inclusion Criteria:
- 1. Ability to understand the purpose and risks of the study and provide signed and dated
informed consent and authorization to use confidential health information in accordance
with applicable privacy regulations 2. Diagnosis of probable or possible multiple system
atrophy (MSA-P or MSA-C) according to current consensus diagnostic criteria [8].
3. Aged 40-80 with anticipated survival of at least 3 years (in the opinion of the
Investigator) 4. Able to walk for, at least, 10 meters with or without assistance 5.
Willingness and ability to participate in all study procedures. 6. Ability to tolerate and
no contraindications for brain MRI. 7. Ability to tolerate and no contraindications for CSF
collection. Participants with contraindication to the CSF procedure will be given the
option to participate in the study and opt out the CSF collection. An effort will be made
to ensure that at least 50% of patients enrolled in the study undergo CSF collection.
Exclusion Criteria:
- 1. Presence of supranuclear gaze palsy. 2. Known presence of hyposmia (i.e., reduced
ability to smell and detect odors).
3. Presence of cognitive dysfunction (defined as MoCA score <20). 4.
Severe-to-complete dependence on caregivers (score >3 on UMSARS Part IV, Global
Disability), severe impairment of swallowing (score =3 on UMSARS Part I, Question 2),
or frequent falls (score =3 on UMSARS Part I, Question 8) at Baseline.
5. Family history or a known genetic cause of ataxia or parkinsonism. 6. Clinically
significant neuropathy. 7. Hallucinations not induced by drugs. 8. Unstable
psychiatric illness, including psychosis, suicidal ideation, or untreated major
depression within 90 days before Baseline, as determined by the Investigator.
9. History or Baseline MRI results showing evidence of structural abnormalities that
could contribute to the participant's clinical state other than findings typical of
MSA, or any finding that might pose a risk to the participant.
10. Any contraindications to having a brain MRI (e.g., pacemaker; MRI-incompatible
aneurysm clips, artificial heart valves, or other metal foreign body; claustrophobia
that cannot be medically managed without requiring general anesthesia, etc.).
11. Transient ischemic attack or stroke, or any unexplained loss of consciousness
within 1 year before Baseline.
12. History of any brain surgery for MSA (e.g., pallidotomy, deep brain stimulation,
or fetal tissue transplant) or a history of focused ultrasound treatment or
neuromodulation procedures, including but not limited to transcranial magnetic
stimulation (TMS) and transcranial direct or alternating current stimulation
(tDCS/tACS) that have been performed within 90 days of Baseline.
Infection Risk 13. History of human immunodeficiency virus or hepatitis C virus antibody.
14. Chronic, recurrent, or serious infection (e.g., pneumonia, septicemia, recurrent
urinary tract infection), as determined by the Investigator, within 8 weeks before Day 1.
Cardiovascular 15. History of unstable angina, myocardial infarction, chronic heart failure
(New York Heart Association Class 3 or 4), or clinically significant conduction
abnormalities (e.g., unstable atrial fibrillation) within 1 year before Baseline.
16. Chronic, sustained, uncontrolled supine hypertension (unrelated to pharmacological
treatment of orthostatic hypotension) defined by an average of three SBP readings of >180
mmHg or DBP readings of >110 mmHg at baseline.
17. In participants treated pharmacologically for orthostatic hypotension, any documented
sitting or standing SBP reading =180 mmHg or DBP reading =110 mmHg within the 3 months
before Day 1 or on Day 1).
18. Severe orthostatic hypotension despite optimal medical management (defined as a score
of =3 on UMSARS Part I, Question 9).
Oncology 19. History of, or ongoing, malignant disease, including solid tumors and
hematologic malignancies (with the exception of basal cell carcinomas and squamous cell
carcinomas that have been completely excised and considered cured at least 12 months prior
to Day -1). Participants with cancers in remission for greater than 5 years prior to Day -1
may be included.
Metabolic 20. Poorly controlled diabetes mellitus, as defined by having dosage adjustment
of diabetic medication within 3 months before dosing (Day 1) or glycated hemoglobin value
=8% at Baseline.
Hypersensitivity 21. Clinically significant allergies, as determined by the Investigator,
to anesthetics that will be used for the LP per institutional practice, or iodine.
Other Medical History or Health Status 22. History of any clinically significant
endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary,
neurologic, dermatologic, renal ischemic, or other major diseases, as determined by the
Investigator.
23. Surgery within 12 weeks before Day 1 (other than minor cosmetic surgery and minor
dental surgery, as determined by the Investigator).
Any contraindications to LP procedures, including but not limited to:
24. Known or suspected structural abnormality of the lumbar spine, including but not
limited to X-ray, MRI, or myelographic evidence of significant lumbar spine abnormalities,
or other anatomical factors at or near the LP site that, in the opinion of the
Investigator, may interfere with the performance of the LP, render repeated LPs difficult,
or increase the risk of the procedure for the participant.
25. Presence of risk for increased or uncontrolled bleeding and/or risk of bleeding that is
not managed optimally and might place a participant at an increased risk for intraoperative
or postoperative bleeding. These could include, but are not limited to, anatomical factors
at or near the LP site (e.g., vascular abnormalities, neoplasms, or other abnormalities),
known underlying disorders of the coagulation cascade, platelet function, or platelet count
(e.g., hemophilia, von Willebrand's disease, liver disease).
26. Unwillingness or inability to comply with the requirements of this protocol.
27. Other unspecified reasons that, in the opinion of the Investigator, make the
participant unsuitable for enrollment.
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