MRI Study of Blood-brain Barrier Function in CADASIL

Cadasil Clinical Trial

Official title:

MRI Study of Blood-brain Barrier Function in CADASIL

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05902039
• Other study ID #: 2022-715
• Status: Recruiting
• Start date: April 1, 2021
• Est. completion date: April 1, 2026

Study information

• Verified date: June 2023
• Source: Peking University First Hospital
• Contact: Chen Ling, PhD
• Phone: +86 18101358135
• Email: lnyy.chen[@]foxmail.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Diffusion prepared pseudo-continuous ASL (DP-pCASL) is a newly proposed MRI method to noninvasively measure the function of blood-brain barrier (BBB). The investigators aim to investigate whether the water exchange rate across the BBB, estimated with DP-pCASL, is changed in patients with CADASIL, and to analyze the association between BBB water exchange rate and MRI/clinical features in these patients.

Description:

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), caused by NOTCH3 gene mutations, is the most frequent monogenic type of hereditary cerebral small vessel disease (CSVD). The unique pathophysiological mechanisms that small vessel disorders in CADASIL are caused by genetic mutations and that the majority of patients do not combine cerebrovascular disease risk factors make CADASIL an ideal model for studying CSVD, and the imaging findings on CADASIL can be used to diagnose and investigate the etiology of CSVD. While abnormalities in the cerebrovascular structure and hemodynamics have been well demonstrated in CADASIL, the abnormality of the BBB remains controversial. One DCE-MRI study suggested an increase in BBB permeability to gadolinium contrast in CADASIL, whereas no abnormality of BBB was found in subsequent studies in mouse models and patients. The aim of this study was to assess whether BBB function is abnormal in patients with CADASIL using DP-pCASL, which is more sensitive to subtle changes in the BBB compared to DCE-MRI. The investigators hypothesized that the BBB water exchange rate (kw) is reduced in patients with CADASIL compared to controls as assessed by DP-pCASL and that the degree of reduction in BBB water exchange rate correlates with the severity of disease in patients with CADASIL.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: April 1, 2026
• Est. primary completion date: April 1, 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 20 Years to 70 Years

Eligibility

Inclusion Criteria:

1. Patients with CADASIL confirmed by gene or/and skin biopsy.

2. The age range is 20-70 years old.

3. There is no contraindication to MRI examination, and the informed consent is signed.

Exclusion Criteria:

1. Combined with definite cerebrovascular disease, or combined with brain tumor, brain trauma and other causes of brain diseases.

2. CADASIL is not confirmed.

3. There are contraindications to examination or refusal to sign the informed consent.

Related Conditions & MeSH terms

• Blood Brain Barrier Defect
• Cadasil
• Dementia, Multi-Infarct

Intervention

Other:
• MRI
All participants underwent an MR examination on a 3T whole-body Prisma MRI system (Siemens, Erlangen, Germany) with a 64-channel head coil, and a 7T whole-body MAGNETOM MR system (Siemens, Erlangen, Germany) using a 32-channel receive/birdcage transmit head coil (NOVA medical). DP-pCASL, Multi-delay pCASL (MD-pCASL) was acquired to evaluate BBB function and cerebral perfusion. T1-weighted magnetization-prepared rapid gradient echo (T1w-MPRAGE) was scanned at both 3T and 7T for registration in the post-processing workflow. T2-weighted fluid-attenuated inversion recovery (T2w-FLAIR) and T2*-weighted gradient echo (T2*w-GRE) were acquired at 7T for high-resolution structural images and evaluation of lesions.

Locations

Country	Name	City	State
China	Peking University First Hospital	Beijing

Sponsors (2)

Lead Sponsor	Collaborator
Peking University First Hospital	Chinese Academy of Sciences

Country where clinical trial is conducted

China, 

References & Publications (6)

Li Y, Ying Y, Yao T, Jia X, Liang H, Tang W, Jia X, Song H, Shao X, Wang DJJ, Wang C, Cheng X, Yang Q. Decreased water exchange rate across blood-brain barrier in hereditary cerebral small vessel disease. Brain. 2023 Jan 10:awac500. doi: 10.1093/brain/awac500. Online ahead of print. — View Citation

Shao X, Ma SJ, Casey M, D'Orazio L, Ringman JM, Wang DJJ. Mapping water exchange across the blood-brain barrier using 3D diffusion-prepared arterial spin labeled perfusion MRI. Magn Reson Med. 2019 May;81(5):3065-3079. doi: 10.1002/mrm.27632. Epub 2018 Dec 18. — View Citation

St Lawrence KS, Owen D, Wang DJ. A two-stage approach for measuring vascular water exchange and arterial transit time by diffusion-weighted perfusion MRI. Magn Reson Med. 2012 May;67(5):1275-84. doi: 10.1002/mrm.23104. Epub 2011 Aug 19. — View Citation

Sun C, Wu Y, Ling C, Xie Z, Sun Y, Xie Z, Li Z, Fang X, Kong Q, An J, Wang B, Zhuo Y, Zhang W, Wang Z, Yuan Y, Zhang Z. Reduced blood flow velocity in lenticulostriate arteries of patients with CADASIL assessed by PC-MRA at 7T. J Neurol Neurosurg Psychiatry. 2022 Apr;93(4):451-452. doi: 10.1136/jnnp-2021-326258. Epub 2021 Sep 28. No abstract available. — View Citation

Uchida Y, Kan H, Sakurai K, Arai N, Inui S, Kobayashi S, Kato D, Ueki Y, Matsukawa N. Iron leakage owing to blood-brain barrier disruption in small vessel disease CADASIL. Neurology. 2020 Sep 1;95(9):e1188-e1198. doi: 10.1212/WNL.0000000000010148. Epub 2020 Jun 25. — View Citation

Walsh J, Tozer DJ, Sari H, Hong YT, Drazyk A, Williams G, Shah NJ, O'Brien JT, Aigbirhio FI, Rosenberg G, Fryer TD, Markus HS. Microglial activation and blood-brain barrier permeability in cerebral small vessel disease. Brain. 2021 Jun 22;144(5):1361-1371. doi: 10.1093/brain/awab003. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	kw	Post-processing of DP-pCASL data was performed offline using LOFT BBB Toolbox. Head motion was corrected using SPM12 and the temporal fluctuations were minimized by using principal component analysis. DP-pCASL data with the b value of 50 s/mm2 were used to obtain the ASL signal from the tissue and capillary compartments respectively, and kw was quantified by using a single-pass approximation model with total generalized variation regularization.	30 Minutes
Secondary	CBF	Post-processing of MD-pCASL data was performed offline using the BASIL toolkit of FSL. Cerebral blood flow (CBF) were calculated by a custom script using the BASIL toolkit of FSL.	30 Minutes
Secondary	ATT	Post-processing of MD-pCASL data was performed offline using the BASIL toolkit of FSL. Arterial transit time (ATT) were calculated by a custom script using the BASIL toolkit of FSL.	30 Minutes
Secondary	QSM	QSM image reconstruction, including phase pre-processing and estimation of susceptibility maps, followed the default QSMbox (https:// gitlab. com/ acostaj/ QSMbox) pipeline for single-echo, coil-combined data.	30 Minutes