Diagnostic value of cerebrospinal fluid alpha-synuclein seed quantification in synucleinopathies
Open accessAbstract
Several studies have confirmed the α-synuclein real-time quaking-induced conversion (RT-QuIC) assay to have high sensitivity and specificity for Parkinson’s disease. However, whether the assay can be used as a robust, quantitative measure to monitor disease progression, stratify different synucleinopathies and predict disease conversion in patients with idiopathic REM sleep behaviour disorder remains undetermined. The aim of this study was to assess the diagnostic value of CSF α-synuclein RT-QuIC quantitative parameters in regard to disease progression, stratification and conversion in synucleinopathies. We performed α-synuclein RT-QuIC in the CSF samples from 74 Parkinson’s disease, 24 multiple system atrophy and 45 idiopathic REM sleep behaviour disorder patients alongside 55 healthy controls, analysing quantitative assay parameters in relation to clinical data. α-Synuclein RT-QuIC showed 89% sensitivity and 96% specificity for Parkinson’s disease. There was no correlation between RT-QuIC quantitative parameters and Parkinson’s disease clinical scores (e.g. Unified Parkinson’s Disease Rating Scale motor), but RT-QuIC positivity and some quantitative parameters (e.g. Vmax) differed across the different phenotype clusters. RT-QuIC parameters also added value alongside standard clinical data in diagnosing Parkinson’s disease. The sensitivity in multiple system atrophy was 75%, and CSF samples showed longer T50 and lower Vmax compared to Parkinson’s disease. All RT-QuIC parameters correlated with worse clinical progression of multiple system atrophy (e.g. change in Unified Multiple System Atrophy Rating Scale). The overall sensitivity in idiopathic REM sleep behaviour disorder was 64%. In three of the four longitudinally followed idiopathic REM sleep behaviour disorder cohorts, we found around 90% sensitivity, but in one sample (DeNoPa) diagnosing idiopathic REM sleep behaviour disorder earlier from the community cases, this was much lower at 39%. During follow-up, 14 of 45 (31%) idiopathic REM sleep behaviour disorder patients converted to synucleinopathy with 9/14 (64%) of convertors showing baseline RT-QuIC positivity. In summary, our results showed that α-synuclein RT-QuIC adds value in diagnosing Parkinson’s disease and may provide a way to distinguish variations within Parkinson’s disease phenotype. However, the quantitative parameters did not correlate with disease severity in Parkinson’s disease. The assay distinguished multiple system atrophy patients from Parkinson’s disease patients and in contrast to Parkinson’s disease, the quantitative parameters correlated with disease progression of multiple system atrophy. Our results also provided further evidence for α-synuclein RT-QuIC having potential as an early biomarker detecting synucleinopathy in idiopathic REM sleep behaviour disorder patients prior to conversion. Further analysis of longitudinally followed idiopathic REM sleep behaviour disorder patients is needed to better understand the relationship between α-synuclein RT-QuIC signature and the progression from prodromal to different synucleinopathies.
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SAA has already proven to be a robust technique for identifying pathological α-synuclein from cerebrospinal fluid sample from patients with PD and RBD.
“SAA has already proven to be a robust technique for identifying pathological α-synuclein from cerebrospinal fluid sample from patients with PD and RBD [71, 72].”
From The gut–brain axis in early Parkinson’s disease: from prodrome to prevention (2025) · cites this paper as [72]
The Results report 89% sensitivity and 96% specificity for detecting Parkinson’s disease from CSF. For idiopathic RBD, however, they report 64% baseline sensitivity, with substantial variation across cohorts; the Discussion describes the assay as a potential early biomarker rather than an already proven robust technique for that group. (LLM, conf=0.87)
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- Authors
- Poggiolini, I., Gupta, V., Lawton, M., Lee, S., El-Turabi, A., Querejeta-Coma, A., Trenkwalder, C., Sixel-Döring, F., Foubert-Samier, A., Pavy-Le Traon, A., Plazzi, G., Biscarini, F., Montplaisir, J., Gagnon, J.-F., Postuma, R. B., Antelmi, E., Meissner, W. G., Mollenhauer, B., Ben-Shlomo, Y., Hu, M. T., & Parkkinen, L.
- Affiliations
- University of Oxford (GB)
- University of Bristol (GB)
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
- Universitätsmedizin Göttingen (DE)
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France
- French Reference Centre for MSA, University Hospital of Toulouse, Toulouse, France
- University of Modena and Reggio Emilia (IT)
- University of Bologna (IT)
- Hôpital du Sacré-Cœur de Montréal (CA)
- Université du Québec à Montréal (CA)
- Montreal General Hospital (CA)
- University of Verona (IT)
- Centre National de la Recherche Scientifique (FR)
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
- Corresponding author
- Parkkinen, Laura
- ORCID
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-12-11
- Volume
- 145
- Issue
- 2
- Pages
- 584-595
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC9014737
- OpenAlex
- W4200520313
- Cited by
- 191
- References
- 57
- Citations by year
- 2026: 33 · 2025: 50 · 2024: 48 · 2023: 35 · 2022: 25
- FWCI
- 12.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by-nc)
- HAL (submittedVersion, cc-by-nc)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion, cc-by-nc)
- Funders
- Biogen
- Teva Pharmaceutical Industries
- Jazz Pharmaceuticals
- Parkinson's Foundation
- UK Research and Innovation
- National Institute for Health and Care Research
- Parkinson's UK (J-1403, G‐1806, J-0901, J-2101)
- Deutsche Forschungsgemeinschaft
- Eisai
- Servier
- H. Lundbeck A/S
- Deutsche Parkinson Vereinigung
- Idorsia Pharmaceuticals
- Otsuka Pharmaceutical Development and Commercialization
- Canadian Institutes of Health Research
- Medical Research Council (MR/T046287/1)
- Engineering and Physical Sciences Research Council (EP/R013756/1)
- NIHR Oxford Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
- Keywords
- alpha-synuclein, cerebrospinal fluid, RT-QuIC, synucleinopathies, Parkinson's disease, multiple system atrophy, idiopathic REM sleep behavior disorder, disease progression, disease transformation, sensitivity and specificity, Vmax, T50, biomarkers, Unified Parkinson's Disease Rating Scale
- MeSH terms
- Synucleinopathies, Humans, Parkinson Disease, Disease Progression, Multiple System Atrophy, REM Sleep Behavior Disorder, alpha-Synuclein
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