The Parkinson's progression markers initiative (PPMI) - establishing a PD biomarker cohort

Ann Clin Transl Neurol. 2018 Oct 31;5(12):1460-1477. doi: 10.1002/acn3.644. eCollection 2018 Dec.

Abstract

Objective: The Parkinson's Progression Markers Initiative (PPMI) is an observational, international study designed to establish biomarker-defined cohorts and identify clinical, imaging, genetic, and biospecimen Parkinson's disease (PD) progression markers to accelerate disease-modifying therapeutic trials.

Methods: A total of 423 untreated PD, 196 Healthy Control (HC) and 64 SWEDD (scans without evidence of dopaminergic deficit) subjects were enrolled at 24 sites. To enroll PD subjects as early as possible following diagnosis, subjects were eligible with only asymmetric bradykinesia or tremor plus a dopamine transporter (DAT) binding deficit on SPECT imaging. Acquisition of data was standardized as detailed at www.ppmi-info.org.

Results: Approximately 9% of enrolled subjects had a single PD sign at baseline. DAT imaging excluded 16% of potential PD subjects with SWEDD. The total MDS-UPDRS for PD was 32.4 compared to 4.6 for HC and 28.2 for SWEDD. On average, PD subjects demonstrated 45% and 68% reduction in mean striatal and contralateral putamen Specific Binding Ratios (SBR), respectively. Cerebrospinal fluid (CSF) was acquired from >97% of all subjects. CSF (PD/HC/SWEDD pg/mL) α-synuclein (1845/2204/2141) was reduced in PD vs HC or SWEDD (P < 0.03). Similarly, t-tau (45/53) and p-tau (16/18) were reduced in PD versus HC (P < 0.01).

Interpretation: PPMI has detailed the biomarker signature for an early PD cohort defined by clinical features and imaging biomarkers. This strategy provides the framework to establish biomarker cohorts and to define longitudinal progression biomarkers to support future PD treatment trials.

Grant support

This work was funded by Bristol‐Myers Squibb grant ; Covance grant ; Eli Lilly and Company grant ; Biogen grant ; Genentech grant ; UCB grant ; F. Hoffmann‐La Roche grant ; GE Healthcare grant ; Avid Radiopharmaceuticals grant ; Michael J. Fox Foundation for Parkinson's Research grant ; Merck grant ; Lundbeck grant ; GlaxoSmithKline grant ; Piramal grant ; Meso Scale Diagnostics grant ; Pfizer grant ; AbbVie grant .