共济失调临床试验MRI终点:AGI工作组共识
本共识由共济失调全球倡议MRI生物标志物工作组制定,针对SCA1、SCA2、SCA3及Friedreich共济失调系统评估候选MRI终点。基于证据提出疾病特异性MRI终点选择建议,并指出进一步研究方向。
要点
- 定量MRI可作为共济失调病理与进展的候选生物标志物,补充传统临床评估。
- MRI终点选择需按SCA1、SCA2、SCA3与Friedreich共济失调分病种考量。
- 症状前突变携带者的试验入组与监测尤需依赖MRI生物标志物数据。
核心结论
- 定量神经影像可作为共济失调病理及进展的候选生物标志物,补充传统临床结局评估用于临床试验终点。
- 对SCA1、SCA2、SCA3及Friedreich共济失调应分别采用基于证据的疾病特异性MRI终点选择。
研究设计与样本
- 由共济失调全球倡议MRI生物标志物工作组制定,针对最常见脊髓小脑性共济失调及Friedreich共济失调系统综述候选MRI终点并形成共识。
诊断标准与关键数值
- 共识基于证据对SCA1、SCA2、SCA3和Friedreich共济失调分别提出MRI终点选择建议。
临床应用与阅片要点
- 定量MRI指标可用于支持共济失调临床试验的治疗监测与受试者筛选。
- 症状前突变携带者的预防性试验应结合MRI生物标志物进行入选与结局监测。
局限性
- 工作组指出仍存在知识缺口,需进一步研究以完善MRI终点应用。
以上解读依据论文摘要(全文未开放获取或许可不允许翻译转载)。
英文原文(摘要)· 点击展开
Disease-modifying therapies for degenerative ataxias, including emerging gene therapies, are in the clinical trial pipeline. Sensitive outcome measures are urgently needed for treatment monitoring and participant selection to improve trial feasibility in these rare diseases. In hereditary ataxias, the ability to identify people who carry disease-causing mutations before symptom onset also raises the possibility of enrolment into trials before symptom manifestation, but biomarker data are key for participant selection and outcome monitoring in such preventive trials. Quantitative neuroimaging readouts have emerged as viable candidate biomarkers of ataxia pathology and progression that could supplement traditional clinical outcome assessments as clinical trial end-points. In this Consensus Statement, the Ataxia Global Initiative MRI Biomarkers Working Group critically reviews candidate MRI end-points for trials in the most common spinocerebellar ataxias (SCA1, SCA2 and SCA3) and Friedreich ataxia and provides evidence-based, disease-specific recommendations for the selection of MRI end-points for trials in these diseases. Recommendations are also provided for further research to address remaining knowledge gaps.
引用
- Öz, Cocozza, Rezende, et al. MRI end-points for clinical trials in ataxias: recommendations from the Ataxia Global Initiative MRI Biomarkers Working Group. Nat Rev Neurol. 2026. PMID: 42236987. doi:10.1038/s41582-026-01218-7
供执业医师工作参考,不替代临床判断;数值与分级以指南原文为准。