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Updated: Jun 29, 2025

Targeting Alpha Synuclein Aggregates in Cutaneous Peripheral Nerve Fibers by Free-floating Immunofluorescence Assay
Published on: June 25, 2019
Alpha-synuclein pathology in isolated rapid eye movement sleep behaviour disorder: a meta-analysis
Imran H Iftikhar1,2, Sohaila AlShimemeri3, Hussein Rabah1
1Department of Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Testing for alpha-synuclein (a-Syn) in patients with isolated rapid eye movement sleep behaviour disorder (iRBD) shows high positivity. Skin biopsies are preferred over CSF, and phosphorylated a-Syn (p-syn) is more specific than seeding assays.
Area of Science:
- Neurology
- Biomarker Discovery
- Sleep Medicine
Background:
- Isolated rapid eye movement sleep behaviour disorder (iRBD) is a prodromal stage of synucleinopathies.
- Patients with iRBD exhibit abnormal deposition of misfolded alpha-synuclein (a-Syn) in peripheral tissues.
- The clinical utility of a-Syn testing in iRBD requires clarification.
Purpose of the Study:
- To evaluate the clinical utility of testing for abnormal alpha-synuclein (a-Syn) in patients with iRBD.
- To compare the diagnostic performance of phosphorylated a-Syn (p-syn) and a-Syn seeding activity (aSyn-SAA) assays.
- To determine the optimal biological source (CSF vs. skin) for a-Syn pathological analysis.
Main Methods:
- A meta-analysis of 15 studies investigating a-Syn test positivity in iRBD participants.
- Analysis of test positivity rates for aSyn-SAA in cerebrospinal fluid (CSF) and skin.
- Evaluation of p-syn test positivity and specificity in CSF and skin samples.
Main Results:
- High test positivity rates were observed for both aSyn-SAA (CSF: 80%, skin: 74.8%) and p-syn (78.5%) in iRBD.
- Skin biopsies demonstrated higher specificity (99%) compared to CSF for a-Syn detection (p=0.01).
- Phosphorylated a-Syn (p-syn) showed superior specificity (100%) compared to aSyn-SAA (p<0.001).
Conclusions:
- Testing for a-Syn, particularly phosphorylated a-Syn (p-syn) in skin biopsies, is clinically significant for iRBD diagnosis.
- Skin is a more specific source than CSF for a-Syn pathological analysis.
- a-Syn testing can aid in differentiating iRBD from other forms of REM sleep behaviour disorder (RBD).
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