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Progreso de la enfermedad en la atrofia sistémica múltiple: el estudio de biomarcadores multimodales ASPIRE

Margherita Fabbri^1,2,3, Natalia Del Campo¹, Wassilios G Meissner^4,5

¹Clinical Investigation Center CIC1436, Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Centre and NeuroToul Center of Excellence in Neurodegeneration (COEN) of Toulouse; INSERM, University of Toulouse, CHU of Toulouse, Toulouse, France.

Annals of neurology

|August 26, 2025

Resumen

La atrofia múltiple temprana (MSA) muestra cambios rápidos de neuroimagen dentro de los seis meses. Los niveles más altos de cadena ligera de neurofilamentos (NfL) predicen un aumento de la mortalidad y el riesgo de abandono en pacientes con MSA.

Área de la Ciencia:

Neurología
Investigación de biomarcadores
Enfermedades neurodegenerativas

Sus antecedentes:

La atrofia sistémica múltiple (MSA) es un trastorno neurodegenerativo progresivo.
El diagnóstico temprano y la comprensión de la progresión de la enfermedad son cruciales para el manejo del paciente.
Los biomarcadores candidatos requieren una caracterización en las primeras etapas de la MSA.

Objetivo del estudio:

Caracterizar los cambios en los biomarcadores candidatos en la atrofia temprana del sistema múltiple (AMM).
Identificar los predictores iniciales de una progresión más rápida de la enfermedad en la ASM.
Evaluar la utilidad de la neuroimagen y el NfL plasmático en la ASM temprana.

Principales métodos:

Un estudio prospectivo multicéntrico de 1 año en el que participaron pacientes con ASM precoz y controles sanos.
Las puntuaciones clínicas evaluadas (UMSARS), 3T-MRI, DaT-SPECT y NfL plasmático.
Se analizaron los cambios desde el inicio hasta los 6 y 12 meses utilizando regresión lineal mixta.

Principales resultados:

Se observó un empeoramiento significativo de las puntuaciones UMSARS y un aumento de la atrofia del tronco cerebral/cerebeloso en un plazo de 6 meses.
Se observó una disminución de la relación de unión específica estriatal (SBR), con patrones distintos en los subtipos MSA-P y MSA-C.
El volumen basal del tronco encefálico y el SBR predijeron un empeoramiento clínico; un NfL plasmático más alto se correlacionó con el riesgo de abandono y mortalidad.

Conclusiones:

Los cambios en la neuroimagen son detectables dentro de los 6 meses en la ASM temprana.
La NfL plasmática es un predictor significativo de la mortalidad y el riesgo de abandono en la MSA.
La evaluación longitudinal de los biomarcadores ofrece información valiosa sobre la progresión de la MSA.

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