Japanese perspective on CSF diagnostics

Transcription

1 Japanese perspective on CSF diagnostics March 28, 2012 RASAD Department of Neuropathology, Graduate School of Medicine University of Tokyo Principal Investigator of J-ADNI Takeshi Iwatsubo Brain Research Institute Niigata University PI of Biomarker Core, J-ADNI Ryozo Kuwano

2 Early CSF studies on AD in Japan Hiro Arai Mikio Shoji Katsuya Urakami

3 But, not widely used in AD clinics Reasons Concerns for invasive procedures and AE risk Lack of understandings by clinicians of the significance of biomarkers Lack of sufficient man power to conduct LPs No coverage by health insurance

4 Japanese ADNI Sapporo 7-year study (since 2007) 38 clinical sites 600 subjects 532 cases enrolled 2157 visits completed 1.5T MRI (3D MPRAGE, ADNI phantom) PET ---FDG ~67% ---amyloid ~42% (PIB 16 sites, BF227 2 sites) Blood + apoe (100%) Tottori CSF ~40% Clinical (14 compatible test batteries) subjects N follow up early AD yr MCI yr Okayama Kagawa Hirosaki Akita Niigata Iwate NC yr Tohoku Gumma, Tsukuba, Mihara Kanazawa Shinshu NCNP Saitama Kyorin Tokyo Met Geriatric Hosp Tokyo Med col, Nippon Med, Asahi/Chiba-higashi Kyoto Juntendo, TMDU, Tokyo Kyoto Pref Natl Longev., Hamamatsu, Kurihama, Yokohama Kobe, Osaka City Osaka, Nara Fukuoka Kumamoto

5 6M USD/year (2/3 public funding, 1/3 pharma) Matsuda (Saitama) Public Funding from NEDO, MHLW & JST Ishii (Tokyo Met Inst Geront) Senda (Kobe, Biomed Res Innova) Organization of J-ADNI Ito (Nagoya, Natl Inst Longevity) Advisor Ihara (Doshisha) PI Iwatsubo (U Tokyo) WW-ADNI Alz Assoc Weiner NA-ADNI PI Imaging core groups MRI PI:Matsuda;PET: PI Ito PET QC: Senda, PIB: Ishii Imaging and clinical database(ncnp) Yamashita QC, data analysis Imaging company ISAB (7) GE, Siemens, Hitachi, Toshiba Shimadzu, Mediphysics, Micron Asada Arai Sugishita Tsukuba Operation center Consortium office Data registration Tohoku Clinical core QC, evaluation of conversion Sampling J-ADNI clinical sites (38 sites) psychology Kuwano (Arai) Biomarker core feedback AD genome study Kuwano, Ihara Murayama Pathology Japanese-pharma Industry Scientific Advisory Board(11) Astellas, Eisai, Daiichi Sankyo Dainippon-Sumitomo, Shionogi Takeda, Tanabe-Mitsubishi Eli-Lilly, Merck-Banyu. BMS, Pfizer

6 74% (28/38) of J-ADNI sites performed CSF sampling (211/532, 40% of total subjects) 22/27(81%) of Neurology/geriatrics sites, 6/11(55%) of Psychiatry sites have done >1 LP

7 Comparison of experimental conditions for CSF measurement (Kuwano, Shaw) Parameter Time or details Temp Time or details Temp 1. CSF Samples outside the freezer min min Vortexing (every single sample and Conjugate 1) 10 sec sec Spin down the CSF samples rpm, 1 min Vortexing just before plateing 2-3 sec sec (Standard & Control) Vacuum pressure/ time 9-10 inhg/5 sec inhg/ 5 sec overnight incubation (covered by aluminum foil) time H H Detection Conjugate incubation time 60 min min Reading solution incubation time 2 min min Coated Beads vortexing and sonification 10 sec + 3 min + 10 sec sec + 3 min + 10 sec Reagents outside until preparation at least 30min at least 30 min Incubation before dilution of the wash solution 25x in H 2 O 11. Standards preparation 30 min incubation of stock in water bath 7th standard preparation using 6th std (1/3 dilution) 37 leave at room temperture at least 30min Instrument Luminex 200 Luminex 200 7th standard preparation using 6th std (1/3 dilution) Software IS 2.3 xponent 3.1 Plate shaker US-ADNI (U-Penn) Orbital shaker (600rpm) J-ADNI (Niigata Univ.) Reciprocal shaker (37strokes/min)

8 Comparison between two Luminex equipments (Kuwano) (n=28) 102.3% 96.8% 98.1% NO DIFFERENCES! Reactions/measurements were performed simultaneously in two equipments A: Luminex 200 : product number (LX ) B: Luminex 200 : product number (LX )

9 Comparison of 3 different lots of reagents (Kuwano) Lot / Lot % 101.6% 94.8% Lot / Lot % 90.2% 102.1% Lot / Lot % 94.9% 100.8% No significant differences among 3 lots INNO-BIA AlzBio3 standard 1 Lot , Lot , Lot ,

10 Alzheimer s Association QC program for CSF Aβ42 Longitudinal QC-sample (QC-L) Concentrations Round 5, 6, 7 (Feb, May, Oct in 2011) (A) All Labs (B) Niigata Univ. AlzBio3 Aβ42 +2SD Average Round No. of Labs SD Round

11 Alzheimer s Association QC program for CSF T-tau Longitudinal QC-sample (QC-L) Concentrations Round 5, 6, 7 (Feb, May, Oct in 2011) (A) All Labs (B) Niigata Univ. AlzBio3 T-tau +2SD Average -2SD Round Round No. of Labs

12 Alzheimer s Association QC program for CSF P-tau Longitudinal QC-sample (QC-L) Concentrations Round 5, 6, 7 (Feb, May, Oct in 2011) (A) All Labs (B) Niigata Univ. AlzBio3 P-tau +2SD Round No. of Labs Average -2SD Round

13 t-tau (pg/ml) p-tau (pg/ml) Aβ1-42 (pg/ml) 変化率 (%) Adsorption of Ab1-42 on the tube surface Biomarkers were measured after being transferred to a new tube. All tubes are made of polypropylene. ( 回 =times) Aβ1-42 (concentration) 0 回 1 回 2 回 3 回 Aβ1-42 (rate of change) 0 回 1 回 2 回 3 回 CSF #1 CSF #2 CSF #3 CSF #4 CSF #5 CSF #6 CSF #7 CSF #8 CSF #1 CSF #2 CSF #3 CSF #4 CSF #5 CSF #6 CSF #7 CSF # t-tau (concentration) 0 回 1 回 2 回 3 回 CSF #1 CSF #2 CSF #3 CSF #4 CSF #5 CSF #6 CSF #7 CSF # p-tau (concentration) 0 回 1 回 2 回 3 回 CSF #1 CSF #2 CSF #3 CSF #4 CSF #5 CSF #6 CSF #7 CSF #8 Transfer of samples from tube to tube should be minimized!

14 Summary and future perspective on CSF studies for AD in Japan Hurdles being lowered for clinical studies/trials through J-ADNI practice Standardization by J-ADNI ongoing in collaboration with US/NA-ADNI and Fujirebio/Innogenetics More emphasis on CSF and amyloid PET imaging studies in the 2 nd stage of J-ADNI focusing on preclinical-prodromal AD (being planned) CSF tau quantitation just approved for coverage by public health insurance, probably boosting the use of CSF diagnostics (Approve CSF p-tau for the Dx of dementia, total tau for Dx of CJD. March 5, 2012, Japanese official gazette)

15 AD Neuroimaging initiative (ADNI) Worldwide for the standardization of imaging and biomarkers for AD modifier drug development WW-ADNI meeting, 2009 autumn, Sendai S-ADNI Dr. Takeshi Iwatsubo J-ADNI Korean-ADNI China-ADNI Taiwan-ADNI Dr. Michael Weiner US (NA) ADNI EU ADNI Dr. Giovanni Frisoni AIBL (Au-ADNI) Dr. Colin Masters and AIBL PIs