背景:诊断由阿尔茨海默病(AD)或可能的轻度AD痴呆引起的轻度认知障碍(MCI)的主要标准部分依赖于认知评估和淀粉样斑块的存在。尽管这些标准在认知障碍患者中预测AD方面表现出很高的敏感性,它们的特异性仍然有限。值得注意的是,高达25%的非痴呆淀粉样斑块患者可能因AD而误诊为MCI,事实上,他们患有不同的大脑疾病。抗淀粉样蛋白抗体的引入使这种情况复杂化。医生必须优先考虑哪些淀粉样蛋白阳性MCI患者接受这些治疗,因为并非所有人都是合适的候选人。具体来说,患有非AD淀粉样蛋白病理的患者不是淀粉样蛋白修饰疗法的主要目标。因此,对于可以准确检测痴呆前AD的高度特异性血液生物标志物,从而优化淀粉样蛋白抗体处方。
目的:本研究的目的是评估基于外周生物标志物的预测模型,以识别MCI和轻度痴呆患者,这些患者将在认知障碍人群中以高特异性出现AD痴呆症状。
方法:在基于基因转移的AD动物模型中鉴定外周生物标志物,然后在回顾性多中心临床研究中进行验证。
方法:来自7个回顾性队列的参与者(美国,欧盟和澳大利亚)。
方法:这项研究追踪了345名认知障碍个体,长达13年,包括193名MCI患者和152名轻度痴呆症患者,从他们最初的访问开始。最后的诊断,在他们上次评估中建立的,将249名参与者分类为AD患者,96名为非AD脑部疾病,根据每种疾病亚型的具体诊断标准。淀粉样蛋白状态,在基线评估,82.9%的参与者可以使用,61.9%的淀粉样蛋白检测呈阳性。每个临床组中都有淀粉样蛋白阳性和阴性个体。一些AD患者有合并症,如代谢紊乱,慢性疾病,或心血管疾病。
方法:我们开发了81种血液生物标志物的靶向质谱检测方法,包括先前在AAV-AD大鼠中鉴定的45种蛋白质和36种代谢物。
方法:我们分析了研究参与者的血液样本中的81种生物标志物。B-HEALED测试,基于机器学习的诊断工具,被开发来区分AD患者,包括123例前驱性AD和126例轻度AD痴呆,来自96名患有非AD脑部疾病的个体。该模型使用70%的数据进行了训练,选择相关的生物标志物,校准算法,并建立截止值。剩余的30%用作外部测试数据集,用于预测准确性的盲验证。
结果:整合了19种血液生物标志物和参与者年龄的组合,B-HEALED模型成功区分了将发展为AD痴呆症状的参与者(82名患有前驱AD,83名患有AD痴呆)与非AD受试者(71名个体)的特异性为93.0%,敏感性为65.4%(AUROC=81.9%,p<0.001)在内部验证期间。当淀粉样蛋白状态(来自CSF或PET扫描)和B-HEALED模型联合应用时,如果两个测试都呈阳性,则将个人归类为AD,我们实现了100%的特异性和52.8%的敏感性.这种性能在盲外部验证中是一致的,在独立数据集上强调模型的可靠性。
结论:B-HEALED测试,利用基于血液的生物标志物,在识别认知障碍人群中的AD患者方面表现出高预测特异性,尽量减少误报。当与淀粉样蛋白筛查一起使用时,它有效地识别了一个几乎纯的前驱AD队列。这些结果对完善临床试验纳入标准具有重要意义。促进药物开发和验证,并准确识别将从疾病改善性AD治疗中受益最大的患者。
The primary criteria for diagnosing mild cognitive impairment (MCI) due to Alzheimer\'s Disease (AD) or probable mild AD dementia rely partly on cognitive assessments and the presence of amyloid plaques. Although these criteria exhibit high sensitivity in predicting AD among cognitively impaired patients, their specificity remains limited. Notably, up to 25% of non-demented patients with amyloid plaques may be misdiagnosed with MCI due to AD, when in fact they suffer from a different brain disorder. The introduction of anti-amyloid antibodies complicates this scenario. Physicians must prioritize which amyloid-positive MCI patients receive these treatments, as not all are suitable candidates. Specifically, those with non-AD amyloid pathologies are not primary targets for amyloid-modifying therapies. Consequently, there is an escalating medical necessity for highly specific blood biomarkers that can accurately detect pre-dementia AD, thus optimizing amyloid antibody prescription.
The objective of this
study was to evaluate a predictive model based on peripheral biomarkers to identify MCI and mild dementia patients who will develop AD dementia symptoms in cognitively impaired population with high specificity.
Peripheral biomarkers were identified in a gene transfer-based animal model of AD and then validated during a retrospective multi-center clinical
study.
Participants from 7 retrospective cohorts (US, EU and Australia).
This
study followed 345 cognitively impaired individuals over up to 13 years, including 193 with MCI and 152 with mild dementia, starting from their initial visits. The final diagnoses, established during their last assessments, classified 249 participants as AD patients and 96 as having non-AD brain disorders, based on the specific diagnostic criteria for each disorder subtype. Amyloid status, assessed at baseline, was available for 82.9% of the participants, with 61.9% testing positive for amyloid. Both amyloid-positive and negative individuals were represented in each clinical group. Some of the AD patients had co-morbidities such as metabolic disorders, chronic diseases, or cardiovascular pathologies.
We developed targeted mass spectrometry assays for 81 blood-based biomarkers, encompassing 45 proteins and 36 metabolites previously identified in AAV-AD rats.
We analyzed blood samples from
study participants for the 81 biomarkers. The B-HEALED test, a machine learning-based diagnostic tool, was developed to differentiate AD patients, including 123 with Prodromal AD and 126 with mild AD dementia, from 96 individuals with non-AD brain disorders. The model was trained using 70% of the data, selecting relevant biomarkers, calibrating the algorithm, and establishing cutoff values. The remaining 30% served as an external test dataset for blind validation of the predictive accuracy.
Integrating a combination of 19 blood biomarkers and participant age, the B-HEALED model successfully distinguished participants that will develop AD dementia symptoms (82 with Prodromal AD and 83 with AD dementia) from non-AD subjects (71 individuals) with a specificity of 93.0% and sensitivity of 65.4% (AUROC=81.9%, p<0.001) during internal validation. When the amyloid status (derived from CSF or PET scans) and the B-HEALED model were applied in association, with individuals being categorized as AD if they tested positive in both tests, we achieved 100% specificity and 52.8% sensitivity. This performance was consistent in blind external validation, underscoring the model\'s reliability on independent datasets.
The B-HEALED test, utilizing multiomics blood-based biomarkers, demonstrates high predictive specificity in identifying AD patients within the cognitively impaired population, minimizing false positives. When used alongside amyloid screening, it effectively identifies a nearly pure prodromal AD cohort. These results bear significant implications for refining clinical
trial inclusion criteria, facilitating drug development and validation, and accurately identifying patients who will benefit the most from disease-modifying AD treatments.