Huntington's disease (HD) is a devastating untreatable hereditary neurodegenerative disorder that affects most sufferers in early adult life. Through genetic testing, people who will ultimately develop HD can be identified years before clinical onset, raising the possibility of initiating therapy in this preclinical period to delay o prevent disease onset. Performing clinical trials in a group of clinically normal individuals, however, presents several challenges. One major difficulty is defining the best outcome measure for use in such trials. Currently, clinical trials in HD utilize clinical outcome measures such as the Unified Huntington's Disease Rating Scale, but these measures are not useful in clinically unaffected individuals. Measuring phenoconversion (i.e. progressing from preclinical HD to diagnosed HD) as an outcome measure may be impractical as subjects in clinical trials may be many years from developing unequivocal signs of HD. Therefore, there has been a concerted effort to identify reliable biomarkers for measuring progression in preclinical HD (pHD) subjects. PREDICT- HD is an NINDS funded multicenter longitudinal study to measure the earliest clinical and imaging (MRI) changes that occur in preclinical HD with the goal of identifying such biomarkers. Utilizing a new network modeling strategy designed for the analysis of longitudinal brain imaging data, we identified and validated an HD-related progression pattern (HDPP) in resting state metabolic scans of premanifest carriers of the HD mutation. Our preliminary data suggest that by capturing functional changes occurring in a specific pattern across the whole brain, HDPP is likely to be more sensitive to disease progression than other imaging biomarkers. In this study, we propose adding resting state metabolic imaging with FDG PET (to be conducted at baseline and after 1 year) to quantify individual subject HDPP expression at each longitudinal time point in PREDICT-HD participants. We plan to address the following Specific Aims: (1) To validate HDPP in a new cohort of well characterized pHD subjects and to measure the change in its expression over 1 year;(2) To compare the rate of change in HDPP over 1 year to changes in other PREDICT-HD measures including MRI (volumetrics, MHDPP), and clinical measures;and (3) To reproduce and validate a novel brain network associated with HD symptom onset. The ultimate goal of this work is to identify the most sensitive and reliable imaging measure for use in future clinical trials in individuals with preclinical HD.

Public Health Relevance

HD is a neurodegenerative disorder that usually begins in the prime of life (early adulthood). The disease affects approximately 30,000 individuals, but an additional 150,000 are at-risk for developing HD. This research study seeks to validate a novel brain network biomarker in metabolic scans from preclinical carriers of the HD gene mutation (pHD);this biomarker will be used to measure disease progression in pHD, and will have potential application in future clinical trials aimed at modifying disease progression.

National Institute of Health (NIH)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZNS1)
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Sutherland, Margaret L
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Feinstein Institute for Medical Research
United States
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