Fluid Biomarkers with Deep Phenotyping in Patients with ALS (ALSA-BIO3)

Study Purpose:

The goal of the study is to continue to build the Northeast ALS Consortium (NEALS) biorepository with this collection protocol to associate biofluid collection with specific measures of upper and lower motor neuron function.


Amyotrophic Lateral Sclerosis (ALS),  Sporadic ALS

Study Type:

Observational Study

Study Category:

biological samples

Study Status:

Not enrolling


Not Applicable

Study Chair(s)/Principal Investigator(s):

Shafeeq Ladha, Barrow Neurological Institute

Clinicaltrials.gov ID (11 digit #):


Neals Affiliated?


Coordinating Center Contact Information

Barrow Neurological Institute
Praveena Mohan / .(JavaScript must be enabled to view this email address) / 602-406-3032
Meghan Hall / .(JavaScript must be enabled to view this email address) Phoenix, Arizona 85013 United States

Full Study Summary:

The Northeast ALS Consortium (NEALS) biorepository is an existing resource which has provided scientists with a wide range of samples associated with clinical information. Our goal is to continue to build this repository with this collection protocol to associate biofluid collection with specific measures of upper and lower motor neuron function. This project will compliment others to upgrade the NEALS biorepository infrastructure, including updating the computer systems, expanding the number of sample freezers and establishing a repository in the Western United States, and strengthening the standard operating procedures for the repository. The project also supports existing efforts to expand the biorepository by collecting new blood and spinal fluid samples from people with ALS. This is a multicenter, non-interventional, longitudinal study in patients with ALS. There will be four (4) subject visits in this study: Baseline, month 6, month 12, and month 18. At each visit, subjects will have biofluids collected, and be evaluated with assessment tools that focus on upper and lower motor neuron burden as well as cognitive function.

The primary objective of the study is to obtain information on patients studied at regular intervals over 18 months, in conjunction with biofluid collection over that same time period. The secondary objective of the study is to integrate data from this study to other ongoing projects via the NEALS biorepository, and future collections now being planned. The outcome measures of this study are as follows:
• Motor unit number estimation will be performed on bilateral upper extremity muscles using the multipoint incremental technique (MIMNUE)
• Vital capacity, measured using slow vital capacity (SVC)
• Lower motor neuron excitability will be assessed with threshold tracking nerve conduction studies (ttNCS) in the least affected intrinsic hand muscle
• Cognitive abnormalities will be assessed using the ALS Cognitive Behavior Screen (ALS-CBS™)
• Upper motor neuron burden will be assessed using transcranial magnetic stimulation (TMS), employing a paired pulse protocol and recording from the least affected upper extremity intrinsic hand muscle
• Hand held dynamometry (HHD) will be performed on 9 muscle groups tested bilaterally
• Global function (ALSFRS-R)

At each visit, blood will be collected and banked for biomarker discovery; CSF will be collected at baseline, month 6, and at month 18.

Study Sponsor:

The ALS Association and Fulton Family Foundation

Participant Duration:

4 visits over 18 months

Estimated Enrollment:


Estimated Study Start Date:


Estimated Study Completion Date:


Posting Last Modified Date:


Date Study Added to alsconsortium.org:

  • More Information

    In this informational webinar, Dr. Shafeeq Ladha reviews the BIO3 study design and answers questions about the study: https://www.neals.org/for-people-with-als-caregivers/educational-webinars/alsa-bio3-building-future-success-through-biomarkers

  • Eligibility Criteria


    Female, Male

    Minimum Age:


    Maximum Age:


    Time since Symptom Onset:

    Time since Diagnosis:

    <24 months

    Can participants use Riluzole?


    Inclusion Criteria:

    • Participants with sporadic ALS diagnosed as possible, laboratory-supported probable, probable or definite according to the World Federation of Neurology El Escorial criteria.
    • Expected to survive >1 year (12 months) after enrollment.
    • Male or female, aged 18-75.
    • Ability to medically undergo lumbar puncture (LP) as determined by the investigator (i.e., no bleeding disorder, allergy to local anesthetics, prior lumbar surgery which might make LP difficult, a skin infection at or near the LP site, or evidence of high intracranial pressure).
    • Willingness and medical ability to comply with scheduled visits, LP for CSF collection, laboratory tests, and other study procedures.
    • Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (PHI) in accordance with national and local subject privacy regulations.
    • Geographic accessibility to the study site.

    Exclusion Criteria:

    • Any contraindications to having an LP, including but not limited to: Platelet count <100,000/µL.
    • History of bleeding disorder.
    • History of intolerance to the LP procedure.
    • Evidence of topical or other skin infection at the LP site.
    • History of allergy or other adverse reaction to local anesthetics used in the study.
    • History of traumatic central nervous system injury or stroke.
    • Other unspecified reasons that, in the opinion of the Investigator, make the subject unsuitable for enrollment.

    Additional criteria for sites performing TMS:

    • Inability to perform either TMS or NCS studies due to insufficient motor evoked potential (MEP) or compound muscle action potential (CMAP) amplitude.
    • Contraindication to TMS studies including ferromagnetic metal in the head or neck (potentially found in aneurysm clips, implanted medication pumps, implanted brain stimulators, pacemakers, cochlear implants), or history of epilepsy. Dental fillings are permitted.

    Additional criteria for sites performing MRI cytography:

    • Subjects who have a history of claustrophobia that cannot be adequately controlled.
    • Subjects who have a physical limitation related to fitting in the bore of the magnet.
    • Subjects who have a history of allergic reaction to contrast agents.
    • Subjects with a pacemaker, epicardia pacemaker wires, MRI-incompatible cardiac valve prostheses, MRI-incompatible vascular clips.
    • Subjects with MRI-incompatible cochlear implants.
    • Subjects with spinal nerve simulators.
    • Subjects with an infusion pump.
    • Subjects with metallic fragments in the eyes/orbits or in the vicinity of the brain or major neurovascular structures of the body, subjects with an employment history which involves exposure to welding, or subjects who have shrapnel any place in their body.
    • Subjects with acute kidney injury or renal insufficiency (eGFR of <20 ml/min/1.73 m^2) as they are at increased risk of Nephrogenic Systemic Fibrosis following administration of gadolinium-based MRI contrast agents.
    • Subjects unable to lay supine in the magnet because of orthopnea.

  • Site Contact Information

    Barrow Neurological Institute
    Nicole Turcotte / .(JavaScript must be enabled to view this email address) / 602-406-4775
    Phoenix, Arizona 85013
    United States

    University of California, Irvine
    Ivonne M Turner / .(JavaScript must be enabled to view this email address) / 714-456-8323
    Dept. of Neurology
    Orange, California 92868
    United States

    University of Michigan
    Ann Arbor, Michigan 48109
    United States

    Spectrum Health
    Brandon James / .(JavaScript must be enabled to view this email address) / 616-486-2058
    Grand Rapids, Michigan 49503
    United States

    Hospital for Special Surgery (HSS)
    Mona Shahbazi / 212-774-2361
    New York, New York 10021
    United States

    Oregon Health & Science University
    Diana Dimitrova, PhD / .(JavaScript must be enabled to view this email address) / 503-494-7269
    Portland, Oregon 97239
    United States

    Temple University
    Kathleen Hatala / .(JavaScript must be enabled to view this email address) / 215-707-4171
    Philadelphia, Pennsylvania 19122
    United States

    University of Pittsburgh Medical Center
    Danielle Rowlands / .(JavaScript must be enabled to view this email address) / 412-864-2873
    Pittsburgh, Pennsylvania 15213
    United States

    Medical University of South Carolina
    Michelle DeCandio, RN, OCN / .(JavaScript must be enabled to view this email address) / 843-792-9016
    Department of Neurosurgery & Neurology
    Charleston, South Carolina 29425
    United States