An omics-based strategy using coenzyme Q10 in patients with Parkinson's disease: Concept evaluation in a double-blind randomized placebo-controlled parallel group trial

Background: This study focuses on genetically stratified subgroups of Parkinson's disease patients (PD) with an enrichment of risk variants in mitochondrial genes,who might benefit from treatment with the "mitochondrial enhancer" coenzyme Q10 (156 mg coenzyme Q10/d [QuinoMit Q10® Fluid] over six months). The study will be performed in a double-blind, randomized, and placebo-controlled parallel group manner. Methods: PD patients will be specifically identified and assigned to treatment groups stratified by their genetic "mitochondrial risk burden" and consequently expected mitochondrial dysfunction and treatment response to coenzyme Q10 (homozygous or compound heterozygous Parkin/PINK1 mutation carriers [P++], heterozygous Parkin/PINK1 mutation carriers [P+], "omics" positive [omics+], and "omics" negative PD patients [omics-]). The primary endpoint is the change in motor symptoms over six months (as measured by the change in the motor subscore of the MDS-UPDRS). Secondary clinical endpoints include motor fluctuations, non-motor symptoms, results of magnetic resonance imaging of brain energy metabolism (31P-magnetic resonance spectroscopy imaging), and changes in structural and functional brain anatomy (MRI). Perspective: This study may be a first step towards a successful prediction of treatment response based on the genetic status of PD patients and translate progress in molecular genetics into personalized patient care. Further, magnetic resonance spectroscopy imaging may help quantify increased energy supply objectively and within a brief time after the start of treatment. Therefore, the potential of MRSI also for other studies addressing brain energy metabolism may will be assessed. Trial registration: This study was registered at the German Clinical Trial Registry (DRKS, DRKS00015880) on November 15th, 2018.