Motor Neuron Disease (MND) is the result of dysfunction of the upper motor neurons in the precentral gyrus of the frontal lobe or the lower motor neurons in the ventral horn of the spinal cord. Amyotrophic lateral sclerosis (ALS) is the most common, disabling, and fatal motor neuron disease in adults. Sarcopenia is a syndrome characterized by progressive loss of skeletal muscle mass, accompanied by a reduction in muscle strength and (or) function, and it is an important feature of MND. Aging is an objective and inevitable process that involves the gradual degeneration and loss of physiological functions in various tissues, organs, and cells. With the continuous accumulation of various injuries, the body eventually exhibits signs of frailty such as fatigue, reduced muscle strength, and weight loss. Data from adult ALS patients indicate that 58% of patients are at risk of frailty. Silkworm pupa contains high-quality animal protein and has a wide range of activities in antioxidant, antitumor, antibacterial, and immune enhancement, making it highly nutritious and medicinally valuable. Silkworm pupa extracts can enhance grip strength in older adults with relatively low skeletal muscle mass. As a natural food ingredient with high safety, the value of silkworm pupa in ALS patients lacks corresponding research, which limits its further application in clinical practice. This study aims to select ALS patients as the research subjects and use a randomized, controlled, double-blind prospective study design to evaluate the effectiveness of silkworm pupa tablets in improving sarcopenia, frailty, and quality of life in ALS patients. The study strives to improve the frailty condition of ALS patients and enhance their quality of life by supplementing nutrition, thereby providing new strategies for comprehensive intervention and management of ALS patients.
Voluntarily participate in the clinical study, fully understand and be informed about the study, and sign the Informed Consent Form (ICF); willing to follow and capable of completing all trial procedures.
Gender is not limited, age at the time of signing ICF: ≥18 years old, ≤80 years old; if the ALS patient is at least 18 years old, then the weight must be over 40 kilograms.
Diagnosis conforms to the confirmed and probable ALS in the ALS2020 diagnostic criteria (Gold Coast Criteria).
Clinical, neurophysiological, or pathological examination confirms evidence of lower motor neuron involvement.
Patients with other neurological diseases similar to ALS symptoms or affecting drug efficacy evaluation, such as cervical spondylosis, lumbar disease, dementia, etc.
Patients with other autoimmune diseases, such as Multiple Sclerosis (MS), Polymyositis, Myasthenia Gravis, Guillain-Barré Syndrome, Ankylosing Spondylitis, Rheumatoid Arthritis, Systemic Lupus Erythematosus, Vitiligo, etc.
Severe renal insufficiency: Creatinine clearance < 30 mL/min (Cockcroft-Gault formula), or other known severe renal insufficiency diseases.
Severe liver damage: ALT, AST > 3 times the upper limit of normal, or other known liver diseases such as acute and chronic active hepatitis, cirrhosis, etc.
Parallel
Chinese medicine - Silkworm pupa powder
Other interventionSilkworm pupa contains high-quality animal protein and has a wide range of activities in antioxidant, antitumor, antibacterial, and immune enhancement, making it highly nutritious and medicinally valuable.
Ultra-low dose silkworm pupa powder
Other intervention0.5% of the effective components in the experimental group
Assessing patient nutritional improvement using Third Lumbar Skeletal Muscle Index (L3-SMI).
The nutritional index is evaluated using the Third Lumbar Skeletal Muscle Index (L3-SMI): A single cross-sectional image of L3 is obtained through CT scanning, and skeletal muscles in the image are identified and quantified using a HU threshold of -29 to 150. The total muscle area at this level is calculated using 3D Slicer software, and then divided by the square of the height (m\^2) to obtain the Third Lumbar Skeletal Muscle Index (L3-SMI).
The improvement of frailty in patients treated by the Frailty Phenotype (FP) Scale assessment.
Frailty Phenotype Scale: The Frailty Phenotype (FP) Scale encompasses the following five clinical criteria: * Unintentional Weight Loss * Self-reported Fatigue * Decreased Physical Activity * Slowed Gait Speed * Weak Grip Strength Each criterion is scored as 1 point if met, with a total score ranging from 0 to 5. A score of 0 indicates robust health, a score of 1 to 2 indicates pre-frailty, and a score of 3 or higher indicates frailty. This scale is used to assess the frailty status of individuals, providing a separate outcome measure that focuses on the physical vulnerability and decreased resilience commonly associated with aging.
Using the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) to assess patient functional status, thereby evaluating the improvement of neurological dysfunction.
Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) consists of 12 items with a total score of 48 points, where each item is rated from 0 to 4, with 0 indicating complete loss of function and 4 indicating normal function. The minimum score is 0 points, which indicates that the patient is completely unable to perform any of the tasks listed in the scale, while the maximum score is 48 points, indicating that the patient can perform all tasks normally. A higher score implies better functional status in the patient, meaning less severe neurological impairment; a lower score indicates worse functional status, meaning more severe neurological impairment. This scale is a specific tool for evaluating the functional status of patients with Amyotrophic Lateral Sclerosis, offering a distinct outcome measure that quantifies the progression of the disease.
Assess the respiratory function of patients with Amyotrophic Lateral Sclerosis undergoing treatment using the Oxygenation Index.
Oxygenation Index: The Oxygenation Index combines arterial oxygen partial pressure (PaO2) and inspired oxygen fraction (FiO2), calculated using the formula Oxygenation Index (mmHg) = PaO2 (mmHg) / FiO2 (%). It provides a single value indicating a patient's oxygenation status relative to the oxygen concentration they are breathing, thereby characterizing respiratory function. During the treatment process, the change coefficients of the Oxygenation Index after intervention in the silkworm pupa treatment group and the placebo group are calculated, using this coefficient to characterize the relief ratio of respiratory function following Silkworm pupa powder intervention.
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First People's Hospital of Hangzhou
Lead sponsor
Hangzhou Institute of Medicine Chinese Academy of Sciences
Collaborator
