IRCCS: The Italian network of neurosciences and neurorehabilitation

1. IRCCS : the Italian Network of
Neuroscience and Neurorehabilitation
UK-Italy Workshop on Dementia Research – Rome, 18 January 2018
Fabrizio Tagliavini
IRCCS Foundation «Carlo Besta» Neurological Institute, Milan

2. IRCCS Network of Neuroscience and Neurorehabilitation
§ 24 Research Hospitals (IRCCS)
CLINICAL ACTIVITIES
• Neurology (22)
• Child Neurology (8)
• Neurosurgery (9)
• Neurorehabilitation (10)
§ Mission: Translational Reserach
§ Funding: Italian Ministry of Health &
Regional Health System

3. Network of Neuroscience and Neurorehabilitation
• FONDAZIONE ISTITUTO NEUROLOGICO CARLO BESTA - MI
• FONDAZIONE CA’ GRANDA OSPEDALE MAGGIORE POLICLINICO -
MI
• OSPEDALE SAN RAFFAELE - MI
• ISTITUTO DI RICERCHE FARMACOLOGICHE MARIO NEGRI -MI
• FONDAZIONE DON CARLO GNOCCHI ONLUS - MI
• ISTITUTO AUXOLOGICO ITALIANO - MI
• ISTITUTO CLINICO HUMANITAS - ROZZANO (MI)
• FONDAZIONE POLICLINICO SAN MATTEO - PV
• ISTITUTO NEUROLOGICO CASIMIRO MONDINO - PV
• ISTITUTI CLINICI SCIENTIFICI MAUGERI - PV
• CENTRO SAN GIOVANNI DI DIO FATEBENEFRATELLI - BS
• EUGENIO MEDEA - LA NOSTRA FAMIGLIA - BOSISIO PARINI (LC)
• FONDAZIONE “OPERA SAN CAMILLO” - VE
• ISTITUTO DELLE SCIENZE NEUROLOGICHE DI BOLOGNA - BO
• ISTITUTO GIANNINA GASLINI - GE
• FONDAZIONE STELLA MARIS - CALAMBRONE (PI)
• FONDAZIONE SANTA LUCIA - ROMA
• OSPEDALE PEDIATRICO BAMBIN GESU’ - ROMA
• ISTITUTO SAN RAFFAELE PISANA - ROMA
• FONDAZIONE "GB BIETTI" - ROMA
• ISTITUTO NEUROLOGICO MEDITERRANEO NEUROMED - POZZILLI
(IS)
• ISTITUTO DI RICERCA DIAGNOSTICA E NUCLEARE - NA
• CENTRO NEUROLESI BONINO PULEJO - ME
• OASI MARIA SS - TROINA (EN)
Research Hospital (IRCCS)

4. Global Clinical and Research Capacity of the Network
Neurology, Child Neurology, Neurosurgery, Neurorehabilitation
q In-patients
q Out-patients
q Active Clinical Trials
q Impact Factor
• 7,385 beds
• ≈ 126,000 admissions/year
• ≈ 1,060,000 visits/year
• 1,006
• 14,349 (2016)
12 IRCCS carry out substantial clinical and preclinical
research on neurodegenerative diseases

5. Current Programs and Activities
§ Imaging Platforms
§ Genomic and Proteomic Platforms
§ Teleneurorehabilitation Platfotms
§ Harmonization and Research Projects
ü Advanced Neuroimaging Protocols
ü Genomics and Proteomic procedures and protocols
(including informed consent for genetics)
ü Teleneurorehabilitation procedures and protocols
Network of Neuroscience and Neurorehabilitation

6. Planned Programs and Activities
§ Harmonization
ü Clinical Protocols
ü Neuroimmunology protocols
§ Disease Registries
§ Database of Biorepositories and Biobanks
§ Teleneurology Platforms
§ Cell Factory
§ Structured interactions with Research Organizations,
Research Institutes, Industry, Patients’ Associations
ü Human Brain Project
ü Italian Institute of Technology
ü Human Technopole
Network of Neuroscience and Neurorehabilitation

7. IRCCS Network
Advanced Neuroimaging
Harmonization Procedures
MRI protocols across multiple sites and scanners
Research project funded by the Italian Ministry of Health
Sites: 22 IRCCS June
2018
March
2017

8. Co-funded by
the European Union
SlideSP8 Medical Informatics Platform – June 2017 Review – presentation slides, 14 June 2017
SP8
HBP-MIP validation in
IRCCS Neuroscience Network
BESTA - MI
FbF - BS
MONDINO - PV
Expected Outcome
1. Assessment of the added value
of MIP
2. Classification performance
assessments
3. Assessment of agreement
between data-driven
classification and clinical
diagnosis. Disagreement will be
formally discussed among
clinical experts
4. Validation of MIP as second
opinion tools
Show-Case on Dementias
today June 2018Oct 2017

9. § Implementation of
National Cloud Server
§ Each IRCCS shares the
Server, with its own private
account
§ No restriction concerning
additional IRCCS interested
in joining the net
14 Centres Involved
§ 9 with the same technology
§ 5 with different ICT devices
4 addtional centres will join the net
IRCCS
Telerehabilitation Network

10. Alzheimer Disease
IRCCS Research Project
1. Development of operational research criteria for early recognition of typical and
atypical forms of AD based on a multi-factorial protocol which integrates clinical,
imaging, and molecular data → WP1-2-3-4
2. Implementation of SOPs for imaging and CSF biomarkers in Expert Memory Clinics of
the NHS, and dissemination and implementation of an Integrated Care Pathway for
dementia at the community setting in different Italian Regions → WP4-5
AIMS

11. Genetic risk profile
G Di Fede, M Rossi
(Besta, MI)
CSF biomarkers
E Scarpini & D Galimberti
(Policlinico, MI)
‘Innovative’ biomarkers
F Moda (Besta, MI)
R Ghidoni (FbF, BS)
A Cattaneo & G Meli
(EBRI, Roma)
M Gobbi (Negri, MI)
FDG-PET & Amy-PET
D Perani (HSR, MI)
O Schillaci (Tor Vergata, RM)
A Pupi, V Berti (UniFI)
MRI
MG Bruzzone (Besta, MI)
M Bozzali (HSL, RM)
Associated PET Centres
Poliambulanza, BS
E Dottorini (UniPG)
B Paghera (UniBS)
E Fainardi (UniFI)
Associated MRI Centres
R Gasparotti (UniBS)
M Caulo (UniCH)
P Floridi (UniPG)
Enrolment of patients
G Spalletta, F Piras (HSL, RM)
S Iannacone (HSR, MI)
P Tiraboschi (Besta, MI)
B Borroni (UniBS)
S Sensi (UniCH)
Associated Clinical Centres
G Frisoni, S Cappa (FBF, BS)
S Sorbi (UniFI)
L Parnetti (UniPG)
Inter-societal ’Consensus
document’
G Frisoni (FbF, BS)
S Cappa (SINDEM)
M Trabucchi (AIP)
O Schillaci (AIMN)
A Beltramello (AINR)
M Ciaccio (SiBioc)
ICP
G Filippini (Besta, MI)
L Rozzini (UniBS)
S Sorbi (UniFI)
F Piras (HSL, RM)
R D’Alessandro (UniBO)
L Parnetti (UniPG)
AIM 1 - MARKERS FOR EARLY AND DIFFERENTIAL DIAGNOSIS
Coordinating Centre
IRCCS Foundation «Carlo Besta» Neurological Institute
WP4 SOPs for MRI and FDG-
PET
WP4 SOPs for MRI
WP1
Genetic and Biochemical
Markers
WP2
Imaging
PET & MRI Markers
WP3
Neuropsychological and
Neuropsichiatric Markers
WP4
SOPs
WP5
Integrated Care Pathway
(ICP) in 5 Regions
PI Fabrizio Tagliavini PI Daniela Perani PI Gianfranco Spalletta PI Giovanni Frisoni PI Lombardy Region
AIM 2 - SOPS FOR MEMORY CLINICS &
INTEGRATED CARE PATHWAY

12. All inclusion and exclusion criteria must be metAll inclusion and exclusion criteria must be met
T3 Clinical diagnosis re-formulated following
biomarkers results
Clinical diagnosis re-formulated following
biomarkers results
T12 Neuropsychology – MRI (only if MCI)
Clinical diagnosis revised at T12
Neuropsychology – MRI (only if MCI)
Clinical diagnosis revised at T12
T24
Neuropsychology – MRI (only if MCI)
Clinical diagnosis revised at T24
Neuropsychology – MRI (only if MCI)
Clinical diagnosis revised at T24
Neuropsychology
DNA
MRI
Neuropsychology
CSF – DNA
MRI – FDG & Amy-PET
Neuropsychology
CSF – DNA
MRI – FDG & Amy-PET
Neuropsychology
CSF – DNA
MRI – FDG & Amy-PET
Neuropsychology
CSF – DNA
MRI – FDG & Amy-PET
T0
100 Healthy Controls100 Healthy Controls
100 Subjective
Cognitive
Complaints
(Jessen et al., 2014)
100 Subjective
Cognitive
Complaints
(Jessen et al., 2014)
100 Pre-MCI
(Storandt et al., 2006,
mod.)
100 Pre-MCI
(Storandt et al., 2006,
mod.)
100 MCI
(Albert et al., 2011)
100 MCI
(Albert et al., 2011)
100 mild AD
(McKhannet al., 2011)
100 mild AD
(McKhannet al., 2011)
Early Diagnosis: Study Population and Flowchart

13. XNAT DATABASE

14. TOTAL ENROLLED SUBJECTS
(Update Dec 2017)
N Diagnosis
100 HC
51 SCC
45 Pre-MCI
118 MCI
44 AD
8 To be defined
TOT 366 enrolled + 70 in screening = 436

15. Conclusions
Ø Network of 24 IRCCS of Neuroscience and Neurorehabilitation
Support: Italian Ministry of Health, Regional Health Systems
National and International funding agencies
Ø Centres of Exellence
• Diagnosis, treatment, rehabilitation and long-term
menagement of neurological disorders of children and adults
• Translational Research in Neuroscience
ü Large cohorts of extensively characterized patients
ü Large database and biorepositories
ü Critical mass for national and international collaborative studies
and advanced education programs