Multiple System Atrophy (MSA) Clinical Research: The 2026 Outlook
By: Michael Dauer, MS, MBA
Director of Operations, Inland Northwest Research
Multiple System Atrophy (MSA) is a rare, aggressive neurodegenerative disorder that affects both movement and involuntary “autonomic” functions such as blood pressure regulation and bladder control. For those living with MSA and their families, navigating this diagnosis can feel overwhelming. Historically, treatment has focused on symptom management. However, as we move through 2026, the landscape of MSA clinical research is shifting toward investigation of “disease-modifying” therapies—treatments designed to slow down the underlying disease process itself.
At Inland Northwest Research (INWR), we have witnessed this evolving landscape firsthand. While our clinic is rooted in Spokane, our mission extends broadly across the region. We routinely support participants traveling from across the Inland Northwest to access research opportunities that may not be available in their local communities.
Please note: The studies described below reflect research previously conducted at INWR. Enrollment for these specific trials is currently closed at our site.
The Science of 2026: Targeting Alpha-Synuclein
MSA is defined by the abnormal accumulation of a protein called alpha-synuclein within oligodendrocytes—a type of glial cell in the brain. In 2026, much of the investigational research focuses on synucleinopathies, a group of disorders including MSA and Parkinson’s disease where alpha-synuclein misfolding is believed to play a central role. It is worth noting that while these diseases share this protein abnormality, they are pathologically distinct: in MSA, the accumulation occurs primarily in glial cells, whereas in Parkinson’s disease it occurs in neurons. This distinction is one reason why therapeutic approaches must be carefully tailored to each condition.
What We’ve Learned: The Science That Brought Us Here
The research underway in 2026 does not exist in isolation—it is built on a foundation of recent findings that, for the first time, are giving the MSA scientific community genuine reasons for cautious optimism.
In 2024, results from the Phase 2 AMULET trial of amlenetug—the same investigational antibody evaluated in the MASCOT study at INWR—offered an important signal. The trial did not meet its primary endpoint of statistically significant slowing of disease progression in the overall study population, which is an outcome researchers must report honestly and take seriously. However, in participants who were earlier in their disease course, the drug showed a meaningful slowing of progression. That finding is exactly why Lundbeck proceeded to initiate the larger Phase 3 MASCOT trial: to determine whether that signal holds in a broader, better-powered study. INWR’s participation in MASCOT means our patients contributed directly to that next chapter of the science.
Also in early 2025, a separate investigational compound—ATH434, developed by Alterity Therapeutics—reported positive Phase 2 results in MSA, becoming one of the first therapies to demonstrate statistically significant slowing of clinical progression alongside imaging evidence of reduced brain atrophy. ATH434 works through a different mechanism than amlenetug, targeting excess iron in the brain that contributes to alpha-synuclein aggregation. While this drug is not part of INWR’s current research portfolio, its results are meaningful for the entire field: they suggest that the goal of slowing MSA—long considered out of reach—may be scientifically achievable.
Taken together, these developments represent a meaningful shift in the MSA research landscape. The studies INWR has participated in are not isolated efforts—they are part of a coordinated, global scientific push that is beginning to produce results. Every participant who enrolled in our trials contributed to that momentum.
INWR has participated in research across two major investigational pathways.Enrollment for both studies is currently closed at our site:1. Lundbeck MSA – MASCOT Study (Study 20432A)
The MASCOT study evaluated amlenetug (Lu AF82422), an investigational passive immunotherapy antibody targeting forms of alpha-synuclein—meaning the antibody is administered directly rather than prompting the immune system to generate its own response. Initiated following the encouraging Phase 2 AMULET signal described above, MASCOT was a randomized, double-blind, placebo-controlled study with an optional open-label extension, meaning participants who completed the blinded portion may have had the opportunity to receive active study drug, depending on eligibility and study status.
Enrollment for this study is currently closed at Inland Northwest Research.2. Teva Branded Pharmaceutical – TOPAS-MSA Study
The TOPAS-MSA study (Targeting Oligomer Pathology of Alpha-Synuclein) evaluated emrusolmin (TEV-56286) in adults with MSA. Where amlenetug is an injectable antibody that works outside cells, emrusolmin takes a fundamentally different approach: it is an oral, brain-penetrant small molecule that enters brain cells directly and inhibits the formation of toxic alpha-synuclein oligomers from within. The fact that the field is pursuing these two strategies simultaneously—one targeting extracellular alpha-synuclein, one targeting it intracellularly—reflects the breadth and seriousness of the global research effort. Emrusolmin has received both Orphan Drug designation (2022) and FDA Fast Track designation (September 2025), recognizing the significant unmet need it aims to address.
This was a randomized, double-blind, placebo-controlled Phase 2 study. Enrollment for this study is currently closed at Inland Northwest Research, though the trial continues at other sites globally.Understanding the Two Presentations of MSA
Research in 2026 increasingly recognizes that MSA presents differently across individuals. Clinical trials often stratify participants based on their subtype:
MSA-P (Parkinsonian type): Characterized by stiffness, slowness (bradykinesia), and tremor that often resembles Parkinson’s disease. In some studies, MSA-P has been associated with more rapid progression, though rates can vary across individuals.
MSA-C (Cerebellar type): Characterized by balance impairment, coordination difficulties (ataxia), and speech or swallowing changes (dysarthria or dysphagia).
Participation in research helps investigators better understand how investigational approaches may perform across these differing clinical presentations.
How Participation Advances Rare Disease Research
Because MSA is a rare “orphan” disease, each participant—including those who receive placebo—contributes data that the scientific community cannot obtain any other way. For many who participate, the motivation is not the hope of personal benefit, but the knowledge that their contribution may help families who receive this diagnosis years from now. By joining a study at INWR, participants may contribute to:
Testing Whether Treatments Can Slow or Modify the Disease: The ultimate goal of MSA research is to find therapies that do more than manage symptoms—therapies that can slow or halt the disease process itself. Current trials are rigorously evaluating whether investigational treatments move us closer to that goal. Every participant, whether receiving the investigational drug or placebo, helps answer that question.
Understanding How MSA Progresses Over Time: Participants who receive placebo are not “missing out”—they are making an essential contribution. Tracking how MSA evolves in the absence of an investigational drug helps researchers map the natural course of the disease, identify reliable biological markers, and build a clearer picture of what future treatments will need to achieve. This knowledge directly shapes the next generation of clinical trials.
Laying the Groundwork for Future Patients: Even when a trial does not result in an approved treatment, it is never without value. Each study establishes safer, smarter ways to design future research—refining what outcomes to measure, what dosing approaches to explore, and what patient populations may benefit most. Participants today are building the scientific foundation that researchers and future patients will stand on.
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About Clinical Research at Inland Northwest Research
Future Research Opportunities
Inland Northwest Research actively participates in clinical research across the full spectrum of movement disorders, including Parkinson’s disease, Multiple System Atrophy, Huntington’s disease, Ataxia, Dystonia, Essential Tremor, and related conditions. New studies are continuously entering development, and our research portfolio evolves as the science does.
We are committed to posting new research opportunities on our website only after they have received IRB approval and are formally open for enrollment. This ensures that any study we publicize has undergone independent ethical review and that participants can be properly informed and screened. We encourage patients, caregivers, and referring clinicians to check back regularly or reach out to our team directly to ask about studies that may be relevant to a specific diagnosis.
If you have been diagnosed with a movement disorder and are interested in learning whether any current or upcoming studies may be a fit, we welcome your inquiry—even if nothing is available today. Connecting early allows us to reach out when relevant opportunities open.
Research vs. Treatment: An Important Distinction
Inland Northwest Research is a clinical trial site, not a primary care clinic. While our sister organization, Selkirk Neurology, provides established medical treatments and symptom management, INWR conducts regulated clinical studies designed to evaluate investigational drugs and devices. If you are seeking treatment for a diagnosed condition, your neurologist or primary care provider is the appropriate first point of contact.
In many clinical trials, participants are randomized and some may receive a placebo as part of the study design. This is a scientifically necessary method used to determine whether an investigational treatment is safe and effective. There is no guarantee of direct medical benefit to any individual participant. Participation is entirely voluntary, and individuals may withdraw at any time without penalty or effect on their medical care.
Eligibility criteria, visit schedules, risks, and potential compensation vary by protocol. All of these details are reviewed thoroughly during the informed consent process, which occurs prior to any research activities beginning. Participants are encouraged to review consent documents with family members and their treating neurologist before making any decision.
How the Enrollment Process Works
For any study at INWR, the enrollment process follows the same structured steps designed to protect participants and ensure the right fit between individual and protocol:
Connect: Reach out to us at (509) 960-2818 or contact@inwresearch.com.
Pre-Screen: We review medical history and basic eligibility criteria specific to each protocol.
Informed Consent Review: If preliminarily eligible, you will receive a detailed informed consent form to review with family members and your treating neurologist before making any decision.
Screening Visit: If you choose to proceed, formal screening assessments are completed at our Spokane clinic. Final eligibility is determined strictly according to protocol-defined inclusion and exclusion criteria.