- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01928420
A Single Site, Randomized, Double-blind, Placebo Controlled Trial of NIC5-15 in Subjects With Alzheimer's Disease
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Recent epidemiologic evidence, has suggested that diabetes mellitus significantly increases risk for the development of Alzheimer's disease, independent of vascular risk factors. Moreover, even patients who are simply insulin resistant, without frank diabetes, have been shown to share this elevated risk for the development of AD. As insulin's role as a neuromodulator in the brain has been revealed, several potential mechanisms for the interaction of diabetes or insulin resistance with AD have been suggested such as decreased cortical glucose utilization particularly in the hippocampus and entorhinal cortex; increased oxidative stress through the formation of advanced glycation end products; increased Tau phosphorylation and neurofibrillary tangle formation; and increased beta-amyloid aggregation through inhibition of insulin-degrading enzyme. The future treatment of AD might involve pharmacologic and dietary manipulations of insulin and glucose regulation
NIC5-15 is a single, small, naturally occurring molecule. Animal studies and some human trials have shown NIC5-15 to be safe and a potent insulin sensitizer at doses equivalent to 800-2000mg per day. In preclinical studies at doses higher than those previously studied in clinical trials, we found that NIC5-15 interferes with the accumulation of beta amyloid, an important step in the development of Alzheimer's pathology. These data suggest that NIC5-15 may be a reasonable therapeutic agent for the treatment of Alzheimer Disease for two reasons:
It is a -secretase inhibitor that is Notch-sparing. It is potentially an insulin-sensitizer.
However critical safety and human efficacy studies must be conducted. This application proposes to conduct these early critical human studies. The goal of the studies contained in this proposal is to establish safety and efficacy of NIC5-15 for the treatment of AD. The specific objectives of this study are to:
Specific Objective #1) Conduct a multiple dose safety study of NIC5-15 to establish safety in the doses that appear to block amyloid accumulation. These studies will characterize the safety profile, pharmacokinetics, and tolerability
This objective was met with completion of the initial study ID#NCT00470418.
The current study continues investigations of NIC5-15 in Alzheimer's disease with the following objective:
Specific Objective #2) Conduct a double blind placebo controlled pilot efficacy study of NIC5-15 in patients with AD. The goals of this study are to:
A) Demonstrate feasibility for a multi-site trial that will be used to guide the design of a future larger effort. Demonstration of feasibility will include examination of accrual rate, overall recruitment, adherence to protocol, compliance with medication and willingness to complete a randomized trial, and lack of short term toxicity.
B) Collect preliminary evidence of efficacy in terms of cognitive and global measures as well as secondary efficacy outcomes of activities of daily living, behavioral disturbances and AD biomarkers.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
New York
-
Bronx, New York, United States, 10468
- James J Peters Veterans Affairs Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- NINCDS/ADRDA criteria for probable AD
- MMSE between 12-27
- Treatment with a cholinesterase inhibitor or an NMDA (N-methyl-D-asparate) antagonist with stable dose for at least 12 weeks
- Home monitoring available for supervision of medications
- Caregiver available to accompany patient to all visits and willing to participate in study as informant
- Fluent in English or Spanish
- Medical stability for this study as confirmed by review of records, internist's physical exam, neurological exam, and laboratory tests
- Stable doses of non-excluded medication
- No evidence of hepatic insufficiency
- Able to swallow oral medications
- Ability to participate in the informed consent process
Exclusion Criteria:
- History of Diabetes Mellitus (OGTT criteria) requiring treatment with an excluded antidiabetic medication (see below) or history of hypoglycemia
- Active hepatic or renal disease
- Cardiac disease including history of congestive heart failure or current treatment for CHF; history of recent myocardial infarction
- Use of another investigational drug within the past two months
- History of clinically significant stroke
- History of seizure or head trauma with disturbance of consciousness within the past two years
- Major mental illness including psychotic disorders, bipolar disorder, or major depressive episode within the past two years Medication Exclusion
- Current use of oral hypoglycemic agents including sulfonylureas and meglintinides
- Current or past treatment with insulin for longer than two weeks
- Current use of drugs with significant anticholinergic or antihistaminic properties
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: NIC5-15
Subjects with Alzheimer's Disease Intervention: Drug: NIC5-15
|
A natural product, found in many foods and plants with mild insulin sensitizing effects
Other Names:
|
Placebo Comparator: Placebo
Subjects with Alzheimer's Disease Intervention: Drug: Placebo
|
Subjects with Alzheimer's Disease placebo comparator
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog)Score
Time Frame: Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
A psychometric instrument that evaluates memory, attention, reasoning, language, orientation, and praxis.
|
Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Alzheimer's Disease Cooperative Study Clinician's Global Impression of Change (ADCS-CCGIC) Score
Time Frame: Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
A systematic method for assessing clinically significant change in a clinical trial as viewed by an independent skilled and experienced clinician .
The ADCS-CGIC focuses on clinician's observations of change in the subject's cognitive, functional, and behavioral performance since the beginning of a trial.
It relies on both direct examination of the subject and an interview of an informant.
Unlike a targeted symptom scale, it takes into account a subject's overall function in the cognitive, behavioral, and functional activity domains.
|
Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
Change in Mini-Mental State Examination (MMSE) Score
Time Frame: Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
A frequently used screening instrument for Alzheimer's disease drug studies.
It evaluates orientation, memory, attention, concentration, naming, repetition, comprehension, and ability to create a sentence and to copy two intersecting polygons
|
Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
Change in Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL) Score
Time Frame: Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
ADCS-ADL assesses functional performance in subjects with Alzheimer's disease.
In a structured interview format, informants are queried as to whether subjects attempted each item in the inventory during the prior 4 weeks and their level of performance.
The ADCS-ADL scale discriminates well between normal controls and mild AD patients.
It has good test-retest reliability.
The ADCS-ADL includes some items from traditional basic ADL scales (e.g., grooming, dressing, walking, bathing, feeding, toileting) as well as items from instrumental activities of daily living scales (e.g., shopping, preparing meals, using household appliances, keeping appointments, reading).
|
Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
Change in Neuropsychiatric Inventory (NPI) Score
Time Frame: Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
The NPI is a well-validated, reliable, multi-item instrument to assess psychopathology and behavior in AD based on interview with the informant.
|
Over 6 months, measured at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
Changes in AD Biomarkers
Time Frame: Blood collected at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
Plasma beta-amyloid proteins will be collected from blood samples obtained at visit 2 (week 2), visit 6 (week 12), and visit 8 (week 24).
|
Blood collected at visits 2 (week 2), 6 (week 12), 8 (week 24)
|
APO-E genotyping
Time Frame: Collected at visit 2 (week 2)
|
APOe e4 is an important genetic risk factor for AD.
In this trial, as in many studies of AD and memory and cognition in aging, the APOe e4 allele will be analyzed as a predictor of clinical change over time.
|
Collected at visit 2 (week 2)
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Symptoms Checklist and Adverse Event Assessment
Time Frame: 6 Months, conducted at visits 3 (week 2), 4 (week 4), 5 (week 8), 6 (week 12), 7 (week 18), 8 (week 24)
|
Adverse events and symptoms checklist are used to monitor signs or symptoms that may or may not be related to study medication, abnormalities detected during physical examination, or clinical significant laboratory abnormalities.
|
6 Months, conducted at visits 3 (week 2), 4 (week 4), 5 (week 8), 6 (week 12), 7 (week 18), 8 (week 24)
|
Safety Laboratory Assessments
Time Frame: 6 Months, conducted at visits 1 (week 1), 3 (week 2), 4 (week 4), 5 (week 8), 6 (week 12), 7 (week 18), 8 (week 24)
|
Blood tests: hematology, serum chemistries, folate, B12, RPR, thyroid function (TSH or free thyroxine index), Urinalysis, Metabolic panel: HgbA1c, triglyceride profile serum albumin
|
6 Months, conducted at visits 1 (week 1), 3 (week 2), 4 (week 4), 5 (week 8), 6 (week 12), 7 (week 18), 8 (week 24)
|
Neurological examination
Time Frame: 6 Months, conducted at visits 1 (week 1), 6 (week 12), 8 (week 24)
|
Neurological examination measuring any possible sensory impairments and/or neurological abnormalities to determine if findings are consistent with eligibility for safety.
This must be signed by a clinician.
|
6 Months, conducted at visits 1 (week 1), 6 (week 12), 8 (week 24)
|
Physical examination
Time Frame: 6 Months, conducted at visits 1 (week 1), 3 (week 2), 5 (week 8), 6 (week 12), 7 (week 18), 8 (week 24)
|
Standard physical examination of vital signs, weight and height (to calculate BMI), seated blood pressure, EKG, seated pulse rate, respiration rate, and temperature, to determine if findings are consistent with eligibility for safety, which must be signed by a clinician.
|
6 Months, conducted at visits 1 (week 1), 3 (week 2), 5 (week 8), 6 (week 12), 7 (week 18), 8 (week 24)
|
Pharmacokinetic analysis
Time Frame: 6 Months, conducted at visits 2 (week 2), 8 (week 24)
|
A single assay of NIC5-15 concentration in blood samples obtained at visit 2 (week 2) and visit 8 (week 24).
|
6 Months, conducted at visits 2 (week 2), 8 (week 24)
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Hillel Grossman, MD, James J. Peters Veterans Affairs Medical Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
- diabetes
- dementia
- Alzheimer's Disease
- Nervous System Diseases
- clinical trial
- Therapeutics
- Alzheimer Disease
- Central Nervous System Diseases
- Neurodegenerative Diseases
- dietary supplements
- Mental Disorders
- Brain Diseases
- Alzheimer Type Senile Dementia
- Senile Dementia, Alzheimer
- Delirium, Dementia, Amnestic, Cognitive
- Disorders
Additional Relevant MeSH Terms
Other Study ID Numbers
- NCT01928420
- R21AT003302-01A1 (NIH)
- MHBB-009-06S (Department of Veterans Affairs)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Dementia
-
University of North Carolina, Chapel HillNational Institute on Aging (NIA)CompletedAlzheimer Dementia | Dementia Alzheimers | CaregiverUnited States
-
Temple UniversityRecruitingDementia | Mild Cognitive Impairment | Dementia, Vascular | Dementia, Mixed | Dementia Alzheimers | Mild Dementia | Dementia of Alzheimer Type | Dementia, MildUnited States
-
Hebrew SeniorLifeRecruitingAging | Alzheimer Dementia | Presenile Alzheimer DementiaUnited States
-
Temple UniversityRecruitingDementia | Alzheimer Disease | Mild Cognitive Impairment | Dementia, Vascular | Dementia, Mixed | Dementia Alzheimers | Mild Dementia | Dementia of Alzheimer Type | Dementia, MildUnited States
-
Cognito Therapeutics, Inc.Enrolling by invitationExtension to a Pivotal Study of Sensory Stimulation in Alzheimer's Disease (OLE Hope Study, CA-0015)Cognitive Impairment | Alzheimer Disease | Mild Cognitive Impairment | Dementia Alzheimers | Dementia of Alzheimer Type | AD | Dementia, Mild | Dementia ModerateUnited States
-
National Tainan Junior College of NursingCompletedCognitive Impairment | Dementia, Mild | Dementia ModerateTaiwan
-
Karen RobertoNational Institute on Aging (NIA)RecruitingDementia | Dementia Alzheimers | Neuro-Degenerative Disease | Dementia of Alzheimer Type | Dementia SevereUnited States
-
University College, LondonNot yet recruitingDementia | Dementia, Vascular | Dementia, Mixed | Dementia With Lewy Bodies | Dementia of Alzheimer Type | Dementia Moderate | Dementia Severe | Dementia Frontal | DEM
-
University College, LondonThe University of Hong KongUnknownDementia | Dementia, Vascular | Dementia, Mixed | Dementia With Lewy Bodies | Dementia of Alzheimer Type | Dementia Moderate | Dementia Severe | Dementia Frontal
-
Karolinska InstitutetRegion Stockholm; KTH Royal Institute of TechnologyActive, not recruitingAlzheimer Dementia | Dementia DisordersSweden
Clinical Trials on Drug: NIC5-15
-
VA Office of Research and DevelopmentNational Center for Complementary and Integrative Health (NCCIH); Humanetics...CompletedDementia | Alzheimer DiseaseUnited States
-
Mayo ClinicCompleted
-
University Hospital, Strasbourg, FranceCompletedSurgical Intervention | MinorFrance
-
National Cancer Institute (NCI)CompletedHead and Neck Squamous Cell Carcinoma | Recurrent Head and Neck Carcinoma | Recurrent Renal Cell Carcinoma | Recurrent Skin Carcinoma | Stage III Renal Cell Cancer | Stage IV Cutaneous Melanoma AJCC v6 and v7 | Recurrent Non-Small Cell Lung Carcinoma | Stage IIIC Cutaneous Melanoma AJCC v7 | Stage IV... and other conditionsUnited States
-
NEURALIS s.a.Active, not recruitingCovid19Belgium, Hungary, Russian Federation, Poland
-
National Cancer Institute (NCI)Completed
-
Dr. Reddy's Laboratories LimitedCompleted
-
University of ZurichCompleted
-
University of ZurichRecruitingChronic Obstructive Pulmonary DiseaseSwitzerland
-
National Cancer Institute (NCI)CompletedMycosis Fungoides | Sezary Syndrome | Adult T-Cell Lymphoma/LeukemiaUnited States