Pediatric Exploratory Research Study of EGCG Use and Safety (PERSEUS) (PERSEUS)

June 10, 2021 updated by: Rafael de la Torre, Parc de Salut Mar
To evaluate safety and tolerability of epigallocatechin gallate (EGCG) in children from 6 to 12 years old with Intellectual Developmental Disorders (IDD) (Down syndrome or Fragile X syndrome).

Study Overview

Detailed Description

This project first objective is to evaluate the safety and tolerability of the EGCG molecule (extracted form green tea) on children from 6 to 12 years old with Intellectual Development Disorder (Down syndrome and Fragile X syndrome).

The secondary objective is to evaluate the benefits of the EGCG on attention, memory, executive functions, language and adaptive behaviour of these children. Dyrk1A and homocysteine in plasma will also be quantified, using them as biomarkers of efficacy.

Study Type

Interventional

Enrollment (Actual)

76

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Barcelona, Spain, 08003
        • IMIM (Institut Hospital del Mar d'Investigacions Mèdiques)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

4 years to 10 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Males and females aged 6 to 12 years on day 1 of treatment.
  • Clinical diagnosis of DS (full trisomy 21 or translocated) confirmed by chromosomal analysis (karyotyping) (Cohort I) or molecular diagnosis for FXS (mutations or premutations on the fragile mental retardation 1 gene-Fmr1 of the X chromosome) (Cohort II). A karyotype will be performed if not available in DS population. FXS molecular diagnosis will be performed if not available in FXS population.
  • A body-weight under 50 kg.
  • Parent or legal guardian/representative and caregiver willing to give written informed consent.
  • Mental age ≥ 3 years (Brunet-Lézine scale C version, picture naming and receptive vocabulary of the WPPSI-IV)
  • Study participants must have sufficient vision and hearing to participate in study evaluations. Mild hearing loss will be allowed.
  • Availability of parent/caregiver to accompany the subject to clinical visits, provide information about the subject's behavior and symptoms and ensure compliance with the medication schedule.
  • Subjects must be able to understand basic instructions. Naming and comprehension tasks of the WPPSI-IV will be used as an evaluation

Exclusion Criteria:

  • Study participants with a current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of any primary psychiatric diagnosis (including autism spectrum disorder). For secondary diagnoses, such as attention deficit hyperactivity disorder, depression and conduct disorder, individuals under a fixed regime of medication (a regime that does not change in the 6 weeks prior to enrollment) are allowed as long as they are considered stable and their medication does not interfere with the progression of the study.
  • Personal history of infantile spasms, of epilepsy, of severe head trauma or Central Nervous System (CNS) infections (e.g. meningitis), with the exception of a single isolated febrile seizure.
  • Subjects with past history of seizures from primary causes (such as West syndrome and Lennox-Gastaut syndrome) or secondary causes.
  • Clinical history of moderate or severe Obstructive Sleep Apnea (OSA) as defined by Apnea-Hypopnea Index (AHI) (>15 events per hour not well controlled by positive airway pressure therapy with stable settings) for at least 3 months prior to screening visit.
  • Subjects with thyroid disease that is not controlled (elevated basal Thyroid-stimulating hormone (TSH) > 10 microU/mL) by thyroid hormone respective therapy.
  • Evidence of active, clinically significant, and unstable gastrointestinal, renal, hepatic, endocrine or cardiovascular system disease.
  • Cardiovascular, Systolic Blood Pressure (SBP) and/or Diastolic Blood Pressure (DBP) outside the 95th percentile for age; resting heart rate above 100 bpm.
  • Cardiovascular, ECG: clinically relevant ECG abnormalities at screening. Auscultation is mandatory part of cardiovascular examination.
  • Clinically significant abnormalities in laboratory test results at screening unless acceptable by the investigator.
  • Life-threatening illness or major surgery in the 3 months prior to the study.
  • Concomitant disease or condition or any clinically significant finding at screening that could interfere with the conduct of the study, or that would, in the opinion of the investigator, could lead to an unacceptable risk to the subject in this study.
  • Patients with risk factors of liver dysfunction such as previous history of liver disease, previous clinically significant hepatic abnormalities in laboratory testing, previous allergy or intolerance with liver disorders or any clinically significant abnormalities in hepatic laboratory testing at screening
  • Participation in other clinical trials in the last 3 months prior to the study.
  • Concomitant use of unapproved medication.
  • Current intake of vitamin supplements, catechins or products containing EGCG (i.e. TEAVIGO, Mega Green Tea capsules Life Extension or Font-UP Grand Fontaine Laboratories) for at least 3 months previous to the screening.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

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: Experimental group DS and FXS
Cohort 1: a 35 DS children group taking EGCG FontUp. Cohort 2: a 6 FXS children group taking EGCG FontUp. (Experimental open-label)
Intake of 10mg/kg/day of EGCG, in the form of a dietary supplement (FontUp), two times a day.
Placebo Comparator: Control group DS
Cohort 1: a 35 DS children group taking placebo FontUp.
Intake of placebo, in the form of a dietary supplement (FontUp) (without EGCG), two times a day.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety Outcome Measure : Adverse Events
Time Frame: From day -5 to day 252 (through study completion)
Medical evaluations of incidence, nature, severity and causality of Adverse Events and Serious Adverse Events (SAE).
From day -5 to day 252 (through study completion)
Safety Outcome Measure: Number of participants with treatment-related adverse events with supporting evidence with blood analysis: Changes in liver function
Time Frame: Days -5, 5, 42, 84, 126, and 168.
The finding of an elevated alanine transaminase (ALT) or aspartate transaminase (AST) (>3xULN), elevated total bilirubin (>2xULN)
Days -5, 5, 42, 84, 126, and 168.
Safety Outcome Measure: Number of participants with treatment-related adverse events with supporting evidence with blood analysis: Changes in thyroid function
Time Frame: Days -5, 42, 84, 126, and 168.
Elevated TSH (>10 microU/mL) or any decrease of free T4 below the lower limit of normal values (<0.8 ng/dL)
Days -5, 42, 84, 126, and 168.
Safety Outcome Measure: Number of participants with treatment-related adverse events with supporting evidence with blood analysis: Changes in renal function
Time Frame: Days -15, 84, and 168
Serum creatinine will be measured at various time points and an increase exceeding x1.5 ULN (upper limit of normal values) that is confirmed by a repeat testing within 3 days.
Days -15, 84, and 168
Safety Outcome Measure: Number of participants with treatment-related adverse events with supporting evidence with Electroencephalography (EEG): Clinical significant changes in cerebral activity
Time Frame: Days -15, 84, and 168
Electroencephalogram recording to detect epileptiform abnormalities and/or seizure activity and/or pro-convulsive effects in pediatric participants, enabling a deeper understanding of the pharmacological effects of the intervention.
Days -15, 84, and 168
Safety Outcome Measure: Measure: Number of participants with treatment-related adverse events with supporting evidence with Electrocardiogram: Clinical significant changes in QTcF
Time Frame: Days -56 and 168

A QTcF (Fridericia's correction) value (mean of the three measurements) exceeding 500 ms when confirmed in repeat measurement within 15-30 minutes will be recorded as SAE.

A QTcF value exceeding a change from screening (mean of three time-matched measurements) of 60 ms when confirmed in repeat measurement within 15-30 minutes will be recorded as SAE.

Days -56 and 168
Safety Outcome Measure: Measure: Number of participants with treatment-related adverse events with supporting evidence with Echocardiogram: Clinical significant changes in size of the chambers of the heart.
Time Frame: Days -56 and 168
Doppler echocardiogram is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through heart and blood vessels.
Days -56 and 168
Safety Outcome Measure: Measure: Number of participants with treatment-related adverse events with supporting evidence with Echocardiogram: Clinical significant changes in pumping function of the heart.
Time Frame: Days -56 and 168
This measure is known as an ejection fraction or EF.
Days -56 and 168

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in Expressive language
Time Frame: Days -15, 168 and 252
Assessed by Picture Naming (PN) (WPPSI-IV). It is a verbal Comprehension subtest. It has 24 items. The child should name the drawings shown in the stimulus book. PN measures expressive language, ability and language development. Range score 0-24. Higher score is better outcome.
Days -15, 168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in Receptive language
Time Frame: Days -1,168 and 252
Assessed by Receptive Vocabulary (RV)(WPPSI-IV). It is a verbal comprehension subtest. It has 31 items. The child selects the picture that best represents the word the examiner reads aloud. RV measures receptive language ability and language development. Range score 0-40. Higher score is better outcome.
Days -1,168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in Memory and Learning
Time Frame: Days -1,168 and 252
Assessed by Sentence Repetition (NEPSY-II): This subtest is designed to assess the ability to repeat sentences of increasing complexity and length. The child is read a series of sentences and asked to recall each sentence immediately after it is presented. Range score 0-34. Higher score is better outcome.
Days -1,168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in Working Memory (WM)
Time Frame: Days -1,168 and 252
Assessed by Picture memory (WPPSI-IV). This subtest measures visual WM. It has 35 items. The child views a stimulus page of pictures for a specified time and then selects these pictures from options on a response page, for which a set of stimuli is viewed and then recognized from among a set of responses. Range score 0-35. Higher score is better outcome.
Days -1,168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in Verbal Fluency (VF)
Time Frame: Days -1,168 and 252
Subjects are asked to generate as many words as possible in 1 minute belonging to the category of "animals". No range score. A higher score is better outcome.
Days -1,168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in inhibition behavior
Time Frame: Days -1,168 and 252
Assessed by Cats & Dogs Test. 16 pictures presented on a single strip of card (two trials with two conditions, control and experimental-inhibition). Measures of task accuracy in the experimental inhibition trial (total number of correct responses, range score 0-16) and total time performance (in seconds) were included in the analyses.
Days -1,168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in mental flexibility
Time Frame: Days -1,84,168 and 252
Assessed by Dimensional Change Card Sort (DCCS). Sort a series of bivalent test cards, according to one dimension(colour) or another(shape). Range score 0-24, higher score is better outcome.
Days -1,84,168 and 252
Cognitive Outcome Measure : IDD-CHILD Battery. Cognitive changes in Visual-spatial Process
Time Frame: Days -1,168 and 252
Assessed by Blocks Design(WPPSI-IV). It is a visual spatial subtest which has 17 items. It measures ability to analyze and synthesize abstract visual stimuli. Range score 0-34, higher score is better outcome.
Days -1,168 and 252
Functional Outcome Measure : IDD-CHILD Vineland Adaptive Behavior Scales Scale Parent/Caregiver Interview Form, Second Edition (VABS-II)(Vineland™-II survey version)
Time Frame: Days -1,168 and 252

Changes in adaptive behavior

  • A. Communication domain: Sum of A1+A2+A3. Range Score 0-198
  • A1. Receptive subdomain: Range Score 0-40
  • A2. Expressive subdomain: Range Score 0-108
  • A3. Written subdomain: Range Score 0-50
  • B. Daily living skills domain: Sum of B1+B2+B3. Range Score 0-109
  • B1. Personal subdomain: Range Score 0-82
  • B2. Domestic subdomain: Range Score 0-48
  • B3. Community subdomain: Range Score 0-88
  • C. Socialization domain: Sum of C1+C2+C3. Range Score 0-180
  • C1. Interpersonal relationships subdomain: Range Score 0-64
  • C2. Play and leisure time subdomain: Range Score 0-62
  • C3. Coping skills subdomain: Range Score 0-60
  • Total score: Sum of A+B+C. Range Score 0-576

For all measures: a higher score is a better outcome

Days -1,168 and 252

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Exploratory Outcome: Efficacy Biomarkers analysis in plasma
Time Frame: Baseline, months 3 and 6
Dyrk1A and homocysteine (markers of efficacy); and Catechins and EGC concentrations (EGCG metabolites).
Baseline, months 3 and 6
Exploratory Outcome: Blood folate concentration
Time Frame: Months -1, 3 and 6
Exploratory biomarkers: determination of folate in blood samples
Months -1, 3 and 6
Exploratory Outcome Targeted metabolomics
Time Frame: Months -1, 3 and 6
In the PERSEUS project spot urine samples will be collected to further evaluate the metabolome of subjects with Down syndrome, seeking biomarkers of treatment efficacy or those differentiating responders and non-responders. Analysis will be focused in the biosynthesis and metabolism of neurotransmitters, the kynurenine pathway and the hypothalamic-hypophyseal-adrenal axis.
Months -1, 3 and 6
Exploratory Outcome: Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P)
Time Frame: Baseline, months 6 and 9
Evaluating changes in executive performance. BRIEF-P is a widely used caregiver questionnaire of everyday skills reflective of abilities in the executive domain. It generates a range of scales, including scales specific to working memory and inhibitory control.Raw scores and T-scores will be derived for the following scales: inhibit, shift, emotional control, initiate, working memory, plan/organize, organization of materials and monitor.
Baseline, months 6 and 9
Exploratory Outcome: Observed Memory Questionnaire Parent Form (OMQ-PF)
Time Frame: Baseline, months 6 and 9
Evaluating changes in memory performance. OMQ-PF is a 27-item questionnaire designed to ascertain parental perceptions about their child's memory function. All items are rated on a 5-point Likert (from 1- Strongly agree to 5-Strongly disagree OR 1- Never to 5- Always).
Baseline, months 6 and 9
Exploratory Outcome: Paediatric Quality of Life Inventory (PedsQL)
Time Frame: Baseline, months 6 and 9

Evaluating Quality of life.

The PedsQL measurement model was designed to integrate the merits of generic and disease-specific instruments to evaluate quality of life. Three modules will be used:

  1. cognitive functioning scale module. Range score 0-100
  2. generic core module. Range score 0-100
  3. family impact module. Range score 0-100 For all measures: a higher score is a better outcome
Baseline, months 6 and 9
Exploratory Outcome: Children's Sleep habits questionnaire (CSHQ)
Time Frame: Baseline, months 6 and 9

Rebound effects after discontinuation of treatment measures: evaluating changes sleep disturbances.

CSHQ is a 22-item parent-report questionnaire that encompasses eight domains:

  1. bedtime resistance. Range score 0-36
  2. sleep behavior. Range score 0-24
  3. night waking. Range score 0-8
  4. morning wake up. 0-16 For all items except item 19, a higher score is a better outcome
Baseline, months 6 and 9
Exploratory Outcome: Aberrant Behavior Checklist (ABC)
Time Frame: Baseline, months 6 and 9

Rebound effects after discontinuation of treatment measures: evaluating changes in disrupting behaviors.

The ABC-C is a 58-item rating scale used to assess maladaptive behaviors across five original dimensions or subscales (Items are evaluated on a four-point Liker scale ranging from 0 (not at all a problem) to 3 (the problem is severe in degree)).

  1. Irritability. Range score 0-45
  2. Hyperactivity. Range score 0-48
  3. Lethargy/Withdrawal. Range score 0-21
  4. Stereotypy. Range score 0-48
  5. Inappropriate Speech. Range score 0-12 For all measures: a higher score is a worst outcome
Baseline, months 6 and 9
Exploratory Outcome: Mediterranean Diet Quality Index for children and adolescents (KidMed Questionnaire)
Time Frame: Baseline, months 6 and 9
KIDMED index includes 16 questions based on the principles of the Mediterranean diet, where higher scores indicate greater adherence to healthy diet. Range score -4 -16.
Baseline, months 6 and 9
Exploratory Outcome: Changes in Cognitive composite Z-score
Time Frame: Baseline, months 6 and 9
This variable will be created by computing the sum of the Z-scores from tests that make up IDD-CHILD battery described in secondary outcome measures. No range score. A higher score is better outcome.
Baseline, months 6 and 9

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

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General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 29, 2018

Primary Completion (Actual)

March 29, 2020

Study Completion (Actual)

November 30, 2020

Study Registration Dates

First Submitted

June 6, 2018

First Submitted That Met QC Criteria

August 6, 2018

First Posted (Actual)

August 10, 2018

Study Record Updates

Last Update Posted (Actual)

June 11, 2021

Last Update Submitted That Met QC Criteria

June 10, 2021

Last Verified

June 1, 2021

More Information

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.

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