Neuroimmune Dysfunction in Alcohol Use Disorder

Characterization of Neuroimmune Dysfunction in Alcohol Use Disorder

The objective of this proposal is to advance medication development for alcohol use disorder by examining the efficacy and mechanisms of action of minocycline, a neuroimmune modulator, as a potential treatment. This study has important clinical implications, as the available treatments for alcohol use disorder are only modestly effective and testing novel medications is a high research priority.

Study Overview

• Status: Completed
• Conditions: Substance-Related Disorders; Chemically-Induced Disorders; Pathologic Processes; Alcohol Drinking; Drinking Behavior; Alcoholism; Alcohol-Related Disorders; Inflammation; Neurocognitive Disorders; Disease; Cognitive Dysfunction; Mental Disorder; Anti-Bacterial Agents; Anti-Infective Agents; Minocycline; Cognition Disorder
• Intervention / Treatment: Drug: Minocycline; Drug: Sugar pill

Detailed Description

The research objective of this project is to characterize the role of the neuroimmune system in alcohol use disorder (AUD). The proposed study employs a randomized, double-blind, and placebo-controlled design to examine how neuroinflammation, as measured via neuroimaging [e.g., magnetic resonance imaging (MRI)], relates to alcohol craving, neurocognitive impairment (e.g., memory, attention, etc.), and alcohol use in non-treatment seeking individuals with AUD. The study will also determine whether minocycline (MINO), an FDA-approved antibiotic medication, affects any of the above listed measures. In the proposed study, healthy controls (n = 36) and non-treatment seeking individuals with a current Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 AUD diagnosis (n = 36) will be randomized to receive either 200 mg of minocycline per day or placebo for approximately 28 days and complete two laboratory sessions. The first laboratory session will be performed immediately before commencing the medication regimen (day 0) and the second will be completed after taking the medication daily for approximately 28 days. Within each laboratory session, participants will complete a cue reactivity paradigm, neurocognitive performance tasks, and a magnetic resonance imaging (MRI) session. Additionally, blood samples will be drawn on days 0, 7, 14, 21, and 28 of treatment to measure circulating levels of proinflammatory molecules in order to identify the specific immune signaling pathways underlying neuroinflammation in AUD. Clinical labs (e.g., blood chemistry, liver function tests) and adverse events (AEs) will also be assessed at these five visits.

• Study Type: Interventional
• Enrollment (Actual): 142
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Brian Brandler, MA; Phone Number: 410-402-6425; Email: bbrandler@som.umaryland.edu
• Study Contact Backup: Name: Ann Kearns, BS; Phone Number: 410-402-6854; Email: akearns@mprc.umaryland.edu

Study Locations

• United States
  • Maryland
    • Catonsville, Maryland, United States, 21228
      • Maryland Psychiatric Research Center (MPRC) Treatment Research Program (TRP)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 23 years to 63 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

AUD Group Inclusion Criteria:

• Meet DSM-5 diagnostic criteria for an AUD
• In the 30-day period before enrollment, consume ≥ 14 and ≥ 7 standard drinks per week for men and women, respectively, AND
• In the 30-day period before enrollment, engage in heavy drinking (5 or more drinks for men, 4 or more drinks for women) and ≥ 5 times per month

AUD Group Exclusion Criteria:

• Currently in treatment for AUD, a history of treatment within the 30 days before enrollment, or currently seeking immediate treatment
• Current (last 12 months) DSM-5 diagnosis of substance use disorder for any psychoactive substances other than alcohol and nicotine
• Currently prescribed a psychotropic medication for the treatment of schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, and mood disorders.
• Lifetime DSM-5 diagnosis of schizophrenia spectrum and other psychotic disorders and bipolar and related disorders
• Positive urine toxicology screen for the following substances: cocaine, opiates, amphetamines, methamphetamine, phencyclidine, barbiturates, benzodiazepine, methadone, and tricyclic antidepressants.
• Self-reported daily use of cannabidiol (CBD) or opioids (including prescribed)
• Serious alcohol withdrawal symptoms as indicated by a score ≥ 10 on the Clinical Institute Withdrawal Assessment for Alcohol-Revised
• If female: pregnancy, nursing, or refusal to use reliable method of birth control; if using hormonal contraceptives, refusal to use secondary birth control method
• Any autoimmune or inflammatory medical disorder or medical condition that may interfere with safe study participation and/or study aims (e.g., unstable cardiac, renal, or liver disease, uncontrolled hypertension or diabetes)
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST), or γ-glutamyl transferase (GGT) ≥ 4 times upper normal limit
• Attempted suicide in the past 3 years and/or serious suicidal intention or plan within the past year
• Currently on prescription medication that contraindicates use of minocycline, including but not necessarily limited to: isoretinoin, ergot alkaloids, and anti-coagulants.
• Previously known hypersensitivity to tetracyclines
• Current or recent (within one month) treatment with any antibiotic
• Regular use of a prebiotic or probiotic supplement
• Claustrophobia or physical issues preventing MRI scan
• Presence of a metal device in the body (e.g., pacemaker, infusion pump, aneurysm clip, metal prosthesis or plate)
• Current or recent (within 3 months) participation in a clinical trial involving medication administration
• Suffered a mild or moderate traumatic brain injury (TBI) within the last 12 months, a severe TBI at any point in their life, or a moderate TBI before the age of 12.
• Having below a 6th grade reading level
• Within the last 3 months, tested positive for COVID-19 (i.e. the SARS-CoV-2 virus) and experienced common related symptoms.
• Any other circumstances that, in the opinion of the investigators, compromises participant safety, ability of the investigators to conduct the study as designed, and/or study integrity.

Healthy Control Group Inclusion Criteria:

• Does not meet DSM-5 diagnostic criteria for an AUD (current or lifetime)
• In the 30-day period before enrollment, consume ≤ 14 and ≤ 7 standard drinks per week for men and women, respectively
• Engage in infrequent heavy drinking during the past 6 months (≤ 2 heavy drinking events in past 6 months)

Healthy Control Group Exclusion Criteria:

• Lifetime DSM-5 diagnosis of substance use disorder for any psychoactive substances other than nicotine
• Self-reported daily use of cannabidiol (CBD) or opioids (including prescribed)
• Lifetime DSM-5 diagnosis of schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders (panic disorder, agoraphobia, social anxiety, and generalized anxiety), obsessive-compulsive and related disorders, trauma- and stressor-related disorders, feeding and eating disorders (binge eating, anorexia, and bulimia), conduct disorders, and gambling disorder
• Positive urine toxicology screen for the following substances: cocaine, opiates, amphetamines, methamphetamine, phencyclidine, barbiturates, benzodiazepine, methadone, and tricyclic antidepressants.
• Serious alcohol withdrawal symptoms as indicated by a score ≥ 10 on the Clinical Institute Withdrawal Assessment for Alcohol-Revised
• If female: pregnancy, nursing, or refusal to use reliable method of birth control; if using hormonal contraceptives, refusal to use secondary birth control method
• Any autoimmune or inflammatory medical disorder or medical condition that may interfere with safe study participation and/or study aims (e.g., unstable cardiac, renal, or liver disease, uncontrolled hypertension or diabetes)
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST), or γ-glutamyl transferase (GGT) ≥ 4 times upper normal limit
• Attempted suicide in the past 3 years and/or serious suicidal intention or plan within the past year
• Currently on prescription medication that contraindicates use of minocycline, including but not necessarily limited to: isoretinoin, ergot alkaloids, and anti-coagulants.
• Previously known hypersensitivity to tetracyclines
• Current or recent (within one month) treatment with any antibiotic
• Regular use of a prebiotic or probiotic supplement
• Claustrophobia or physical issues preventing MRI scan
• Presence of a metal device in the body (e.g., pacemaker, infusion pump, aneurysm clip, metal prosthesis or plate)
• Current or recent (within 3 months) participation in a clinical trial involving medication administration
• Suffered a mild or moderate traumatic brain injury (TBI) within the last 12 months, a severe TBI at any point in their life, or a moderate TBI before the age of 12.
• Having below a 6th grade reading level
• Within the last 3 months, tested positive for COVID-19 (i.e. the SARS-CoV-2 virus) and experienced common related symptoms.
• Any other circumstances that, in the opinion of the investigators, compromises participant safety, ability of the investigators to conduct the study as designed, and/or study integrity.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: AUD-Minocycline; Participants diagnosed with alcohol use disorder will be randomly assigned to take minocycline for 4 weeks. The randomization is double-blinded and will alternate between minocycline and placebo.	Drug: Minocycline; 200 mg/day
Placebo Comparator: AUD-Placebo; Participants diagnosed with alcohol use disorder will be randomly assigned to take placebo for 4 weeks. The randomization is double-blinded and will alternate between minocycline and placebo.	Drug: Sugar pill; Matched placebo; Other Names: Placebo
Active Comparator: Healthy Control-Minocycline; Healthy control participants will be randomly assigned to take minocycline for 4 weeks. The randomization is double-blinded and will alternate between minocycline and placebo.	Drug: Minocycline; 200 mg/day
Placebo Comparator: Healthy Control-Placebo; Healthy control participants will be randomly assigned to take placebo for 4 weeks. The randomization is double-blinded and will alternate between minocycline and placebo.	Drug: Sugar pill; Matched placebo; Other Names: Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neuroinflammation	A multimodal MRI approach consisting of Diffusion Tensor Imaging (DTI) with free water imaging and Magnetic Resonance Spectroscopy (MRS) will be utilized to assess neuroinflammation	Change from baseline after 28 days of medication dosing
Cue-Induced Alcohol Craving	Participants will listen to a 5-minute guided cue exposure script, during which they are exposed to both a neutral and their preferred alcoholic beverage. Prior to beginning the paradigm and after each cue exposure participants will rate their alcohol craving using the "Alcohol Urge Questionnaire (AUQ)" and cigarette craving using the "Brief Questionnaire on Smoking Urges (BQSU)." Both scales range from 1 to 7 with higher scores reflecting more craving.	Change from baseline after 28 days of medication dosing
Alcohol consumption	Total drinks consumed assessed using the Timeline Follow Back	Change from baseline after 28 days of medication dosing
Verbal Fluency/Language	Wechsler Abbreviated Scale of Intelligence (WASI)-Vocabulary, WASI-Similarities, Verbal Fluency (Animals), with higher scores indicating greater intellectual ability.	Change from baseline after 28 days of medication dosing
Speed of processing	Brief Assessment of Cognition in Schizophrenia (BACS)-Symbol Coding [scored by number of correct numerals (range: 0 -110)]	Change from baseline after 28 days of medication dosing
Speed of processing	Trail Making Test: Part A (scored by time to complete test with lower scores being better)	Change from baseline after 28 days of medication dosing
Speed of processing	Grooved Pegboard (scored as a sum of the total time, total number of drops, and the total number of pegs correctly placed in the board with higher scores corresponding to worse performance)	Change from baseline after 28 days of medication dosing
Working Memory	Wechsler Memory Scale (WMS)-Spatial Span (scored up to 32 correct series), Letter-Number Span (scored up to 30 correct series)	Change from baseline after 28 days of medication dosing
Attention	Continuous Performance Test	Change from baseline after 28 days of medication dosing
Problem Solving/Executive Functioning	Wisconsin Card Sorting Test-64	Change from baseline after 28 days of medication dosing
Inhibition/Impulsivity	Stop-Signal Reaction Time	Change from baseline after 28 days of medication dosing
Verbal Learning	Hopkins Verbal Learning Test	Change from baseline after 28 days of medication dosing
Visual Learning	Brief Visuospatial Memory Test [scoring is as follows, 1) Total recall: The sum of all valid items generated across learning trials 1-3, 2) Delayed recall: The number of valid items generated after a delay (trial 4), 3) Percent retained: Delayed recall score divided by the higher of trial 2 or 3 × 100, and 4) Recognition Discrimination Index: True positive responses minus false positive responses.]	Change from baseline after 28 days of medication dosing

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peripheral Proinflammatory Marker levels	Serum level of inflammatory molecules	At baseline (day zero) and after 7, 14, and 21 and 28 days of medication dosing
Alcohol Use Disorder Severity	Symptom count from the alcohol module for the Structured Clinical Interview for DSM-5	At baseline (day zero) and after 28 days of medication dosing
Gut microbiota	Gut microbiota from stool samples using the following parameters: 1) diversity and evenness (Shannon, Simpson index) and 2) similarity (phylogenetic UniFrac distance, Jensen-Shannon divergence)	At baseline (day zero) and after 7, 14, and 21 and 28 days of medication dosing

Collaborators and Investigators

• Sponsor: University of Maryland, Baltimore
• Collaborators: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
• Investigators: Principal Investigator: Daniel Roche, PhD, University of Maryland, Baltimore

Study record dates

Study Major Dates

• Study Start (Actual): February 3, 2020
• Primary Completion (Actual): September 20, 2023
• Study Completion (Actual): September 20, 2023

Study Registration Dates

• First Submitted: December 17, 2019
• First Submitted That Met QC Criteria: December 21, 2019
• First Posted (Actual): December 26, 2019

Study Record Updates

• Last Update Posted (Actual): December 1, 2023
• Last Update Submitted That Met QC Criteria: November 30, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: Minocycline
• Additional Relevant MeSH Terms: Substance-Related Disorders; Alcohol Drinking; Alcoholism; Inflammation; Mental Disorders; Cognitive Dysfunction; Cognition Disorders; Alcohol-Related Disorders; Pathologic Processes; Neurocognitive Disorders; Chemically-Induced Disorders; Drinking Behavior; Anti-Infective Agents; Anti-Bacterial Agents; Minocycline
• Other Study ID Numbers: HP-00080891; 5K01AA026005-03 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes