A Trial to Evaluate the Effects of BCG in Adults With MCI and Mild-to-Moderate AD

February 2, 2023 updated by: Steven E Arnold, MD

An Open-label Trial to Evaluate the Effects of BCG Immunization on Biomarkers of Inflammation/Immune Response and Alzheimer's Disease in Adults With Mild Cognitive Impairment and Mild-to-Moderate Dementia Due to Alzheimer's Disease

A study of the effects of Bacillus Calmette-Guérin (BCG) immunization on cerebrospinal fluid and blood-based biomarkers in older with mild cognitive impairment and mild-to-moderate to Alzheimer's disease.

Study Overview

Detailed Description

This single-site, open-label trial will investigate the effects of BCG vaccination on IIR and AD biofluid biomarkers, magnetic resonance imaging (MRI) biomarkers, and neurocognitive/behavioral functioning over a one year period in older adults with mild cognitive impairment (MCI) to mild-to-moderate dementia due to AD. This study will also gather data on tolerability and safety.

Study Type

Interventional

Enrollment (Anticipated)

15

Phase

  • Phase 2

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

    • Massachusetts
      • Charlestown, Massachusetts, United States, 02129
        • Alzheimer's Clinical and Translational Research Unit

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

55 years to 85 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Individuals between the ages of 55-85;
  2. MCI or moderate dementia due to AD as defined by the 2011 NIA-AA Workgroup recommendations;
  3. MoCA ≥ 8 at screening;
  4. Global CDR between 0.5-2 (inclusive) at screening;
  5. Amyloid and/or tau biomarkers indicative of AD pathology;
  6. Education level, English language skills and literacy indicates subject will be able to complete all assessments;
  7. Has a study partner who, in the investigator's judgement, has frequent, direct contact with the participant at least several days a week, can accompany the participant to all visits, and is also able to provide information to study investigator/staff;
  8. Willing and able to complete all assessment and study procedures, including blood and lumbar punctures, and clinical assessments;
  9. If on cholinesterase inhibitor and/or memantine, doses are stable for 3 months prior to baseline;
  10. Negative test results for HIV antibody and Tuberculosis (QuantiFERON) at screening;
  11. No prior BCG exposure either through birth vaccinations (born in North American) or BCG bladder cancer treatment.

Exclusion Criteria:

  1. History of chronic infectious disease, such as HIV or untreated or active hepatitis;
  2. History of tuberculosis, positive interferon-gamma release assay (IGRA, also known as the QuantiFERON-TB test), including a test with a high reactivity to mycobacteria of non-tuberculosis variety;
  3. Prior BCG vaccination, positive T-spot tuberculosis test or a T-spot test showing significant Mycobacteria exposure;
  4. A positive SARS-CoV-2 PCR result within 3 months of screening, or known close contact with a confirmed COVID-19 positive person or symptoms highly suspicious for COVID-19 (per CDC guidelines) within 1 month of screening, including fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat, based on clinician's judgment;
  5. History of treatment with metformin within the past one year;
  6. Treatment with other investigational agents which, at the discretion of the investigator, interfere with safety and/or study outcomes;
  7. Current treatment with immunosuppressants (calcineurin inhibitors, corticosteroids, or biological or cytotoxic immunosuppressants, or disease or condition likely to require high dose steroid or immunosuppressive therapy);
  8. Other conditions or treatments associated with increased risk of infections or treatment with immunosuppressive medications for any reason;
  9. Current treatment with aspirin > 160 mg/day or chronic, daily NSAIDs;
  10. Current (as of time of study screening) or chronic use of antibiotics;
  11. History of keloid formation;
  12. Living with someone who is immunosuppressed and/or at high risk for infectious diseases (for example, HIV+ or taking immunosuppressive medications for any reason), or in a job (e.g. healthcare) in which the subject works with immunosuppressed populations;
  13. Other/confounding neurological or psychiatric condition, unstable medical or psychiatric conditions, contraindications to BCG use and lab abnormalities or concurrent medication use posing risk for BCG or study procedures;
  14. Laboratory abnormalities in B12, Folate, TSH, or other common laboratory parameters that may contribute to cognitive dysfunction per clinician judgment;
  15. Laboratory abnormalities in CBC, electrolytes, LFTs, BUN, Cr, total serum immunoglobulins, ESR, CRP, or urinalysis posing risk to treatment with BCG per clinician judgment;
  16. Laboratory abnormalities in PT-INR, which would pose a risk to performing the lumbar puncture procedure;
  17. Discontinuation of cholinesterase inhibitor or memantine within one month (28 days) prior to baseline visit;
  18. Females who are pregnant, lactating or of child-bearing potential;
  19. If male with female partner(s) of childbearing potential, unwilling or unable to adhere to contraception requirements specified in the protocol.
  20. Administration of live vaccine within 30 days of screening visit or BCG immunizations
  21. Administration of non-live vaccine within 14 days of screening visit or BCG immunizations
  22. If participating in optional MRI: Existing contraindication to MRI per MGH Athinoula A. Martinos Center research guidelines

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: Other
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: BCG
Active BCG immunization
Two Bacillus Calmette-Guérin (Japan BCG) vaccine injections spaced four week apart. Each injection will have 0.36-3.9 x 10^6 colony forming units (CFU) reconstituted in 0.1 mL saline.
Other Names:
  • BCG

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
CSF biomarkers of pharmacodynamic response- cytokines
Time Frame: Day 84
Change in concentration of circulating cytokines in CSF from baseline
Day 84
Blood biomarkers of pharmacodynamic response- cytokines
Time Frame: Day 84
Change in concentration of circulating cytokines in blood from baseline
Day 84
Cognitive Measures (RBANS)
Time Frame: Day 84
Change from baseline in Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score
Day 84
Blood biomarkers of pharmacodynamic response- cytokines
Time Frame: Day 364
Change in concentration of circulating cytokines in blood from baseline
Day 364
CSF biomarkers of pharmacodynamic response- cytokines
Time Frame: Day 364
Change in concentration of circulating cytokines in CSF from baseline
Day 364
Blood biomarkers of AD pathology-ATN
Time Frame: Day 364
Change in concentration of ATN markers of AD pathophysiology (Amyloid-β42/40, phospho-tau, total tau and neurofilament light protein biomarkers) in blood from baseline
Day 364
CSF biomarkers of AD pathology-ATN
Time Frame: Day 364
Change in concentration of ATN markers of AD pathophysiology (Amyloid-β42/40, phospho-tau, total tau and neurofilament light protein biomarkers) in CSF from baseline
Day 364
Blood biomarkers of AD pathology-ATN
Time Frame: Day 84
Change in concentration of ATN markers of AD pathophysiology (Amyloid-β42/40, phospho-tau, total tau and neurofilament light protein biomarkers) in blood from baseline
Day 84
CSF biomarkers of AD pathology-ATN
Time Frame: Day 84
Change in concentration of ATN markers of AD pathophysiology (Amyloid-β42/40, phospho-tau, total tau and neurofilament light protein biomarkers) in CSF from baseline
Day 84
Cognitive Measures (RBANS)
Time Frame: Day 364
Change from baseline in Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score
Day 364

Collaborators and Investigators

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

Investigators

  • Principal Investigator: Steven Arnold, MD, Massachusetts General Hospital

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)

March 25, 2022

Primary Completion (Anticipated)

October 1, 2023

Study Completion (Anticipated)

October 1, 2023

Study Registration Dates

First Submitted

August 6, 2021

First Submitted That Met QC Criteria

August 6, 2021

First Posted (Actual)

August 13, 2021

Study Record Updates

Last Update Posted (Actual)

February 3, 2023

Last Update Submitted That Met QC Criteria

February 2, 2023

Last Verified

February 1, 2023

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

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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