- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05741060
Effect of Equol Supplementation on Arterial Stiffness and Cognition in Healthy Volunteers (ACE)
Arterial Stiffness, Cognition and Equol
The ACE Trial, funded by the National Institute on Ageing/National Institutes of Health (NIH), is a multicenter clinical trial. The ACE Trial will determine if taking the dietary supplement Equol could slow the progression of stiffening of the arteries, small blood vessel disease in the brain and memory decline. Equol is a soy-based supplement that has plant estrogen-like compounds in it.
Equol is a metabolite of soy isoflavone. Our studies in Japan and other studies suggest that Equol may slow mechanisms related to memory decline. No previous studies in the United States have tested the effect of Equol on these mechanisms or memory decline. Supplementation of Equol in the ACE Trial is approved by the Food and Drug Administration (FDA).
Researchers at the University of Pittsburgh, Pittsburgh, Pennsylvania, Wake Forest University, Winston-Salem, North Carolina, and Emory University, Atlanta, Georgia, are recruiting participants.
The ACE Trial will ask participants to complete 7 clinic visits over a two-year period. The participants are asked to take Equol tablets daily for 24 months. Clinic procedures include Pulse Wave Velocity (to measure arterial stiffness), Magnetic Resonance Imaging (MRI) of the brain and tests of awareness and thinking.
Study Overview
Status
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Akira Sekikawa, MD, PhD, PhD
- Phone Number: 412-383-1063
- Email: akira@pitt.edu
Study Contact Backup
- Name: Monica Love, MLIS
- Phone Number: 412-383-1895
- Email: lovem@edc.pitt.edu
Study Locations
-
-
Georgia
-
Atlanta, Georgia, United States, 30322
- Recruiting
- Emory University
-
Contact:
- Whitney Wharton, PhD
- Phone Number: 404-712-7359
- Email: w.wharton@emory.edu
-
Contact:
- Danielle Verble, MA
- Phone Number: 404-712-7085
- Email: danelle.d.verble@emory.edu
-
-
North Carolina
-
Winston-Salem, North Carolina, United States, 27157
- Recruiting
- Wake Forest University Health Sciences
-
Contact:
- Timothy Hughes, PhD
- Phone Number: 336-713-3851
- Email: tmhughes@wakehealth.org
-
Contact:
- Carrie Smith
- Phone Number: 336-713-3851
- Email: suscsmit@wakehealth.edu
-
Principal Investigator:
- Timothy Hughes, PhD
-
Sub-Investigator:
- Ezequiel Zamora, MD
-
Sub-Investigator:
- Mia Yang, MD, MS
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15213
- Recruiting
- University of Pittsburgh
-
Contact:
- Akira Sekikawa, MD, PhD, PhD
- Phone Number: 412-383-1063
- Email: akira@pitt.edu
-
Contact:
- Monica Love, MLIS
- Phone Number: 412-383-1895
- Email: lovem@edc.pitt.edu
-
Sub-Investigator:
- Emma Barinas-Mitchell, PhD
-
Sub-Investigator:
- Caterina Rosano, MD, MPH
-
Sub-Investigator:
- Beth Snitz, PhD
-
Sub-Investigator:
- Minjie Wu, PhD
-
Sub-Investigator:
- Yuefang Chang, PhD
-
Sub-Investigator:
- Cristina Murray-Krezan, PhD
-
Sub-Investigator:
- Neelesh Nadkarni, PhD
-
Sub-Investigator:
- Tae Kim, PhD
-
Sub-Investigator:
- Joseph Mettenburg, MD, PhD
-
Sub-Investigator:
- Oscar Lopez, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Men and women age between 65 and 85 at entry of European Americans or African Americans
Inclusion criteria via screening visit:
- Individuals who are able to provide informed consent
- Individuals who are willing to be randomized to the intervention or placebo group
Exclusion Criteria:
Exclusion criteria via initial screening by phone
- Individuals who are regularly taking isoflavone supplements or eat soy product ≥ 2 times a week (by specific questionnaire)
- Individuals who do not agree to maintain isoflavone supplements or soy product intake described above during the study period.
- Individuals who have allergy or intolerance to soy isoflavones.
- Individuals whose score for the Telephone Interview for Cognitive Status is 22 and below.
- Individuals with stroke, neurological disorders, bipolar disease whether or not under medical treatment, cancer treatment in the past 6 months, head trauma or other condition which is not appropriate for the study (e.g., contraindication to magnetic resonance imaging (MRI)).
- Individuals with untreated depression
- Individuals with atrial fibrillation
- Individuals with heart failure
- Individuals with heart attack or coronary intervention in the past 6 months
- Individuals with carotid endarterectomy or peripheral artery disease
- Individuals currently undergoing treatment for pulmonary embolism or deep vein thrombosis
- Individuals with aortic (abdominal, thoracic) aneurysm
- Individuals with inflammatory bowel diseases
- Individuals currently undergoing hemodialysis
- Women with a past or family history of breast cancer.*1
- Women on estrogen replacement therapy
- Individuals unable to lay supine for 30-60 minutes
- Individuals with weight ≥300 lbs
- Individuals who are planning to move out of the area in the next 2 years
- Individuals who participated in another clinical trial in the past 3 months
Exclusion criteria via screening visit
- Individuals with Quick Dementia Rating System (QDRS) score ≥ 6.0
- Individuals who are regularly taking isoflavone supplements or eat soy product ≥ 2 times a week (by specific questionnaire)
- Individuals who do not agree to maintain isoflavone supplements or soy product intake described above during the study period.
- Individuals who have allergy or intolerance to soy isoflavones.
- Blood pressure (BP) - systolic BP ≥ 180 mmHg or diastolic BP ≥ 110 mmHg
- Heart rate ≥110 or ≤40
- Hemoglobin <10 g/dL
- HbA1c ≥ 7.5%
- Blood creatinine > 2.0 mg/dL
- Liver function tests > 2 X upper limit of normal
- Abnormal thyroid function (Thyroid Stimulating Hormone)
- Vitamin B12 levels ≤ 210 pg/mL
- Hematocrit <30%
- White blood cell count <3,000 or >15,000
- Platelet count <100,000 or >600,000
- Urinary protein ≥ + by dipstick
- Any condition or therapy which, in the opinion of the investigator, might pose a risk to the participant or make participation in the study not in the participant's best interest
In addition, individuals with the following condition will be excluded because these conditions do not allow subjects to undergo examinations the investigators proposed in the project:
- Those who are contraindicated for 3 Tesla (3T) structural brain magnetic resonance imaging (MRI) such as pacemakers.
- Atrial fibrillation because pulse wave velocity is not accurately measured.
- Hearing impairment which interferes with cognitive testing
- Vision impairment which interferes with cognitive testing
Exclusion criteria at structural brain MRI Any other conditions which, in the opinion of the investigator, might pose a risk to the participant or make participation in the study not in the participant's best interest
*1 Few studies have investigated the association of equol, a metabolite of soy isoflavone daidzein, with breast cancer. These studies reported no significant association of serum or urine equol with the risk of breast cancer. Dietary intake of soy and soy isoflavones is generally considered to have benefits for menopausal symptoms, cardiovascular health, bone health, and cancers of the breast and prostate. Observational studies show that soy consumption is associated with a reduced risk of many cancers including breast cancer. Moreover, a prospective cohort study of 6,000+ North American women with breast cancer showed that dietary intake of soy and isoflavones was associated with reduced all-cause mortality. However, there is little evidence to support that the use of supplements containing soy isoflavones or soy protein powder to reduce cancer risk. A recent large prospective cohort study in France reported that supplementation of soy isoflavones increased the risk of estrogen receptor-negative breast cancer, especially among women who had a history of breast cancer in first-degree relatives.
Exclusion criteria at the baseline visit
The investigators recruit subjects without dementia. Thus, at the initial screening by phone, the investigators exclude individuals whose score for the Telephone Interview for Cognitive Status is 22 and below. Then, at the screening visit, investigators will exclude individuals with a Quick Dementia Rating System score ≥ 6.0.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Equol Arm
S-equol - 10 mg per day tablet for 24 months.
|
Experimental drug
Other Names:
|
Placebo Comparator: Placebo Arm
10 mg per day for 24 months of tablets that will be of the same size/shape/color as the experimental tablet.
|
Placebo - 10 mg per day for 24 months of tablets that will be the same size/shape/color as the s-equol tablets.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in arterial stiffness
Time Frame: Change from baseline in arterial stiffness at 12 months
|
Arterial stiffness describes the rigidity of the arterial wall and is a significant predictor of cognitive decline.
Arterial stiffness will be measured by pulse wave velocity (m/s) with a SphygmoCor device (Sydney, Australia).
The range of pulse wave velocity is from 5 to 20 m/s.
|
Change from baseline in arterial stiffness at 12 months
|
Change in arterial stiffness
Time Frame: Change from baseline in arterial stiffness at 24 months
|
Arterial stiffness describes the rigidity of the arterial wall and is a significant predictor of cognitive decline.
Arterial stiffness will be measured by pulse wave velocity (m/s) with a SphygmoCor device (Sydney, Australia).
The range of pulse wave velocity is from 5 to 20 m/s.
|
Change from baseline in arterial stiffness at 24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in white matter lesion (WML) volume percent
Time Frame: Change from baseline in WML volume percent at 24 months
|
WMLs are a significant predictor of cognitive decline.
WMLs will be measured using an automated brain magnetic resonance imaging method.
WML volume percent will be calculated by dividing WML volume by total brain volume as a percentage.
The range of WML volume percent is from 0 to 4.2%.
|
Change from baseline in WML volume percent at 24 months
|
Change in cognitive score measured by the Preclinical Alzheimer's Cognitive Composite-5 (PACC-5) score
Time Frame: Change from baseline in cognitive score measured by the PACC-5 at 12 months
|
The PACC-5 is a composite neuropsychological measure optimized to detect subtle changes over time in cognitively unimpaired older adults.
The range of PACC-5 score is from -3 to 3.
|
Change from baseline in cognitive score measured by the PACC-5 at 12 months
|
Change in cognitive score measured by the Preclinical Alzheimer's Cognitive Composite-5 (PACC-5) score.
Time Frame: Change from baseline in cognitive score measured by the PACC-5 at 24 months
|
The PACC-5 is a composite neuropsychological measure optimized to detect subtle changes over time in cognitively unimpaired older adults.
The range of PACC-5 score is from -3 to 3 where 3 represents better cognition.
|
Change from baseline in cognitive score measured by the PACC-5 at 24 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in NIH Toolbox (NIH-TB) cognition battery score
Time Frame: Change from baseline in NIH-TB cognition battery score at 12 months
|
NIH-TB Cognition battery, comprised of computerized tests of fluid and crystallized cognitive abilities, via proctored iPad administration.
|
Change from baseline in NIH-TB cognition battery score at 12 months
|
Change in NIH Toolbox (NIH-TB) cognition battery score
Time Frame: Change from baseline in NIH-TB cognition battery score at 24 months
|
NIH-TB Cognition battery, comprised of computerized tests of fluid and crystallized cognitive abilities, via proctored iPad administration.
|
Change from baseline in NIH-TB cognition battery score at 24 months
|
Changes in select brain markers other than white matter lesion (WML) volume percent
Time Frame: Change from baseline in brain markers other than WML volume percent at 24 months
|
Brain markers other than WML volume percent will be measured using MRI, including cerebral blood flow, venous oxygenation, white matter organization lacunar infarct and cortical thickness.
|
Change from baseline in brain markers other than WML volume percent at 24 months
|
Change in select plasma biomarkers
Time Frame: Change from baseline in select plasma biomarkers at 24 months
|
Plasma biomarkers of inflammation and endothelial function (C-reactive protein, intracellular adhesion molecule, vascular cell adhesion molecule, glial fibrillary acidic protein, neurofilament light) as well as amyloid-β40, amyloid-β42 and phosphorylated tau 181 will be measured.
|
Change from baseline in select plasma biomarkers at 24 months
|
Change in ultrasound measurements of carotid artery
Time Frame: Change from baseline in ultrasound measurements of carotid artery at 24 months
|
Ultrasound measurements of carotid artery include carotid plaque and intima-media thickness.
Investigators will use a high-resolution ultrasound system equipped with a variable frequency transducer (NextGen LOGIQ*e R7).
|
Change from baseline in ultrasound measurements of carotid artery at 24 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Akira Sekikawa, MD, PhD, PhD, University of Pittsburgh
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- STUDY22010165
- R01AG074971 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Data Requestors must agree to the terms of the ACE Data Use Agreement (DUA) and will be asked to complete an online application for access to anonymized datasets. The agreement will be reviewed by the ACE Trial Steering Committee (SC).
The ACE SC approval of the Data Requestor's Data Sharing Agreement request will trigger a process that allows access to the files described above and provides the requestor with an email notification of the review decision. All data and supporting documents selected by the project leadership for sharing will be made available for approved applicants to download. The review committee may require requestors to provide an annual update on their use of project data, to submit manuscripts for SC review and/or may revoke access for investigators who do not respond to annual update requests.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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