Adrenomedullin for CADASIL (AMCAD)

A Multicenter, Single-arm, Clinical Trial of Adrenomedullin for Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary cerebral small vessel disease, with no proven disease-modifying treatments. Adrenomedullin, a vasoactive peptide, has angiogenic, vasodilation, anti-inflammatory, and anti-oxidative properties and could have triple sites of action on components of the neuro-glial-vascular unit consisting of vessels, microglia and oligodendrocytes or, more specifically, on the white matter oligovascular unit. The aim of the AMCAD trial is to assess the safety and efficacy of Adrenomedullin in CADASIL patients.

Study Overview

• Status: Completed
• Conditions: Cadasil
• Intervention / Treatment: Drug: Adrenomedullin

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Phase 2

Contacts and Locations

Study Locations

• Japan
  • Osaka
    • Suita, Osaka, Japan, 564-8565
      • National Cerebral and Cardiovascular Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Patients who have given written informed consent from the patient or the sponsor to participate in the clinical trial
2. Patients aged between 20 and 90 at the time of obtaining consent
3. Patients diagnosed as CADASIL after confirming NOTCH3 gene mutation by genetic testing
4. Patients with Mini-mental state examination-J score of 10-27 or Trail maiking test score (age ajustment) of average + 1.5 SD (standard deviation) or higher

Exclusion Criteria:

1. Patients who cannot perform cognitive function tests (deafness, blindness, etc., MMSE-J less than 10 points Severe cognitive impairment, etc.)
2. Patients received reatment with prohibited drugs or prohibited therapy within the past 12 weeks from the time of registration
3. Patients who started to take concomitant restriction drugs or changed dosage of concomitant restriction drugs within the past 4 weeks from the time of registration
4. Patients whose Mini-mental state examination-J with 4 or more points improvements between the time of registration and 4 weeks or more at the time of screening (If patients who take concomitant restriction drugs)
5. Patients with active infections requiring antibiotic treatment at registration
6. Patients with a disability equivalent to modified Rankin Scale 5 at registration
7. Patients with severe consciousness impairment (Japan Coma Scale 100 or more)
8. Patients with severe renal impairment (estimated GFR less than 30 mL / min / 1.73m2) at registration
9. Patients with severe liver damage (transaminase AST (GOT) or ALT (GPT) 100 IU / L or more) at registration
10. Patients diagnosed as having cerebral infarction or intracranial hemorrhage or transient ischemic attack or cerebral aneurysm with high probability of rupture within the last 12 weeks from the time of registration
11. Patients with occlusion or severe stenosis of the intracranial main artery or carotid artery at the time of registration
12. Patients with significant ECG abnormalities (atrioventricular block of 2-3 degrees, extension of QRS interval of 120 ms or more, extension of QTcB of 450 msec or more) at registration, or past histroy of acute coronary syndrome or acute heart failure within the last 12 weeks from the time of registration
13. Patients with systolic blood pressure less than 100 mmHg at registration
14. Patients whose pulse rate is less than 45 beats / minute or 120 beats / minute or more at registration
15. Patients with substance abuse or alcoholism
16. Patients who cannot perform MRI
17. Patients with active solid malignant tumors
18. Patients who do not give consent to contraception from the date of obtaining consent until the end of the safety evaluation period
19. Pregnant, lactating, and possibly pregnant
20. Patient who participated in another trial within 24 weeks before registration
21. Other patients judged by the Investigator or Investigator to be ineligible for this study

Study Plan

How is the study designed?

Design Details

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

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Adrenomedullin group	Drug: Adrenomedullin; Dosing at 15 ng/kg/min for 8 hours is continued for 14 days.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cerebral blood flow change rate evaluated by arterial spin labeling	Frontal lobe	at 28 days post adrenomedullin administration

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cerebral blood flow change rate evaluated by arterial spin labeling	Frontal lobe	at 8 hours / 15 days / 90 days / 180 days post adrenomedullin administration
Cerebral blood flow change rate evaluated by arterial spin labeling	Whole brain mean and each area	at 8 hours / 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Mean diffusivity change rate of the white matter evaluated by MR diffusion tensor imaging	Whole brain mean and each area	at 8 hours / 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Fractional anisotropy change rate of the white matter evaluated by MR diffusion tensor imaging	Whole brain mean and each area	at 8 hours / 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Change in times of Trail making test-A/B from baseline evaluation		at 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Change in scores of Montreal cognitive assessment from baseline evaluation		at 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Change in scores of Wechsler Adult Intelligence Scale-Fourth edition from baseline evaluation		at 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Occurence of cerebral infarction		at 8 hours / 15 days / 28 days / 90 days / 180 days post adrenomedullin administration
Cerebral blood flow change rate evaluated by single photon emission computed tomography	Frontal lobe	at 28 days post adrenomedullin administration
Safety: Serious adverse event		From the initiation of adrenomedullin administration to 28 days post

Collaborators and Investigators

• Sponsor: National Cerebral and Cardiovascular Center, Japan

Publications and helpful links

Helpful Links

• Trial registration

Study record dates

Study Major Dates

• Study Start (Actual): January 6, 2022
• Primary Completion (Actual): January 23, 2023
• Study Completion (Actual): June 12, 2023

Study Registration Dates

• First Submitted: October 2, 2023
• First Submitted That Met QC Criteria: October 2, 2023
• First Posted (Estimated): October 9, 2023

Study Record Updates

• Last Update Posted (Estimated): October 9, 2023
• Last Update Submitted That Met QC Criteria: October 2, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Ischemia; Pathologic Processes; Necrosis; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Genetic Diseases, Inborn; Brain Ischemia; Dementia; Infarction; Stroke; Brain Infarction; Cerebral Arterial Diseases; Intracranial Arterial Diseases; Cerebral Small Vessel Diseases; Cerebral Infarction; Dementia, Vascular; CADASIL; Dementia, Multi-Infarct; Physiological Effects of Drugs; Antihypertensive Agents; Vasodilator Agents; Autonomic Agents; Peripheral Nervous System Agents; Protective Agents; Cardiotonic Agents; Bronchodilator Agents; Anti-Asthmatic Agents; Respiratory System Agents; Adrenomedullin
• Other Study ID Numbers: NCVC-AM-CAD; jRCT2051210117 (Registry Identifier: Japan Registry of Clinical Trials)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No