Deep Cervical Lymphatic Venous Anastomosis in the Treatment of Alzheimer's Disease (CLEAN-AD)

Deep Cervical Lymphatic Venous Anastomosis in the Treatment of Alzheimer's Disease: A Multicenter, Prospective, Open-label, Blinded-Endpoint, Randomized Controlled Trial (CLEAN-AD)

This multicenter, prospective, open-label, blinded-endpoint, randomized controlled trial is to evaluate the efficacy and safety of deep cervical lymphatic venous anastomosis (DC-LVA) plus usual care versus usual care in reduing the score of clinical dementia rating-sum of boxes (CDR-SB) at 12 months in patients with moderate-to-severe Alzheimer's Disease (AD).

Study Overview

• Status: Recruiting
• Conditions: Alzheimers Disease
• Intervention / Treatment: Procedure: DC-LVA treatment plus usual care; Other: Usual care

Detailed Description

Alzheimer's Disease (AD) is a common neurodegenerative disorder affecting the elderly population. Global health data estimates that there are 50 million AD patients worldwide, and this number may triple to 150 million cases by 2050. Anti-amyloid β (Aβ) monoclonal antibodies have emerged as disease-modifying therapies for preclinical or mild AD, but the majority of candidate agents have failed to demonstrate clinical efficacy. For patients with moderate-to-severe AD, who comprise approximately 50% of the existing AD population, there are limitied treatment options in clinical practice. A series of case studies has suggested the efficacy of deep cervical lymphatic venous anastomosis (DC-LVA) in AD patients, however, there is currently no evidence from randomized controlled clinical trials.

The primary purpose of this study is to evaluate the efficacy and safety of deep cervical lymphatic venous anastomosis (DC-LVA) plus usual care versus usual care in reduing the score of clinical dementia rating-sum of boxes (CDR-SB) at 12 months in patients with moderate-to-severe Alzheimer's Disease (AD). This study also aims to assess the efficacy and safety of DC-LVA in reducing AD biomarker levels of brain Aβ PET imaging.

This trial is a multicenter, prospective, open-label, blinded-endpoint, randomized controlled trial. A total of 754 patients in 20 centers from China will be enrolled. Patients will be randomly assigned into DC-LVA plus usual care or usual care according to the ratio of 1:1. Face to face interviews will be made at baseline, 7 days (or hospital discharge), 3th months ± 7 days, 6th months ± 15 days, 9th months ± 15 days and 12th month ± 15 days after randomization. After 12 months, there will be 12 months open-label extension of follow-up, participants in the control group can choose to conduct DC-LVA. During the open-label extension phase, follow-up visits will be conducted every 3 months until 24th months after randomization.

Primary outcome is defined as the change of CDR-SB score at 12th months after randomization. The changes of CDR-SB score will be analyzed using a repeated measures mixed-effects model. Least squares means will be used to estimate the levels at each time point, and the mean difference with 95% confidence intervals will be calculated. Safety outcomes in the DC-LVA treatment group will be summarized using counts/percentages. Adverse events and serious adverse events will be summarized.

In exploratory outcome measures, the investigators will analyse the AD associated biomarkers in lymphatic tissue in the intervetnon group during the surgery, and analyse the change of fluid biomarkers ( AD associated biomarkers in peripheral blood, saliva, urine, and cerebrospinal fluid), the change of MRI brain volumes (total brain volume, hippocampal volume, lateral ventricle volume), the change of glymphatic function index(DTI-ALPS), the change of MRS metabolic markers (N-Acetylaspartate, Creatine, Choline, Lactate, Glutamate and Glutamine, myo-Inositol), and the change of artificial intelligence-assisted oculomotor/gait measurements during 12 months of follow-up.

• Study Type: Interventional
• Enrollment (Estimated): 376
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yuesong Pan; Phone Number: 0086-010-59975807; Email: yuesongpan@aliyun.com
• Study Contact Backup: Name: Yilong Wang; Phone Number: 0086-010-67092222; Email: yilong528@aliyun.com

Study Locations

• China
  • Beijing, China, 100070
    • Recruiting
    • Beijing Tiantan Hopital, Capital Medical University
    • Contact: Yijia Guo, phD; Phone Number: 0086-010-59975029; Email: guoyijia_cmu@163.com
    • Contact: Yuesong Pan, phD; Phone Number: 0086-010-59975029; Email: yuesongpan@aliyun.com
    • Principal Investigator: Yilong Wang, PhD
    • Sub-Investigator: Yuesong Pan, phD
  • Guangdong
    • Dongguan, Guangdong, China
      • Recruiting
      • Dongguan Chashan Hospital
      • Contact: Haiwen Wang; Phone Number: 0086-13609048317; Email: shizetianv@163.com
  • Guangzhou
    • Guangdong, Guangzhou, China, 510000
      • Recruiting
      • Guangdong Second People's Hospital
      • Contact: Ping Luan; Phone Number: 13612992682; Email: luanping@szu.edu.cn
  • Henan
    • Zhengzhou, Henan, China, 450000
      • Recruiting
      • Zhengzhou Central Hospital
      • Contact: Xiwen Ma; Phone Number: 0086-13623805170; Email: zmydocument@163.com
  • Shandong
    • Jinan, Shandong, China, 250000
      • Recruiting
      • Shandong Provincial Third Hospital
      • Contact: Tingzhong Wang; Phone Number: 0086-18900912311; Email: wangtingzhong@126.com
      • Principal Investigator: Tingzhong Wang
    • Jinan, Shandong, China, 250000
      • Active, not recruiting
      • First Affiliated Hospital of Shandong First Medical University
    • Jinan, Shandong, China, 250000
      • Recruiting
      • Shandong Provincial Public Health Clinical Center
      • Contact: Qinghua Zhang; Phone Number: 0086-15168863112; Email: zhang.qinghua@outlook.com
    • Jining, Shandong, China, 272000
      • Recruiting
      • Jining First People's Hospital
      • Contact: Lei Feng; Phone Number: 0086-13181326326; Email: flneuro@163.com
      • Principal Investigator: Lei Feng
      • Sub-Investigator: Gaoyang Fan
      • Sub-Investigator: Zhongrui Yan
      • Sub-Investigator: Peng Wang
  • Zhejiang
    • Ningbo, Zhejiang, China, 315000
      • Recruiting
      • The First Affiliated Hospital of Ningbo University
      • Contact: Xiang Gao; Phone Number: 0086-18888611859; Email: yehand120@163.com
      • Contact: Zhaohui Ye

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Age 50-80 years, male or female.
2. Diagnosed with AD according to NIA-AA criteria.
3. Moderate-to-severe AD dementia, defined as Clinical Dementia Rating Scale Global Score (CDR-GS) ≥1.
4. Mini-Mental State Examination (MMSE) score 10-20.
5. The course of AD more than 6 months.
6. If receiving an approved AD treatment, must be on a stable drug dose for at least 3 months prior to Baseline. AD Treatment-naïve subjects can be entered into the study.
7. Have an identified caregiver (defined as a person able to support the subject for the duration of the study and who spends at least 8 hours per week with the subject). The caregiver must accompany with the participant at all study follow-up visits.
8. Signed informed consent (from the participant or their relative, and the caregiver).

Exclusion Criteria:

1. Any neurological condition other than AD that may affect cognitive function, including stroke, Parkinson's disease, epilepsy, intracranial tumors or space-occupying lesions, traumatic brain injury, intracranial infections, metabolic encephalopathy, etc.
2. Other causes of dementia, including vascular dementia, hereditary cerebral small vessel disease, vitamin deficiency, or any other etiology leading to dementia.
3. Previous evidence of severe stenosis (≥70%) in the middle cerebral artery and/or internal carotid artery.
4. Presence of primary psychiatric disorders (such as schizophrenia, schizoaffective disorder, major depressive disorder, or bipolar disorder) rather than psychiatric symptoms caused by AD.
5. Severe neurological deficits in limb movement, language, vision, hearing, or consciousness, or any condition that the investigator determines may prevent the completion of cognitive function assessments.
6. History of drug or alcohol abuse or dependence.
7. History of malignant tumors or prior radiotherapy or surgery involving the head and neck.
8. Major surgical procedures or severe head or body trauma within the past 30 days.
9. Presence of other life-threatening conditions with an expected survival time of less than 2 years.
10. Contraindications to head MRI (including cardiac pacemakers/defibrillators, ferromagnetic metal implants, etc.).
11. Severe diseases or functional impairment of the heart, lungs, liver, kidneys, or other solid organs, making the patient unable to tolerate anesthesia or DC-LVA.
12. Severe bleeding tendency (including but not limited to): platelet count <100×10⁹/L; heparin therapy within the last 48 hours with APTT ≥35 seconds; ongoing warfarin use with INR >1.7.
13. Requirement for long-term use of antithrombotic medications, with inability to discontinue them before surgery or potential risks associated with discontinuation.
14. Uncontrolled persistent hypertension (systolic blood pressure >160 mmHg or diastolic blood pressure >95 mmHg).
15. Co-infection with HIV or Treponema pallidum, or any uncontrolled infectious disease.
16. Use of other investigational drugs or devices within 30 days prior to obtaining informed consent, or current participation in other interventional clinical studies.
17. Pregnancy, lactation, potential for pregnancy, or plans for pregnancy during the study period.
18. Immediate family members of the investigator (spouse, parents, children, or siblings), staff of the research institution or third-party organizations, or any other individuals with potential conflicts of interest related to the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: DC-LVA treatment plus usual care; The intervention requires to perform bilateral deep cervical lymphatic venous anastomosis (DC-LVA). The usual care includes patients who were not using or were currently using medications for improving cognitive function.	Procedure: DC-LVA treatment plus usual care; Through cervical incision, the deep cervical lymphatic tissue is anatomically dissected and anastomosed with the venous system of the neck. Under indocyanine green (ICG) navigation, the flow of lymphatic fluid into the vein could be observed via ICG tracing fluorescence after surgery.; Other Names: LVA
Active Comparator: Usual care; The usual care group includes patients who were not using or were currently using medications for improving cognitive function.	Other: Usual care; The usual care group includes patients who were not using or were currently using medications for improving cognitive function.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The change of Clinical Dementia Rating-Sum of Boxes score at 12th months after randomization	The change of Clinical Dementia Rating-Sum of Boxes score (CDR-SB, 0-18 score, higher scores mean a worse outcome)	From baseline to 12th months after randomization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Change of Severe Impairment Batterty Score	Severe Impairment Batterty Score (SIB, 0-100 score, higher scores mean a worse outcome)	From baseline to 3th, 6th, 9th, 12th months after randomization
The Change of Aβ PET-CT Centiloid value	The change of Aβ PET-CT Centiloid value at 12 months	From baseline to 12th months after randomization
The Change of Clinician's Interview-Based Impression of Change plus caregiver input score	Clinician's Interview-Based Impression of Change plus caregiver input score (CIBIC-plus, 1-7 score, higher scores mean a worse outcome)	From baseline to 12th months after randomization
The Change of Neuropsychiatric Inventory Score	Neuropsychiatric Inventory Score (NPI, 0-144 score, higher scores mean a worse outcome)	From baseline to 12th months after randomization
The Change of Zarit Caregiver Interview of Alzheimer's Disease Score	Zarit Caregiver Interview of Alzheimer's Disease Score (ZCI-AD, 0-88 score, higher scores mean a worse outcome)	From baseline to 12th months after randomization
The Change of Alzheimer's Disease Assessment Scale-Activity of Daily Living score	Alzheimer's Disease Assessment Scale-Activity of Daily Living score (ADCS-ADL, 0-78 score, higher scores mean a better outcome)	From baseline to 12th months after randomization
The Change of Mini-Mental State Examination Score	Mini-Mental State Examination Score (MMSE, 0-30 score, higher scores mean a better outcome)	From baseline to 12th months after randomization
The Change of Clinical Dementia Rating-Sum of Boxes score	Clinical Dementia Rating-Sum of Boxes score (CDR-SB, 0-18 score, higher scores mean a worse outcome	From baseline to 3th, 6th, 9th months after randomization
The Change of Clinician's Interview-Based Impression of Change plus caregiver input score	Clinician's Interview-Based Impression of Change plus caregiver input score (CIBIC-plus, 1-7 score, higher scores mean a worse outcome)	From baseline to 3th, 6th, 9th months after randomization
The Change of Neuropsychiatric Inventory Score	Neuropsychiatric Inventory Score (NPI, 0-144 score, higher scores mean a worse outcome)	From baseline to 3th, 6th, 9th months after randomization
The Change of Zarit Caregiver Interview of Alzheimer's Disease Score	Zarit Caregiver Interview of Alzheimer's Disease Score (ZCI-AD, 0-88 score, higher scores mean a worse outcome)	From baseline to 3th, 6th, 9th months after randomization
The Change of Alzheimer's Disease Assessment Scale-Activity of Daily Living score	Alzheimer's Disease Assessment Scale-Activity of Daily Living score (ADCS-ADL, 0-78 score, higher scores mean a better outcome)	From baseline to 3th, 6th, 9th months after randomization
The Change of Mini-Mental State Examination Score	Mini-Mental State Examination Score (MMSE, 0-30 score, higher scores mean a better outcome	From baseline to 3th, 6th, 9th months after randomization
The Change of Alzheimer's Disease Assessment Scale Cognitive Score	Alzheimer's Disease Assessment Scale Cognitive score (ADCS-Cog-13, 0-85 score, higher scores mean a worse outcome)	From baseline to 3th, 6th, 9th, 12th months after randomization
The Change of Alzheimer's Disease Composite Score	Alzheimer's Disease Composite Score (ADCOMS, 0-1.97 score, higher scores mean a worse outcome) is calculated by a weighted items from three scales including ADCS-Cog, MMSE, and CDR-SB.	From baseline to 3th, 6th, 9th, 12th months after randomization

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
The incidence of perioperative complications in the intervention group within 7 days after randomization	The incidence of perioperative complications in the intervention group	From baseline to 7th days after randomization
The change of Clinical Dementia Rating-Sum of Boxes score during the open-label extension phase	Clinical Dementia Rating-Sum of Boxes score (CDR-SB, 0-18 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Clinician's Interview-Based Impression of Change plus caregiver input score during the open-label extension phase	Clinician's Interview-Based Impression of Change plus caregiver input score (CIBIC-plus, 1-7 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Zarit Caregiver Interview of Alzheimer's Disease Score during the open-label extension phase	Zarit Caregiver Interview of Alzheimer's Disease Score (ZCI-AD, 0-88 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Mini-Mental State Examination Score during the open-label extension phase	Mini-Mental State Examination Score (MMSE, 0-30 score, higher scores mean a better outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Severe Impairment Batterty Score during the open-label extension phase	Severe Impairment Batterty Score (SIB, 0-100 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Neuropsychiatric Inventory Score during the open-label extension phase	Neuropsychiatric Inventory Score (NPI, 0-144 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Alzheimer's Disease Assessment Scale-Activity of Daily Living score during the open-label extension phase	Alzheimer's Disease Assessment Scale-Activity of Daily Living score (ADCS-ADL, 0-78 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Alzheimer's Disease Assessment Scale-Cognitive Score during the open-label extension phase	Alzheimer's Disease Assessment Scale-Cognitive Score (ADCS-Cog-13, 0-85 score, higher scores mean a worse outcome)	From baseline to 15th, 18th, 21th, and 24th months after randomization
The Change of Alzheimer's Disease Composite Score during the open-label extension phase	Alzheimer's Disease Composite Score(ADCOMS, 0-1.97 score, higher scores mean a worse outcome) is calculated by a weighted items from three scales including ADCS-Cog, MMSE, and CDR-SB.	From baseline to 15th, 18th, 21th, and 24th months after randomization

Collaborators and Investigators

• Sponsor: Beijing Tiantan Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 13, 2026
• Primary Completion (Estimated): November 30, 2028
• Study Completion (Estimated): November 30, 2029

Study Registration Dates

• First Submitted: May 11, 2025
• First Submitted That Met QC Criteria: July 9, 2025
• First Posted (Actual): July 18, 2025

Study Record Updates

• Last Update Posted (Actual): May 12, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Randomized Controlled Trial; Alzheimers disease; Cervical Lymphatic Venous Anastomosis
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Neurocognitive Disorders; Dementia; Tauopathies; Neurodegenerative Diseases; Alzheimer Disease
• Other Study ID Numbers: KY2025-089-02

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