Prospective Single-Arm Safety Study of Cervical LVA in AD Patients (Neck LVA)

March 4, 2026 updated by: Chang Gung Memorial Hospital

Prospective Single-Arm Safety Study of Cervical Lymphaticovenular Anastomosis (LVA) in Patients With Alzheimer's Disease

Official Title Prospective Single-Arm Safety Study of Cervical Lymphaticovenular Anastomosis (LVA) in Patients with Alzheimer's Disease

Purpose of the Study Researchers are conducting this study to see if a minimally invasive microsurgery, called Cervical Lymphaticovenular Anastomosis (LVA), is safe for people with Alzheimer's Disease.

How the Surgery Works Alzheimer's Disease is linked to the buildup of metabolic waste products (certain proteins) in the brain. Recent medical discoveries show that these wastes normally drain through small channels in the neck into the blood system. In this study, surgeons will use high-powered microscopes to connect these drainage channels (lymphatic vessels) in the neck directly to small nearby veins. The goal is to create a "detour" that helps the brain clear out these harmful proteins more effectively.

What to Expect Safety First: The main goal is to find out if the surgery is safe and well-tolerated by patients.

The Procedure: The surgery is performed under general anesthesia and typically takes 4 to 6 hours. It involves small (about 5 cm) incisions on both sides of the neck.

Follow-up: Participants will be monitored for at least 12 months. Researchers will use memory tests, brain scans (MRI and PET), and blood tests to see if the surgery helps with daily activities or slows down memory loss.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Official Title Prospective Single-Arm Safety Study of Cervical Lymphaticovenular Anastomosis (LVA) in Patients with Alzheimer's Disease

Scientific Rationale Neurodegenerative diseases like Alzheimer's (AD) are characterized by the misfolding and accumulation of proteins such as Amyloid-beta and Tau. The glymphatic and meningeal lymphatic systems serve as the primary pathways for clearing these metabolic wastes from the central nervous system into the deep cervical lymph nodes. This study investigates whether enhancing this drainage via supermicrosurgical lymphaticovenular anastomosis (LVA) can reduce intracranial protein burden and systemic oxidative stress.

Study Design and Intervention This is a prospective, single-arm safety study. Participants undergo bilateral cervical LVA. Using Indocyanine Green (ICG) fluorescence lymphography for navigation, lymphatic vessels in the neck are identified and anastomosed to adjacent small veins to facilitate lymph drainage into the venous circulation.

Safety Monitoring and Data Integrity Primary Safety Endpoint: The study defines safety as a Serious Adverse Event (SAE) rate of ≤10% within the first month post-operation. Events are graded using CTCAE v5.0.

Independent Oversight: To ensure objectivity, cognitive and behavioral assessments (including MMSE, CDR, and CASI) are conducted by clinical psychologists who are not members of the core research team.

External Auditing: An independent Clinical Research Organization (CRO) has been contracted to perform four periodic audits to verify data accuracy and GCP compliance.

Exploratory Objectives

The study will track longitudinal changes in:

Fluid Biomarkers: Plasma levels of Amyloid-beta 40/42, p-Tau 217, GFAP, and Nf-L at baseline, 1, 6, and 12 months.

Neuroimaging: Amyloid-PET and FDG-PET scans at baseline and 12 months to evaluate protein deposition and metabolic activity.

Clinical Outcomes: Changes in cognitive scores (CDR, MMSE, CASI, NPI) from baseline to 6 months post-surgery.

Study Type

Interventional

Enrollment (Estimated)

35

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Taiwan
      • Kaohsiung City, Taiwan, 833
        • Kaohsiung Chang Gung Memorial Hospital
        • Contact:

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosis of Alzheimer's Disease: Participants must have a confirmed diagnosis of Alzheimer's Disease as evaluated by a neurologist and a psychiatrist at the hospital.
  • Positive Amyloid-PET Scan: The result of a [18F] Florbetapir (Amyloid-PET) scan must be positive, indicating the presence of amyloid plaques in the brain.
  • Willingness to Consent: Participants or their legal representatives must be willing to sign a written informed consent form.
  • Participants must be adults aged 18 years or older

Exclusion Criteria:

  • Lack of Informed Consent: Potential participants are excluded if they are unable to exercise autonomy and informed consent cannot be obtained from a legal representative or authorized person.
  • Prior Surgical History: Individuals who have previously undergone neck lymphatic dissection, nasopharyngeal surgery, or intracranial surgery are excluded.
  • Concurrent Medical Conditions: The trial excludes persons with thyroid disease or chronic heart failure.
  • Specific Allergies: Candidates with a history of allergies to shellfish or iodine are excluded due to the use of Indocyanine Green (ICG) during the procedure.
  • Unresolved Concerns: Anyone who has doubts about the trial and cannot receive satisfactory answers is excluded.
  • Anesthesia Risks: Individuals deemed medically unfit for general anesthesia-for example, those with severe cardiopulmonary insufficiency or a history of specific anesthetic drug allergies-are ineligible.

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Single-Arm Cervical LVA Intervention Supporting Context Arm Type

The single experimental arm involves bilateral cervical supermicrosurgical Lymphaticovenular Anastomosis (LVA). Participants undergo a surgical procedure where high-power microscopy is used to identify cervical lymphatic vessels. These vessels are then microsurgically connected (anastomosed) to adjacent small veins to create an extra-cranial bypass.

The intervention utilizes Indocyanine Green (ICG) fluorescence imaging to precisely map the lymphatic drainage pathways in the neck. The primary goal of this bypass is to enhance the clearance of metabolic waste-specifically Amyloid-beta and tau proteins-from the brain by facilitating their drainage from the glymphatic and meningeal lymphatic systems into the systemic venous circulation. This trial evaluates the safety and feasibility of this approach in mitigating the progression of Alzheimer's Disease.
Procedure: Supermicrosurgical Lymphaticovenular Anastomosis (LVA)

This intervention is uniquely distinguished by its use of supermicrosurgery to perform bilateral cervical Lymphaticovenular Anastomosis (LVA) as a direct physiological treatment for Alzheimer's Disease. Unlike traditional pharmacological trials that target protein production or aggregation, this surgical approach focuses on the mechanical clearance of metabolic waste.

A key technical differentiator is the specific targeting of neck lymph nodes using Indocyanine Green (ICG) fluorescence to map the drainage pathway of cerebrospinal fluid. This allows for a precise, "super-microsurgical" bypass (connecting vessels often <0.8mm) in the neck. This method aims to bypass potential blockages in the aging dCLNs (deep cervical lymph nodes), directly enhancing the outflow of Amyloid-beta and Taufrom the glymphatic and meningeal systems into the venous circulation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of Treatment-Emergent Adverse Events (Safety and Feasibility)
Time Frame: From the start of surgery up to 1 month post-operation.
Assessment of the safety and feasibility of bilateral cervical supermicrosurgical lymphaticovenular anastomosis (LVA). Safety is evaluated by the frequency and severity of adverse events (AEs) and serious adverse events (SAEs) occurring from the start of the surgical procedure through the 1-month post-operative follow-up period. Events are graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
From the start of surgery up to 1 month post-operation.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from Baseline in Mini-Mental State Examination (MMSE) Score
Time Frame: Baseline and 6 months post-operation
A 30-point questionnaire used to measure cognitive impairment. Lower scores indicate greater impairment.
Baseline and 6 months post-operation
Change from Baseline in Clinical Dementia Rating (CDR)
Time Frame: Baseline and 6 months post-operation.
A scale used to characterize the level of cognitive and functional performance.
Baseline and 6 months post-operation.
Changes from Baseline in Cognitive Abilities Screening Instrument (CASI)
Time Frame: Baseline and 6 months post-operation.
The CASI is a comprehensive tool used to assess multiple cognitive domains, including attention, concentration, orientation, short-term memory, long-term memory, language abilities, visual construction, list-generating fluency, and abstraction. It provides a more detailed assessment than the MMSE, with a total score ranging from 0 to 100. Higher scores indicate better cognitive performance, while lower scores represent greater impairment.
Baseline and 6 months post-operation.
Change in Brain Amyloid-beta Deposition via PET Scan
Time Frame: Baseline and post-operation.
Assessment of the change in brain amyloid plaque density using [18F] Florbetapir (Amyloid-PET) imaging. This measures whether the surgical intervention has facilitated the clearance of pathological proteins.
Baseline and post-operation.
Change in Plasma Neurodegenerative Biomarker Levels
Time Frame: Baseline and post-operation.
Quantification of plasma levels for GFAP and NfL. These markers are used to track neuroaxonal damage and protein clearance efficiency.
Baseline and post-operation.

Collaborators and Investigators

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

Sponsor

Chang Gung Memorial Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Estimated)

March 1, 2026

Primary Completion (Estimated)

May 1, 2027

Study Completion (Estimated)

September 1, 2028

Study Registration Dates

First Submitted

February 22, 2026

First Submitted That Met QC Criteria

March 4, 2026

First Posted (Actual)

March 9, 2026

Study Record Updates

Last Update Posted (Actual)

March 9, 2026

Last Update Submitted That Met QC Criteria

March 4, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 202500102A0

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

  1. Data Protection and Retention Limits: The protocol strictly mandates that all de-identified data and specimens will be destroyed five years after the formal conclusion of the trial.
  2. Privacy and Confidentiality: To protect the privacy of participants, data is stored under locked and encrypted conditions, with access restricted to the immediate research team members.
  3. Restricted Future Use: While participants can consent to have their data stored in the hospital's internal biobank, this authorization is limited specifically to future research within Kaohsiung Chang Gung Memorial Hospital and does not extend to public or external sharing.
  4. Legal Representative Consent: Because the study involves participants with cognitive impairments who may lack the capacity to exercise autonomy, data management is subject to strict ethical oversight that prioritizes the protection of the participants' rights over broad data dissemination.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

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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