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Biomarkers of Neuroinflammation and Anti-Inflammatory Treatments in Major Depressive Disorder

22 de mayo de 2019 actualizado por: Jeff Meyer, Centre for Addiction and Mental Health
The purpose of this study is to determine if translocator protein total distribution volume (TSPO VT) is elevated in major depressive disorder that is not responding to medication and if adding minocycline can affect TSPO VT. Many remain treatment resistant with common antidepressant treatments and the investigators think it may be due to poor targeting of brain pathologies.

Descripción general del estudio

Estado

Terminado

Descripción detallada

There will be three Phases in the study. Only MDE subjects will be invited to continue to Phase 2 and 3. Subjects will be invited to continue to the subsequent Phase given they meet entry criteria described below:

Phase 1: The investigators will evaluate whether TSPO is elevated in individuals during a current MDE compared to healthy controls. Eligible participants will receive one [18F]FEPPA PET scan and one MRI scan. Other measures will include urine sample, blood samples for genetic and peripheral biomarker analysis, a neurocognitive battery, mood scales and questionnaires.

Phase 2: Participants who have elevated TSPO VT in Phase 1 and are agreeable to receiving minocycline will be invited to participate in Phase 2. Based on our previous results participants will be considered candidates for Phase 2 if TSPO VT ≥ 10.5 (HAB) or ≥8.5 (MAB) in any of the primary regions of interest (prefrontal cortex, anterior cingulate cortex or insula). Eligible participants will be invited to participate in a randomized, double blind, placebo controlled trial, to receive either minocycline or placebo. After the eight weeks of treatment, participants will receive one [18F]FEPPA PET scan. Other measures will include urine samples, blood samples, mood scales and questionnaires.

Phase 3: If, after the initial eight week treatment period with either minocycline or placebo, any participant continues to have depressive symptoms (17-item Hamilton Depression Rating Scale score ≥ 8) they will be invited to participate in an eight week open label trial of celecoxib. Participants not eligible for Phase 2 may also be invited to participate in Phase 3 directly from Phase 1.

Tipo de estudio

Intervencionista

Inscripción (Anticipado)

115

Fase

  • Fase temprana 1

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Ubicaciones de estudio

    • Ontario
      • Toronto, Ontario, Canadá, M5T 1R8
        • Centre for Addiction and Mental Health

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años a 65 años (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

Géneros elegibles para el estudio

Todos

Descripción

Group 1 - Current major depressive episode (MDE) secondary to MDD

Inclusion Criteria:

  • good physical health with no active medical conditions
  • non-cigarette smoking
  • no past or current substance abuse or dependence
  • negative urine pregnancy test at screening and scan days (for women)
  • primary diagnosis of current major depressive episode (MDE) and major depressive disorder (MDD) verified by SCID for DSM IV
  • score greater than 19 on the 17 item HDRS
  • non-response to a clinical trial of at least one antidepressant given at appropriate clinical dose
  • willing to take medication for the duration of the trial and has previously taken antidepressants for the duration of the trial
  • presently taking an antidepressant at a standard clinical dose.

Exclusion Criteria:

  • history of neurological illness or autoimmune disorders
  • never taken a tricyclic antidepressant or an antidepressant that raises norepinephrine
  • received treatment with electroconvulsive therapy or mechanical brain stimulation in the previous 6 months
  • currently taking medication contraindicated or that may possibly interact with either minocycline or celecoxib
  • known intolerance or allergy to minocycline, other tetracyclines, sulfonamides or NSAIDs
  • taken diazepam or other benzodiazepine use within the past month, except for lorazepam and clonazepam
  • use of anti-inflammatory drugs or tetracyclines lasting ≥1 week within the past month
  • history of severe hepatic or renal insufficiency, asthma, allergies, gastrointestinal disease, ischemic heart disease, cerebrovascular disease or congestive heart failure
  • lactose intolerance

Group 2 - Healthy Controls - Phase 1 (baseline scan) only

Inclusion criteria:

  • score below 8 on the 17 item HDRS
  • good physical health
  • non-cigarette smoking
  • negative urine pregnancy test at screening and scan days (for women)
  • negative urine screen for drugs of abuse

Exclusion criteria:

  • past or current diagnosis of axis I or axis II disorder as determined by the SCID I and SCID II for DSM IV
  • history of psychotropic medication use
  • history of neurological illness or autoimmune disorder

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Ciencia básica
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación de un solo grupo
  • Enmascaramiento: Cuadruplicar

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Experimental: Minocycline
The dose of minocycline would be 50mg per day on week 1, 50mg bid on week 2 and 100mg bid weeks 3-8. For tapering, the dose will be reduced to 50mg bid for a week, and then stopped.
50 mg and 100 mg capsule, oral administration
Otros nombres:
  • Mylan-minocycline
Comparador de placebos: Placebo
The number and appearance of the pills would be identical to those in the minocycline arm.
Lactose monohydrate in identical gel capsules to minocycline, oral administration.
Otros nombres:
  • Lactosa monohidrato
Otro: Celecoxib
This will be an open label trial for those with Hamilton Depression Rating Scale score ≥ 8 following the minocycline v. placebo trial or those not eligible for Phase 2. Dose of celecoxib will be 100 mg bid for the first week and 200mg bid for weeks 2-8. For tapering, the dose of celecoxib will be reduced to 100mg bid for one week, and then stopped.
100 mg and 200 mg capsules, oral administration.
Otros nombres:
  • Celebrex (Pfizer)

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Translocator total distribution volume (TSPO VT): Treatment Effect of Minocycline in MDE Subjects
Periodo de tiempo: Pre- and post-minocycline or placebo treatment= 8 weeks total between pretreatment and posttreatment scans
TSPO VT will be measured using [18F]FEPPA positron emission tomography brain scans. Eligible MDE participants will be randomized to either minocycline or placebo. Following 8 weeks of either minocycline or placebo treatment, MDE participants will have a second PET scan .
Pre- and post-minocycline or placebo treatment= 8 weeks total between pretreatment and posttreatment scans
Translocator total distribution volume (TSPO VT): Difference between MDE and healthy subjects
Periodo de tiempo: Pre-treatment scan will take place up to 8 weeks from initial assessment
Compare baseline TSPO VT prior to treatment between MDE group and healthy group
Pre-treatment scan will take place up to 8 weeks from initial assessment

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Change in Hamilton Depression Rating Scale Score
Periodo de tiempo: Pre- and post-minocycline treatment (8 weeks total between pre- and post-treatment). Pre- and post-celecoxib treatment (8 weeks total between pre- and post-treatment).
Change in HDRS score following minocycline vs. placebo treatment. Change in HDRS score following celecoxib treatment.
Pre- and post-minocycline treatment (8 weeks total between pre- and post-treatment). Pre- and post-celecoxib treatment (8 weeks total between pre- and post-treatment).

Otras medidas de resultado

Medida de resultado
Medida Descripción
Periodo de tiempo
Hopkins Verbal Learning Test-Revised
Periodo de tiempo: Pre- and post-minocycline or placebo treatment (8 weeks between pre- and post-treatment measure)
To assess verbal memory we will administer the Hopkins Verbal Learning Test-Revised to MDE participants before and after treatment.
Pre- and post-minocycline or placebo treatment (8 weeks between pre- and post-treatment measure)
Brief Visuospatial Memory Test-Revised
Periodo de tiempo: Pre- and post-minocycline or placebo treatment (8 weeks between pre- and post-treatment measure)
To assess visuospatial memory we will administer the Brief Visuospatial Memory Test-Revised to MDE participants before and after treatment.
Pre- and post-minocycline or placebo treatment (8 weeks between pre- and post-treatment measure)
Comprehensive Trails Making Test
Periodo de tiempo: Pre- and post-minocycline or placebo treatment.
To assess psychomotor speed and attention we will administer the Comprehensive Trails Making Test to MDE participants before and after treatment.
Pre- and post-minocycline or placebo treatment.
Genetic sample
Periodo de tiempo: Phase 1-single sample
The priority of the genetic sample is to analyze the alleles of polymorphism rs6971 which has an association with the affinity of most second generation TSPO ligands including [18F]FEPPA. The genetic sample will also be used to study sequences of genes that are believed to affect TSPO expression, inflammation, mood and conditions that may predispose to mood disorders.
Phase 1-single sample
Blood samples (serum and plasma)
Periodo de tiempo: Pre- and post-minocycline or placebo treatment (8 weeks between measures). Pre- and post-celecoxib treatment (8 weeks between measures).
Analyses will include complete blood cell count (CBC), ESR, hepatic and renal function. Peripheral marker analyses will include proteins related to TSPO expression and inflammation. Plasma minocycline and celecoxib levels will be analyzed.
Pre- and post-minocycline or placebo treatment (8 weeks between measures). Pre- and post-celecoxib treatment (8 weeks between measures).

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Investigadores

  • Investigador principal: Jeffrey H Meyer, MD, PhD, Centre for Addiction and Mental Health; University of Toronto

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio

1 de febrero de 2015

Finalización primaria (Actual)

1 de abril de 2019

Finalización del estudio (Actual)

1 de abril de 2019

Fechas de registro del estudio

Enviado por primera vez

4 de febrero de 2015

Primero enviado que cumplió con los criterios de control de calidad

9 de febrero de 2015

Publicado por primera vez (Estimar)

13 de febrero de 2015

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

23 de mayo de 2019

Última actualización enviada que cumplió con los criterios de control de calidad

22 de mayo de 2019

Última verificación

1 de mayo de 2019

Más información

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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