Lamivudine as a Novel Clinical Effort for Rett Syndrome (LANCE)
Lamivudine in Individuals With Rett Syndrome: Clinical, Biochemical, and Cellular Evaluation
연구 개요
상세 설명
Rett syndrome (RTT) is a rare genetic neurodevelopmental disorder caused primarily by loss-of-function mutations in the MECP2 gene, leading to progressive impairments in motor, cognitive, and communicative function after an initial period of apparently typical development. Currently, there are no medications that change the course of the disease, and treatment is mainly focused on managing symptoms.
Functional MeCP2 represses the activity of the LINE-1 (L1) retroelement, and loss of this repression may result in increased L1 accumulation in glial cells in the brain, promoting genomic instability, oxidative stress, and neuroinflammation associated with RTT pathophysiology.
Lamivudine inhibits L1 reverse transcription and has shown beneficial effects in preclinical neuronal culture and MeCP2-deficient mouse models, including reduced inflammatory and oxidative stress markers, improved neurological and behavioral outcomes, and increased survival. In this study, each participant is evaluated before and after receiving treatment, allowing changes to be assessed within the same individual over time. Following screening and baseline assessments, participants enter a treatment phase during which oral lamivudine is administered for a defined period. Longitudinal clinical, laboratory, and safety evaluations are conducted at scheduled visits, followed by a post-treatment follow-up period to assess the persistence of effects.
A 24-week intervention period was selected as a feasible and acceptable duration for participants and caregivers and as an appropriate timeframe for an initial open-label evaluation of therapeutic potential. This duration is expected to provide sufficient exposure to lamivudine to allow detection of short-term clinical and biological changes suggested by preclinical studies, while also enabling systematic assessment of safety and tolerability in this population.
Participants may continue their usual medical treatments, including medications for seizures and other supportive therapies, as long as these treatments remain stable during the study, unless a change is medically necessary.
Caregivers receive standardized instructions on medication administration, and adherence is monitored throughout the treatment phase through caregiver reporting and visit-based verification to ensure accurate assessment of treatment exposure.
Clinical assessments employ validated clinician and caregiver-reported instruments to evaluate symptom severity, functional status, quality of life, and seizure activity, capturing changes across motor, behavioral, and daily functioning domains relevant to RTT. Safety is monitored continuously through adverse event surveillance, routine clinical evaluations, and laboratory testing, with predefined criteria for treatment interruption if clinically indicated. Venous blood samples are collected at baseline and during treatment to evaluate systemic biomarkers related to oxidative stress, inflammation, and neurodevelopment. These measures complement clinical outcomes and explore potential mechanistic effects of lamivudine treatment.
In addition to the biomarkers reported as outcome measures, a panel of exploratory, hypothesis-generating biomarkers will be analyzed, including markers of oxidative stress, neuroinflammation and neurodevelopment, mitochondrial and energy metabolism, and nutritional and micronutrient status. These analyses are not considered clinical endpoints and are not reported as outcome measures.
As a translational research component, skin punch biopsies from a subset of participants are used to establish a dermal fibroblast biobank, enabling the generation of patient-derived induced pluripotent stem cells and brain organoids. These models will be used in exploratory laboratory studies to investigate cellular and molecular mechanisms in RTT and responses to lamivudine, without being considered clinical endpoints. Based on preclinical evidence and the proposed mechanism of action, lamivudine treatment is expected to be safe and well-tolerated in individuals with Rett syndrome. Clinically, it may lead to improvements in motor function, social engagement, and overall symptom severity, while reducing seizure frequency and enhancing quality of life. Biologically, lamivudine is anticipated to modulate oxidative stress and inflammatory pathways, potentially restoring a more balanced neurodevelopmental environment. The combined clinical and laboratory observations from this study will provide critical insights into the therapeutic potential of lamivudine and inform future research directions in RTT.
연구 유형
등록 (추정된)
단계
- 2 단계
연락처 및 위치
연구 장소
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Ceará
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Fortaleza, Ceará, 브라질
- GenClinics
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참여기준
자격 기준
공부할 수 있는 나이
- 어린이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
설명
Inclusion Criteria:
- Clinical and molecular diagnosis of Rett syndrome;
- Age 2 years or older at the time of enrollment;
- Ability to swallow liquid medication;
- Stable clinical condition, as determined by the study investigator;
- Availability of a parent or legal guardian able to provide informed consent and comply with study procedures;
- Willingness of the participant and/or legal guardian to comply with study visits and assessments.
Exclusion Criteria:
- Known hypersensitivity or contraindication to lamivudine;
- Severe hepatic or renal impairment that, in the investigator's judgment, would preclude safe participation;
- Use of investigational drugs or participation in another clinical trial within a defined washout period before enrollment;
- Presence of any medical condition or acute illness that could interfere with study participation or outcome assessment, as determined by the investigator;
- Inability to undergo blood collection or skin biopsy procedures required for the study;
- Any condition that, in the opinion of the investigator, would place the participant at undue risk or compromise adherence to the study protocol.
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: Lamivudine Treatment
Approximately 10 participants aged ≥2 years with a confirmed clinical and molecular diagnosis of Rett syndrome will receive oral lamivudine using weight-based dosing for 24 weeks following baseline clinical and laboratory assessments.
Participants will undergo regular monitoring for safety, tolerability, and efficacy, including clinical evaluations, laboratory testing, and assessment of neurological and functional outcomes.
Dose adjustments or discontinuation may occur in response to adverse events.
Blood samples will be collected for biomarker analyses, with an optional skin biopsy in a subset of participants for exploratory research.
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Lamivudine will be given orally to participants with Rett syndrome using weight-based dosing after baseline clinical and laboratory assessments.
Children <14 kg will receive oral solution at 4 mg/kg twice daily (max 300 mg/day).
Participants ≥14 kg will receive tablets by weight: 14-20 kg, 150 mg/day; 20-25 kg, 225 mg/day; >25 kg, 300 mg/day.
Medication may be taken with or without food.
Tablets should not be crushed unless swallowing is difficult.
If needed, they may be crushed and mixed with liquid or soft food and taken immediately, or oral solution may be used.
Caregivers will be instructed on dosing and concomitant medications.
Treatment lasts 24 weeks with weekly safety, tolerability, and efficacy monitoring.
Dose adjustment or discontinuation may occur if significant adverse events arise.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Change in Rett Syndrome Symptom Severity (RARS)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Rett syndrome symptom severity assessed using the Rett Assessment Rating Scale (RARS), comparing total scores obtained at baseline with scores obtained after treatment with lamivudine and at post-treatment follow-up. Total scores range from 0 to 128, with higher scores indicating greater symptom severity. A reduction in total score will be interpreted as clinical improvement. Unit of Measure: Units on a scale (0-128) |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Rett Syndrome Behavioral Symptoms
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Rett syndrome behavioral symptoms assessed using the Rett Syndrome Behaviour Questionnaire (RSBQ), comparing total scores obtained at baseline with scores obtained at the end of treatment with lamivudine and at post-treatment follow-up. The RSBQ is a Rett syndrome-specific instrument used to assess behavioral, autonomic, and functional manifestations associated with Rett syndrome, including breathing abnormalities, irritability, anxiety, mood, repetitive hand movements, communication, and social interaction. The RSBQ consists of 45 items scored from 0 to 2, where 0 indicates "not true," 1 indicates "somewhat or sometimes true," and 2 indicates "often true" or "very true." Total scores range from 0 to 90, with higher scores indicating greater frequency or severity of behavioral symptoms and worse clinical status. A reduction in total score after treatment will be interpreted as improvement in Rett syndrome behavioral symptoms. Unit of Measure: Units on a scale (0-90) |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Safety of Lamivudine: Occurrence of Adverse Events
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Safety assessed by the number and proportion of participants experiencing at least one adverse event (serious or non-serious) during treatment with lamivudine, based on clinical assessment and laboratory monitoring. Unit of Measure: Number and proportion of participants with adverse events |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Causality of Adverse Events (LCAT)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Causality of adverse events related to lamivudine assessed using the Liverpool Adverse Drug Reaction Causality Assessment Tool (LCAT). The tool classifies the causal relationship between the drug and each adverse event as unlikely, possible, probable, or definite. Higher categories indicate a greater likelihood of a causal relationship between the adverse event and lamivudine. Unit of Measure: Number and proportion of adverse events in each causality category |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Health-Related Quality of Life: Pediatric Participants (PedsQL Neuromuscular Module)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in health-related quality of life assessed primarily by the PedsQL 3.0 Neuromuscular Module (PedsQL NMM), caregiver-report adapted version, comparing baseline scores with scores at the end of treatment and at follow-up. The PedsQL NMM yields transformed scores from 0 to 100; higher scores indicate better health-related quality of life and lower symptom impact. An increase after treatment is interpreted as improvement. Unit of Measure: Units on a scale (0-100) |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Health-Related Quality of Life - Adult participants (SF-36)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in health-related quality of life assessed by the Short Form (36) Health Survey (SF-36) in adult participants, comparing baseline scores with scores at the end of treatment and follow-up. SF-36 domain scores range from 0 to 100, with higher scores indicating better quality of life. An increase in score after treatment is interpreted as improvement. Unit of Measure: Units on a scale (0-100) |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Adaptive Behavior (Vineland Adaptive Behavior Scales - Adaptive Behavior Composite)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in adaptive behavior assessed using the Vineland Adaptive Behavior Scales, reported as the Adaptive Behavior Composite standard score, comparing baseline with end-of-treatment and follow-up values. Standard scores have a mean of 100 and a standard deviation of 15, higher scores indicate better adaptive functioning. Unit of Measure: Standard score |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Presence of Epileptic Seizures
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Presence of epileptic seizures during treatment with lamivudine, assessed by the number of participants experiencing at least one epileptic seizure after the start of the intervention. Data obtained from caregiver records and clinical assessment by the research team. Unit of Measure: Participants |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Frequency of Epileptic Seizures
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in the frequency of epileptic seizures, comparing the mean number of seizures per participant at baseline with the mean number recorded during treatment with lamivudine. Information obtained from a caregiver-completed seizure diary, confirmed at follow-up visits. Unit of Measure: Number of seizures per month |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Need for Medical Intervention Related to Epileptic Seizures
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Need for medical intervention related to epileptic seizures during treatment with lamivudine, assessed by the number of participants requiring emergency care, hospitalization, or rescue medication due to an epileptic seizure. Unit of Measure: Participants |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Caregiver Burden (Zarit Burden Interview, ZBI-22)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in caregiver burden assessed using the Zarit Burden Interview (ZBI-22), comparing baseline scores with scores at the end of treatment and at follow-up. Total scores range from 0 to 88, with higher scores indicating greater caregiver burden. A reduction in total score after treatment is interpreted as improvement. Unit of Measure: Units on a scale (0-88) |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Global Clinical Severity (CGI-S)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in global clinical severity assessed by the Clinical Global Impression Severity (CGI-S) scale, comparing the score at baseline with the score at the end of treatment. The CGI-S is a 7-point clinician-rated scale ranging from 1 to 7, where 1 = normal (not at all ill) and 7 = among the most extremely ill patients. Higher scores indicate greater global clinical severity. A reduction after treatment is interpreted as clinical improvement. Unit of Measure: Units on a scale (1-7) |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Global Clinical Improvement (CGI-I)
기간: Week 24 and Week 52
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Global clinical improvement assessed using the Clinical Global Impression-Improvement scale (CGI-I) at the end of lamivudine treatment and during post-treatment follow-up. Scores range from 1 ("very much improved") to 7 ("very much worse"), with lower scores indicating greater improvement. Unit of Measure: Units on a scale (1-7) |
Week 24 and Week 52
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Change in serum C-reactive protein (CRP)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum C-reactive protein (CRP) concentrations, comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/L |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Monocyte chemoattractant protein-1 (MCP-1)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Monocyte chemoattractant protein-1 (MCP-1), comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: pg/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Ferritin
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Ferritin, comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: ng/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-1 beta (IL-1β)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-1 beta (IL-1β), comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: pg/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-6 (IL-6)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-6 (IL-6), comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: pg/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-8 (IL-8)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-8 (IL-8), comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: pg/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-10 (IL-10)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Interleukin-10 (IL-10), comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: pg/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Tumor Necrosis Factor alpha (TNF-α)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Tumor Necrosis Factor alpha (TNF-α), comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: pg/mL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Aspartate aminotransferase (AST/TGO)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Aspartate aminotransferase (AST/TGO) levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: U/L |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Alanine aminotransferase (ALT/TGP)
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Alanine aminotransferase (ALT/TGP) levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: U/L |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Alkaline phosphatase
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Alkaline phosphatase levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: U/L |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Urea
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Urea levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Creatinine
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Creatinine levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Glucose
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Glucose levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Uric acid
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Uric acid levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Total bilirubin
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum total bilirubin levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Direct bilirubin
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum direct bilirubin levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: mg/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum Albumin
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in serum albumin levels comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: g/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Hemoglobin
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in hemoglobin comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: g/dL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Hematocrit
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in hematocrit comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: % |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Leukocyte count
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in leukocyte count comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: cells/µL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in Platelet count
기간: Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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Change in platelet count comparing values at baseline with values at the end of treatment and at follow-up. Unit of Measure: cells/µL |
Baseline (Week 0), Week 24 (end of treatment), and Week 52 (post-treatment follow-up)
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공동 작업자 및 조사자
수사관
- 수석 연구원: Maria Denise Fernandes Carvalho de Andrade, MD, PhD, Universidade Estadual do Ceara
간행물 및 유용한 링크
일반 간행물
- Martins AMA, Nakashima H, Macia A, et al. Dormant viral pathways underlie space-induced neural senescence: a neuroprotective strategy for spaceflight and neurological diseases. bioRxiv. 2025. doi:10.1101/2025.11.02.686043
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
기본 완료 (추정된)
연구 완료 (추정된)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- 88455225.8.0000.5534
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
미국에서 제조되어 미국에서 수출되는 제품
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
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ViiV Healthcare아직 모집하지 않음
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ANRS, Emerging Infectious DiseasesAbbott완전한
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Assistance Publique - Hôpitaux de ParisUnité de Recherche Clinique Necker Cochin, France완전한