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Sirtuin-NAD Activator in Alzheimer's Disease

Primary Purpose

Alzheimer's Disease (Incl Subtypes), Dementia

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
MIB-626
Placebo
Sponsored by
Brigham and Women's Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alzheimer's Disease (Incl Subtypes) focused on measuring Dementia, NAD, MIB-626

Eligibility Criteria

55 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. A man or a woman between the ages of 55 and 85 years (inclusive)
  2. Meets National Institute on Aging-Alzheimer's Association (NIA-AA) clinical diagnostic criteria for AD dementia
  3. Has evidence of AD pathological process by a positive amyloid assessment with cerebrospinal fluid (CSF) Aβ42
  4. Has a Clinical Dementia Rating (CDR) global score of 0.5 or 1
  5. Has a Mini-Mental State Exam (MMSE) Score of 18 to 26 (inclusive)
  6. Has a 15-item Geriatric Depression Scale (GDS) score of < 6
  7. Impaired memory performance below education adjusted cut-off score on the Logical Memory II subscale delayed paragraph recall (LM-IIa) of the Wechsler Memory Scale-Revised (WMS-R) (≥16 years: ≤8; 8-15 years: ≤4; 0-7 years: ≤2)
  8. May take Food and Drug Administration (FDA) approved medications for the treatment of AD dementia (cholinesterase inhibitors and/or memantine), but if taking such medications, they must be stable for at least 8 weeks before screening
  9. Has adequate visual and auditory acuity to participate in neuropsychological testing and other study assessments
  10. Has the availability of an informant (study partner) who has regular contact with the participant and knows him/her well
  11. Is willing and able to participate in all assessments in English
  12. Is capable of providing written informed consent

Exclusion Criteria:

Subjects may not be enrolled if:

  1. Neurologic diseases: Any significant neurologic disease other than AD that can lead to cognitive impairment, such as Parkinson's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, Huntington's disease, normal pressure hydrocephalus, corticobasal syndrome, brain tumor, seizure disorder, subdural hematoma (within the last 1 year), multiple sclerosis, or history of significant head trauma (e.g. loss of consciousness for 30 minutes or more) followed by persistent neurologic deficits or known structural brain abnormalities.
  2. Neuroimaging: Baseline or prior magnetic resonance imaging (MRI) scans with evidence of cortical stroke or hemorrhage, strategically located lacunar stroke (ex: left thalamus), or severe small vessel ischemic disease.
  3. History of alcohol or substance use disorder or dependence (DSM V criteria) within the last 2 years.
  4. Psychiatric disorder: Major depressive disorder (within the last 1 year), bipolar disorder, schizophrenia (DSM V criteria), or current major psychotic symptoms or behavioral problems that could interfere with study procedures.
  5. Any significant systemic illness or unstable medical condition, which could obfuscate cognitive aging or neurodegenerative trajectories or affect valid cognitive and self-report measurements.
  6. Excluded medications: Niacin or dietary supplements containing nicotinamide mononucleotide (NMN) or nicotinamide riboside (NR); antipsychotic medications, antidepressant medications with anticholinergic side effects. Washout from psychoactive medications for at least 8 weeks before screening.
  7. Current use of anticoagulants; significant back or spine disease that would make a lumbar puncture difficult or unsafe as determined by a clinician.
  8. Other laboratory abnormalities: Has AST or ALT > 3 times the upper limit of normal; serum creatinine > 2.0 mg/d; HbA1C > 8.5%
  9. Participation in an investigational trial to evaluate pharmaceuticals or biologics within the past 3 months or 5 half-lives, whichever is shorter
  10. Other medical conditions which, in the opinion of the investigator, would jeopardize safety or impact the validity of the study results.

Sites / Locations

  • Brigham and Women's HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

MIB-626

Placebo Tablet

Arm Description

Subjects will either take MIB-626 or placebo tablet twice a day for 90 days. For those who receive MIB-626, we plan on giving subjects 1000mg of the drug, twice a day for 90 days. MIB-626 will be in two 500mg tablets.

Subjects will be randomized to receive either the placebo or MIB-626 tablets twice a day orally.

Outcomes

Primary Outcome Measures

change in CSF concentrations of MIB-626
change in CSF concentrations of MIB-626 at baseline and on day 90 at steady state

Secondary Outcome Measures

change in CSF concentrations of MIB-626 metabolites, nicotinamide (NAM), NR, 2-PY, and MeNAM
change from baseline to day 90 in CSF concentrations of MIB-626 metabolites NAM, NR, 2-PY and MeNAM The concentrations of MIB-626's metabolites NAM, NR, 2-PY, and MeNAM will be measured in the CSF
change in the abundance of NAD in the brain using ultra-high field 7T magnetic resonance spectroscopy
change from baseline to day 90 in the abundance of NAD in the brain using ultra-high field 7T magnetic resonance spectroscopy
change in NAD concentrations in peripheral blood mononuclear cells
change from baseline to day 90 in NAD concentrations in peripheral blood mononuclear cells using validated LC-MS/MS assay
change in the concentration of biomarkers of aging recommended (HbA1C, IGF1, T3, IL6, TNF-alpha, and urinary F2-isoprostane)
change from baseline to day 90 in the concentration of biomarkers of aging recommended (HbA1C, IGF1, T3, IL6, TNF-alpha, and urinary F2-isoprostane)

Full Information

First Posted
July 27, 2021
Last Updated
May 9, 2023
Sponsor
Brigham and Women's Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05040321
Brief Title
Sirtuin-NAD Activator in Alzheimer's Disease
Official Title
A Proof of Concept Trial of a Sirtuin-NAD Activator in Alzheimer's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 1, 2021 (Actual)
Primary Completion Date
April 30, 2024 (Anticipated)
Study Completion Date
December 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Brigham and Women's Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary objectives are to: To determine whether MIB-626, after its daily oral administration, penetrates the blood-brain barrier in humans by measuring the cerebrospinal fluid (CSF) concentrations of MIB-626 and its key metabolites, nicotinamide (NAM), NR, 2-PY, and MeNAM at baseline and on day 90 at steady state. To evaluate whether oral MIB-626 administration engages the sirtuin-NAD pathway by determining the abundance of NAD (a SIRT1 substrate) in the brain using ultra-high field 7T magnetic resonance spectroscopy and in peripheral blood mononuclear cells using a validated LC-MS/MS assay. To determine whether MIB-626 alters the circulating biomarkers of aging that the geroscience experts have recommended (HbA1C, IGF1, T3, IL6, TNF, and urinary F2-isoprostane).
Detailed Description
The sirtuin family of nicotinamide adenine dinucleotide (NAD)-dependent deacetylase enzymes are important regulators of the aging process and mediate many of the beneficial effects of caloric restriction. The upregulation of the sirtuin-NAD pathway by increasing intracellular NAD through administration of NAD precursors, such as niacinamide β nicotinamide mononucleotide (βNMN) and nicotinamide riboside, has been shown to engage fundamental mechanisms of aging and prevent or attenuate Alzheimer's disease (AD) pathology in preclinical models. In contrast to many AD drugs in development that target one mechanism, NAD precursors may prevent AD pathology by multiple mechanisms: by improving mitochondrial energetics; inducing a switch to non-amyloidogenic processing of amyloid precursor protein (APP) due to increased α-secretase activity; reducing the synthesis of oligomerized Aβ peptides; preventing microglia-dependent Aβ toxicity; attenuating neuroinflammation; promoting neuronal regeneration; and improving insulin action. In spite of the promising preclinical data, the human studies of the clinical pharmacology, physiologic effects, efficacy, and safety of NAD precursors have been few and constrained by several methodological barriers. First, βNMN and nicotinamide riboside (NR) are sold as dietary supplements and these over-the-counter products have suffered from variable manufacturing quality. Second, there is only limited information available on the pharmacokinetics (PK) and pharmacodynamics (PD) of βNMN and NR in humans, and the doses used in some initial studies were low. Third, NAD and many other metabolites of βNMN and NR are labile and susceptible to rapid degradation ex vivo. Furthermore, the assays for the measurement of intracellular NAD, βNMN, and its metabolites have been challenging. Although NR and βNMN have been shown to cross the blood-brain barrier, attenuate AD pathology, and improve cognitive function in preclinical models, no clinical trials have been conducted to determine whether βNMN crosses the blood-brain barrier or engages the target mechanisms in humans. To overcome these methodological barriers, we have characterized the pharmacokinetics of MIB-626 in phase 1 studies, validated the methods for measuring intracellular NAD, and established the procedures for blood collection to ensure pre-analytical stability. These phase 1 studies have shown that a regimen of 1 g MIB-626 twice daily is safe and effective in substantially raising circulating NAD levels in healthy adults (preliminary data). These foundational methods and single and multiple-dose pharmacokinetic studies have paved the way for the proposed 90-day randomized trial in 24 mild AD dementia participants to determine whether MIB-626 crosses the blood-brain barrier, engages the hypothesized target mechanism, and whether it improves the biomarkers of aging. We hypothesize that MIB-626 administration at the proposed dose will cross the blood-brain barrier and be associated with an increase in brain NAD. Because of the important role of the sirtuin-NAD pathway in regulation of the mechanisms of aging, we will also assess whether MIB-626 is more efficacious than placebo in improving biomarkers of aging in participants with mild AD dementia.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alzheimer's Disease (Incl Subtypes), Dementia
Keywords
Dementia, NAD, MIB-626

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
We will use an IRB approved structured telephone screen to ask about basic demographics, major study required inclusion/exclusion criteria, and questions regarding MR contraindications. Those who do not have major exclusionary conditions identified during the telephone screening and who are interested in participating will be invited for an in-person visit. During the in-person screening visit, informed consent will be obtained, and subjects will undergo screening neuropsychological testing and medical evaluation. Subjects will come back after their initial screening visit for 2 more screening visits before they are found eligible and go through Baseline visits, also known as Day 0. Subjects will receive MIB-626 or placebo twice a day for 90 days. There will be one more visit, known as the washout period, at day 105. The total completion of all of the study visits will be 8 visits, for 150 days.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double blind; the participants, care provider, investigators and outcome assessors are blinded.
Allocation
Randomized
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
MIB-626
Arm Type
Experimental
Arm Description
Subjects will either take MIB-626 or placebo tablet twice a day for 90 days. For those who receive MIB-626, we plan on giving subjects 1000mg of the drug, twice a day for 90 days. MIB-626 will be in two 500mg tablets.
Arm Title
Placebo Tablet
Arm Type
Placebo Comparator
Arm Description
Subjects will be randomized to receive either the placebo or MIB-626 tablets twice a day orally.
Intervention Type
Drug
Intervention Name(s)
MIB-626
Intervention Description
Participants will be randomized to either receive MIB-626 or matching placebo. The proposed intervention - targets multiple contributors to the pathology of AD; MIB-626 improves mitochondrial function, bioenergetics, and insulin sensitivity, inhibits A beta accumulation by reducing its synthesis and increasing its clearance, reduces neuroinflammation, exerts neuronal protective effects, and promotes neuronal regeneration and connectivity in preclinical models.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Subjects will be randomized to receive either the placebo or 500mg MIB-626 twice daily orally.
Primary Outcome Measure Information:
Title
change in CSF concentrations of MIB-626
Description
change in CSF concentrations of MIB-626 at baseline and on day 90 at steady state
Time Frame
90 days
Secondary Outcome Measure Information:
Title
change in CSF concentrations of MIB-626 metabolites, nicotinamide (NAM), NR, 2-PY, and MeNAM
Description
change from baseline to day 90 in CSF concentrations of MIB-626 metabolites NAM, NR, 2-PY and MeNAM The concentrations of MIB-626's metabolites NAM, NR, 2-PY, and MeNAM will be measured in the CSF
Time Frame
90 days
Title
change in the abundance of NAD in the brain using ultra-high field 7T magnetic resonance spectroscopy
Description
change from baseline to day 90 in the abundance of NAD in the brain using ultra-high field 7T magnetic resonance spectroscopy
Time Frame
90 days
Title
change in NAD concentrations in peripheral blood mononuclear cells
Description
change from baseline to day 90 in NAD concentrations in peripheral blood mononuclear cells using validated LC-MS/MS assay
Time Frame
90 days
Title
change in the concentration of biomarkers of aging recommended (HbA1C, IGF1, T3, IL6, TNF-alpha, and urinary F2-isoprostane)
Description
change from baseline to day 90 in the concentration of biomarkers of aging recommended (HbA1C, IGF1, T3, IL6, TNF-alpha, and urinary F2-isoprostane)
Time Frame
90 days
Other Pre-specified Outcome Measures:
Title
change in CSF concentrations of biomarkers of amyloid deposition (Aβ-42, Aβ-40), neuronal/axonal degeneration (t-tau, p-tau, NFL), synaptic function (neurogranin) and neuroinflammation (YKL40, GFAP)
Description
change from baseline to day 90 in CSF concentrations of biomarkers of amyloid deposition (Aβ-42, Aβ-40).
Time Frame
90 days
Title
Change in circulating biomarkers of amyloid deposition (Aβ-42, Aβ-40), neuronal/axonal degeneration (t-tau, p-tau, NFL), synaptic function (neurogranin), and neuroinflammation (YKL40, GFAP)
Description
Change from baseline to day 90 in circulating biomarkers of amyloid deposition (Aβ-42, Aβ-40), neuronal/axonal degeneration (t-tau, p-tau, NFL), synaptic function (neurogranin), and neuroinflammation (YKL40, GFAP)
Time Frame
90
Title
Change in cognition
Description
Change from baseline to day 90 in cognition, assessed using the Alzheimer's Disease Assessment Scale cognitive subscale 13-item version (ADAS-Cog-13)
Time Frame
90
Title
Change in instrumental activities of daily living (IADL)
Description
Change from baseline to day 90 in the Functional Activities Questionnaire (FAQ) score
Time Frame
90
Title
Change in neuropsychiatric symptoms
Description
Change from baseline to day 90 in Neuropsychiatric Inventory (NPI) score and 15-item GDS scale score
Time Frame
90

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A man or a woman between the ages of 55 and 85 years (inclusive) Meets National Institute on Aging-Alzheimer's Association (NIA-AA) clinical diagnostic criteria for AD dementia Has evidence of AD pathological process by a positive amyloid assessment with cerebrospinal fluid (CSF) Aβ42 Has a Clinical Dementia Rating (CDR) global score of 0.5 or 1 Has a Mini-Mental State Exam (MMSE) Score of 18 to 26 (inclusive) Has a 15-item Geriatric Depression Scale (GDS) score of < 6 Impaired memory performance below education adjusted cut-off score on the Logical Memory II subscale delayed paragraph recall (LM-IIa) of the Wechsler Memory Scale-Revised (WMS-R) (≥16 years: ≤8; 8-15 years: ≤4; 0-7 years: ≤2) May take Food and Drug Administration (FDA) approved medications for the treatment of AD dementia (cholinesterase inhibitors and/or memantine), but if taking such medications, they must be stable for at least 8 weeks before screening Has adequate visual and auditory acuity to participate in neuropsychological testing and other study assessments Has the availability of an informant (study partner) who has regular contact with the participant and knows him/her well Is willing and able to participate in all assessments in English Is capable of providing written informed consent Exclusion Criteria: Subjects may not be enrolled if: Neurologic diseases: Any significant neurologic disease other than AD that can lead to cognitive impairment, such as Parkinson's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, Huntington's disease, normal pressure hydrocephalus, corticobasal syndrome, brain tumor, seizure disorder, subdural hematoma (within the last 1 year), multiple sclerosis, or history of significant head trauma (e.g. loss of consciousness for 30 minutes or more) followed by persistent neurologic deficits or known structural brain abnormalities. Neuroimaging: Baseline or prior magnetic resonance imaging (MRI) scans with evidence of cortical stroke or hemorrhage, strategically located lacunar stroke (ex: left thalamus), or severe small vessel ischemic disease. History of alcohol or substance use disorder or dependence (DSM V criteria) within the last 2 years. Psychiatric disorder: Major depressive disorder (within the last 1 year), bipolar disorder, schizophrenia (DSM V criteria), or current major psychotic symptoms or behavioral problems that could interfere with study procedures. Any significant systemic illness or unstable medical condition, which could obfuscate cognitive aging or neurodegenerative trajectories or affect valid cognitive and self-report measurements. Excluded medications: Niacin or dietary supplements containing nicotinamide mononucleotide (NMN) or nicotinamide riboside (NR); antipsychotic medications, antidepressant medications with anticholinergic side effects. Washout from psychoactive medications for at least 8 weeks before screening. Current use of anticoagulants; significant back or spine disease that would make a lumbar puncture difficult or unsafe as determined by a clinician. Other laboratory abnormalities: Has AST or ALT > 3 times the upper limit of normal; serum creatinine > 2.0 mg/d; HbA1C > 8.5% Participation in an investigational trial to evaluate pharmaceuticals or biologics within the past 3 months or 5 half-lives, whichever is shorter Other medical conditions which, in the opinion of the investigator, would jeopardize safety or impact the validity of the study results.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Shalender Bhasin, MD
Phone
6175259150
Email
sbhasin@bwh.harvard.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Gad Marshall, MD
Phone
617-732-8060
Email
GAMARSHALL@PARTNERS.ORG
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Shalender Bhasin, MD
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Neha K Rupeja, MS
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Study Director
Facility Information:
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115-0000
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shalendar Bhasin, MD
Phone
617-525-9150
Email
SBHASIN@PARTNERS.ORG
First Name & Middle Initial & Last Name & Degree
Neeha Rupeja, MS
Phone
617-525-9195
Email
nrupeja@bwh.harvard.edu

12. IPD Sharing Statement

Learn more about this trial

Sirtuin-NAD Activator in Alzheimer's Disease

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