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ADX-629 Therapy for Sjogren-Larsson Syndrome

Primary Purpose

Sjogren-Larsson Syndrome

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
ADX-629
Sponsored by
University of Nebraska
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sjogren-Larsson Syndrome focused on measuring ichthyosis, spasticity, intellectual disability, retinopathy, spastic diplegia

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subject or subject's guardian is willing to provide written informed consent prior to the initiation of any study procedures. Assent will be solicited from subjects intellectually capable of providing assent.
  • Subject is willing to comply with all study procedures and availability for the duration of the study
  • Subject is male or female and 18-50-years of age at the time of enrollment.
  • Subject body weight is at least 35 kg (35 kg).
  • Subject has a genetically-confirmed diagnosis of SLS with two pathogenic sequence variants in ALDH3A2.
  • Subject has active ichthyosis and neurologic symptoms of spasticity.
  • Subject is able to swallow oral tablet medication and is willing to adhere to the study regimen.
  • Subject is willing to suspend use of all topical creams 7 days before initial baseline evaluation and before the 12-week center visit.
  • Subject has not been treated with any experimental drug for 1 month before baseline visit and during ADX-629 treatment.
  • Subject who is sexually active agrees to use adequate contraception throughout the duration of the study, as follows:
  • For females of child-bearing potential: Negative pregnancy test at Baseline and compliant with a medically approved contraceptive regimen during the study or documented to be surgically sterile or postmenopausal.
  • For sexually-active men: Compliant with a barrier contraceptive regimen during the study.

Exclusion Criteria:

  • History of any malignancy within 5 years of screening except for basal cell or squamous cell in situ skin carcinomas or carcinoma in situ of the cervix that has been treated with no evidence of recurrence.
  • Subject is known to be human immunodeficiency virus (HIV) positive or has other known immunodeficiency.
  • Subject has evidence of an active systemic or skin infection, including severe acute respiratory syndrome (SARS-CoV-2).
  • History of significant tachycardia, bradycardia, acute or chronic cardiovascular disease, or any clinically significant abnormalities in rhythm or conduction detected on electrocardiogram (ECG), or QT interval corrected for heart rate using Fridericia's formula (QTcF) of >440 ms or <340 ms during screening.
  • History or presence of gastrointestinal, hepatic disease, moderate or severe hepatic impairment (defined as Child-Pugh Class B and Class C) or any other condition known to interfere with absorption, distribution, metabolism, or excretion of drug.
  • Acute or chronic renal disease, moderate or severe renal impairment, history of renal disease, or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 calculated by Chronic Kidney Disease Epidemiology (CKD-EPI) equation.
  • Subject has a history of any other condition that, in the opinion of the Investigator, would compromise the subject's ability to comply with the protocol or that might compromise the subject's safety or the interpretation of the study results.
  • Subject is currently receiving immunosuppressive therapy, including intermittent or low-dose corticosteroids and is not able or willing to suspend its use for a period from 2 weeks before and throughout the study.
  • Subject is currently receiving and refuses to interrupt any systemic or topical medication that is excluded.
  • Subject received an investigational systemic or topically administered prescription drug within 30 days before enrollment.
  • Subject has received botulinum toxin (Botox) injections within 6 months of enrollment.
  • Subject has a known allergic reaction to any ingredients of study drug formulation.
  • Subject is currently participating in any other therapeutic clinical study.
  • Subject is pregnant, intending to become pregnant, or breastfeeding.

Sites / Locations

  • University of Nebraska Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ADX-629 treatment

Arm Description

Open label treatment with ADX-629

Outcomes

Primary Outcome Measures

Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Participants are required to report any adverse events as they arise and will be contacted weekly for information regarding adverse events. Physical examinations with vital signs will be done monthly.
Number of participants with abnormal drug-related safety blood tests
Participants will have monthly medical tests to monitor safety of ADX-629 including Complete Blood Count, Comprehensive Chemistry Panel, vitamin A, vitamin B6 (pyridoxal phosphate), Homocysteine, and Urinalysis.
Compliance and tolerability of ADX-629
A written drug log will be required for recording daily administration of ADX-629 tablets and any problems tolerating the drug. Unused tablets will be counted as a measure of compliance.

Secondary Outcome Measures

Biochemical efficacy of ADX-629 as determined by reversal of abnormal biomarkers
Biochemical efficacy of ADX-629 in reversing disease-specific abnormalities in blood levels of fatty alcohols, alkylglycerol lipids, SLS metabolomic profile, SLS lipidomic profile, and oxidative stress markers. Skin elasticity and thickness, transepidermal water loss, stratum corneum fatty alcohols and alkylglycerol lipids will also be measured.

Full Information

First Posted
June 10, 2022
Last Updated
September 29, 2023
Sponsor
University of Nebraska
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1. Study Identification

Unique Protocol Identification Number
NCT05443685
Brief Title
ADX-629 Therapy for Sjogren-Larsson Syndrome
Official Title
An Open-Label, Phase 1/2, Single-Site Study of the Safety, Biochemical Efficacy, and Exploratory Clinical Effects of Oral ADX-629 in Subjects With Sjögren-Larsson Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 2, 2023 (Actual)
Primary Completion Date
December 30, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Nebraska

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
This research study will determine whether orally administered ADX-629 is safe and has biochemical efficacy in patients with Sjögren-Larsson syndrome (SLS), a rare inherited disorder of fatty aldehyde metabolism The disease is caused by bi-allelic mutations in ALDH3A2, which results in deficient activity of fatty aldehyde dehydrogenase (FALDH) and leads to the build-up of harmful long-chain (C16-C20) aldehydes and alcohols. Accumulation of these lipids and their metabolic products in skin, brain and eyes is responsible for the symptoms, which persist lifelong. ADX-629 is an aldehyde trapping agent that is expected to eliminate fatty aldehydes and negate aldehyde toxicity, improve the biochemical abnormalities and have clinical efficacy for SLS. The primary objective of this clinical protocol is to determine whether ADX-629 is safe and tolerable for use in SLS subjects. The secondary objective is to determine the efficacy of ADX-629 in reversing the biochemical abnormalities in SLS. Exploratory objectives are to evaluate the short-term clinical effects of ADX-629 on neurologic, cutaneous and ophthalmologic disease in SLS. Patients will be treated with ADX-629 for 12 weeks and monitored for safety and biochemical efficacy.
Detailed Description
Sjögren-Larsson syndrome (SLS) is a rare inherited disorder of fatty aldehyde metabolism characterized by congenital ichthyosis, spastic diplegia, intellectual disability, seizures and a distinctive retinopathy. The disease is caused by bi-allelic mutations in ALDH3A2, which results in deficient activity of fatty aldehyde dehydrogenase (FALDH) and leads to the build-up of harmful long-chain (C16-C20) aldehydes and alcohols. Accumulation of these lipids and their metabolic products in skin, brain and eyes is responsible for the symptoms, which persist lifelong. We hypothesize that elimination of fatty aldehydes using the oral pharmacologic aldehyde trapping agent ADX-629 will negate aldehyde toxicity, improve the biochemical abnormalities and have clinical efficacy for SLS patients. This study is an open label, Phase 1/2, single center investigation of ADX-629 in SLS. The primary objective is to determine whether ADX-629 is safe and tolerable for use in SLS subjects. The secondary objective is to determine the efficacy of ADX-629 in reversing the biochemical abnormalities in SLS. Exploratory objectives are to evaluate the short-term clinical effects of ADX-629 on neurologic, cutaneous and ophthalmologic disease in SLS. Up to 10 subjects with genetically confirmed SLS who meet eligibility criteria will be enrolled. All subjects will be studied at the University of Nebraska Medical Center/Children's Hospital & Medical Center in Omaha, Nebraska. Subjects will be treated with ADX-629 administered orally as 250 mg tablets for 12 weeks. Subjects will be monitored for safety of ADX-629 every 4 weeks by physical examination and biochemical safety tests. The effects of ADX-629 on SLS-specific biomarkers will be determined after 12 weeks of drug treatment. Clinical tests will monitor neurological, dermatological and ophthalmologic response to drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sjogren-Larsson Syndrome
Keywords
ichthyosis, spasticity, intellectual disability, retinopathy, spastic diplegia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Open label
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ADX-629 treatment
Arm Type
Experimental
Arm Description
Open label treatment with ADX-629
Intervention Type
Drug
Intervention Name(s)
ADX-629
Other Intervention Name(s)
Open label
Intervention Description
Subjects will be administered ADX-629 250 mg tablets twice daily
Primary Outcome Measure Information:
Title
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Description
Participants are required to report any adverse events as they arise and will be contacted weekly for information regarding adverse events. Physical examinations with vital signs will be done monthly.
Time Frame
weekly for 12 weeks
Title
Number of participants with abnormal drug-related safety blood tests
Description
Participants will have monthly medical tests to monitor safety of ADX-629 including Complete Blood Count, Comprehensive Chemistry Panel, vitamin A, vitamin B6 (pyridoxal phosphate), Homocysteine, and Urinalysis.
Time Frame
monthly for 12 weeks
Title
Compliance and tolerability of ADX-629
Description
A written drug log will be required for recording daily administration of ADX-629 tablets and any problems tolerating the drug. Unused tablets will be counted as a measure of compliance.
Time Frame
daily for 12 weeks
Secondary Outcome Measure Information:
Title
Biochemical efficacy of ADX-629 as determined by reversal of abnormal biomarkers
Description
Biochemical efficacy of ADX-629 in reversing disease-specific abnormalities in blood levels of fatty alcohols, alkylglycerol lipids, SLS metabolomic profile, SLS lipidomic profile, and oxidative stress markers. Skin elasticity and thickness, transepidermal water loss, stratum corneum fatty alcohols and alkylglycerol lipids will also be measured.
Time Frame
Tests will be done at week 1 and week 12.
Other Pre-specified Outcome Measures:
Title
Exploratory clinical outcomes to determine drug dependent changes in abnormal clinical measures
Description
Clinical response to ADX-629 will be determined with brain MRI, magnetic resonance spectroscopy, EEG, clinical spasticity scores, Visual Index of Ichthyosis Severity score, and SLS retinopathy based on eye exam and retinal photographs.
Time Frame
Examinations and procedures will be done at week 1 and week 12.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject or subject's guardian is willing to provide written informed consent prior to the initiation of any study procedures. Assent will be solicited from subjects intellectually capable of providing assent. Subject is willing to comply with all study procedures and availability for the duration of the study Subject is male or female and 18-50-years of age at the time of enrollment. Subject body weight is at least 35 kg (35 kg). Subject has a genetically-confirmed diagnosis of SLS with two pathogenic sequence variants in ALDH3A2. Subject has active ichthyosis and neurologic symptoms of spasticity. Subject is able to swallow oral tablet medication and is willing to adhere to the study regimen. Subject is willing to suspend use of all topical creams 7 days before initial baseline evaluation and before the 12-week center visit. Subject has not been treated with any experimental drug for 1 month before baseline visit and during ADX-629 treatment. Subject who is sexually active agrees to use adequate contraception throughout the duration of the study, as follows: For females of child-bearing potential: Negative pregnancy test at Baseline and compliant with a medically approved contraceptive regimen during the study or documented to be surgically sterile or postmenopausal. For sexually-active men: Compliant with a barrier contraceptive regimen during the study. Exclusion Criteria: History of any malignancy within 5 years of screening except for basal cell or squamous cell in situ skin carcinomas or carcinoma in situ of the cervix that has been treated with no evidence of recurrence. Subject is known to be human immunodeficiency virus (HIV) positive or has other known immunodeficiency. Subject has evidence of an active systemic or skin infection, including severe acute respiratory syndrome (SARS-CoV-2). History of significant tachycardia, bradycardia, acute or chronic cardiovascular disease, or any clinically significant abnormalities in rhythm or conduction detected on electrocardiogram (ECG), or QT interval corrected for heart rate using Fridericia's formula (QTcF) of >440 ms or <340 ms during screening. History or presence of gastrointestinal, hepatic disease, moderate or severe hepatic impairment (defined as Child-Pugh Class B and Class C) or any other condition known to interfere with absorption, distribution, metabolism, or excretion of drug. Acute or chronic renal disease, moderate or severe renal impairment, history of renal disease, or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 calculated by Chronic Kidney Disease Epidemiology (CKD-EPI) equation. Subject has a history of any other condition that, in the opinion of the Investigator, would compromise the subject's ability to comply with the protocol or that might compromise the subject's safety or the interpretation of the study results. Subject is currently receiving immunosuppressive therapy, including intermittent or low-dose corticosteroids and is not able or willing to suspend its use for a period from 2 weeks before and throughout the study. Subject is currently receiving and refuses to interrupt any systemic or topical medication that is excluded. Subject received an investigational systemic or topically administered prescription drug within 30 days before enrollment. Subject has received botulinum toxin (Botox) injections within 6 months of enrollment. Subject has a known allergic reaction to any ingredients of study drug formulation. Subject is currently participating in any other therapeutic clinical study. Subject is pregnant, intending to become pregnant, or breastfeeding.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
William B Rizzo, MD
Phone
402-559-2560
Email
wrizzo@unmc.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Sara M Jones, RD
Phone
402-559-1747
Email
saram.jones@unmc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William B Rizzo, MD
Organizational Affiliation
University of Nebraska
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Nebraska Medical Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sara M Jones, RD
Phone
402-559-1747
Email
saram.jones@unmc.edu
First Name & Middle Initial & Last Name & Degree
William B Rizzo, MD
Phone
402-559-2560
Email
wrizzo@unmc.edu

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Aggregate de-identified data will be shared with other investigators by request.
Citations:
PubMed Identifier
16996289
Citation
Rizzo WB. Sjogren-Larsson syndrome: molecular genetics and biochemical pathogenesis of fatty aldehyde dehydrogenase deficiency. Mol Genet Metab. 2007 Jan;90(1):1-9. doi: 10.1016/j.ymgme.2006.08.006. Epub 2006 Sep 22.
Results Reference
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PubMed Identifier
27547594
Citation
Rizzo WB. Genetics and prospective therapeutic targets for Sjogren-Larsson Syndrome. Expert Opin Orphan Drugs. 2016 Apr;4(4):395-406. doi: 10.1517/21678707.2016.1154453. Epub 2016 Mar 10.
Results Reference
background
PubMed Identifier
35242571
Citation
Rizzo WB, S'aulis D, Dorwart E, Bailey Z. Sjogren-Larsson syndrome: A biochemical rationale for using aldehyde-reactive therapeutic agents. Mol Genet Metab Rep. 2021 Dec 23;30:100839. doi: 10.1016/j.ymgmr.2021.100839. eCollection 2022 Mar.
Results Reference
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ADX-629 Therapy for Sjogren-Larsson Syndrome

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