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31P-MRS Imaging to Assess the Effects of CNM-Au8 on Impaired Neuronal Redox State in Amyotrophic Lateral Sclerosis (REPAIR-ALS) (REPAIR-ALS)

Primary Purpose

Amyotrophic Lateral Sclerosis

Status
Withdrawn
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Gold Nanocrystals
Sponsored by
Clene Nanomedicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Amyotrophic Lateral Sclerosis focused on measuring Neurodegeneration, gold, nanocrystal, NAD+, NADH, Redox, Redox Ratio, ALS, Amyotrophic Lateral Sclerosis, 31P-MRS, MRS, magnetic resonance spectroscopy, nanoparticle, nanomedicine

Eligibility Criteria

35 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Able to understand and give written informed consent.
  2. Male or female patients aged 35 years or greater (inclusive) and less than 75 years of age at the time of ALS diagnosis.
  3. Patients with a confirmed ALS diagnosis: "definite ALS" or "probable ALS" or "possible" diagnostic criteria per the revised El Escorial Criteria as determined by a neurologist subspecializing in ALS (e.g., the Principal Investigator by study site).
  4. Stable background therapy (e.g., stable dosing of riluzole within the prior 6-weeks) per Investigator discretion.
  5. At the time of Screening disease duration less than or equal to 24-months from symptom onset OR within 12-moths of a confirmed ALS diagnosis.
  6. Forced vital capacity (FVC) >/= 60% of predicted value as adjusted for gender, height, and age at the Screening Visit.
  7. Patients who are ambulatory (e.g., normal ambulation, early ambulation difficulties, or walks with assistance) on the ALSFRS-R scale.

Exclusion Criteria:

  1. At Screening patients who utilize, or in the Investigator's judgment will be imminently dependent upon during the course of this study:

    1. Non-invasive ventilation
    2. Gastrostomy (e.g., use of percutaneous endoscopic gastrostomy tube)
    3. Use of wheel chair
  2. Patient who have previously undergone tracheostomy.
  3. Patient with a history of significant other major medical condition based on the Investigator's judgment.
  4. Based on the investigator's judgment, patients who may have difficulty complying with the protocol and/or study procedures.
  5. Patient with clinically significant abnormalities in hematology, blood chemistry, ECG, or physical examination not resolved by the Baseline visit which according to Investigator can interfere with study participation.
  6. Patient participating in any other investigational drug trial or using investigational drug (within 12 weeks prior to screening and thereafter)
  7. Females who are pregnant or nursing or who plan to get pregnant during the course of this clinical trial or within 6 months of the end of this trial.
  8. Positive screen for drugs of abuse or known alcohol abuse.
  9. Women of child-bearing potential, or men, who are unwilling or unable to use accepted methods of birth control during the study or for 6 months following completion of study participation.
  10. Women with a positive pregnancy test, are lactating, or are planning to become pregnant during the study.
  11. Patients with implanted metal objects in their body that may be affected by an MRI procedure.
  12. Patients who are claustrophobic or otherwise unlikely to be able to complete the MRI scanning procedures.
  13. Patients with a history of gold allergy.

Sites / Locations

  • UT Southwestern

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

7.5mg CNM-Au8

15mg CNM-Au8

30mg CNM-Au8

60mg CNM-Au8

Arm Description

7.5mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water

15mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water

30mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water

60mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water

Outcomes

Primary Outcome Measures

Change in 31P-MRS Redox Ratio (NAD+/NADH)
Mean change in average NAD+/NADH measured brain Redox Ratio by treatment group

Secondary Outcome Measures

Full Information

First Posted
February 14, 2019
Last Updated
March 30, 2023
Sponsor
Clene Nanomedicine
Collaborators
University of Texas Southwestern Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT03843710
Brief Title
31P-MRS Imaging to Assess the Effects of CNM-Au8 on Impaired Neuronal Redox State in Amyotrophic Lateral Sclerosis (REPAIR-ALS)
Acronym
REPAIR-ALS
Official Title
A Phase 2, Pilot Open Label, Sequential Group, Investigator Blinded Study of Magnetic Resonance Spectroscopy (31P-MRS) to Assess the Effects of CNM-Au8 for the Bioenergetic Improvement of Impaired Neuronal Redox State in Amyotrophic Lateral Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Withdrawn
Why Stopped
Study execution discontinued at this time.
Study Start Date
March 2020 (Anticipated)
Primary Completion Date
February 2022 (Anticipated)
Study Completion Date
March 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Clene Nanomedicine
Collaborators
University of Texas Southwestern Medical Center

4. Oversight

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

5. Study Description

Brief Summary
REPAIR-ALS is a single-center open label pilot, sequential group, investigator and patient blinded study to assess the CNS metabolic effects, safety, pharmacokinetics, and pharmacodynamics of CNM-Au8 in patients who have been diagnosed with Amyotrophic Lateral Sclerosis (ALS) within twelve (12) months of Screening. The primary endpoint is the ratio of the oxidized to reduced form of nicotinamide adenine dinucleotide (NAD+:NADH) measured non-invasively by 31phosphorous magnetic resonance spectroscopy (31P-MRS).
Detailed Description
This is a single-center open label pilot, sequential group, investigator blinded study of the CNS metabolic effects, safety, pharmacokinetics, and pharmacodynamics of CNM-Au8 in patients who have been diagnosed with Amyotrophic Lateral Sclerosis within twelve months of Screening. The Sponsor will select a starting treatment dose of CNM-Au8 for the initial treatment. Investigators and patients will be blinded to each cohort's study dose. Upon completion of the first treatment cohort, the Sponsor will select a single dose or two different doses for the subsequent second cohort from a pre-specified dosing selection plan based on the evaluation of the 31P-Magnetic Resonance Spectroscopy (31P-MRS) changes versus baseline in the first cohort. Up to a total of two treatment cohorts may be studied (n=12 patients/cohort, total n=24 patients). All patients will receive daily oral treatment over twelve consecutive weeks during each cohort's Treatment Period. There will be three study periods per treatment cohort: A four-week screening period (Screening Period); A twelve-week treatment period (Treatment Period); A four-week follow-up period (End-of-Study Assessment). The primary study outcome, CNS metabolic changes, will be assessed based upon each patient's Week 12 study visit versus the pre-treatment baseline. The primary endpoint is the brain metabolic effects of treatment with CNM-Au8 as assessed by an improvement of 31P-MRS assessment of Brain Tissue Cellular Redox Potential defined by the measured tissue ratio of NAD+:NADH concentrations following 12 weeks of once daily treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Amyotrophic Lateral Sclerosis
Keywords
Neurodegeneration, gold, nanocrystal, NAD+, NADH, Redox, Redox Ratio, ALS, Amyotrophic Lateral Sclerosis, 31P-MRS, MRS, magnetic resonance spectroscopy, nanoparticle, nanomedicine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Open Label, Investigator Blinded, Sequential Cohort (max of 2 cohorts amongst the possible 4 interventions)
Masking
None (Open Label)
Masking Description
Research participants and site personnel are not masked to study drug, but will be blinded to study dose for each cohort (single-blinded).
Allocation
Non-Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
7.5mg CNM-Au8
Arm Type
Experimental
Arm Description
7.5mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water
Arm Title
15mg CNM-Au8
Arm Type
Experimental
Arm Description
15mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water
Arm Title
30mg CNM-Au8
Arm Type
Experimental
Arm Description
30mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water
Arm Title
60mg CNM-Au8
Arm Type
Experimental
Arm Description
60mg suspension of clean-surfaced, faceted, gold nanocrystals in 120ml of sodium bicarbonate buffered water
Intervention Type
Drug
Intervention Name(s)
Gold Nanocrystals
Other Intervention Name(s)
CNM-Au8
Intervention Description
CNM-Au8 is a dark red/purple-colored liquid formulation consisting of a stable suspension of faceted clean surfaced elemental gold nanocrystals in buffered deionized water with a concentration of up to 0.5 mg/mL of gold. The formulation is buffered by sodium bicarbonate present at a concentration of 0.546 mg/mL. There are no other excipients. The drug product is formulated to be taken orally and will be provided in single dose HDPE containers. The study doses vary by the concentration of gold nanocrystals per milliliter in a volume of 60 mL.
Primary Outcome Measure Information:
Title
Change in 31P-MRS Redox Ratio (NAD+/NADH)
Description
Mean change in average NAD+/NADH measured brain Redox Ratio by treatment group
Time Frame
At 12 Weeks
Other Pre-specified Outcome Measures:
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of NAD+
Description
Mean change in average CNS concentration of NAD+ [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of NADH
Description
Mean change in average CNS concentration of NADH [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of ATP
Description
Mean change in average CNS concentration of ATP [mmol/kg] (as internal reference) by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of Phosphocreatine (PCr)
Description
Mean change in average CNS concentration of PCr [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of Intracellular Inorganic Phosphate (Pi(in))
Description
Mean change in average CNS concentration of Pi(in) [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of Extracellular Inorganic Phosphate (Pi(ex))
Description
Mean change in average CNS concentration of Pi(ex) [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Bioenergetic Metabolite CNS Tissue Concentration of Uridine Diphosphate Glucose (UDPG)
Description
Mean change in average CNS concentration of UDPG [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Membrane Component Tissue Concentration of Phosphoethanolamine (PE)
Description
Mean change in average CNS concentration of PE [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Membrane Component CNS Tissue Concentration of Phosphocholine (PC)
Description
Mean change in average CNS concentration of PC [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Membrane Component CNS Tissue Concentration of Glycerophosphoethanolamine (GPE)
Description
Mean change in average CNS concentration of GPE [mmol/kg] by treatment group
Time Frame
At 12 Weeks
Title
Mean Change in 31P-MRS Membrane Component CNS Tissue Concentration of Glycerophosphocholine (GPC)
Description
Mean change in average CNS concentration of GPC [mmol/kg] by treatment group
Time Frame
At 12 Weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able to understand and give written informed consent. Male or female patients aged 35 years or greater (inclusive) and less than 75 years of age at the time of ALS diagnosis. Patients with a confirmed ALS diagnosis: "definite ALS" or "probable ALS" or "possible" diagnostic criteria per the revised El Escorial Criteria as determined by a neurologist subspecializing in ALS (e.g., the Principal Investigator by study site). Stable background therapy (e.g., stable dosing of riluzole within the prior 6-weeks) per Investigator discretion. At the time of Screening disease duration less than or equal to 24-months from symptom onset OR within 12-moths of a confirmed ALS diagnosis. Forced vital capacity (FVC) >/= 60% of predicted value as adjusted for gender, height, and age at the Screening Visit. Patients who are ambulatory (e.g., normal ambulation, early ambulation difficulties, or walks with assistance) on the ALSFRS-R scale. Exclusion Criteria: At Screening patients who utilize, or in the Investigator's judgment will be imminently dependent upon during the course of this study: Non-invasive ventilation Gastrostomy (e.g., use of percutaneous endoscopic gastrostomy tube) Use of wheel chair Patient who have previously undergone tracheostomy. Patient with a history of significant other major medical condition based on the Investigator's judgment. Based on the investigator's judgment, patients who may have difficulty complying with the protocol and/or study procedures. Patient with clinically significant abnormalities in hematology, blood chemistry, ECG, or physical examination not resolved by the Baseline visit which according to Investigator can interfere with study participation. Patient participating in any other investigational drug trial or using investigational drug (within 12 weeks prior to screening and thereafter) Females who are pregnant or nursing or who plan to get pregnant during the course of this clinical trial or within 6 months of the end of this trial. Positive screen for drugs of abuse or known alcohol abuse. Women of child-bearing potential, or men, who are unwilling or unable to use accepted methods of birth control during the study or for 6 months following completion of study participation. Women with a positive pregnancy test, are lactating, or are planning to become pregnant during the study. Patients with implanted metal objects in their body that may be affected by an MRI procedure. Patients who are claustrophobic or otherwise unlikely to be able to complete the MRI scanning procedures. Patients with a history of gold allergy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffery Elliott, MD
Organizational Affiliation
UT Southwestern
Official's Role
Principal Investigator
Facility Information:
Facility Name
UT Southwestern
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

31P-MRS Imaging to Assess the Effects of CNM-Au8 on Impaired Neuronal Redox State in Amyotrophic Lateral Sclerosis (REPAIR-ALS)

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