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Evaluation of Safety and Diabetes Status Upon Oral Treatment With GABA in Patients With Longstanding Type-1 Diabetes

Primary Purpose

Type 1 Diabetes Mellitus

Status
Completed
Phase
Phase 1
Locations
Sweden
Study Type
Interventional
Intervention
Gamma-Aminobutyric Acid (GABA)
Alprazolam
Sponsored by
Per-Ola Carlsson
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes Mellitus focused on measuring Remygen, GABA

Eligibility Criteria

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

Inclusion Criteria:

  1. Informed consent given by patients according to national regulations
  2. Type 1 diabetes diagnosed ≥ 5 years at the time of screening
  3. Must have been diagnosed with Type 1-diabetes before the age of 25
  4. Age ≥18 and ≤50
  5. Fasting c-peptide levels should be in the range from not detectable levels up to <0.12 nmol/L
  6. For males of childbearing potential adequate contraception is as follows:

    1. condom (male)
    2. abstinence from heterosexual intercourse
    3. female partner using contraception as below listed:

      • oral (except low-dose gestagen (lynestrenol and norethisterone)), injectable, or implanted hormonal contraceptives
      • combined (estrogen and progestogen containing)
      • oral, intravaginal or transdermal progesterone hormonal contraception associated with inhibition of ovulation
      • intrauterine device
      • intrauterine hormone-releasing system (for example, progestin-releasing coil)
      • bilateral tubal occlusion

Exclusion Criteria:

  1. Females of child-bearing potential
  2. Previous or current treatment with immunosuppressant therapy (although topical and inhalation steroids are accepted)
  3. Treatment with any oral or injected anti-diabetic medications other than insulin
  4. Patients on medications which may disturb GABA action, such as Baclofen, Valium, Acamprosate, Neurontin, or Lyrica
  5. HbA1c > 90 mmol/mol
  6. eGFR <60 ml/min
  7. Increased plasma concentrations of alanine aminotransferase (>0.75 μkatl/l for females or >1.1 μkat/l for males) and/or aspartate aminotransferase (>0.60 μkat/l for females or >0.75μkat/l for males).
  8. Known cancer disease
  9. Known sleeping apnea or pulmonary disorder with carbon dioxide rentention in blood
  10. Previous history of pancreatitis or other exocrine pancreatic disorder
  11. A history of epilepsy, myasthenia gravis, head trauma or cerebrovascular accident, or clinical features of continuous motor unit activity in proximal muscles
  12. A history of alcohol or drug abuse
  13. A significant illness other than diabetes within 2 weeks prior to first dosing
  14. Known human immunodeficiency virus (HIV) or hepatitis
  15. Females who are breastfeeding
  16. Males not willing to use adequate contraception during the study period.
  17. Known hypersensitivity agains benzodiazepins or any excipients of study drugs
  18. Participation in other clinical trials with a new chemical entity within 3 months or 5 half-lives of the new chemical entity, whatever longest.
  19. Inability or unwillingness to comply with the provisions of this protocol
  20. Deemed by the investigator not being able to follow instructions and/or follow the study protocol or other reasons that, at the investigator's discretion, could affect the subject's current clinical condition during study procedures.

Sites / Locations

  • Uppsala University Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Low dose gamma-aminobutyric acid (GABA)

High dose gamma-aminobutyric acid (GABA)

High dose gamma-aminobutyric acid (GABA) + Alprazolam

Arm Description

Oral GABA treatment 200 mg daily for 6 months

Oral GABA treatment 600 mg daily for 6 months

Oral Alprazolam treatment 0.5 mg daily combined with oral GABA treatment 600 mg daily for 3 months. Alprazolam treatment thereafter ended, and study subjects will continue with oral GABA treatment 600 mg daily only for another 3 months.

Outcomes

Primary Outcome Measures

Adverse events possibly or probably related to GABA treatment
To evaluate the acute and long-term safety of oral GABA treatment. The endpoint will investigate number of adverse events possibly or probably related to GABA treatment.

Secondary Outcome Measures

Difference in C-peptide response to mixed meal tolerance test before and directly after treatment
Difference in C-peptide (Area under the curve 0-120 min) during a mixed meal tolerance test between baseline and after 6 months of oral GABA treatment
Difference in C-peptide response to mixed meal tolerance test during and after treatment
Difference in C-peptide (Area under the curve 0-120 min) during a mixed meal tolerance test between baseline and after 3 and and 6 months of treatment and between baseline and the follow-up visit
Difference in maximum stimulated C-peptide to mixed meal tolerance test during and after treatment
Difference in maximum stimulated C-peptide during a mixed meal tolerance test between baseline and after 3 and 6 months of treatment and between baseline and the follow-up visit.
Difference in C-peptide response to mixed meal tolerance test during and after treatment between treatment groups
Difference in C-peptide (Area under the curve 0-120 min) during a mixed meal tolerance test between treatment group 1 and 2 and after 3 and 6 months of treatment and between baseline and the follow-up visit
Difference in glucagon response during a hypoglycemic clamp before and after treatment
Difference in glucagon (area under the curve) during a hypoglycemic clamp between baseline and 6 months of treatment
Difference in glucagon response during a hypoglycemic clamp between treatment groups before and after treatment
Difference in glucagon (area under the curve) during a hypoglycemic clamp between treatment group 1 and 2 between baseline and 6 months of treatment
Change in HbA1c by treatment
Change in HbA1c between 0,3 and 6 months of treatment and at the follow-up one month later.
Change in exogenous insulin consumption by treatment
Change in exogenous insulin consumption between 0,3 and 6 months of treatment and at the follow-up one month later.
Change in fasting C-peptide by treatment
Change in fasting C-peptide levels between 0,3 and 6 months of treatment and at the follow-up one month later.
Change in variables that indicate effects on immune system
Change by treatment in variables that indicate effects on the immune system such as serum autoantibodies to GAD65 and islet antigen-2, and immune cells
Change in GABA plasma levels
Analysis of GABA plasma levels after 0, 3 and 6 months of treatment and at the follow-up visit one month later.
Change in diabetes treatment satisfaction questionnaire
Measurements of patient diabetes treatment satisfaction by questionnaire during study. Each of eight questions have a 7-graded scale from 0-6. 48 points are therefore maximal treatment satisfaction and comparisons will be made to score before treatment start.

Full Information

First Posted
August 9, 2018
Last Updated
November 1, 2022
Sponsor
Per-Ola Carlsson
Collaborators
Diamyd Medical AB
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1. Study Identification

Unique Protocol Identification Number
NCT03635437
Brief Title
Evaluation of Safety and Diabetes Status Upon Oral Treatment With GABA in Patients With Longstanding Type-1 Diabetes
Official Title
A Phase I/II, 3-Arm, Open Label, Single Centre Study to Investigate the Safety and Effect of Oral GABA Therapy on Beta-Cell Regeneration in Type 1-diabetes Patients
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
September 5, 2018 (Actual)
Primary Completion Date
September 27, 2022 (Actual)
Study Completion Date
September 27, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Per-Ola Carlsson
Collaborators
Diamyd Medical AB

4. Oversight

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

5. Study Description

Brief Summary
The main goal of this study is to find a reasonably safe and tolerable treatment for adult patients with type 1-diabetes and that regain some of the endogenous insulin secretion, improve the patients' quality of life (QoL) and reduce the risk of both short- and long-term complications. The hypothesis tested is that oral GABA treatment with the newly developed compound Remygen will be safe and induce regain of some endogenous insulin secretion in adult patients with type 1-diabetes diagnosis for more than five years. The first part of the study will include 6 patients and be performed as a Safety and Dose Escalation study in three steps. The main study is a three-arm, open label, single center, clinical trial. Eligible patients will be randomized into one of three active treatment arms to receive oral GABA treatment for 6 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus
Keywords
Remygen, GABA

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Low dose gamma-aminobutyric acid (GABA)
Arm Type
Experimental
Arm Description
Oral GABA treatment 200 mg daily for 6 months
Arm Title
High dose gamma-aminobutyric acid (GABA)
Arm Type
Experimental
Arm Description
Oral GABA treatment 600 mg daily for 6 months
Arm Title
High dose gamma-aminobutyric acid (GABA) + Alprazolam
Arm Type
Experimental
Arm Description
Oral Alprazolam treatment 0.5 mg daily combined with oral GABA treatment 600 mg daily for 3 months. Alprazolam treatment thereafter ended, and study subjects will continue with oral GABA treatment 600 mg daily only for another 3 months.
Intervention Type
Drug
Intervention Name(s)
Gamma-Aminobutyric Acid (GABA)
Other Intervention Name(s)
GABA (Remygen)
Intervention Description
Patients eligible for the main study will be randomized in a 1:1:1 ratio stratified by the C-peptide level to receive 200 mg of GABA (Remygen) for 6 months, 600 mg of GABA (Remygen) for 6 months, or Alprazolam 0.5 mg combined with GABA 600 mg (Remygen) for 3 months followed by treatment with GABA 600 mg (Remygen) only for another 3 months. The start of the arms with high dose GABA will be delayed and started first after that a data safety monitoring board has evaluated and approved the safety data of the first 4 patients included in the arm with low dose GABA. All patients will continue to receive intensive insulin treatment from their personal physicians during the whole study period.
Intervention Type
Drug
Intervention Name(s)
Alprazolam
Intervention Description
Patients eligible for the main study will be randomized in a 1:1:1 ratio stratified by the C-peptide level to receive 200 mg of GABA (Remygen) for 6 months, 600 mg of GABA (Remygen) for 6 months, or Alprazolam 0.5 mg combined with GABA 600 mg (Remygen) for 3 months followed by treatment with GABA 600 mg (Remygen) only for another 3 months. The start of the arms with high dose GABA will be delayed and started first after that a data safety monitoring board has evaluated and approved the safety data of the first 4 patients included in the arm with low dose GABA. All patients will continue to receive intensive insulin treatment from their personal physicians during the whole study period.
Primary Outcome Measure Information:
Title
Adverse events possibly or probably related to GABA treatment
Description
To evaluate the acute and long-term safety of oral GABA treatment. The endpoint will investigate number of adverse events possibly or probably related to GABA treatment.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Difference in C-peptide response to mixed meal tolerance test before and directly after treatment
Description
Difference in C-peptide (Area under the curve 0-120 min) during a mixed meal tolerance test between baseline and after 6 months of oral GABA treatment
Time Frame
6 months
Title
Difference in C-peptide response to mixed meal tolerance test during and after treatment
Description
Difference in C-peptide (Area under the curve 0-120 min) during a mixed meal tolerance test between baseline and after 3 and and 6 months of treatment and between baseline and the follow-up visit
Time Frame
7 months
Title
Difference in maximum stimulated C-peptide to mixed meal tolerance test during and after treatment
Description
Difference in maximum stimulated C-peptide during a mixed meal tolerance test between baseline and after 3 and 6 months of treatment and between baseline and the follow-up visit.
Time Frame
7 months
Title
Difference in C-peptide response to mixed meal tolerance test during and after treatment between treatment groups
Description
Difference in C-peptide (Area under the curve 0-120 min) during a mixed meal tolerance test between treatment group 1 and 2 and after 3 and 6 months of treatment and between baseline and the follow-up visit
Time Frame
7 months
Title
Difference in glucagon response during a hypoglycemic clamp before and after treatment
Description
Difference in glucagon (area under the curve) during a hypoglycemic clamp between baseline and 6 months of treatment
Time Frame
7 months
Title
Difference in glucagon response during a hypoglycemic clamp between treatment groups before and after treatment
Description
Difference in glucagon (area under the curve) during a hypoglycemic clamp between treatment group 1 and 2 between baseline and 6 months of treatment
Time Frame
7 months
Title
Change in HbA1c by treatment
Description
Change in HbA1c between 0,3 and 6 months of treatment and at the follow-up one month later.
Time Frame
7 months
Title
Change in exogenous insulin consumption by treatment
Description
Change in exogenous insulin consumption between 0,3 and 6 months of treatment and at the follow-up one month later.
Time Frame
7 months
Title
Change in fasting C-peptide by treatment
Description
Change in fasting C-peptide levels between 0,3 and 6 months of treatment and at the follow-up one month later.
Time Frame
7 months
Title
Change in variables that indicate effects on immune system
Description
Change by treatment in variables that indicate effects on the immune system such as serum autoantibodies to GAD65 and islet antigen-2, and immune cells
Time Frame
7 months
Title
Change in GABA plasma levels
Description
Analysis of GABA plasma levels after 0, 3 and 6 months of treatment and at the follow-up visit one month later.
Time Frame
7 months
Title
Change in diabetes treatment satisfaction questionnaire
Description
Measurements of patient diabetes treatment satisfaction by questionnaire during study. Each of eight questions have a 7-graded scale from 0-6. 48 points are therefore maximal treatment satisfaction and comparisons will be made to score before treatment start.
Time Frame
7 months

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: Informed consent given by patients according to national regulations Type 1 diabetes diagnosed ≥ 5 years at the time of screening Must have been diagnosed with Type 1-diabetes before the age of 25 Age ≥18 and ≤50 Fasting c-peptide levels should be in the range from not detectable levels up to <0.12 nmol/L For males of childbearing potential adequate contraception is as follows: condom (male) abstinence from heterosexual intercourse female partner using contraception as below listed: oral (except low-dose gestagen (lynestrenol and norethisterone)), injectable, or implanted hormonal contraceptives combined (estrogen and progestogen containing) oral, intravaginal or transdermal progesterone hormonal contraception associated with inhibition of ovulation intrauterine device intrauterine hormone-releasing system (for example, progestin-releasing coil) bilateral tubal occlusion Exclusion Criteria: Females of child-bearing potential Previous or current treatment with immunosuppressant therapy (although topical and inhalation steroids are accepted) Treatment with any oral or injected anti-diabetic medications other than insulin Patients on medications which may disturb GABA action, such as Baclofen, Valium, Acamprosate, Neurontin, or Lyrica HbA1c > 90 mmol/mol eGFR <60 ml/min Increased plasma concentrations of alanine aminotransferase (>0.75 μkatl/l for females or >1.1 μkat/l for males) and/or aspartate aminotransferase (>0.60 μkat/l for females or >0.75μkat/l for males). Known cancer disease Known sleeping apnea or pulmonary disorder with carbon dioxide rentention in blood Previous history of pancreatitis or other exocrine pancreatic disorder A history of epilepsy, myasthenia gravis, head trauma or cerebrovascular accident, or clinical features of continuous motor unit activity in proximal muscles A history of alcohol or drug abuse A significant illness other than diabetes within 2 weeks prior to first dosing Known human immunodeficiency virus (HIV) or hepatitis Females who are breastfeeding Males not willing to use adequate contraception during the study period. Known hypersensitivity agains benzodiazepins or any excipients of study drugs Participation in other clinical trials with a new chemical entity within 3 months or 5 half-lives of the new chemical entity, whatever longest. Inability or unwillingness to comply with the provisions of this protocol Deemed by the investigator not being able to follow instructions and/or follow the study protocol or other reasons that, at the investigator's discretion, could affect the subject's current clinical condition during study procedures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Per-Ola Carlsson, MD, PhD
Organizational Affiliation
Uppsala University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Uppsala University Hospital
City
Uppsala
ZIP/Postal Code
75185
Country
Sweden

12. IPD Sharing Statement

Citations:
PubMed Identifier
34635547
Citation
Espes D, Liljeback H, Hill H, Elksnis A, Caballero-Corbalan J, Carlsson PO. GABA induces a hormonal counter-regulatory response in subjects with long-standing type 1 diabetes. BMJ Open Diabetes Res Care. 2021 Oct;9(1):e002442. doi: 10.1136/bmjdrc-2021-002442.
Results Reference
derived

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Evaluation of Safety and Diabetes Status Upon Oral Treatment With GABA in Patients With Longstanding Type-1 Diabetes

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