search
Back to results

Validation of the 18 kiloDalton Translocator Protein (TSPO) as a Novel Neuroimmunodulatory Target (TSPO)

Primary Purpose

Multiple Sclerosis

Status
Recruiting
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
XBD173
Etifoxine
Sponsored by
Imperial College London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Multiple Sclerosis

Eligibility Criteria

35 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form.
  2. Aged 35-65 years old
  3. A female subject is eligible to participate if she is a) of non-childbearing potential, defined as pre-menopausal females with a documented tubal ligation or hysterectomy, or postmenopausal defined as 12 months of spontaneous amenorrhea or b) of childbearing potential but not pregnant (as determined by urinary pregnancy test on screening and on each study day) and willing to use one of the contraception methods listed below
  4. Male subject must agree to use one of the contraception methods listed above.
  5. Willing to abstain from alcohol for the duration of dosing.
  6. Expanded Disability Status Scale (EDSS) >3.5 <6.5 (SPMS patients only)

Exclusion Criteria:

  1. History of active neurological disease other than migraine or MS
  2. Clinically meaningful abnormalities in routine bloods including:

    • eGFR < 60ml/min
    • Elevation of liver enzymes/bilirubin
    • Prolonged prothrombin time
    • Thrombocytopenia
  3. Use of the following medications or therapies:

    • Immunosuppressive or immunomodulatory drugs within the last 6 months
    • Alemtuzumab or haematopeotic stem cell therapy
    • Central nervous system depressants (including opioid analgesics, barbiturates, sleeping pills, antihistamines, antipsychotics)
    • P450 CY3A4 inducers or inhibitors
    • oral contraceptives
    • oral anticoagulants or antiplatelet agents other than low dose aspirin
    • levothyroxine
  4. Currently breastfeeding
  5. Any clinical significant medical conditions that in the opinion of the investigator would compromise subjects' safety or compliance with study procedures.
  6. History of any clinical condition which in the opinion of the principal investigator would compromise the scientific integrity of the study, such as some chronic systemic diseases affecting blood, liver or kidneys or endocrine system
  7. Unwillingness or inability to follow the procedures outlined in the protocol
  8. Subject is mentally or legally incapacitated
  9. Contraindication to XBD173 use:

    • Hypersensitivity to the active substance or to any of the excipients

  10. Contraindication to etifoxine use:

    • Myasthenia gravis
    • syndromes of glucose and galactose malabsorption or lactose deficiency

Sites / Locations

  • Imperial College Healthcare NHS TrustRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Etifoxine then XBD173

XBD173 then Etifoxine

Arm Description

Outcomes

Primary Outcome Measures

Monocyte phenotye - Tissue necrosis factor-α
Plasma cytokine concentrations
Monocyte phenotye - Interferon-γ
Plasma cytokine concentrations
Monocyte phenotype - Interleukins- 1β
Plasma cytokine concentrations
Monocyte phenotype - Interleukins- 16
Plasma cytokine concentrations
Monocyte phenotype - Interleukins- 17
Plasma cytokine concentrations
Monocyte phenotype - Interleukins- 23
Plasma cytokine concentrations
Immunomodulatory factor -Transforming growth factor-β
Transforming growth factor-β
Immunomodulatory factor - Interleukins -4
Interleukins -4
Immunomodulatory factor - Interleukins - 10
Interleukins - 10
Relative proportions of WBC subsets
Flow

Secondary Outcome Measures

Monocyte phenotype - 'omic analyses
Genome, proteome, metabolome
Neurofilament
Plasma levels of neurofilament

Full Information

First Posted
February 12, 2019
Last Updated
June 21, 2022
Sponsor
Imperial College London
search

1. Study Identification

Unique Protocol Identification Number
NCT03850301
Brief Title
Validation of the 18 kiloDalton Translocator Protein (TSPO) as a Novel Neuroimmunodulatory Target
Acronym
TSPO
Official Title
An Experimental Medicine Study to Validate the 18 kiloDalton Translocator Protein (TSPO) as a Novel Neuroimmunodulatory Target in Multiple Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Recruiting
Study Start Date
April 1, 2018 (Actual)
Primary Completion Date
December 31, 2022 (Anticipated)
Study Completion Date
December 31, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Imperial College London

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
In multiple sclerosis (MS) cells of the immune system attack the brain causing tissue damage. In secondary progressive MS (SPMS) these repeated immune attacks have stopped but despite this new damage continues to appear. TSPO is a protein found in the brain and cells of the immune system, whose levels increase during MS. The investigators would like to know whether drugs that bind TSPO could dampen the immune responses in patients with SPMS. The investigators will be testing two drugs that affect TSPO; etifoxine and XBD173. Subjects with SPMS will be recruited from neurology clinics at hospitals associated with Imperial College Healthcare NHS Trust. Healthy volunteers will also be recruited in order to provide a comparison to these patients. The volunteers recruited will be invited to the clinical research facility (CRF) at Hammersmith Hospital. The volunteers will take one of the two drugs every day for 7 days. The researchers will perform blood tests before the first dose and after the last dose to investigate the effects of the drugs, including the expression of genes and immune cell activity. This will allow the researchers to explore which of the two drugs produces the greatest changes in the amount of TSPO in the blood in MS patients relative to healthy controls.
Detailed Description
The 18 kiloDalton Translocator Protein (TSPO) is a mitochondrial protein highly expressed in myeloid cells. While the full range of its functions are unknown, preclinical and in vitro studies provide suggestive evidence that TSPO ligands alter TSPO protein function to bias monocytes/macrophages and microglia towards reparative phenotypes. XBD173 and etifoxine are two TSPO ligands and represent two distinct chemotypes. Etifoxine is a benzoxaine, licenced in France (although not the UK) for the treatment of anxiety. XBD173 (Emapunil) is a phenylpurine that has recently been investigated for the treatment of anxiety, but is not licensed. The aim of this experimental medicine study is to test the hypothesis in humans that functional changes effected by TSPO can induce pro-inflammatory monocytes/macrophages and microglia to adopt a reparative phenotype. People with multiple sclerosis (MS) will be enrolled in this study because monocytes from MS patients have a chronic pro-inflammatory phenotype. Healthy volunteers (HVs) will also be enrolled to determine whether TSPO mediated effects are immune state dependant. The primary objective of this study is to determine the effects of TSPO ligand binding on monocyte/macrophage phenotype in humans. The secondary objectives are: a To characterise immunological responses in blood plasma and in circulating immune cell subsets of healthy volunteers and people with SPMS after TSPO functional changes induced by challenge ligand binding. b To explore the potential dependence of these pharmacodynamic responses on variation at rs6971 (a common polymorphism influencing ligand binding affinities in the TSPO protein) in the TSPO gene.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis

7. Study Design

Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
Outcomes Assessor
Masking Description
The people who undertake the analysis of the blood test will be blind about whether the blood sample came from an MS patient or a healthy volunteer.
Allocation
Randomized
Enrollment
44 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Etifoxine then XBD173
Arm Type
Experimental
Arm Title
XBD173 then Etifoxine
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
XBD173
Intervention Description
7 days treatment
Intervention Type
Drug
Intervention Name(s)
Etifoxine
Intervention Description
7 days treatment
Primary Outcome Measure Information:
Title
Monocyte phenotye - Tissue necrosis factor-α
Description
Plasma cytokine concentrations
Time Frame
7 days
Title
Monocyte phenotye - Interferon-γ
Description
Plasma cytokine concentrations
Time Frame
7 days
Title
Monocyte phenotype - Interleukins- 1β
Description
Plasma cytokine concentrations
Time Frame
7 days
Title
Monocyte phenotype - Interleukins- 16
Description
Plasma cytokine concentrations
Time Frame
7 days
Title
Monocyte phenotype - Interleukins- 17
Description
Plasma cytokine concentrations
Time Frame
7 days
Title
Monocyte phenotype - Interleukins- 23
Description
Plasma cytokine concentrations
Time Frame
7 days
Title
Immunomodulatory factor -Transforming growth factor-β
Description
Transforming growth factor-β
Time Frame
7 days
Title
Immunomodulatory factor - Interleukins -4
Description
Interleukins -4
Time Frame
7 days
Title
Immunomodulatory factor - Interleukins - 10
Description
Interleukins - 10
Time Frame
7 days
Title
Relative proportions of WBC subsets
Description
Flow
Time Frame
7 days
Secondary Outcome Measure Information:
Title
Monocyte phenotype - 'omic analyses
Description
Genome, proteome, metabolome
Time Frame
7 days
Title
Neurofilament
Description
Plasma levels of neurofilament
Time Frame
7 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form. Aged 35-65 years old A female subject is eligible to participate if she is a) of non-childbearing potential, defined as pre-menopausal females with a documented tubal ligation or hysterectomy, or postmenopausal defined as 12 months of spontaneous amenorrhea or b) of childbearing potential but not pregnant (as determined by urinary pregnancy test on screening and on each study day) and willing to use one of the contraception methods listed below Male subject must agree to use one of the contraception methods listed above. Willing to abstain from alcohol for the duration of dosing. Expanded Disability Status Scale (EDSS) >3.5 <6.5 (SPMS patients only) Exclusion Criteria: History of active neurological disease other than migraine or MS Clinically meaningful abnormalities in routine bloods including: eGFR < 60ml/min Elevation of liver enzymes/bilirubin Prolonged prothrombin time Thrombocytopenia Use of the following medications or therapies: Immunosuppressive or immunomodulatory drugs within the last 6 months Alemtuzumab or haematopeotic stem cell therapy Central nervous system depressants (including opioid analgesics, barbiturates, sleeping pills, antihistamines, antipsychotics) P450 CY3A4 inducers or inhibitors oral contraceptives oral anticoagulants or antiplatelet agents other than low dose aspirin levothyroxine Currently breastfeeding Any clinical significant medical conditions that in the opinion of the investigator would compromise subjects' safety or compliance with study procedures. History of any clinical condition which in the opinion of the principal investigator would compromise the scientific integrity of the study, such as some chronic systemic diseases affecting blood, liver or kidneys or endocrine system Unwillingness or inability to follow the procedures outlined in the protocol Subject is mentally or legally incapacitated Contraindication to XBD173 use: • Hypersensitivity to the active substance or to any of the excipients Contraindication to etifoxine use: Myasthenia gravis syndromes of glucose and galactose malabsorption or lactose deficiency
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
David Owen, PhD
Phone
07801140800
Email
d.owen@imperial.ac.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Lina Aimola, PhD
Phone
0207 594 1357
Email
l.aimola@imperial.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul Matthews, PhD
Organizational Affiliation
Imperial College London
Official's Role
Study Chair
Facility Information:
Facility Name
Imperial College Healthcare NHS Trust
City
London
State/Province
England
ZIP/Postal Code
W12 0NN
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Richard Nicholas, PhD
Email
r.nicholas@imperial.ac.uk

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

Validation of the 18 kiloDalton Translocator Protein (TSPO) as a Novel Neuroimmunodulatory Target

We'll reach out to this number within 24 hrs