Impact of Nilotinib on Safety, Biomarkers and Clinical Outcomes in Mild to Moderate Alzheimer's Disease

Last updated: March 12, 2019
Sponsor: Georgetown University
Overall Status: Active - Not Recruiting

Phase

2

Condition

Dementia

Memory Loss

Alzheimer's Disease

Treatment

N/A

Clinical Study ID

NCT02947893
2016-0315
  • Ages 50-85
  • All Genders

Study Summary

The investigators hypothesize that Nilotinib will be safe in individuals with mild to moderate AD. Specifically, investigators hypothesize that low daily oral doses of Nilotinib will lead to CSF penetration, CNS Abl inhibition, and stabilization of CSF total Tau and p-Tau231/181 and Abeta42/40 levels. The investigators hypothesize that Nilotinib will decrease brain load of amyloid using amyloid positron emission tomography (PET). The investigators also predict that Nilotinib will reduce CSF markers of cell death, including neuron specific enolase (NSE) and S100B.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. Age ≥ 50

  2. Fluent in English

  3. Biomarker confirmed AD with CSF level of Abeta42 <600ng/mL

  4. Able to ingest oral medications

  5. Diagnosis of mild to moderate AD according to dementia criteria outlined by McKhann etal.

  6. Neuroimaging (MRI or CT) consistent with the diagnosis of AD within the past year

  7. MMSE between 17 and 24 (inclusive) at screening

  8. Modified Hachinski score ≤ 4

  9. QTc interval 350-460ms, inclusive

  10. Caregiver/study partner to accompany participant to all visits and have direct contactwith the participant > 2 days/week

  11. Written informed consent

  12. Capability and willingness to comply with all study criteria

  13. Supervision available for study medication

  14. Stable medical conditions for 3 months prior to screening visit

  15. Stable medications for 4 weeks prior to screening visit

  16. Able to complete baseline assessments

  17. Minimum of 6 years of education, or work history sufficient to exclude mentalretardation

  18. Stable use of cholinesterase inhibitors and memantine (U.S. FDA-approved medicationsfor patients with probable AD), vitamin E (up to 400 IU daily), estrogens, aspirin (81-300 mg daily), and cholesterol-lowering agents for 3 months prior to screening isallowed.

  19. Clinical laboratory values within normal limits or, if abnormal, must be judged to beclinically insignificant by the investigator

Exclusion

Exclusion Criteria:

  1. Non-AD dementia, probable AD with Down syndrome, APP, PS-1, or PS-2 mutations (knownfamilial AD), LBD and Fronto-temporal dementia (FTD)

  2. History of clinically significant stroke

  3. Current evidence or history in past two years of epilepsy, focal brain lesion, headinjury with loss of consciousness or DSM-IV criteria for any major psychiatricdisorder including psychosis, major depression, bipolar disorder, alcohol or substanceabuse

  4. Sensory impairment that would preclude participation/cooperation with the protocol

  5. Patients with hypokalemia, hypomagnesaemia, or long QTc syndrome.

  6. Concomitant drugs known to prolong the QTc interval (>461ms) and history ofcardiovascular disease, including myocardial infarction or cardiac failure, angina,arrhythmia

  7. Prescribed strong CYP3A4 inhibitors or a medical history of liver or pancreaticdisease

  8. Evidence of any significant clinical disorder or laboratory finding that renders theparticipant unsuitable for receiving an investigational drug including clinicallysignificant or unstable hematologic, hepatic, cardiovascular, pulmonary,gastrointestinal, endocrine, metabolic, renal or other systemic disease or laboratoryabnormality

  9. Active neoplastic disease, history of cancer five years prior to screening, includingbreast cancer (history of treated basal or squamous skin cancer, or stable prostatecancer are not exclusionary)

  10. Pregnancy or possible pregnancy

  11. Contraindications to LP: prior lumbosacral spine surgery, severe degenerative jointdisease or deformity of the spine, platelets < 100,000, use of Coumadin/warfarin, orhistory of a bleeding disorder

  12. Contraindication to MRI

  13. Evidence of more than 4 micro hemorrhages and/or hemosiderosis by a recent (12 months)and/or the screening MRI.

  14. A low B12 is exclusionary, unless follow-up labs (homocysteine (HC) and methylmalonicacid (MMA)) indicate that it is not physiologically significant.

  15. Enrolled in another active trial investigating an experimental drug or therapy for AD

  16. HIV positive

Study Design

Total Participants: 42
Study Start date:
January 01, 2017
Estimated Completion Date:
February 29, 2020

Study Description

The investigators propose a novel treatment strategy that involves Abl inhibition to alter Abeta40/42, total Tau and p-Tau231/181 in subjects with mild to moderate dementia due to AD. The investigators pre-clinical studies show that Nilotinib inhibits brain Abl, decreases Abeta and p-Tau, modulates brain and peripheral immune profiles and reverses cognitive decline in AD models. Taken together, these data support the hypothesis that Nilotinib is a viable therapeutic candidate - via Abl inhibition - in subjects with AD. Based on strong pre-clinical evidence about the effects of Nilotinib on neurodegenerative pathologies, including autophagic clearance of neurotoxic proteins, immunity and behavior, the investigators conducted an open label pilot clinical trial in advanced (stage 3-5) PD with dementia (PDD) and Lewy Body Dementia (LBD) patients. Participants (N=12) were randomized 1:1 to once daily oral dose of 150mg and 300mg Nilotinib for 6 months. The investigators showed that Nilotinib penetrates the blood brain barrier (BBB), in agreement with pre-clinical data. Several studies show that Abeta42 is decreased and CSF total Tau and p-Tau are increased in PD and LBD. Investigators data show that Nilotinib reverses loss of CSF Abeta40/42 and significantly reduces (N=5, P<0.05) CSF total Tau and p-Tau between baseline and 6 months treatment. These biomarker changes are consistent with cognitive improvement (3.5-3.85 points) using Mini-Mental Status Exam (MMSE) and the Scales for Outcomes in Parkinson's Disease-Cognition (SCOPA-Cog) between baseline and 6 months. These data are very compelling to evaluate the effects of Nilotinib in a phase II, randomized, double-blind, placebo-controlled trial in patients with mild to moderate AD.

Connect with a study center

  • Georgetown University Medical Center

    Washington, District of Columbia 20007
    United States

    Site Not Available

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