Evaluating Rapamycin Treatment in Alzheimer's Disease Using Positron Emission Tomography

Alzheimer Disease Clinical Trial

— ERAP  

Official title:

Evaluating Rapamycin Treatment in Alzheimer's Disease Using Positron Emission Tomography (ERAP)

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT06022068
• Other study ID #: 2023-00611-01
• Status: Enrolling by invitation
• Phase: Phase 1/Phase 2
• Start date: September 1, 2023
• Est. completion date: January 31, 2025

Study information

• Verified date: March 2024
• Source: Karolinska Institutet
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This single-center, uncontrolled pilot study aims to evaluate the efficacy, safety, and tolerability of six months of intermittently dosed oral rapamycin (sirolimus) in subjects with early-stage Alzheimer's disease. Fifteen participants will be recruited. Following a set of baseline measurements, all participants will receive a weekly oral dose of 7 mg rapamycin for six months. Participants will be continuously monitored for safety and side effects. At the termination of the treatment, follow-up measurements will be taken. The primary endpoint will be change in cerebral glucose metabolism, measured using 18F labeled fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET). In addition to the registered outcome measures this pilot trial will explore the feasibility of acquiring data on the effect of sirolimus treatment on age-related tissue changes in the body using a variety of imaging modalities, such as bone mineral density assessed using quantitative computed tomography, retinal structures assessed using optical coherence tomography, periodontal tissue assessed using MRI and FDG-PET, cardiac function assessed using MRI, vessel wall in large arteries using MRI and [18F]FDG PET.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 15
• Est. completion date: January 31, 2025
• Est. primary completion date: January 31, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years to 80 Years

Eligibility

Inclusion Criteria:

1. Clinical diagnosis of mild cognitive impairment (MCI), or dementia of Alzheimer's type

2. Amyloid positivity established with either amyloid positron emission tomography or cerebrospinal fluid analysis.

3. For subjects with dementia, the disease should be in an early stage, operationalized

as:

• Stage 4 (Mild dementia) or lower, according to the National Institute on Aging - Alzheimer's Association 2018 clinical staging criteria, AND
• Clinical Dementia Rating Scale (CDR) global score of 1 or lower, AND
• Montreal Cognitive Assessment (MoCA) score of = 18 OR Rey Auditory Verbal Learning Test (RAVLT) >4 words after 30 minutes

4. Capable of giving, and has the capacity to give informed consent

5. Availability of a responsible study partner who can accompany the subject to all planned visits

6. Male or female between 50 and 80 years

7. Normal or clinically acceptable medical history, physical examination, and vital signs

Exclusion Criteria:

1. History of any major disease that may interfere with safe engagement in the intervention (especially severe liver or kidney disease, or uncontrolled diabetes).

2. Central nervous system infarct, infection, or focal lesions of clinical significance on MRI scans.

3. Fulfills any contraindication for the use of sirolimus as per the summary of product

characteristics, including but not restricted to:

• Current or planned medication with a strong inhibitor of CYP3A4 or P-gp
• Current or planned medication with a strong inducer of CYP3A4 or P-gp
• Other current medications with known serious interaction risks with sirolimus
• Known allergy or hypersensitivity to sirolimus

4. Significant obesity

5. Untreated and clinically significant hyperlipidemia

6. Treatment with immunosuppressive medications within the last 90 days (topical and nasal corticosteroids and inhaled corticosteroids for asthma are permitted), or chemotherapeutic agents for malignancy within the last 3 years

7. Major surgery within 3 months prior to the planned start of sirolimus treatment, OR has major surgery planned during the period of the trial.

8. Use of experimental medications for Alzheimer's or any other investigational medication or device within 60 days. Participants who have been involved in a monoclonal antibody study are excluded unless it is known that they were receiving placebo in that trial

Related Conditions & MeSH terms

• Alzheimer Disease

Intervention

Drug:
• Sirolimus
7 mg taken once per week during 26 weeks.

Locations

Country	Name	City	State
Sweden	Karolinska University Hospital Memory clinic	Solna	Stockholm

Sponsors (2)

Lead Sponsor	Collaborator
Karolinska Institutet	Karolinska University Hospital

Country where clinical trial is conducted

Sweden, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Change in composite z-score of neuropsychological tests	Cognition assessed with a composite score of the following tests: Rey Auditory Verbal Learning Test; Rey-Osterrieth Complex Figure; Hagman test; Trail Making Test A + B; Wechsler Adult Intelligence Scale (subtest to assess processing speed/attention). A composite score will be calculated using z-score approach..	From baseline to six months
Other	Change in concentration of neurofilament light in CSF	Neuronal damage assessed using concentraion of neurofilament light in CSF.	From baseline to six months
Other	Change in quotient of albumin concentration in serum and CSF	Blood-brain barrier integrity assessed using quotient of concentration albumin in serum and CSF	From baseline to six months
Other	Change in hand-grip strength	Measured using a hand-grip dynamometer	From baseline to six months
Other	Change in chair stand test	Number of completed chair stands in 30 seconds	From baseline to six months
Other	Change in walking speed	Timed 10-metre dual task walking test	From baseline to six months
Other	Change in ratio of CSF concentration of amyloid beta 42 and 40	CSF biomarker for Alzheimers disease	From baseline to six months
Primary	Change in cerebral glucose metabolism	Cerebral glucose uptake measured through [18F]FDG positron emission tomography	From baseline to six months
Secondary	Incidence of Treatment-Emergent Adverse Events	Safety and tolerability of intermittent sirolimus treatment	From baseline to six months
Secondary	Change in Cerebrospinal fluid (CSF) concentration of amyloid beta 42	CSF biomarker for Alzheimers disease	From baseline to six months
Secondary	Change in CSF concentration of phosphorylated tau	CSF biomarker for Alzheimers disease	From baseline to six months
Secondary	Change in CSF concentration of total tau	CSF biomarker for Alzheimers disease	From baseline to six months
Secondary	Change in cerebral blood flow	Cerebral blood flow measured with MRI using arterial spin labeling	From baseline to six months
Secondary	Area under the concentration versus time curve (AUC) of sirolimus	Whole blood measurements of sirolimus concentration.	Tested at one occasion between baseline to six months
Secondary	Peak Plasma Concentration (Cmax) of sirolimus	Whole blood measurements of sirolimus concentration.	Tested at one occasion between baseline to six months
Secondary	Trough Plasma Concentration (Cmin) of sirolimus	Whole blood measurements of sirolimus concentration.	Tested at one occasion between baseline to six months
Secondary	Change in Montreal Cognitive Assessment (MoCA) rating	Cognition assessed using the MoCA rating scale (0-30 points, higher scores indicating better cognitive performance)	From baseline to six months