Symptoms and General Pathology

All Conditions

Nervous System Diseases

Behaviors and Mental Disorders

Rare Diseases

Inflammation

Dementia

Mental Disorders

Alzheimer Disease

Cognitive Dysfunction

Necrosis

Brain Diseases

Psychotic Disorders

Central Nervous System Diseases

Neurodegenerative Diseases

Tauopathies

Neurocognitive Disorders

Cognition Disorders

Familial Alzheimer Disease

1.0 mg/kg XPro1595 will be administered via subcutaneous injection once a week for 12 weeks.

1.0 mg/kg of Placebo will be administered via subcutaneous injection once a week for 12 weeks.

XPro1595 will be delivered by subcutaneous injection once a week.

XPro1595

Placebo will be delivered by subcutaneous injection once a week

Placebo

Tara Lehner

The goal of this Phase 2 MCI study is to determine whether 1.0 mg/kg XPro1595 is superior to placebo at improving measures of cognition, functioning and brain quality in individuals with MCI and biomarkers associated with neuroinflammation (APOE4) and to evaluate safety, tolerability, and efficacy of XPro1595.

This study is designed as a Phase 2, double-blind randomized, placebo-controlled study investigating the safety, tolerability, and efficacy of XPro1595 in patients with MCI. The planned dose is 1.0 mg/kg of XPro1595 and matching placebo.

* (2:1) XPro1595 (1mg/kg), placebo
* Weekly subcutaneous injections

Study to Assess the Efficacy of XPro1595 in Patients With Mild Cognitive Impairment With Biomarkers of Inflammation

A Phase 2, Randomized, Placebo-Controlled, Double-Blind Study of XPro1595 in Patients With Mild Cognitive Impairment (MCI) With Biomarkers of Inflammation

Change in Goal Attainment Scale (GAS)

The achievement of each goal is rated on a 5-point attainment scale (-2, -1, 0, +1, +2) to allow standardized scoring of personalized outcomes. A participant's overall goal attainment is quantified using a formula that takes into account the number of goals that have been set, and the extent to which they are correlated with each other. For each identified goal area, the caregiver will be asked to give a detailed description of the patient's current (baseline) status and goal status, which will be recorded at the -1 and 0 levels on the 5-point scale, respectively. The remaining levels of the scale will then be set: somewhat better than the goal (+1), much better than the goal (+2), and much worse than the goal (-2).

To evaluate the effect of XPro1595 compared with placebo on goal attainment scores

Change from Screening to Week 12 in activity metrics (time spent lying, sitting, standing, stepping, upright, in walking bouts, in-context specific walking bouts; number of steps, and sit-to-stand transitions) as measured by the activity monitor. Physical activity will be measured in real time using the activity monitor worn on the patient's wrist. Total activity counts per minute (higher activity counts = more activity) and number of steps taken will be derived from data. Patients will be equipped with the monitoring device during the screening period and activity metrics will be measured for 7 days prior to each EMACC assessment. Data will be measured at Screening, Week 1, Week 3, Week 6, Week 9 and Week 12.

To assess the effect of XPro1595 compared to placebo on measures of activity

The Multidimensional Psychological Questionnaire (MPsQ) questionnaires have been designed to specifically measure patient personality characteristics associated with the placebo response. The MPsQ questionnaires are self-reported, and each item is rated on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree).

MPsQs will be completed by the patient and separate MPsQs will be completed by the study partner at screening.

MPsQs will be completed by the patient and separate MPsQs will be completed by the study partner prior to investigational product administration.

The patient and study partner will complete MPsQs at Screening and Week 1.

To measure patient personality characteristics associated with the placebo response.

Change from Baseline to Week 12 in the Early and Mild Alzheimer's Cognitive Composite (EMACC) (Jaeger 2017) made up of the following tests:

* International Shopping List Test- Immediate recall (Word List Learning Test-Immediate recall)
* Trail Making Test Part A and B
* Digit Symbol Coding Test
* Digit Span Forward and Backward
* Category Fluency Test (DKEFS)
* Letter Fluency Test (DKEFS)

To assess the efficacy of XPro1595 compared with placebo on cognitive performance in patients with MCI

Change from Screening to Week 12 in Cogstate Composite mean score.

Cogstate is a brief, computerized, neuropsychological battery to evaluate cognitive impairments in mild cognitive impairment (MCI), and Alzheimer's disease (AD). CogState assesses attention and memory functions - including Information processing speed, Visual attention, Working memory and Visual learning. Cogstate scores are measured on a linear scale (with no maximum score). A reduction in scores compared to baseline signifies an improvement in cognitive functions.

The Cogstate battery will be administered at Screening and each week for 12 weeks.

To assess the efficacy of XPro1595 compared with placebo on cognitive performance in patients with MCI

Change from Screening to Week 12 in myelin content.

Change from Screening to Week 12 in blood inflammatory and neurodegeneration biomarkers (on blood inflammatory and neurodegeneration biomarker amyloid)

To assess the efficacy of XPro1595 compared with placebo on blood inflammatory and neurodegeneration biomarkers (on blood inflammatory and neurodegeneration biomarker amyloid)

Change from Screening to Week 12 in blood inflammatory and neurodegeneration biomarkers (on blood inflammatory and neurodegeneration biomarker pTau)

To assess the efficacy of XPro1595 compared with placebo on blood inflammatory and neurodegeneration biomarkers (on blood inflammatory and neurodegeneration biomarker pTau)

Change from Screening to Week 12 in MRI neuroinflammation (White matter Free Water)

To assess the efficacy of XPro1595 compared with placebo on imaging neuroinflammation

Change from Screening to Week 12 in regional brain glucose uptake as measured by F-fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) scans

Alzheimer's Disease (AD) is characterized by a chronic brain glucose deficit. White matter glucose deterioration is also evident in Mild Cognitive Impairment (MCI) and specific to limbic fascicles. We will quantify the change in regional brain glucose uptake for gray matter and white matter tracts using PET imaging and the F-fluorodeoxyglucose (FDG) radiotracer. PET maps will be registered to Magnetic Resonance (MR) anatomical images and corrected for partial volume effect. Standard uptake value ratios (SUVr) will be calculated using the cerebellum as a reference region.

FDG-PET scans will be performed at Screening and Week 12.

To assess the efficacy of XPro1595 compared with placebo on imaging markers of brain quality

Change from Baseline to Week 12 in MRI Apparent Fiber Density (AFD)

To assess the efficacy of XPro1595 compared with placebo on axonal integrity in patients with MCI

Change from Screening to Week 12 in Neuropsychiatric Inventory (NPI-12) study partner items

To assess the effect of XPro1595 compared with placebo on non-cognitive behavioral symptoms in patients with MCI

Change from Screening to Week 12 in brain activity as measured by electroencephalogram (EEG) scans (Change in brain activity as measured by the EEG in microvolts).

Specifically, a series of EEG markers previously associated with AD (Horvath et al. 2018) including high and low frequency band powers, the P300, and Mismatch Negativity (MMN) event-related potentials will be evaluated.

An EEG scan will be administered at Screening and each week for 12 weeks.

To assess the efficacy of XPro1595 compared with placebo on brain activity in patients with MCI

Change from Baseline to Week 12 in language and speech patterns using Winterlight Labs analysis

To assess the effect of XPro1595 compared with placebo on speech and language in patients with MCI

Change from Screening to Week 12 in Alzheimer's Disease Cooperative Study - Mild Cognitive Impairment Activities of Daily Living (ADCS-MCI ADL)

The 23-item ADCS-MCI-ADL Scale has good test-retest reliability, will be utilized to assess performance functioning in MCI patients (Galasko et al., 1997; Douglas Galasko et al., 2006; Pedrosa et al., 2010). The ADCS-ADL includes 18 items from traditional basic ADL scales and 5 items from instrumental activities of daily living scales (IADL) The possible range of total scores for the ADL Scale is 0-53 and higher scores indicate better functioning. The internal reliability was .91( Galasko et al., 1997; Douglas Galasko et al., 2006; Pedrosa et al., 2010).

The ADCS-MCI ADL will be performed at Screening and Week 12.

To assess the effect of XPro1595 compared with placebo on Activities of Daily Living (ADL) in patients with MCI

Change from Screening to Week 12 in Clinical Dementia Rating Scale Sum of Boxes (CDR-SB)

The CDR scale is a clinician-rated dementia staging system that tracks the progression of cognitive impairment in 6 categories (memory, orientation, judgement and problem solving, community affairs, home and hobbies, and personal care). Each category is scored on a 5-point scale in which None = 0, Questionable = 0.5, Mild = 1, Moderate = 2, and Severe = 3. The global CDR score is established by clinical scoring rules and has values of 0 (no dementia), 0.5, (questionable dementia), 1 (mild dementia), 2 (moderate dementia), and 3 (severe dementia). The Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) is obtained by adding the ratings in each of the 6 categories and ranges from 0 to 18 with higher scores indicative of greater impairment.

To assess the effect of XPro1595 compared with placebo on cognition and global function in patients with MCI

Clinically significant abnormalities of laboratory values, physical findings, electrocardiogram findings and other safety assessments will be recorded as adverse events if the findings meet the defined criteria for adverse events.

Spots Global Cancer Trial Database for Study to Assess the Efficacy of XPro1595 in Patients With Mild Cognitive Impairment With Biomarkers of Inflammation

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