Tricaprilin in Mild to Moderate Alzheimer’s Disease

Overview

The purpose of this study is to evaluate the safety, tolerability and effectiveness of tricaprilin administered once a day for ninety days in subjects with mild to moderate, probable Alzheimer's disease.

Full Title of Study: “Safety, Tolerability and Efficacy Study of Tricaprilin (AC-1202) Administered for Ninety Days in Subjects With Probable Alzheimer’s Disease of Mild to Moderate Severity”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Investigator)
  • Study Primary Completion Date: June 29, 2006

Detailed Description

Substantial scientific evidence has shown that defects in glucose metabolism occur in Alzheimer's disease. Attempts to compensate for the reduced cerebral metabolic rates in AD have met with some success. Treatment of AD patients with high doses of glucose and insulin will raise cognitive scores. However, this effect is slight, and high doses of insulin can have adverse consequences. Administration of ketone bodies or their metabolic precursors such as medium chain triglycerides (MCTs) presents an attractive alternative to glucose and insulin. In a preliminary study, tricaprilin, an MCT, demonstrated pharmacological activity and statistically significant efficacy in improving short-term memory and attention performance after a single dose. Participants will be randomized to receive either tricaprilin or a matching placebo, administered once a day by mixing powder in a glass of liquid. The treatment period will last 90 days, followed by a 2-week washout period. Each patient will be seen 5 times: at screening, baseline, and post-baseline days 45, 90, and 104. The visits will include physical and/or neuropsychological examinations, electrocardiograms (ECGs) and laboratory tests.

Interventions

  • Drug: Tricaprilin
    • Powder formulation will be mixed in a liquid (approximately 8 oz).
  • Other: Placebo
    • Powder formulation will be mixed in a liquid (approximately 8 oz).

Arms, Groups and Cohorts

  • Active Comparator: AC-1202
    • Tricaprilin formulation, once daily. Administered orally
  • Placebo Comparator: Matching Placebo to AC-1202
    • Placebo formulation, once daily. Administered orally

Clinical Trial Outcome Measures

Primary Measures

  • Number of subjects with treatment related adverse events
    • Time Frame: 104 days
    • AE incidence rate per treatment group

Secondary Measures

  • Pharmacokinetics (PK) profile of tricaprilin
    • Time Frame: Baseline, Day 45, Day 90
    • Correlations between the Cmax serum BHB level on Day 90 and the change from baseline total score for the three efficacy scales was determined by the Pearson correlation statistics
  • Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog)
    • Time Frame: 90 days
    • Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog 11) is an 11- item cognitive subscale that objectively measures memory, language, orientation, and praxis with a total score range of 0 (no impairment) to 70 (severe impairment)
  • Clinical Global Impression of Change
    • Time Frame: 90 days
    • Clinician’s global impression rated with Alzheimer’s Disease cooperative Study – Clinical Global Impression of Change (ADCS-CGIC). The rating is from marked improvement to marked worsening.
  • Mini-Mental State Exam (MMSE)
    • Time Frame: 90 days
    • Change in MMSE

Participating in This Clinical Trial

Inclusion Criteria

  • Informed Consent Form signed by patient and caregiver – Diagnosis of probably Alzheimer's disease of mild to moderate severity – Age 50 or older – If female, 2 years postmenopausal or surgically sterile – Hearing, vision, and physical abilities adequate to perform assessments (corrective aids allowed) – Caregiver to attend all visits, perform assessments, and supervise administration of study medication – CT or MRI within 24 months prior to screening compatible with a diagnosis of probably Alzheimer's disease – Modified Hachinski Ischemia Scale score of 4 or less – ADAS-Cog score between 15 and 35 inclusive at screening – MMSE score between 14 and 24 inclusive at screening – Stable medical condition for 3 consecutive months immediately prior to baseline – No clinically significant abnormal findings on the physical examination, medical history, or clinical laboratory results during screening Exclusion Criteria:

  • Any condition that would, in the opinion of the Principal Investigator, render the patient or the caregiver unsuitable for the study, or place them at substantial risk of adverse outcome – Unwillingness or inability of the patient and/or caregiver to fulfill the requirements of the study – Resident in a skilled nursing facility – Any significant neurological disease other than probable AD (e.g. Parkinson's disease, Huntington's disease, brain tumor, normal pressure hydrocephalus, progressive supranuclear palsy, seizure disorder, subdural hematoma, multiple sclerosis, history of stroke, or history of head injury requiring hospitalization) – An alternate cause for dementia other than AD as determined by a required CT or MRI scan within 24 months prior to screening – Current history of major psychiatric disorder – Major depression as determined by a Cornell Scale for Depression in Dementia – Clinically significant hypothyroidism – Clinically significant B12 deficiency – Unstable or clinically significant cardiovascular disease – Diabetes of any type – History of tertiary syphilis – Cancer within 3 years prior to baseline, with the exception of squamous and basal cell carcinoma – Vital sign abnormalities – Clinically significant renal disease or insufficiency – Clinically significant hepatic disease or insufficiency – Alcohol consumption greater than 2 oz of spirits per day or 14 oz per week (1 oz of spirits is equal to 6 oz of wine or 12 oz of beer) – Current history of alcohol abuse or other substance abuse within 24 months prior to baseline – Known HIV infection – Use of any investigational compound within 30 days prior to screening – Use of prohibited medications (contact site for details) – Prior or current use of medium-chain triglycerides (MCTs) for medical purposes – Known allergies to coconut oil

Gender Eligibility: All

Minimum Age: 50 Years

Maximum Age: 90 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Cerecin
  • Provider of Information About this Clinical Study
    • Sponsor

References

Blass JP, Zemcov A. Alzheimer's disease. A metabolic systems degeneration? Neurochem Pathol. 1984 Summer;2(2):103-14. doi: 10.1007/BF02834249.

Reiman EM, Caselli RJ, Yun LS, Chen K, Bandy D, Minoshima S, Thibodeau SN, Osborne D. Preclinical evidence of Alzheimer's disease in persons homozygous for the epsilon 4 allele for apolipoprotein E. N Engl J Med. 1996 Mar 21;334(12):752-8. doi: 10.1056/NEJM199603213341202.

Small GW, Ercoli LM, Silverman DH, Huang SC, Komo S, Bookheimer SY, Lavretsky H, Miller K, Siddarth P, Rasgon NL, Mazziotta JC, Saxena S, Wu HM, Mega MS, Cummings JL, Saunders AM, Pericak-Vance MA, Roses AD, Barrio JR, Phelps ME. Cerebral metabolic and cognitive decline in persons at genetic risk for Alzheimer's disease. Proc Natl Acad Sci U S A. 2000 May 23;97(11):6037-42. doi: 10.1073/pnas.090106797.

Swaab DF, Lucassen PJ, Salehi A, Scherder EJ, van Someren EJ, Verwer RW. Reduced neuronal activity and reactivation in Alzheimer's disease. Prog Brain Res. 1998;117:343-77. doi: 10.1016/s0079-6123(08)64027-3.

Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999 Nov-Dec;15(6):412-26. doi: 10.1002/(sici)1520-7560(199911/12)15:63.0.co;2-8.

Kashiwaya Y, Takeshima T, Mori N, Nakashima K, Clarke K, Veech RL. D-beta-hydroxybutyrate protects neurons in models of Alzheimer's and Parkinson's disease. Proc Natl Acad Sci U S A. 2000 May 9;97(10):5440-4. doi: 10.1073/pnas.97.10.5440.

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