This study investigates the effects of Valaciclovir treatment to individuals with Alzheimer's disease or Mild Cognitive Impairment of Alzheimer's Disease Type. It is an open pilot trial where 36 participants will receive 4 weeks of Valaciclovir treatment. Participants will be investigated using different measures before and after the treatment period.
This study investigates the effects of valaciclovir treatment to individuals with Alzheimer's disease (AD) or Mild Cognitive Impairment of Alzheimer's Disease Type. It is an open pilot trial where 36 participants will receive 4 weeks of oral valaciclovir treatment. To find 36 persons fulfilling inclusion criteria, up to 120 persons will be screened. Important inclusion criteria are Herpes Simplex Virus (HSV) Immunoglobulin G (IgG)-positivity (HSV carriage), Apolipoprotein E allele 4 carriage and sufficient kidney function (estimated glomerular filtration rate above 30 ml/min). All participants must give their informed consent to participation. The valaciclovir dose will be 500 mg three times daily the first week and 1000 mg three times daily week 2-4. Participants will be investigated using different measures before and after the treatment period: Mini Mental State Examination to assess cognitive function, Cerebrospinal fluid biomarkers of Alzheimer's disease and \[18F\]-FHBG-PET/CT (9-\[4-\[18F\]fluoro-3-(hydroxymethyl)butyl\]guanine positron emission tomography/computed tomography)) to possibly indicate active HSV infection within the central nervous system.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
33
Valaciclovir treatment (oral, 500 mg tablets). First week: 500 mg three times daily, second to fourth week: 1000 mg three times daily.
Geriatric Centre, University Hospital in Umeå
Umeå, Västerbotten County, Sweden
Memory Clinic, Uppsala University Hospital
Uppsala, Sweden
Cerebrospinal fluid (CSF) Total Tau
Change in CSF Total Tau between samples taken before and after drug treatment
Time frame: Baseline and treatment day 28
Cerebrospinal fluid (CSF) Neurofilament light chain (NFL)
Change in CSF NFL between samples taken before and after drug treatment
Time frame: Baseline and treatment day 28
Cerebrospinal fluid (CSF) phosphorylated Tau (p-Tau)
Change in CSF p-Tau between samples taken before and after drug treatment
Time frame: Baseline and treatment day 28
Cerebrospinal fluid (CSF) Amyloid beta 1-42
Change in Amyloid beta 1-42 between samples taken before and after drug treatment
Time frame: Baseline and treatment day 28
PET/CT: [18F]-FHBG accumulation within the central nervous system (CNS)
Can \[18F\]-FHBG-PET/CT detect replicating HSV infection within the CNS?
Time frame: One week before drug treatment start
PET/CT: Location of [18F]-FHBG accumulation
Do \[18F\]-FHBG accumulation locate to brain areas affected in AD?
Time frame: One week before drug treatment start
PET/CT: [18F]-FHBG accumulation
Change in \[18F\]-FHBG accumulation after, as compared to before, drug treatment
Time frame: One week before and one week after drug treatment
Mini Mental State Examination - Swedish Revision (MMSE-SR)
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Change in MMSE-SR scores from baseline to after drug treatment
Time frame: Baseline and treatment day 28
Cerebrospinal fluid (CSF) acyclovir concentration
Cerebrospinal fluid (CSF) acyclovir concentration
Time frame: Treatment day 28
Cerebrospinal fluid (CSF) 9-carboxymethoxymethylguanine (CMMG) concentration
Concentration of CMMG, main acyclovir metabolite
Time frame: Treatment day 28
Serum acyclovir concentration
Serum acyclovir concentration
Time frame: Treatment day 28
Serum 9-carboxymethoxymethylguanine (CMMG) concentration
Concentration of CMMG, main acyclovir metabolite
Time frame: Treatment day 28
Proportion completing the [18F]-FHBG-PET/CT investigations
Is \[18F\]-FHBG-PET/CT a feasible examination among persons with Alzheimer's disease
Time frame: For the investigations one week before and one week after drug treatment
Proportion completing the 28 days treatment with valaciclovir at specified doses
Feasibility of valaciclovir treatment as measured by the number of participants completing the full treatment period at the specified dose
Time frame: Treatment day 28