Nutritional Formulation for Angelman Syndrome

University of Colorado, Denver15 enrolled

Overview

Low carbohydrate diets such as the ketogenic (KD) and low glycemic index (LGIT) diets have been shown to be effective in treating drug resistant seizures in children with Angelman syndrome (AS). The investigators hypothesize that consuming a fat based nutritional formulation with an exogenous ketone throughout the day will produce urinary ketosis in children consuming both low and high carbohydrate diets, depending upon dietary background. The nutritional formulation will provide fuel substrates that push metabolism away from carbohydrates and towards fat utilization. This research is being done to assess the safety and tolerability of a nutritional formulation for use in dietary interventions in AS.

An evaluation of the safety and tolerability of a nutritional formulation in Angelman syndrome in children ages 4-11 years. Study is conducted over 16 weeks: 2 week baseline period - Patient continues on current dietary regimen they were on before joining the study (standard, ketogenic, or LGIT). 4 week intervention period - Patient consumes either placebo or nutritional formulation for 4 weeks, maintaining their current diet. 4 week washout period - Patient continues on current dietary regimen without consuming any study formulations. 4 week intervention period - Patient consumes either placebo or nutritional formulation for 4 weeks (crossover), maintaining their current diet. 2 week washout period - Patient continues on current dietary regimen without consuming any study formulations. Follow-up phone call to be conducted by study personnel during this time. Data is captured by the investigator during baseline, intervention, and washout periods, and by the parent/caregiver daily throughout the protocol using apps loaded on a provided tablet.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

QUADRUPLE

Enrollment

Interventions

Nutritional Formulation Containing Exogenous KetonesDIETARY_SUPPLEMENT

A nutritional formulation providing beta-hydroxybutyrate, 2g of carbohydrate, 1g of protein, and 9g of fat, plus minerals, per 100kcal. Given orally as food or beverage three times daily.

Placebo FormulationDIETARY_SUPPLEMENT

A placebo formulation providing similar amounts of carbohydrates, proteins and minerals as the nutritional formulation. Given orally as food or beverage three times daily.

Eligibility

Sex: ALLMin age: 4 YearsMax age: 11 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Male or female * 4-11 years of age * Diagnosed with Angelman syndrome with prior lab report indicating genetic diagnosis * Currently on a LGIT, KD, or standard diet consistently for at least three months * Motivated to maintain the LGIT or KD for at least the duration of the trial period, as applicable * Written informed consent from patient and/or parent/caregiver * Willing to drink provided formulations, or to eat them mixed with food * Daytime toilet trained, or parents willing to use cotton balls in diapers to sample urine * Willing to test urine daily * Willing to comply with protocol examinations, including EEG, ERP, and venipuncture * Ambulatory, willing to perform gait tracking Exclusion Criteria: * Being pregnant or planning pregnancy * Requiring parenteral nutrition * Major hepatic or renal dysfunction * History of a diagnosis of diabetes * Participation in other clinical intervention studies within 1 month prior to entry of this study * Allergy to any of the study product ingredients * Investigator concern around willingness/ability of patient or parent/caregiver to comply with protocol requirements * Any contraindications for the use of the ketogenic or low carbohydrate diets * Significantly underweight (Body Mass Index \<18.5) * Unwilling to drink provided formulations, or to consume formulation mixed with food * Not ambulatory, or unwilling to perform gait tracking * Not daytime toilet trained, or parents unwilling to use cotton balls in diapers to sample urine * Unwilling to test urine daily

Outcomes

Primary Outcomes

Compliance with feeding protocol

Tolerability will be demonstrated through patient compliance with the protocol as determined by the amount as measured in grams per day of nutritional formulation consumed as compared to the amount prescribed.

Time frame: 16 weeks

Secondary Outcomes

Convenience, taste, and acceptability

Parents/caregivers will rate convenience, taste, and acceptability of the nutritional formulation on a ten-point Likert scale. Each parameter will be rated individually with 1 = poor and 10 = excellent.

Time frame: 16 weeks (measured 2 times)

Urinary Ketosis

The degree of nutritional ketosis will be evaluated in patients with different dietary backgrounds when consuming the nutritional formulation. Urine ketones will be recorded daily as mmol of acetoacetate.

Time frame: 16 weeks

Serum Ketosis

The degree of nutritional ketosis will be evaluated in patients with different dietary backgrounds when consuming the nutritional formulation. Serum ketones will be recorded as mmol of R-beta-hydroxybutyrate.

Time frame: 16 weeks (measured 3 times)

Number of Patients with Adverse Events

All adverse events will be monitored throughout the study. The number and type of adverse event will be recorded.

Time frame: 16 weeks (measured 3 times)

Change in Mobility Measured Using Zeno Walkway

Patients with Angelman Syndrome typically have motor coordination and physical developmental delays resulting in an ataxic gate. As a measure of safety, the patient's gate characteristics for cadence will be compared to baseline.

Time frame: 16 weeks (measured 3 times)

Change in Cognition as Measured by Event Related Potentials (ERP)

Patients with Angelman Syndrome have global severe intellectual disability. As a measure of safety, ERP waveform amplitude and timing in response to a presented stimuli will be compared to baseline.

Time frame: 16 weeks (measured 3 times)

Change in Cortical Irritability Measured Using Electroencephalogram (EEG)

Patients with Angelman Syndrome have a characteristic EEG signature and are prone to seizure. As a measure of safety, the EEG signature will be compared to baseline in terms of the numbers of epileptiform discharges, notched delta and rhythmic theta activity.

Time frame: 16 weeks (measured 3 times)

Number of Patients with Treatment Related Adverse Events as Assessed by Blood Metabolic Panel

Blood samples will be taken and assessed for complete blood count, comprehensive metabolic panel, ketones, and lipids.

Time frame: 16 weeks (measured 3 times)

Nutrient Intake

Food diaries recorded daily to establish total caloric and macro-nutrient intake.

Time frame: 16 weeks

Changes in Gastrointestinal (GI) Health

Patients with Angelman Syndrome frequently suffer from poor GI health. As a measure of safety, bowel movements will be characterized daily according to the Bristol Stool Chart and compared to baseline.

Time frame: 16 weeks

Changes in Sleep

Patients with Angelman Syndrome frequently suffer from sleep issues. As a measure of safety, sleep duration and stage will be characterized by recording movement, heart rate and breathing during nighttime sleep and compared to baseline.

Time frame: 16 weeks

Changes in Seizures

A significant percentage of Patients with Angelman Syndrome suffer from epileptic seizures. As a measure of safety, the number and type of seizures that occur will be recorded daily in a diary and compare to baseline.

Time frame: 16 weeks

Height

Height (cm)

Time frame: 16 weeks (measured 3 times)

Weight

Weight (kg)

Time frame: 16 weeks (measured 3 times)

Change from Baseline in the Vineland Adaptive Behavior Score

Patients with Angelman Syndrome have severe global developmental delays. As a measure of safety, the Vineland Adaptive Behavior Scale, Third Edition will be used to measure changes from baseline in skills and independence.

Time frame: 16 weeks (measured 3 times)

Nutritional Formulation for Angelman Syndrome

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes