This is a prospective, multicentric, randomized, double blind, placebo controlled Phase II clinical study to compare the safety and efficacy of PMZ-1620 therapy along with standard supportive care in subjects with mild to moderate Alzheimer's disease.
Alzheimer's is not just a disease of old age, approximately 200,000 Americans under the age of 65 having younger-onset Alzheimer's disease (AD). In 2015, there were approximately 29.8 million people worldwide with AD. The person with Alzheimer's disease can live an average of eight years after their symptoms become noticeable to others, but survival range is 4 to 20 years, depending on the age and other health conditions (www.alz.org). The pathophysiology of AD is related to the injury and death of neurons, initiating in the hippocampus brain region that is involved with memory and learning, then atrophy affects the entire brain. The cause of Alzheimer's disease is still poorly understood and about 70% of the risk is associated with genetic. Other risk factors may also associate with this like history of head injuries, depression, or hypertension. Like all types of dementia, Alzheimer's is also caused by brain cell death. Although AD is classified as a neurodegenerative dementia, considerable evidence links vascular dysfunction and vascular risk factors as pathogenesis of AD. However, it is a progressive brain cell death that happens over a course of time and treatments can't stop Alzheimer's from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer's and their caregivers (www.alz.org; www.who.int). Sovateltide is an endothelin B (ETB) receptor agonist (previously used names IRL-1620, SPI-1620 and PMZ-1620; International Non-proprietary Name (INN) approved by WHO is sovateltide). Activation of ETB receptors with PMZ-1620 produces neurovascular repair and remodeling or neuroregeneration. There are hidden stem cells in the brain, which becomes active following injury to the brain. Intravenous administration of PMZ-1620 (sovateltide) augments the activity of neuronal progenitor cells in the brain to repair the damage by formation of new mature neurons and blood vessels. In addition, PMZ-1620 has anti-apoptotic activity and also increases cerebral blood flow.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
80
PMZ-1620 (sovateltide) is an endothelin-B receptor agonist. PMZ-1620 has the potential to be a first-in-class neuronal progenitor cell therapeutics that is likely to promote quicker recovery and improve neurological outcome in Alzheimer's disease patients. In this arm normal saline along with standard treatment will be given for active comparison.
PMZ-1620 (sovateltide) is an endothelin-B receptor agonist. PMZ-1620 has the potential to be a first-in-class neuronal progenitor cell therapeutics that is likely to promote quicker recovery and improve neurological outcome in Alzheimer's disease patients.
Post Graduate Institute of Medical Education and Research
Chandigarh, India
King George's Medical University
Lucknow, India
Sanjay Gandhi Post Graduate Institute of Medical Sciences
Lucknow, India
Seth GSMC & KEM Hospital
Mumbai, India
Incidence of PMZ-1620 related adverse events
The primary objective of the study is to determine incidence of drug (PMZ-1620) related adverse events.
Time frame: 160 days
Number of patients not receiving full treatment due to intolerance to PMZ-1620
Tolerability will be determined by the number of patients that do not receive all the 18 doses of PMZ-1620.
Time frame: 160 days
Changes in clinical progression of AD as measured by Mini-Mental State Examination (MMSE)
Statistically relevant changes in clinical progression of AD as measured by MMSE after 3 and 6 months of treatment. Mini-Mental State Examination (MMSE) is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia.
Time frame: 160 days
Changes in neuropsychiatric inventory (NPI) Score
Statistically relevant changes in NPI Score after 3 and 6 months of treatment. The Neuropsychiatric Inventory (NPI) is designed to detect, quantify and track changes of psychiatric symptoms in a demented population. The NPI examines 12 sub-domains of behavioral functioning: delusions, hallucinations, agitation/aggression, dysphoria, anxiety, euphoria, apathy, disinhibition, irritability/lability, aberrant motor activity, night-time behavioral disturbances, and appetite and eating abnormalities. Maximum is 144 points, where less number of points is mild behavioral disturbance and more number of points is severe behavioral disturbance.
Time frame: 160 days
Changes in Alzheimer's disease Assessment Scale-Cognitive Subscale (ADAS-Cog)
Statistically relevant changes in ADAS-Cog after 3 and 6 months of treatment. Alzheimer's disease Assessment Scale-Cognitive Subscale is a commonly used objective measure of cognitive change. It is designed to measure cognitive areas commonly seen to decline in AD patients.Total scores range from 0-70, with higher scores indicating greater cognitive impairment. Many regulatory authorities recognize a four-point change on the ADAS-Cog at 6 months as indicating a clinically important difference.
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All India Institute of Medical Sciences
New Delhi, India
Time frame: 160 days
Changes in hippocampal atrophy using MRI/CT
Changes in hippocampal atrophy using MRI/CT before and at the end of study
Time frame: 160 days
Changes in electroencephalograms (EEGs)
Changes in electroencephalograms (EEGs) suggestive progression in AD symptom after 3 and 6 months of treatment. A decline of posterior slow-frequency alpha power which is peculiar feature of Alzheimer's disease and an amplitude increase of widespread delta and theta and an amplitude decrease of posterior alpha and/or beta sources that are reflective of Alzheimer's disease will be observed.
Time frame: 160 days