The goal of this clinical trial is to assess the safety and effects of a crystallized form of lithium, AL001, when compared to commonly used lithium carbonate in individuals diagnosed with bipolar I disorder. The main questions this study aims to answer are: * How safe is AL001 when compared to lithium carbonate? * How is AL001 broken down in the brain and body compared to lithium carbonate? Participants will be asked to: * Take both the study drug (AL001) and lithium carbonate each for a period of 14 days. * Stay overnight at MGH's research unit for two separate 2-week periods. * Participate in two separate 24 hour periods of multiple MRIs and blood draws.
This study is researching the effects of a new type of crystallized lithium, AL001, on it's ability to reach the brain and have an effect in subjects with bipolar I disorder diagnosis. The investigators will be comparing this to a commonly used type of lithium, lithium carbonate. Investigators want to see if the AL001 can have the same or better effect when compared to lithium carbonate. Past research has shown a greater effect within the body with AL001 when compared to commonly used lithium. This past research suggests that AL001 may be more effective, potentially allowing for lower doses and fewer side effects. If successful, this new form of lithium could offer a new and safe treatment option for psychiatric and neurological disorders. This study involves two, 2-week long overnight stays at the main campus of Massachusetts General Hospital (MGH). During these stays, participants will receive lithium carbonate for one stay and the AL001 for the other. There are frequent blood draws and brain MRI scans during two periods of the study to look at how the AL001 is broken down in the body and to see how it reaches the brain. This study will compare AL001 to a study reference treatment of lithium carbonate. The majority of the blood draws and MRIs will occur over a 24 hour period during each 2-week long overnight stay at MGH.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Crystallized lithium
Lithium carbonate
Massachusetts General Hospital
Boston, Massachusetts, United States
RECRUITINGTo evaluate differences in brain and/or brain structure lithium PK relative to plasma PK for AL001 capsule compared to a lithium carbonate capsule.
Brain (and brain structures)-to-plasma ratios between AL001 and lithium carbonate for steady-state PK measures/ parameters.
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To evaluate differences in brain and/or brain structure lithium PK relative to plasma PK for AL001 capsule compared to a lithium carbonate capsule.
Area under the plasma and brain concentration versus time curve (AUC) will be measured.
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma AUCtau ss = Area under the plasma concentration versus time curve from time zero to the end of the 24-hour 3-dose interval at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state
To characterize AL001 lithium PK under the conditions of this study
Brain AUCtau ss = Area under the plasma concentration versus time curve from time zero to the end of the 24-hour 3- dose interval at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma Cmax ss = Maximum plasma concentration at steady-state.
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain Cmax ss = Maximum brain concentration at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma tmax ss = Time to reach the maximum plasma concentration at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain tmax ss = Time to reach the maximum brain concentration at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma Cmin ss = Minimum plasma concentration at steady-state (if at end-of-24 hour dosing interval: Ctrough
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain Cmin ss = Minimum brain concentration at steady-state (if at end-of-24 hour dosing interval: Ctrough)
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma tmin ss = Time to reach the minimum plasma concentration at steady-state over 24 hours
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain tmin ss = Time to reach the minimum brain concentration at steady-state over 24 hours
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain/Plasma AUCtau ss ratio = Ratio of brain/plasma areas under the plasma concentration versus time curve from time zero to the end of the 24-hour 3-dose interval at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain/Plasma Cmax ss ratio = Ratio of brain/plasma minimum concentrations from time zero to the end of the 24-hour 3-dose interval at steady-state.
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain/Plasma Cmin ss ratio = Ratio of brain/plasma minimum concentrations from time zero to the end of the 24-hour 3-dose interval at steady-state.
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma apparent oral clearance (CLoral) = Dose24 hours/Plasma AUCtau ss
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Average plasma concentration at steady-state (Css ave plasma) = Plasma 24 h AUCtau ss/24 hours
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Average brain concentration at steady-state (Css ave brain) = Brain 24 h AUCtau ss/24 hours
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma degree of fluctuation at steady-state (FIplasma ss) = Ratio of plasma (Cmax ss - Cmin ss) to Css ave plasma
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain degree of fluctuation at steady-state (FIbrain ss) = Ratio of brain 24 h (Cmax ss - Cmin ss) to Css ave brain
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Plasma swing 24 h = \[(Cmax ss - Cmin ss)/ Cmin ss \]
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
Brain swing 24 h = \[(Cmax ss - Cmin ss)/ Cmin ss \]
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 lithium PK under the conditions of this study
MRT oral doses (0-24h ss) = Mean Residence Time following oral doses at steady-state (0 to tau, end of 24-hour dosing interval)
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with adverse events and serious adverse events
Time frame: From enrollment to end of follow-up period at Day 42(P2)
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with abnormal vital signs
Time frame: From enrollment to Day 23 (P2)
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with abnormal values and change from baseline reading for each ECG parameter. Individual parameters including heart rate, PR, QT, QTcF, QRS, and RR intervals will be collected.
Time frame: From enrollment to Day 23 (P2)
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with abnormal findings on physical exam.
Time frame: From enrollment to Day 23 (P2)
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with abnormal values and changes from baseline for each Safety laboratory test (standard hematology, blood chemistry \[clinical chemistry\], urinalysis, and pregnancy test \[for females of childbearing potential only).
Time frame: From enrollment to Day 23 (P2)
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with prevalence of plasma lithium concentrations above 1.2 mEq/L
Time frame: From enrollment to Day 23 (P2)
To evaluate the safety and tolerability of AL001 under multiple-dose, steady-state conditions in subjects with bipolar I disorder diagnosis under the conditions of this study.
Proportion of participants with prevalence of plasma salicylic acid concentrations above 30 mg/dL
Time frame: From enrollment to Day 23 (P2)
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma AUCtau ss = Area under the plasma concentration versus time curve from time zero to the end of the 24-hour 3-dose interval at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma Cmax ss = Maximum plasma concentration at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma tmax ss = Time to reach the maximum plasma concentration at steady-state
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma Cmin ss = Minimum plasma concentration at steady-state (if at end-of-24 hour dosing interval: Ctrough)
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma tmin ss = Time to reach the minimum plasma concentration at steady-state over 24 hours
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma apparent oral clearance (CLoral) = Dose24 hours/Plasma AUCtau ss
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Average plasma concentration at steady-state (Css ave plasma) = Plasma 24 h AUCtau ss/24 hours
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Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma degree of fluctuation at steady-state (FIplasma ss) = Ratio of plasma (Cmax ss - Cmin ss) to Css ave plasma
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
Plasma swing 24 h = \[(Cmax ss - Cmin ss)/ Cmin ss \]
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
To characterize AL001 salicylic acid PK under the conditions of this study
MRT oral doses (0-24h ss) = Mean Residence Time following oral doses at steady-state (0 to tau, end of 24-hour dosing interval)
Time frame: From time zero to the end of the 24 hour 3-dose interval at steady state.
Exploring Brain Pharmacodynamics using Magnetic Resonance Spectroscopy
Magnetic resonance spectroscopy (MRS) techniques will be applied to explore brain metabolism, including possible metabolic similarities/differences between treatments
Time frame: From Screening (Day 1) to Day 23 (P2)