This study aims to evaluate the safety, tolerability, and preliminary efficacy of ZR001, a novel chemogenetic gene therapy product, in patients with moderately advanced Parkinson's disease (PD). ZR001 is administered via stereotactic injection into the bilateral substantia nigra, followed by postoperative ultra-low-dose clozapine to activate the transduced direct pathway, with the goal of improving motor symptoms of Parkinson's disease.
This is a first-in-human (FIH), open-label, single-arm, single-dose, dose-escalation study. The trial plans to enroll 6-8 patients with moderately advanced PD across three dose cohorts: 0.5E12, 1.0E12, and 2.0E12 vg/participant. All participants will receive a single bilateral stereotactic injection into the substantia nigra under robot-assisted guidance. To mitigate immunogenicity, prophylactic corticosteroids will be administered (intravenous methylprednisolone followed by a 12-week oral prednisone taper). Four weeks after injection, oral clozapine will be titrated over 9 days to a maintenance dose of 3.125 mg (1/8 tablet) twice daily, continued through Week 52. The study includes a 60-day screening period, an inpatient stay from Day 1 to Day 7, and outpatient follow-up visits through Week 52 at Weeks 4, 8, 12, 26, 39, and 52. After completion, participants will be invited to participate in a 5-year long-term follow-up study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
8
This is a prospective, open-label, single-arm, single-dose, dose-escalation, investigator-initiated trial. A sentinel-based 3+ design will evaluate three dose cohorts: 0.5E12, 1.0E12, and 2.0E12 vg/participant. One sentinel participant is enrolled per cohort; a Safety Review Committee assesses safety at 6-8 weeks post-injection before escalation. After completing escalation, remaining participants are enrolled at the selected dose for expansion. Total planned enrollment is 6-8 evaluable participants.
The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital)
Jinan, Shandong, China
The incidence of adverse events and serious adverse events after ZR001 treatment
Adverse events and serious adverse events will be collected from dosing through Week 52; Including vital signs, clinical laboratory parameters, and physical examinations
Time frame: 52 weeks
The differences of the daily levodopa equivalent dose (LED) after ZR001 treatment
Compare total daily LED (collected from dosing through Week 52) with baseline; LED is calculated using standard conversion factors for all dopaminergic medications
Time frame: 52 weeks
The differences of the Clinical Global Impression - Severity (CGI-S) after ZR001 treatment
Compare the change in CGI-S scores from baseline to post-treatment; CGI-S is a 7-point-scale (1 = normal to 7 = among the most extremely ill)
Time frame: 52 weeks
The differences of the Clinical Global Impression - Improvement (CGI-I) after ZR001 treatment
Compare the change in CGI-I scores from baseline to post-treatment; CGI-I is a 7-point-scale (1 = very much improved to 7 = very much worse)
Time frame: 52 weeks
The differences of the MDS Unified Parkinson's Disease Rating Scale (MDS-UPDRS) after ZR001 treatment
Change from baseline in the total UPDRS score and subscores for Parts I-IV. The UPDRS is an internationally recognized rating scale for Parkinson's disease symptoms. It comprises 4 parts assessing non-motor and motor experiences of daily living and motor complications. The total score is the sum of all 4 part scores, ranging from 0 to 183 (Part I: 0-16, Part II: 0-52, Part III: 0-56, Part IV: 0-23), with higher scores indicating greater severity of Parkinson's disease symptoms. Part I assesses non-motor experiences of daily living, including neuropsychiatric symptoms such as cognition, mood, and behavior. Part II assesses motor experiences of daily living, including activities such as writing, dressing, personal hygiene, and turning in bed. Part III assesses motor function through clinician-scored examination, including facial expression, tremor, rigidity, bradykinesia, postural instability, and gait. Part IV assesses motor complications, including dyskinesia and motor fluctuations.
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Time frame: 52 weeks
The differences of the Parkinson's Disease Questionnaire 39 (PDQ-39) after ZR001 treatment
Compare the change from baseline to Week 52 in PDQ-39 score; The PDQ-39 is a 39-item questionnaire, with each item scored from 0 to 4, where 0 = never and 4 = always or unable to do at all. Item scores are summed, higher scores indicating worse quality of life.
Time frame: 52 weeks
The differences of the Non-Motor Symptom Scale (NMSS) after ZR001 treatment
Change from baseline in the NMSS total score. The NMSS is a 30-item scale covering 9 dimensions assessing non-motor symptoms in Parkinson's disease. Each item evaluates both severity and frequency of each symptom. Severity is scored from 0 to 3, where 0 = none, 1 = mild (symptom present but causes slight discomfort or distress), 2 = moderate (symptom causes some distress), and 3 = severe (symptom causes great distress). Frequency is scored from 1 to 4, where 1 = rarely (less than once a week), 2 = often (once a week), 3 = frequently (several times a week), and 4 = very frequently (daily or continuously present). For each item, the final score is calculated as severity × frequency (product). The total score is the sum of all 30 item products, ranging from 0 to 360, with higher scores indicating greater severity and higher frequency of non-motor symptoms. Units are expressed as the score on the 0-360 scale. Assessments are performed at specified post-treatment timepoints.
Time frame: 52 weeks
The differences of the Parkinson's Disease Sleep Scale (PDSS) after ZR001 treatment
Change from baseline in the PDSS total score. The PDSS is a 15-item scale assessing common sleep disturbances in Parkinson's disease. Each item is scored from 0 to 10, with the total score calculated as the sum of all 15 items, ranging from 0 to 150. Higher scores indicate worse sleep quality.
Time frame: 52 weeks
The differences of the Pittsburgh Sleep Quality Index (PSQI) after ZR001 treatment
Change from baseline to Week 52 in PSQI global score; The PSQI is a standardized instrument developed by the Sleep Research Center at the University of Pittsburgh Medical Center for assessing sleep quality. It comprises 7 components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored, and the total score is ranging from 0 to 21. Higher scores indicate worse sleep quality, with a total score \>5 generally considered indicative of poor sleep quality.
Time frame: 52 weeks
The differences of the Montreal Cognitive Assessment (MoCA) after ZR001 treatment
Change from baseline to Week 52 in MoCA total score; The MoCA is a neuropsychological assessment tool developed by Nasreddine and colleagues in 2004 at McGill University, Canada. It covers 8 cognitive domains, including attention and concentration, executive functions, memory, language, and visuospatial skills, and comprises 11 testing tasks such as the Trail Making Test (alternating), cube copying, and delayed recall of memory. The total score is ranging from 0 to 30. A score of ≥26 is generally considered as normal, with lower scores indicating cognitive impairment.
Time frame: 52 weeks
The differences of the Mini Mental State Examination (MMSE) after ZR001 treatment
Change from baseline in the MMSE total score. The MMSE is a screening tool for cognitive and intellectual function impairment in the elderly, developed by Folstein and colleagues in 1975 in the United States. The scale comprises 5 cognitive domains: orientation, registration(memory), attention and calculation, recall, and language. Each item is scored 1 point for a correct answer, and 0 points for an incorrect answer or unknown. The total score ranges from 0 to 30, with higher scores indicating better cognitive function. The cut-off for dementia is adjusted by educational level: \<17 for illiterate individuals, \<20 for primary school education, and \<24 for middle school education or above are considered indicative of dementia. Severity reference: 27-30 = normal, 21-26 = mild, 10-20 = moderate, and 0-9 = sever
Time frame: 52 weeks
The differences of the Hamilton Depression Rating Scale (HAM-D) after ZR001 treatment
Change from baseline in the HAM-D total score. The HAM-D is a clinician-rated scale developed by Hamilton in 1960 for assessing the severity of depressive symptoms and evaluating treatment response. Assessments are performed through interview and observation. The total score is calculated as the sum of all item scores, ranging from 0 to 52, with higher scores indicating greater severity of depression. Clinical interpretation: total score \< 8 = normal; 8-20 = possible depression; 20-35 = definite depression; \> 35 = severe depression. A score of ≥ 20 is generally considered to indicate moderate to severe depressive symptoms.
Time frame: 52 weeks
The differences of the Hamilton Anxiety Scale (HAM-A) after ZR001 treatment
Change from baseline in the HAM-A total score. The HAM-A can be used to evaluate the severity of anxiety symptoms in patients with anxiety and depressive disorders, as well as to assess treatment response to various pharmacological and psychological interventions. All items are rated on a 5-point scale from 0 to 4, where 0 = absent, 1 = mild, 2 = moderate, 3 = severe, and 4 = very severe. The total score is calculated as the sum of all item scores, ranging from 0 to 56, with higher scores indicating greater severity of anxiety. Clinical interpretation: total score \< 7 = no anxiety; 7-13 = possible anxiety; 14-20 = definite anxiety; 21-28 = definite marked anxiety; ≥ 29 = severe anxiety. Additionally, scores of ≥ 17, ≥ 25, and ≥ 30 are commonly used as thresholds for mild, moderate, and severe anxiety respectively.
Time frame: 52 weeks
The differences of the viral shedding after ZR001 treatment
Detection of vector DNA by qPCR in blood, saliva, urine, and feces at baseline and at Day 7, Weeks 4, 8, 12, 26, 39, and 52 post-dose
Time frame: 52 weeks
The humoral and cellular immune responses to ZR001
Change from baseline to Week 52 in humoral and cellular immune responses to ZR001
Time frame: 52 weeks