Feasibility Study in Subjects With Mild to Moderate Alzheimer's Disease
Condition: Alzheimer's Disease
MeSH terms: Alzheimer Disease
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      The study is a randomized, parallel, 4-dose design in subjects with mild-to-moderate
      Alzheimer's Disease. Subjects will be randomized to one of 4 doses of T3D-959. Subjects will
      be evaluated for changes from baseline in cerebral metabolic rate of glucose (FDG-PET
      imaging), functional connectivity of the hippocampus (BOLD-fMRI), and cognitive function
      (ADAS-Cog11 and DSST) as well as assessed for safety and tolerability to T3D-959.

      An expanded access extension is planed to provide access to study medication to subjects who
      have completed the main study and requested continued use.
    

Detailed description: 
      T3D-959 is an orally-delivered, once-a-day administered, small molecule dual nuclear receptor
      agonist that has been shown in animal and Phase 1 studies in normal human subjects to be safe
      and well tolerated. The purpose of this clinical study in AD patients is to demonstrate
      mechanistic proof of concept that T3D-959, can produce desired changes in cerebral glucose
      metabolism and functional connectivity that may indicate potential for cognitive improvement.
      The therapeutic approach to be tested is based on two suppositions; (A) ameliorating multiple
      pathologies in the disease with a single therapy may provide a superior clinical benefit than
      therapeutic approaches which target a single pathology and (B) correcting insulin resistance
      in the brain, (highly correlated with AD and potential key driver of AD pathophysiology) and
      peripherally may be disease remedial.

      The brain requires integral insulin signaling for metabolic homeostasis and neuronal
      plasticity. Insulin resistance disrupts energy balance and signaling networks needed for a
      broad range of functions. Impaired insulin signaling in neurons enhances apoptosis, promotes
      oxidative cell death induced by Abeta1-42, increases secretion of Abeta1-42, blocks removal
      of extracellular Abeta oligomers and increases plaque loads. A growing body of evidence
      suggests that brain insulin resistance promotes or possibly is the trigger of key pathologies
      in AD and is supported by observed changes in levels of insulin signaling molecules in AD
      forebrains and associated changes in memory. Pre-clinical studies in animals have
      demonstrated the insulin sensitizing activity of T3D-959 and ability to improve multiple
      pathologies of AD in a rat model of disease.

      This non-placebo controlled trial will be conducted in one to three clinical centers. Thirty
      six (36) patients with mild-to-moderate Alzheimer's disease will be randomly assigned to once
      daily, orally administered treatment with 3mg, 10mg, 30mg or 90mg doses of T3D-959.
      Participants will be treated for two weeks and will undergo at baseline and at two weeks;
      FDG-PET scans to measure brain glucose metabolism, BOLD fMRI scans to measure functional
      connectivity of the hippocampus, venous blood draws for biomarker analysis and ApoE
      genotyping, and ADAS-Cog11 and DSST cognitive testing. For monitoring potential toxicities of
      the drug subjects will undergo physical examination, neurological examination, adverse event
      review, blood chemistries, and pharmacokinetic (PK) analyses for T3D-959 plasma levels.

      BOLD fMRI definition of terms:

      GoF (Goodness of Fit): The degree to which the spatial extent and magnitude of one subject's
      default mode network (DMN) regions matches the one of an elderly control group.

      Hippo-PreC Link (Hippocampus - Precuneus Link): The resting-state BOLD signal correlation
      strength between hippocampus and precuneus regions of interest.

      GlobEff_DMN: (Global Efficiency from DMN Regions): The global efficiency among 11 pre-defined
      default mode network regions.

      GlobEff_AAL: (Global Efficiency from AAL Regions): The global efficiency among 90 pre-defined
      cerebral regions based on automated anatomical labeling.

      ALFF_lPCC_PreC: Amplitude of Low Frequency Fluctuations (ALFF) from left posterior cingulate
      cortex (PCC) and precuneus (PreC).

      ALFF_rPCC_PreC: ALFF from right PCC and precuneus. fALFF_lPCC_PreC: Ratio ALFF from left PCC
      and precuneus. fALFF_rPCC_PreC: Ratio ALFF from right PCC and precuneus. ReHo_lPCC_PreC:
      Regional Homogeneity in left PCC and PreC. ReHo_rPCC_PreC: Regional Homogeneity in right PCC
      and PreC. ALFF_lIPL: ALFF from left inferior parietal lobule (IPL). ALFF_rIPL: ALFF from
      right IPL. fALFF_lIPL: Ratio ALFF from left IPL. fALFF_rIPL : Ratio ALFF from right IPL.
      ReHo_lIPL: Regional Homogeneity in left IPL. ReHo_rIPL: Regional Homogeneity in right IPL.

      Expanded Access Extension: This is an open label 10 visit extension for up to 5 subjects who
      have completed the T3D959-201 protocol and whose caregivers and physician requested their
      continued treatment in an expanded access protocol. All subjects enrolled in this study will
      be treated with a 15mg q.d. dose of T3D959 for six months, regardless of their assigned dose
      level from the main study. A continued risk/benefit assessment by the investigator will be
      conducted at each visit to determine the need for treatment continuation. Subjects will be
      assessed for safety and tolerability to T3D-959 and evaluated for changes from baseline
      cognitive function via ADAS-Cog11 and DSST testing and global change via CIBIC-plus testing.
    

Intervention name(s): T3D-959
Intervention type(s): Drug
Intervention description(s): The 3mg dosage is supplied as 1mg capsules (three capsules, taken once daily by mouth) The 10mg dosage is supplied as 5mg capsules (two capsules, taken once daily by mouth) The 30mg dosage is supplied as either 5mg or 15mg capsules (six 5mg capsules or two 15mg capsules taken once daily by mouth) The 90mg dosage is supplied as 15mg capsules (six capsules, taken once daily by mouth)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment