Modulation of the Brain Excitatory/Inhibitory (E/I) Balance in Autism Spectrum Disorder (ASD)

Study Overview
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Brief Summary
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This study investigates the brain response to a single acute dose of Arbaclofen, the R-enantiomer of the GABA-B agonist Baclofen, compared to a single dose of placebo in healthy men with and without autism spectrum disorder.

Detailed Description
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Previous research suggests that GABAergic drug compounds could shift brain excitation and inhibition (E-I) in the healthy brain and in neurodevelopmental psychiatric conditions, such as autism spectrum disorder (ASD) - where this balance is disrupted. A study by Ajram et al. (2017) has shown an E-I shifted towards more GABA in individuals with ASD, and not in controls, after a single dose of the anti-glutamatergic and pro-GABAergic drug Riluzole. Moreover, brain connectivity patterns in ASD patients where shifted towards the ones observed in the control group. However, it was unclear whether this changes could be driven by GABA receptors, thus more specific probes may help to clarify the mechanism underlying the E-I coordination in ASD. Therefore, this study will use neuroimaging and electrophysiology to investigate the brain E-I coordination in ASD compared to control participants when the system is responding to a single dose of the specific GABA-B (STX209) receptor agonist. 50 adult individuals with ASD and 50 neurotypical adults (25 males and 25 females per group) will be invited to participate. Each participant will receive a single dose of the drug (15mg or 30mg Arbaclofen) or matched placebo). Brain activity and neurochemistry will be investigated using magnetic resonance imaging. Further data will be collected through questionnaires, behavioural tasks, blood samples, and sensory tasks using electroencephalography and retinal imaging.

Official Title
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Modulation of the Brain Excitatory/Inhibitory (E/I) Balance Through Neuronal and Glial Systems in Autism Spectrum Disorder (ASD

Conditions
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Autism Spectrum Disorder

Intervention / Treatment
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* Drug: Arbaclofen_15
* Drug: Arbaclofen_30
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASD participants must pass diagnostic threshold for ASD on the Autism Diagnostic Interview-Revised (if and informant is available) ASD participants must be currently symptomatic on Autism Diagnostic Observation Schedule (ADOS) Age 18-60 years Can give informed consent medication free in the month preceding participation; but regular medication (used in a stable dose over the two months previous to participation) with drug which does not affect glutamate or GABA directly may be permitted IQ>70 Exclusion Criteria: IQ<70 history of psychosis, co-morbid major mental illness, significant physical illness (heart disease, high blood pressure, seizures) habitual substance misuse (including alcohol) ASD caused by a known genetic syndrome e.g. Fragile X or 22q11 deletion syndrome, past/present treatment for epilepsy Change of medication dose/start of a new pharmacological therapy in the month prior to participation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Repeated-measures cross-over study, where each subject received each one of the three pharmacological probes in separate visits (i.e., placebo, arbaclofen low dose and arbaclofen high dose), with the order of tablet administration being pseudorandomized.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Placebo, Arbaclofen_15, Arbaclofen_30<br>Dose order: Placebo, Arbaclofen 15mg, Arbaclofen 30mg | Drug: Arbaclofen_15<br>* Single oral dose (15mg)<br>* Other names: r-baclofen, STX209;Drug: Arbaclofen_30<br>* Single oral dose (30mg)<br>* Other names: r-baclofen, STX209;Drug: Placebo<br>* Single oral dose placebo (oral tablet)<br>* Other names: Placebo oral tablet;|
| Experimental: Placebo, Arbaclofen_30, Arbaclofen_15<br>Dose order: Placebo, Arbaclofen 30mg, Arbaclofen 15 mg | Drug: Arbaclofen_15<br>* Single oral dose (15mg)<br>* Other names: r-baclofen, STX209;Drug: Arbaclofen_30<br>* Single oral dose (30mg)<br>* Other names: r-baclofen, STX209;Drug: Placebo<br>* Single oral dose placebo (oral tablet)<br>* Other names: Placebo oral tablet;|
| Experimental: Arbaclofen_30, Placebo, Arbaclofen_15<br>Dose order: Arbaclofen 30mg, Placebo, Arbaclofen 15mg | Drug: Arbaclofen_15<br>* Single oral dose (15mg)<br>* Other names: r-baclofen, STX209;Drug: Arbaclofen_30<br>* Single oral dose (30mg)<br>* Other names: r-baclofen, STX209;Drug: Placebo<br>* Single oral dose placebo (oral tablet)<br>* Other names: Placebo oral tablet;|
| Experimental: Arbaclofen_15, Placebo, Arbaclofen_30<br>Dose order: Arbaclofen 15mg, Placebo, Arbaclofen 30mg | Drug: Arbaclofen_15<br>* Single oral dose (15mg)<br>* Other names: r-baclofen, STX209;Drug: Arbaclofen_30<br>* Single oral dose (30mg)<br>* Other names: r-baclofen, STX209;Drug: Placebo<br>* Single oral dose placebo (oral tablet)<br>* Other names: Placebo oral tablet;|
| Experimental: Arbaclofen_15, Arbaclofen_30, Placebo<br>Dose order: Arbaclofen 15mg, Arbaclofen 30mg, Placebo | Drug: Arbaclofen_15<br>* Single oral dose (15mg)<br>* Other names: r-baclofen, STX209;Drug: Arbaclofen_30<br>* Single oral dose (30mg)<br>* Other names: r-baclofen, STX209;Drug: Placebo<br>* Single oral dose placebo (oral tablet)<br>* Other names: Placebo oral tablet;|
| Experimental: Arbaclofen_30, Arbaclofen_15, Placebo<br>Dose order: Arbaclofen 30mg, Arbaclofen 15mg, Placebo | Drug: Arbaclofen_15<br>* Single oral dose (15mg)<br>* Other names: r-baclofen, STX209;Drug: Arbaclofen_30<br>* Single oral dose (30mg)<br>* Other names: r-baclofen, STX209;Drug: Placebo<br>* Single oral dose placebo (oral tablet)<br>* Other names: Placebo oral tablet;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neurochemical response to GABAergic stimulation. | Comparing brain excitation-inhibition measures (i.e., glutamate and GABA) when the GABAergic system is activated by a single oral dose of the GABA-B drug Arbaclofen versus the placebo condition. | Through study completion, an average of 2 years. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional connectivity measures using resting state functional magnetic resonance imaging. | Maps of functional connectivity will be obtained for each condition and compared between adults with and without ASD. | Through study completion, an average of 2 years. | 
| Brain oscillations under sensory stimulation | Brain oscillations and event-related potentials will be recorded during sensory stimulation using high density electroencephalography. | Through study completion, an average of 2 years. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Autism Spectrum Disorder, Arbaclofen, E-I balance, pharmacological imaging, GABA