Clinical trial NCT04390646: GnRH Therapy on Cognition in Down Syndrome
Official title: Effect of Pulsatile GnRH Therapy on Cognition in Down Syndrome: Randomized Placebo Control Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
PHASE3
Conditions: Down Syndrome
Cognitive Decline
Alzheimer Disease, Early Onset
Olfaction Disorders
Keywords: GnRH
Lead sponsor: Centre Hospitalier Universitaire Vaudois
Sponsor class: OTHER
First posted: 2020-05-15
Enrollment: 56
Sex: ALL
Minimum age (years): 16
Maximum age (years): 50
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Multicentric randomized double-blind clinical trial
Primary purpose: TREATMENT

Brief summary: Down syndrome (DS) is the most common chromosomal disorder; with the increasing life expectancy, about 80% of DS adults reach age 65 years old. Early Alzheimer's disease (AD) is the most common cause of death within this population. DS individuals already show AD neuropathology by the age of 30, while it becomes clinically recognized in their late forties. DS subjects also exhibit olfaction defects in adulthood.

To date, there is no treatment available for the cognitive or olfactory defects in DS. The development of an effective treatment targeting cognitive dysfunction in DS adolescents/adults would be warranted.

GnRH, a decapeptide secreted by hypothalamic neurons is the pilot light of reproduction in all mammals. Pulsatile GnRH acts on the gonadotrophs via the GnRH receptor (GNRHR) in the pituitary gland to stimulate LH and FSH, which themselves will act on the gonads to produce gametes and steroids. However, GNRHR are also expressed in cerebral cortex, hippocampus, amygdala, habenula, olfactory structures, and adrenal gland, suggesting that GnRH may have a role beyond reproduction.

Recently, GnRH has been shown to be involved in the process of ageing and lifespan control. Notably, in murine models, GnRH acts as an anti-ageing factor, independent of sex hormones. While ageing is characterized by hypothalamic inflammation and diminished neurogenesis, particularly in the hypothalamus and the hippocampus, GnRH was able to promote adult neurogenesis.

The regulation of GnRH secretion is complex and involves hormonal, neuronal input, and environmental factors.

Prévot et al. recently explored cognition within the Ts65Dn model and showed an age-dependent loss of the ability to recognize new objects. Also, these mice exhibit defects in olfaction. Given the role of GnRH in anti-aging mice model, pulsatile GnRH or continuous GnRH infusion (leading to desensitization of the GNRHR) were given to the Ts65Dn mice for two weeks. Amazingly, pulsatile but not continuous GnRH therapy was able to recover cognitive and olfaction defects.


Eligibility criteria: Inclusion Criteria:

* Diagnosis of trisomy 21
* Verbal expression (ability to follow the procedures of the study)
* Consent to a non-hormonal contraception during the whole duration of the study For women: intra-uterine device with copper, a prior tubal ligation or condoms for the partner For men: condoms or vasectomy

Exclusion Criteria:

* Acute illness (clinical or biochemical findings suggesting acute illness/hospitalization)
* Chronic alcohol abuse, illicit drug use, anabolic steroid abuse, psychotropic drugs reported by caregivers
* Taking medication that modifies hormones: spironolactone, ketoconazole, anticoagulants, corticosteroids, ACTH hormone, psychotropics, including antidepressants, antipsychotics and anticonvulsants.
* Known pituitary adenoma and other hormone-dependent tumours
* Participation in another clinical study
* Intention to become a parent during the course of the study
* Females: ovarian cysts, non-hypothalamic anovulation (i.e. polycystic ovary syndrome), pregnancy or lactation
* Males: hematocrit \> 54%
* Contraindications for MRI (e.g. pacemaker, metal clips,etc)
* Participant or his/her legal representative do not want to be informed in case of incidental findings

Primary outcomes:
measure: Cognition
timeFrame: Baseline to end of treatment (Week 24)
Secondary outcomes:
measure: Dimensional change card sorting task (DCCS)
timeFrame: baseline to end of treatment (Week 24)
measure: Paired Associated Learning (PAL, part of the CANTAB battery)
timeFrame: baseline to end of treatment (Week 24)
measure: Token test
timeFrame: baseline to end of treatment (Week 24)
measure: Corsi block tapping task
timeFrame: baseline to end of treatment (Week 24)
measure: Litmus non-word-repetition test
timeFrame: baseline to end of treatment (Week 24)
measure: Health-related quality of life SF-12
timeFrame: baseline to end of treatment (Week 24)
measure: Adaptive behavior (Vineland II) - caregiver questionnaire
timeFrame: baseline to end of treatment (Week 24)
measure: Glycemia
timeFrame: baseline to end of treatment (Week 24)
measure: Insulinemia
timeFrame: baseline to end of treatment (Week 24)
measure: Total cholesterol
timeFrame: baseline to end of treatment (Week 24)
measure: High density lipoprotein (HDL)-cholesterol
timeFrame: baseline to end of treatment (Week 24)
measure: Low density lipoprotein (LDL)-cholesterol
timeFrame: baseline to end of treatment (Week 24)
measure: Triglycerides
timeFrame: baseline to end of treatment (Week 24)
Other outcomes:
Locations:
city: Lausanne
country: Switzerland
facility: Centre Hospitalier Universitaire Vaudois (CHUV)
state: Vaud
Study officials:
affiliation: Endocrinology, Metabolism, Diabetology (CHUV)
name: Nelly Pitteloud, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Manfredi-Lozano M, Leysen V, Adamo M, Paiva I, Rovera R, Pignat JM, Timzoura FE, Candlish M, Eddarkaoui S, Malone SA, Silva MSB, Trova S, Imbernon M, Decoster L, Cotellessa L, Tena-Sempere M, Claret M, Paoloni-Giacobino A, Plassard D, Paccou E, Vionnet N, Acierno J, Maceski AM, Lutti A, Pfrieger F, Rasika S, Santoni F, Boehm U, Ciofi P, Buee L, Haddjeri N, Boutillier AL, Kuhle J, Messina A, Draganski B, Giacobini P, Pitteloud N, Prevot V. GnRH replacement rescues cognition in Down syndrome. Science. 2022 Sep 2;377(6610):eabq4515. doi: 10.1126/science.abq4515. Epub 2022 Sep 2.