Clinical trial NCT02134951: Biomarker Assessment of Glutamatergic Target Engagement
Official title: Biomarker Assessment of Glutamatergic Target Engagement
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Healthy Controls
Lead sponsor: New York State Psychiatric Institute
Sponsor class: OTHER
Collaborators: name: National Institute of Mental Health (NIMH)
First posted: 2014-05-09
Enrollment: 65
Sex: ALL
Minimum age (years): 18
Maximum age (years): 55
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to assess the relative feasibility of 2 potential functional measures of target engagement (Glx MRS, BOLD fMRI) to systematically assess mGluR 2/3 in drug development for psychotic spectrum disorders.

Detailed description: This is a pilot study of healthy subject to assess the feasibility of Glx MRS and BOLD fMRI to measure ketamine induced changes in glutamatergic indices. The investigators will randomize 18 subjects at each site. Subjects will be randomized to ketamine or placebo in a 2:1 ratio and receive two drug challenges separated by at least two weeks. Ketamine challenge is used to induce a "glutamate surge" within prefrontal brain regions that can be detected using neurochemical and functional imaging techniques. Each subject will receive MRS and BOLD fMRI during each challenge day. The goal of the pilot study is to assess the feasibility of both the proposed ketamine challenge paradigm and of the proposed imaging-based biomarkers. Specific indices to be used in assessing feasibility will include effect size, cross-site and cross-subject reliability, safety, and subject tolerability as similar studies will be performed independently at Yale and UC Davis. Second this information will be used to select and refine final study parameters for a subsequent full proof-of-clinical mechanism (POCM) study investigating the effect of Pomaglumetad on ketamine-induced MRS and fMRI effects.

Eligibility criteria: Inclusion Criteria:

* Age 18-55
* Negative Urine Toxicology
* No present or past psychiatric conditions (including substance abuse or dependence, with the exception of nicotine dependence)
* No family history of schizophrenia in a first-degree relative

Exclusion Criteria:

* Any current DSM IV Axis I disorder and/or past substance abuse of dependence (nicotine dependence is allowed)
* Any current use of amphetamines, opiates, cocaine, sedative-hypnotics, or cannabis
* Current (i.e., within the last 3 months) treatment with any psychotropic medications
* Pregnancy, lactation, or lack of use of effective birth control
* Presence of positive history of significant medical or neurological illness (including any history of seizure), including high blood pressure (SBP \>140, DBP \>90), low blood pressure (SBP \<100, DBP \<60), orthostatic BP change\>20% (1/3 SBP + 2/3 DBP) or cardiac illness or resting heart rate \>100 or \<50
* History of significant violent behavior
* History of recreational ketamine use, recreational PCP use, or an adverse reaction to ketamine. Subjects who have participated prior research ketamine studies will be eligible providing they have participated in no more than 5 previous research ketamine infusions. Subjects can have infusions not more frequently than biweekly and not more than 1/month on average, therefore subjects entering the study will need to wait 1 month if they had a single infusion and 6 weeks if they have had two closely spaced infusions.
* Contraindication to MRI scanning, including metal implants or claustrophobia. Metal implants, pacemaker, other metal (e.g. shrapnel or surgical prostheses) or paramagnetic objects contained within the body which may present a risk to the subject or interfere with the MR scan, as determined in consultation with a neuroradiologist and according to the guidelines set forth in the following reference book commonly used by neuroradiologists: "Guide to MR procedures and metallic objects", F.G. Shellock, Lippincott Williams and Wilkins NY 2001
* Color Blindness

Primary outcomes:
measure: Glutamate + Glutamine (Glx) Response
timeFrame: Day 1
Secondary outcomes:
Other outcomes:
measure: Pharmacological Blood-oxygen-level Dependent (pharmacoBOLD) Response
timeFrame: Day 14
Locations:
city: Sacramento
country: United States
facility: University of California Davis
state: California
city: New Haven
country: United States
facility: Yale University
state: Connecticut
city: New York
country: United States
facility: New York State Psychiatric Institute
state: New York
Study officials:
affiliation: New York State Psychiatric Institute
name: Jeffrey A Lieberman, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Javitt DC, Carter CS, Krystal JH, Kantrowitz JT, Girgis RR, Kegeles LS, Ragland JD, Maddock RJ, Lesh TA, Tanase C, Corlett PR, Rothman DL, Mason G, Qiu M, Robinson J, Potter WZ, Carlson M, Wall MM, Choo TH, Grinband J, Lieberman JA. Utility of Imaging-Based Biomarkers for Glutamate-Targeted Drug Development in Psychotic Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2018 Jan 1;75(1):11-19. doi: 10.1001/jamapsychiatry.2017.3572.