Journal Article

A multicenter, randomized, double-blind, placebo-controlled ascending dose study to evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamic (PD) effects of Posiphen in subjects with early Alzheimer’s Disease

Galasko, Douglas, Momper, Jeremiah, Elbert, Donald, Feldman, Howard H., Thomas, Ronald G., West, Tim, Farlow, Martin R., Honig, Lawrence S., Bateman, Randall, Lucey, Brendan P., Pa, Judy, Balasubramanian, Archana, Maccecchini, Maria, Aslanyan, Vahan, Rissman, Robert A.

2024

Overview

Background Amyloid beta protein (Aβ) is a treatment target in Alzheimer’s Disease (AD). Lowering production of its parent protein, APP, has benefits in preclinical models. Posiphen, an orally administered small molecule, binds to an iron-responsive element in APP mRNA and decreases translation of APP and Aβ. To augment human data for Posiphen, we evaluated safety, tolerability and pharmacokinetic and pharmacodynamic (PD) effects on Aβ metabolism using Stable Isotope Labeling Kinetic (SILK) analysis. Methods Double-blind phase 1b randomized ascending dose clinical trial, at five sites, under an IRB-approved protocol. Participants with mild cognitive impairment or mild AD (Early AD) confirmed by low CSF Aβ42/40 were randomized (within each dose arm) to Posiphen or placebo. Pretreatment assessment included lumbar puncture for CSF. Participants took Posiphen or placebo for 21–23 days, then underwent CSF catheter placement, intravenous infusion of 13 C 6 -leucine, and CSF sampling for 36 h. Safety and tolerability were assessed through participant reports, EKG and laboratory tests. CSF SILK analysis measured Aβ40, 38 and 42 with immunoprecipitation-mass spectrometry. Baseline and day 21 CSF APP, Aβ and other biomarkers were measured with immunoassays. The Mini-Mental State Exam and ADAS-cog12 were given at baseline and day 21. Results From June 2017 to December 2021, 19 participants were enrolled, randomized within dose cohorts (5 active: 3 placebo) of 60 mg once/day and 60 mg twice/day; 1 participant was enrolled and completed 60 mg three times/day. 10 active drug and 5 placebo participants completed all study procedures. Posiphen was safe and well-tolerated. 8 participants had headaches related to CSF catheterization; 5 needed blood patches. Prespecified SILK analyses of Fractional Synthesis Rate (FSR) for CSF Aβ40 showed no significant overall or dose-dependent effects of Posiphen vs. placebo. Comprehensive multiparameter modeling of APP kinetics supported dose-dependent lowering of APP production by Posiphen. Cognitive measures and CSF biomarkers did not change significantly from baseline to 21 days in Posiphen vs. placebo groups. Conclusions Posiphen was safe and well-tolerated in Early AD. A multicenter SILK study was feasible. Findings are limited by small sample size but provide additional supportive safety and PK data. Comprehensive modeling of biomarker dynamics using SILK data may reveal subtle drug effects. Trial registration NCT02925650 on clinicaltrials.gov (registered on 10-24-2016).

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Aged / Aged, 80 and over / Alzheimer Disease - cerebrospinal fluid / Alzheimer Disease - drug therapy / Alzheimer's disease / Amyloid beta protein / Amyloid beta-Peptides - cerebrospinal fluid / Amyloid beta-Protein Precursor - genetics / APP / Biomarkers - cerebrospinal fluid / Biomedical and Life Sciences / Biomedicine / Clinical trial / Clinical trials / Cognitive Dysfunction - drug therapy / Dose-Response Relationship, Drug / Double-Blind Method / Drug therapy / Female / Geriatric Psychiatry / Geriatrics/Gerontology / Humans / Male / Methods / Middle Aged / Neurology / Neurosciences / Peptide Fragments - cerebrospinal fluid / Pharmacodynamics / Pharmacokinetics / Pharmacology / Treatment Outcome