Modulating ApoE Signalling to Reduce Brain Inflammation, deLirium and postopErative Cognitive Dysfunction
Keywords
Abstract
Description
This research study will evaluate the effectiveness and estimate the feasibility of administering an investigational drug called 'CN-105' (the study drug), to prevent postoperative cognitive decline, delirium (serious confusion) and underlying brain inflammatory and brain activity changes in adults 60 years and older undergoing surgery. The word "investigational" means the study drug is still being tested in research studies and is not approved by the U.S. Food and Drug Administration (FDA).
It is hoped that CN-105 will block signaling via a gene known as ApoE4, the most common gene implicated in late life Alzheimer's disease.
Depending on when patients enroll in this study, participants will receive either a placebo or a progressively higher dose of CN-105 until the safest and best tolerated dose is reached. The study drug is given via IV (intravenous, meaning through a vein) infusion in the hospital. Study drug infusions will be given up to 4 days after surgery.
Participants will also perform memory and thinking tests, as well as complete a survey and functional assessments, both prior to surgery and again 6 weeks after surgery. Each of those research visits will last about 1 hour.
Additionally, the investigators will collect a blood sample and a cerebrospinal fluid (CSF) sample prior to the participant's surgery, 24 hours after surgery, and again 6 weeks after surgery. To obtain the CSF (cerebrospinal fluid) sample, investigators will perform a lumbar (the lower part of the spinal column) puncture. During surgery, investigators will also record participant brain waves from the scalp using an EEG (electroencephalography) monitor. An electroencephalography monitor reads the electrical activity of the brain in different places using a cap with sensors that is worn on the head.
Although previous studies have not found any associations between the study drug and any serious medical problems, investigators will monitor its effect on wound healing and postoperative infections.
Benefits of this study include the possibility of fewer problems in thinking and memory after surgery if this study drug works as hoped.
Risks of participation in this study include headache, infection/discomfort from the lumbar puncture, discomfort from the blood draw, and minor skin irritation or redness from the EEG and heart rate monitor procedures.
Dates
| Last Verified: | 06/30/2020 |
| First Submitted: | 01/09/2019 |
| Estimated Enrollment Submitted: | 01/09/2019 |
| First Posted: | 01/13/2019 |
| Last Update Submitted: | 07/09/2020 |
| Last Update Posted: | 07/13/2020 |
| Actual Study Start Date: | 04/16/2019 |
| Estimated Primary Completion Date: | 10/16/2022 |
| Estimated Study Completion Date: | 12/16/2022 |
Condition or disease
Intervention/treatment
Drug: CN-105
Drug: Placebo
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| Experimental: CN-105 Cohort 1: 67 Patients Dose of CN-105: 0.1 mg/kg Patients receiving drug: 50 Patients receiving placebo: 17
Cohort 2: 67 Patients Dose of CN-105: 0.5 mg/kg Patients receiving drug: 50 Patients receiving placebo: 17
Cohort 3: 67 Patients Dose of CN-105: 1 mg/kg Patients receiving drug: 50 Patients receiving placebo: 17 | Drug: CN-105 Three doses of CN-105 will be used in three successive cohorts of 67 patients each (50 receiving drug and 17 receiving placebo) 0.1 mg/kg (cohort 1) 0.5 mg/kg (cohort 2)
1 mg/kg (cohort 3)
The study drug will be administered by IV every 6 hours, beginning 1 hour prior to surgery, until postoperative day 3 or hospital discharge, whichever occurs first, up to a maximum of 13 doses. |
| Placebo Comparator: Placebo Cohort 1: 67 Patients Dose of CN-105: 0.1 mg/kg Patients receiving drug: 50 Patients receiving placebo: 17
Cohort 2: 67 Patients Dose of CN-105: 0.5 mg/kg Patients receiving drug: 50 Patients receiving placebo: 17
Cohort 3: 67 Patients Dose of CN-105: 1 mg/kg Patients receiving drug: 50 Patients receiving placebo: 17 | Drug: Placebo Patients will receive placebo intravenously every 6 hours, beginning 1 hour prior to surgery, until postoperative day 3 or hospital discharge, whichever occurs first, up to a maximum of 13 doses, identical to those receiving the study drug. |
Eligibility Criteria
| Ages Eligible for Study | 60 Years To 60 Years |
| Sexes Eligible for Study | All |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - Age ≥ 60 - Ability to speak English - Undergoing non-cardiac, non-neurologic surgical procedures; surgery scheduled to last > 2 hours; due to be admitted to the hospital following surgery Exclusion Criteria: - Inmate of a correctional facility - Scheduled to receive systemic chemotherapy between the time of the two cognitive testing sessions - Known inability to undergo LPs due to anticoagulant use, severe anxiety, or other clinical contraindication known ahead of time. - Inappropriate for study inclusion based on the judgement of the principal investigator. - If a patient undergoes major head trauma that occurs between the times of the two cognitive testing sessions, then they will be withdrawn from the study. |
Outcome
Primary Outcome Measures
1. Number of adverse events (AEs) [2 years for entire study; until 6 week follow-up for individual patients]
Secondary Outcome Measures
1. Change in cerebrosprinal fluid (CSF) IL-6 cytokine levels between drug vs placebo treated patients [Baseline, 24 hours, 6 weeks +/- 3 weeks]
2. Change in CSF IL-8 cytokine levels between drug vs placebo treated patients [Baseline, 24 hours, 6 weeks +/- 3 weeks]
3. Change in CSF MCP-1 cytokine levels between drug vs placebo treated patients [Baseline, 24 hours, 6 weeks +/- 3 weeks]
4. Change in CSF G-CSF cytokine levels between drug vs placebo treated patients [Baseline, 24 hours, 6 weeks +/- 3 weeks]
5. Change in cognitive change index (CCI) between drug vs placebo treated patients [Baseline, 6 weeks +/- 3 weeks]
6. Feasibility of drug administration within correct time windows [within 1 hour prior to the scheduled or actual start time of the surgery, and every 6 hours afterwards within a +/- 90 minute time window for subsequent drug doses]
7. Incidence of delirium between drug vs. placebo treated patients [Baseline, day of surgery (twice), post-operative days 1 - 5 (twice), 6 weeks +/- 3 weeks]
8. Severity of delirium symptoms between drug vs. placebo treated patients [Baseline, day of surgery (twice), post-operative days 1 - 5 (twice), 6 weeks +/- 3 weeks]
