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Stability of investigational product could not be established.
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| Name | Class |
|---|---|
| Brain Chemistry Labs | OTHER |
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This is a Phase IIa, randomized, double-blind, placebo controlled trial. Subjects for participation in this study will be identified by the Investigator based on their Clinical Dementia Rating score which will be completed as part of standard practice. Patients meeting the criteria for early Alzheimer's disease will be considered for study participation, with the Investigator taking the additional inclusion/exclusion criteria into consideration. Up to 40 subjects will be enrolled. Subjects participating in the study will be randomized to receive either gummies containing L-Serine or placebo gummies, with the Investigator and study staff blinded to the group assignments.
L-serine (C3H7NO3; 105.09 g/mol; synonym (S)-2-amino-3-hydroxypropanoic acid) is a naturally-occurring dietary amino acid. It is abundant in soy products, some edible seaweeds, sweet potatoes, eggs, and meat. Since some L-serine is produced by astrocytes in the brain, it is considered a non-essential amino acid. L-serine is directly involved in the biosynthesis of purines, pyrimidines, and other amino acids. Serine residues are found in most proteins and within proteins function as a site for phosphorylation.
L-serine is considered as GRAS (generally recognized as safe) by the FDA and has been approved as a normal food additive under CFR172.320. It is widely sold as a dietary supplement. A pilot study of L-serine supplementation of 14 patients with hereditary sensory neuropathy has been published, and subsequent trial is on-going (ClinicalTrials.gov identifier NCT01733407). The authors did not report adverse effects at doses of 400mg/kg/day, which for an average American of 75.5kg is about 30 grams, the dose which we propose to use in this study.
L-serine will be administered orally through gummies. Each gummy contains 1 g L-serine (treatment) and will be packaged in a foil packet containing 15 pieces to be taken both morning and evening for nine months. The placebo will be a gummy containing no L-serine, packaged and taken in the same manner. In order to assess tolerability in patients, we have designed a 4 week dose ramp-up. We will monitor side-effects and amino acid balances in blood samples in the early Alzheimer's Disease patients during a dose ramp-up period. If a patient cannot tolerate the full dose of gummies, they will remain in the study taking a total of 1 package of gummies split into two time periods within the day. The same ramp-up schedule and procedures will be observed for both placebo and L-serine patients. Patients will be assessed at baseline, 3 months, 6 months, and 9 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| L-Serine Gummy Arm | Active Comparator | L-serine will be presented in gummies containing 1g serine each. Subjects randomized into the L-serine arm will take 15 grams of L-Serine (15 gummies containing 1g of L-serine) orally twice daily for 246 days after the initial ascending dose period to confirm tolerability of the dose. |
|
| Placebo Gummy Arm | Placebo Comparator | Placebo gummies containing no L-serine will be packaged in the same manner as that of the L-Serine gummy arm and be given to patients to take two times a day. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| L-Serine | Drug | Gummy containing L serine dose |
| |
| Placebo Gummy |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Score on the Montreal Cognitive Assessment Assessment Evaluation | Cognitive Assessment will be performed and score obtained at clinical trial visits. The Montreal Cognitive Assessment or The MoCA Test is a highly sensitive tool for early detection of mild cognitive impairment. The assessment evaluates eight domains of cognitive functions, including visuospatial and executive function, naming, memory, attention, language, abstraction, and orientation. Scores on the MoCA range from 0 to 30. A score less than 26 is considered as mild cognitive impairment. Higher values represent a better outcome. | Baseline, 6 Months, 9 Months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Plasma Biomarker Levels. | Levels of biomarkers related to cognitive status will be assessed in plasma that was collected at clinical trial visits. | Baseline, 6 Months, 9 months |
| Relationship Between Montreal Cognitive Assessment Score and Plasma Biomarker Levels |
| Measure | Description | Time Frame |
|---|---|---|
| Self-reported L-serine Tolerability | Each participant will report tolerability on a scale of 1 to 10 (1 = poor and 10 = excellent). This assessment was completed at the end of participation via a phone calls 4 weeks after visit 4. | 4 weeks (+/- 2 weeks) after visit 4 (week 36 +/- 2 weeks) |
| Number of Clinically Significant Lab Values for Complete Blood Count, Liver Function Test, Basic Metabolic Panel Measures. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Aleksandra C Stark, MD | Dartmouth-Hitchcock Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Dartmouth Hitchcock Medical Center | Lebanon | New Hampshire | 03756 | United States |
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Study participants are grouped for the participant flow. The study was closed by the Sponsor-Investigator and institution prior to study completion because the stability of the investigational product could not be verified.
The study was placed on voluntary hold by the institution prior to study completion. Upon review of the stability data of the investigational agent provided by the product's manufacturer, the FDA IND Sponsor-Investigator (PI) and institutional officials determined that the available information was unsatisfactory. No reportable study outcome data are available as determined by the institution and Sponsor-Investigator (PI) because the stability of the investigational product cannot be verified.
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| ID | Title | Description |
|---|---|---|
| FG000 | L-Serine Gummy Arm | L-serine will be presented in gummies containing 1g serine each. Subjects randomized into the L-serine arm will take 15 grams of L-Serine (15 gummies containing 1g of L-serine) orally twice daily for 246 days after the initial ascending dose period to confirm tolerability of the dose. L-Serine: Gummy containing L serine dose |
| FG001 | Placebo Gummy Arm | Placebo gummies containing no L-serine will be packaged in the same manner as that of the L-Serine gummy arm and be given to patients to take two times a day. Placebo Gummy: Gummy with no dosing of L Serine |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
All study participants are grouped for the baseline measure and reported for all participants collectively. The study was closed by the PI and institution prior to study completion because the stability of the investigational product could not be verified.
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| ID | Title | Description |
|---|---|---|
| BG000 | L-serine Gummy Arm | L-serine will be presented in gummies containing 1g serine each. Subjects randomized into the L-serine arm will take 15 grams of L-Serine (15 gummies containing 1g of L-serine) orally twice daily for 246 days after the initial ascending dose period to confirm tolerability of the dose. L-Serine: Gummy containing L serine dose |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Score on the Montreal Cognitive Assessment Assessment Evaluation | Cognitive Assessment will be performed and score obtained at clinical trial visits. The Montreal Cognitive Assessment or The MoCA Test is a highly sensitive tool for early detection of mild cognitive impairment. The assessment evaluates eight domains of cognitive functions, including visuospatial and executive function, naming, memory, attention, language, abstraction, and orientation. Scores on the MoCA range from 0 to 30. A score less than 26 is considered as mild cognitive impairment. Higher values represent a better outcome. | Investigational agent stability data provided by product's manufacturer was determined to be unsatisfactory by the Sponsor-Investigator (PI) and institutional officials. The study was closed by the PI and institution prior to study completion. Data are potentially invalid due to the inadequate stability testing performed by the manufacturer, as the sponsor-investigator is unable to confirm that the investigational product remained stable over time. No reportable study outcome data are available. | Posted | Mean | Full Range | score on a scale | Baseline, 6 Months, 9 Months |
Investigational agent stability data provided by product's manufacturer was determined to be unsatisfactory by the Sponsor-Investigator (PI) and institutional officials. Study was closed by the PI and institution prior to study completion. Data are potentially invalid due to inadequate stability testing performed by the manufacturer; the sponsor-investigator is unable to confirm that investigational product remained stable overtime. Adverse event data were collected over approximately 4 months.
Due to the inability to confirm adherence with the study treatment (Gummy Bears) by the subjects enrolled in the study, the attribution of any adverse events (including serious events) to study treatment is not possible. Thus, adverse events are being reported in aggregate.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | L-Serine: Gummy Arm | L-serine will be presented in gummies containing 1g serine each. Subjects randomized into the L-serine arm will take 15 grams of L-Serine (15 gummies containing 1g of L-serine) orally twice daily for 246 days after the initial ascending dose period to confirm tolerability of the dose. L-Serine: Gummy containing L serine dose |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| chest pain | General disorders | Systematic Assessment | chest pain |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| movement disorder | Nervous system disorders | Systematic Assessment | abnormal movement |
The Sponsor-Investigator (PI) and institutional officials determined that the available investigational agent stability data of provided by the product's manufacturer was unsatisfactory. The study was closed by the PI and institution prior to study completion. Data are potentially invalid due to the inadequate stability testing performed by the manufacturer, as the sponsor-investigator is unable to confirm that the investigational product remained stable over time.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Aleksandra C. Stark | Dartmouth Health | (603) 650-5104 | Aleksandra.C.Stark@hitchcock.org |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 14, 2020 | Jul 20, 2022 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D000544 | Alzheimer Disease |
| ID | Term |
|---|---|
| D003704 | Dementia |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D012694 | Serine |
| ID | Term |
|---|---|
| D021542 | Amino Acids, Neutral |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
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| Other |
Gummy with no dosing of L Serine |
|
Disease status biomarker levels will be assessed in plasma at trial visits. Montreal Cognitive Assessment testing will be performed and scored at each visit. |
| Baseline, 6 Months, 9 months |
Health check labs will be collected from every participant at each clinical trial visit. clinically significant lab values will be identified for complete blood count, liver function test, and basic metabolic panel measures. |
| Baseline, 3 Months, 6 Months, 9 months |
| BG001 |
| Placebo Gummy Arm |
Placebo gummies containing no L-serine will be packaged in the same manner as that of the L-Serine gummy arm and be given to patients to take two times a day. Placebo Gummy: Gummy with no dosing of L Serine |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| ID |
|---|
| Title |
|---|
| Description |
|---|
| OG000 | L-Serine Gummy Arm | L-serine will be presented in gummies containing 1g serine each. Subjects randomized into the L-serine arm will take 15 grams of L-Serine (15 gummies containing 1g of L-serine) orally twice daily for 246 days after the initial ascending dose period to confirm tolerability of the dose. L-Serine: Gummy containing L serine dose |
| OG001 | Placebo Gummy Arm | Placebo gummies containing no L-serine will be packaged in the same manner as that of the L-Serine gummy arm and be given to patients to take two times a day. Placebo Gummy: Gummy with no dosing of L Serine |
|
|
| Secondary | Change in Plasma Biomarker Levels. | Levels of biomarkers related to cognitive status will be assessed in plasma that was collected at clinical trial visits. | Investigational agent stability data provided by product's manufacturer was determined to be unsatisfactory by the Sponsor-Investigator (PI) and institutional officials. The study was closed by the PI and institution prior to study completion. Data are potentially invalid due to the inadequate stability testing performed by the manufacturer, as the sponsor-investigator is unable to confirm that the investigational product remained stable over time. The biomarker data does not exist. | Posted | Baseline, 6 Months, 9 months |
|
|
| Secondary | Relationship Between Montreal Cognitive Assessment Score and Plasma Biomarker Levels | Disease status biomarker levels will be assessed in plasma at trial visits. Montreal Cognitive Assessment testing will be performed and scored at each visit. | Investigational agent stability data provided by product's manufacturer was determined to be unsatisfactory by the Sponsor-Investigator (PI) and institutional officials. The study was closed by the PI and institution prior to study completion. Data are potentially invalid due to the inadequate stability testing performed by the manufacturer, as the sponsor-investigator is unable to confirm that the investigational product remained stable over time. The biomarker data does not exist. | Posted | Baseline, 6 Months, 9 months |
|
|
| Other Pre-specified | Self-reported L-serine Tolerability | Each participant will report tolerability on a scale of 1 to 10 (1 = poor and 10 = excellent). This assessment was completed at the end of participation via a phone calls 4 weeks after visit 4. | Investigational agent stability data provided by product's manufacturer was determined to be unsatisfactory by Sponsor-Investigator (PI) and institutional officials. The study was closed by PI and institution prior to study completion. Data are potentially invalid due to inadequate stability testing performed by the manufacturer, as PI is unable to confirm that investigational product remained stable over time. Only 10 participants from L-serine and 7 from placebo group completed the assessment. | Posted | Mean | Full Range | units on a scale | 4 weeks (+/- 2 weeks) after visit 4 (week 36 +/- 2 weeks) |
|
|
|
| Other Pre-specified | Number of Clinically Significant Lab Values for Complete Blood Count, Liver Function Test, Basic Metabolic Panel Measures. | Health check labs will be collected from every participant at each clinical trial visit. clinically significant lab values will be identified for complete blood count, liver function test, and basic metabolic panel measures. | Investigational agent stability data provided by product's manufacturer was determined to be unsatisfactory by the Sponsor-Investigator (PI) and institutional officials. Data are potentially invalid due to the inadequate stability testing performed by the manufacturer, as the sponsor-investigator is unable to confirm that the investigational product remained stable over time. The number of participants analyzed decreased over time due to participants withdrawing or being withdrawn by the PI. | Posted | Number | # of clinically significant lab values | Baseline, 3 Months, 6 Months, 9 months |
|
|
|
| 0 |
| 16 |
| 1 |
| 16 |
| 16 |
| 16 |
| EG001 | Placebo Gummy Arm | Placebo gummies containing no L-serine will be packaged in the same manner as that of the L-Serine gummy arm and be given to patients to take two times a day. Placebo Gummy: Gummy with no dosing of L Serine | 0 | 13 | 2 | 13 | 13 | 13 |
| gastroenteritis | Gastrointestinal disorders | Systematic Assessment | gastroenteritis |
|
| skin lesion or rash | Injury, poisoning and procedural complications | Systematic Assessment | injury |
|
| sleep disturbance | Psychiatric disorders | Systematic Assessment | sleep disruption |
|
| weight gain | Investigations | Systematic Assessment | weight gain |
|
| cataract extraction | Eye disorders | Systematic Assessment | surgery |
|
| syncope | Nervous system disorders | Systematic Assessment | syncope |
|
| bradycardia | Cardiac disorders | Systematic Assessment | bradycardia |
|
| diarrhea | Gastrointestinal disorders | Systematic Assessment | diarrhea |
|
| cognitive decline | Nervous system disorders | Systematic Assessment | cognitive decline |
|
| weight loss | Investigations | Systematic Assessment | weight loss |
|
| anxiety | Psychiatric disorders | Systematic Assessment | anxiety |
|
| dog bite | Injury, poisoning and procedural complications | Systematic Assessment | injury |
|
| tic bite | Injury, poisoning and procedural complications | Systematic Assessment | injury |
|
| potential overdose | Injury, poisoning and procedural complications | Systematic Assessment | over dose |
|
| atrophy of hands | Musculoskeletal and connective tissue disorders | Systematic Assessment | atrophy |
|
| pneumonia | Infections and infestations | Systematic Assessment | pneumonia |
|
| leg edema | Vascular disorders | Systematic Assessment | edema |
|
| pulmonary vascular congestion | Vascular disorders | Systematic Assessment | vascular congestion |
|
| cellulitis | Infections and infestations | Systematic Assessment | cellulitis |
|
| recurrent major depressive disorder | Psychiatric disorders | Systematic Assessment | depression |
|
| taste change | Nervous system disorders | Systematic Assessment | taste change |
|
| reduced appetite | Metabolism and nutrition disorders | Systematic Assessment | reduced appetite |
|
| nausea | Gastrointestinal disorders | Systematic Assessment | nausea |
|
| gas | Gastrointestinal disorders | Systematic Assessment | gas |
|
| reduced platelets | Blood and lymphatic system disorders | Systematic Assessment | reduced platelets |
|
| change in bowel habits | Gastrointestinal disorders | Systematic Assessment | change in bowel habits |
|
| hiccups | Respiratory, thoracic and mediastinal disorders | Systematic Assessment | hiccups |
|
| headache | Nervous system disorders | Systematic Assessment | headache |
|
| upper respiratory infection | Infections and infestations | Systematic Assessment | URI |
|
| fatigue | General disorders | Systematic Assessment | fatigue |
|
| peripheral neuropathy | Nervous system disorders | Systematic Assessment | neuropathy |
|
| abdominal pain | Gastrointestinal disorders | Systematic Assessment | abdominal pain |
|
| worsening vision secondary to left cataract | Eye disorders | Systematic Assessment | visual decline |
|
| dental procedure | Surgical and medical procedures | Systematic Assessment | procedure |
|
| blood pressure elevation | Vascular disorders | Systematic Assessment | hypertension |
|
| focal pain above left breast | Reproductive system and breast disorders | Systematic Assessment | pain |
|
| right hearing impairment | Ear and labyrinth disorders | Systematic Assessment | hearing loss |
|
| hypothyroidism | Endocrine disorders | Systematic Assessment | hypothyroidism |
|
| hyperlipidemia | Metabolism and nutrition disorders | Systematic Assessment | hyperlipidemia |
|
| cold | General disorders | Systematic Assessment | cold |
|
| puncture wound left foot | Injury, poisoning and procedural complications | Systematic Assessment | injury |
|
| irritability | Psychiatric disorders | Systematic Assessment | agitation |
|
| lightheadedness | Nervous system disorders | Systematic Assessment | lightheadedness |
|
| nasal congestion | Respiratory, thoracic and mediastinal disorders | Systematic Assessment | nasal congestion |
|
| flashing lights at night | Eye disorders | Systematic Assessment | flashing lights |
|
| feeling sped up | Psychiatric disorders | Systematic Assessment | anxiety |
|
| right ear infection | Infections and infestations | Systematic Assessment | infection |
|
| gout | Musculoskeletal and connective tissue disorders | Systematic Assessment | gout |
|
| lack of motivation | Psychiatric disorders | Systematic Assessment | lack of motivation |
|
| soft tissue injury due to fall | Injury, poisoning and procedural complications | Systematic Assessment | injury |
|
| arthritis | Musculoskeletal and connective tissue disorders | Systematic Assessment | arthritis |
|
| increased restlessness | Psychiatric disorders | Systematic Assessment | agitation |
|
| hot flashes | Vascular disorders | Systematic Assessment | hot flashes |
|
| falls, no injury | Injury, poisoning and procedural complications | Systematic Assessment | falls |
|
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| D024801 |
| Tauopathies |
| D019636 | Neurodegenerative Diseases |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| 3 Months |
|
|
| 6 Months |
|
|
| 9 Months |
|
|