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This will be a double blind, randomised, placebo controlled, single and multiple oral dose study conducted in 3 parts: Part A, Part B and Part C. Part A and Part B include healthy volunteers only and will be completed before Part C including patients with primary mitochondrial disease will be initiated. The starting dose in the first cohort of Part A will be 25 mg. The dose level in the additional cohorts will be decided following review of data of the previous cohorts.
Part A: Eight healthy subjects will be studied in a single cohort (Group A1). Potential subjects will be screened to assess their eligibility to enter the study within 28 days prior to the first dose administration. Subjects will participate in 2 treatment periods, fasting or after consuming a standard high-fat breakfast. For each treatment period, subjects will reside at the Phase I clinical site from Days 1 to 3 (48 hours postdose). Subjects will return to the clinical site for outpatient visits on Days 4 and 5. There will be at least a 10 day washout between doses Additional single-dose cohorts may be enrolled based on data obtained from either Parts A or B.
Part B: Sixteen healthy subjects will be studied in 2 cohorts (Groups B1 and B2), with each cohort consisting of 8 subjects. Following review of safety, tolerability, and PK data, up to 3 additional dose cohorts of healthy subjects may be added to further explore the PK, safety, and tolerability of KL1333. Potential subjects will be screened to assess their eligibility to enter the study within 28 days prior to the first dose administration. All subjects will participate in 1 treatment period and will reside at the Phase I clinical site from Days -1 to 12 (48 hours post final dose). Subjects will return to the clinical site for outpatient visits on Days 13 and 14. On Day 1, 6 subjects will be randomised to receive KL1333 and 2 subjects will be randomised to receive placebo. Subjects will return for a Follow-up visit on Day 15, 5 days after their final dose.
Part C: A total of 8 patients diagnosed with any mitochondrial disease will be enrolled in this part of the study. Part C may start after the dose selection conference has been completed for the final cohort of Part B, at a daily dose no higher than the highest well-tolerated dose in Part B. Potential study patients will be screened to assess their eligibility to enter the study within 35 days prior to the first dose administration. Patients will reside at the clinical site from Days -1 to 2 and Days 10 to 11 and return to the clinical site for outpatient visits on Days 4 and 8. It is planned for patients to receive study drug once daily on Days 1 to 10. Patients will return for a Follow-up visit on Day 15, 5 days after their final dose.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| KL1333 | Experimental | 25 and 100 mg KL1333 encapsulated tablets for daily oral dosing |
|
| Matching placebo | Placebo Comparator | 25 and 100 mg KL placebo encapsulated tablets for daily oral dosing |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| KL1333 | Drug | 25 and 100 mg KL1333 encapsulated tablets |
| |
| Placebo Oral Tablet |
| Measure | Description | Time Frame |
|---|---|---|
| Safety: incidence and severity of AEs | Day 15 | |
| Safety: incidence of laboratory abnormalities, based on haematology, clinical chemistry, and urinalysis test results | Day 15 | |
| Safety: 12 lead ECG parameters | Day 15 | |
| Safety: Number of participants with clinically significant abnormal vital signs measurements | Day 15 | |
| Safety: Number of participants with clinically significant abnormal physical examinations | Day 15 |
| Measure | Description | Time Frame |
|---|---|---|
| PK: area under the curve, AUC0 ∞ | Day 1 | |
| PK: AUC over a dosing interval (AUC0 Ï„) | Days 1 and 10 | |
| PK: temporal change parameter (TCP; AUC0 τ/AUC0-∞) |
| Measure | Description | Time Frame |
|---|---|---|
| NAD+/NADH concentrations and ratio (part B and C) | Biomarker | Days 10 and 15 |
| FGF21 and GDF15 concentrations (part B and C) | Biomarker | Days 10 and 15 |
Inclusion Criteria (selected):
Healthy subjects and patients with mitochondrial disease must satisfy all of the following criteria at the Screening visit unless otherwise stated:
Females will not be pregnant or lactating, and females of childbearing potential and males will agree to use contraception.
Able to comprehend and willing to sign an ICF and to abide by the study restrictions.
Able to perform all protocol-specified assessments and comply with the study visit schedule.
Additional inclusion criteria for healthy subjects:
Males or females, of any race, between 18 and 65 years of age, inclusive.
Weight ≥50 kg and body mass index between 18.0 and 32.0 kg/m2, inclusive.
In good health, determined by no clinically significant findings from medical history, physical examination, 12 lead ECG, vital signs measurements, and clinical laboratory evaluations (congenital nonhaemolytic hyperbilirubinemia [eg, Gilbert's syndrome] is not acceptable) at Screening and Check in as assessed by the Investigator.
Additional inclusion criteria for patients with mitochondrial disease:
Males or females, of any race, between 18 and 75 years of age, inclusive.
Body mass index between 15.0 and 32.0 kg/m2, inclusive.
Any mitochondrial disease that has been genetically confirmed.
Clinically stable, apart from symptoms associated with the diagnosis of mitochondrial disease, as determined by medical history, physical examination, 12 lead ECG, vital signs measurements, and clinical laboratory evaluations at Screening and Check-in as assessed by the Investigator.
Exclusion Criteria (selected):
Healthy subjects and patients with mitochondrial disease will be excluded from the study if they satisfy any of the following criteria at the Screening visit unless otherwise stated:
Additional exclusion criteria for patients with mitochondrial disease:
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| Name | Affiliation | Role |
|---|---|---|
| Matilda Hugerth, MSc | Abliva AB | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Covance Leeds | Leeds | West Yorkshire | LS2 9LH | United Kingdom | ||
| UCL |
According to EMA rules.
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| Drug |
25 and 100 mg placebo encapsulated tablets |
|
| Days 1 and 10 |
| PK: Cmax | Day 1 |
| PK: time of the Cmax (Tmax) | Day 1 |
| PK: minimum observed plasma concentration (Cmin) | Days 1 and 10 |
| PK: apparent plasma terminal elimination half life (t1/2) | Days 1 and 10 |
| PK: mean residence time (MRT) | Days 1 and 10 |
| PK: apparent total plasma clearance (CL/F) | Days 1 and 10 |
| PK: apparent volume of distribution during the terminal phase (Vz/F) | Days 1 and 10 |
| Lactate/pyruvate concentrations and ratio (part B and C) | Biomarker | Days 10 and 15 |
| Newcastle Mitochondrial Disease Adult Scale (NMDAS) (part C) | Assessment of mitochondrial disease. The NMDAS is a validated clinical rating scale designed to capture the natural history of mitochondrial disease. The NMDAS includes 3 domains: current function, system specific involvement, and current clinical, assessed on 6-point Likert-type scale from 0 to 5, as well as a fourth section including a score for the 12-Item Short Form Survey-Version 2. | Day 10 |
| Clinician Global Impression (CGI) (part C) | Assessment of illness severity, global improvement or change, and therapeutic response.The CGI is a 3-item observer-rated scale that measures illness severity, global improvement or change, and therapeutic response. The CGI is rated on a 7-point Likert-type scale, with the severity of illness scale using a range of responses from 1 (normal) to 7 (amongst the most severely ill patients). | Day 10 |
| Patient Global Impression-Improvement (PGI-I) (part C) | Patient reported assessment of severity of illness. The PGI-I is a patient-rated scale using a 7-point Likert-type scale, with the severity of illness scale using a range of responses from 1 (normal) to 7 (amongst the most severely ill patients). An item about the patient's worst symptom will be included in the assessment for this study. | Day 10 |
| Daily Fatigue Impact Severity (D-FIS) (part C) | Assessment of fatigue. The D-FIS is a patient-rated scale developed to assess the symptom of fatigue as part of an underlying chronic disease or condition. The D-FIS includes 8 items assessed on 5-point Likert-type scale from 0 (no problem) to 4 (extreme problem). | Day 10 |
| Quality of Life in Neurological Disorders Fatigue Scale (Neuro-QoL Fatigue) (part C) | Assessment of fatigue. The Neuro-QoL Fatigue is one of several scales that make up the Quality of Life in Neurological Disorders measurement system. It is a reliable and validated brief 19-item survey of fatigue, completed by the subject, with a recall period of the past 7 days. The 19 items are scored from 1 (never) to 5 (always) and consequently, Neuro-QoL Fatigue total scores range from 19 to 95, with higher scores indicating greater fatigue and greater impact of mitochondrial disease on activities. | Day 10 |
| 30 Second Sit-to-Stand Test (part C) | Test | Day 10 |
| London |
| United Kingdom |
| ID | Term |
|---|---|
| D028361 | Mitochondrial Diseases |
| D017241 | MELAS Syndrome |
| D017240 | Mitochondrial Myopathies |
| D007625 | Kearns-Sayre Syndrome |
| D017246 | Ophthalmoplegia, Chronic Progressive External |
| ID | Term |
|---|---|
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D017237 | Mitochondrial Encephalomyopathies |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D020739 | Brain Diseases, Metabolic, Inborn |
| D001928 | Brain Diseases, Metabolic |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D059345 | Cerebral Small Vessel Diseases |
| D002561 | Cerebrovascular Disorders |
| D009468 | Neuromuscular Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D008661 | Metabolism, Inborn Errors |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D009886 | Ophthalmoplegia |
| D015835 | Ocular Motility Disorders |
| D003389 | Cranial Nerve Diseases |
| D010243 | Paralysis |
| D009461 | Neurologic Manifestations |
| D005128 | Eye Diseases |
| D012174 | Retinitis Pigmentosa |
| D058499 | Retinal Dystrophies |
| D012162 | Retinal Degeneration |
| D012164 | Retinal Diseases |
| D009202 | Cardiomyopathies |
| D006331 | Heart Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
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