Assessment of Safety and Feasibility of Exablate Blood-Brain Barrier Disruption for the Treatment of Patients With With Mild Cognitive Impairment (MCI) or Mild Alzheimer's Disease (AD) Undergoing Standard of Care Monoclonal Antibody (mAb) Therapy
Overview
- Phase
- Early Phase 1
- Intervention
- Aducanumab
- Conditions
- Mild Cognitive Impairment
- Sponsor
- Ali Rezai
- Enrollment
- 15
- Locations
- 1
- Primary Endpoint
- Treatment intervention related adverse events
- Status
- Active, not recruiting
- Last Updated
- 3 months ago
Overview
Brief Summary
The purpose of this study is to assess the safety and feasibility of administering standard of care monoclonal antibody (mAb) infusion therapy in combination with opening the blood-brain barrier with the Exablate Model 4000 Type 2 device in patients with mild Alzheimer's disease (AD) or mild cognitive impairment (MCI).
Detailed Description
The primary objectives of this study is to evaluate the safety and feasibility of BBBO (blood-brain barrier opening) using the Exablate Model 4000 Type 2 in the setting of standard aducanumab or lecanemab therapy among patients with mild cognitive impairment (MCI) or mild Alzheimer's disease (AD) with confirmed β-amyloid, who are eligible for aducanumab or lecanemab infusion therapy, and to also evaluate the safety of the BBO procedure through patient examination (neurological and cognitive/behavioral) and MRI assessments during the treatment and follow-up. The secondary objectives of this study is to determine the effect of BBBO in patients with MCI or mild AD treated with aducanumab or lecanemab on brain β-amyloid plaque measured by amyloid positron emission tomography (PET), as well as to assess the clinical impact of BBBO with standard aducanumab or lecanemab therapy, if any, as assessed with ADAS Cog 11 and MMSE over time following BBBO.
Investigators
Ali Rezai
Neurosurgeon
West Virginia University
Eligibility Criteria
Inclusion Criteria
- •Able and willing to give informed consent
- •Probable mild cognitive impairment due to AD
- •Modified Hachinski Ischemia Scale (MHIS) score of \<= 4
- •Mini Mental State Exam (MMSE) scores \> 21+.
- •Short form Geriatric Depression Scale (GDS) score of \<= 7
- •Amyloid PET scan consistent with the presence of β-amyloid (A+)
- •Able to communicate sensations during the Exablate MRgFUS procedure
- •Able to attend all study visits (i.e., life expectancy of 1 year or more)
Exclusion Criteria
- •MRI findings:
- •Significant cardiac disease or unstable hemodynamic status
- •History of a liver disease, bleeding disorder, coagulopathy or a history of spontaneous hemorrhage
- •Known cerebral or systemic vasculopathy
- •Significant depression (GDS \> 7) and/or at potential risk of suicide (C-SSRS \> 2)
- •A severity score of 2 or more on any of the 'Delusions', 'Hallucinations' or 'Agitation/Aggression' subscales of the Neuropsychiatry Inventory (NPI-Q)
- •Known sensitivity/allergy to gadolinium(gadobutrol), DEFINITY or its components, or 18F-florbetaben.
- •Known hypersensitivity to DEFINITY or its components.
- •Any contraindications to MRI scanning
- •Untreated, uncontrolled sleep apnea
Arms & Interventions
Infusion plus Exablate BBBO Treatment
Intravenous infusion of Aducanumab or Lecanemab every 2-4 weeks (per standard of care) followed by blood brain barrier opening by FUS.
Intervention: Aducanumab
Infusion plus Exablate BBBO Treatment
Intravenous infusion of Aducanumab or Lecanemab every 2-4 weeks (per standard of care) followed by blood brain barrier opening by FUS.
Intervention: Exablate Model 4000 Type 2
Infusion plus Exablate BBBO Treatment
Intravenous infusion of Aducanumab or Lecanemab every 2-4 weeks (per standard of care) followed by blood brain barrier opening by FUS.
Intervention: Lecanemab
Outcomes
Primary Outcomes
Treatment intervention related adverse events
Time Frame: From baseline, up to 5 year post last treatment
The total number of adverse events following each treatment through end of the study
Treatment intervention related serious adverse events
Time Frame: From baseline, up to 5 year post last treatment
The total number of serious adverse events following each treatment through end of the study
Secondary Outcomes
- Cognitive performance (MMSE)(From baseline, up to 5 year post last treatment)
- Cognitive performance (ADAS COG 11)(From baseline, up to 5 year post last treatment)
- Beta-Amyloid plaques within the brain(From baseline, up to 5 year post last treatment)