Genetic Variants and Microglial Activation Imaging for Alzheimer's Disease

Overseen by Philip De Jager, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: William Charles Kreisl

Must not be taking: Anticoagulants, Immunosuppressives, Steroids

Disqualifiers: Brain disorders, Epilepsy, Obesity, others

No Placebo Group

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial aims to understand how specific gene variants affect brain immune cells in Alzheimer's disease. It focuses on white, non-Hispanic individuals to validate previous findings. Researchers will use genetic analysis and brain imaging to study these effects.

Will I have to stop taking my current medications?

The trial excludes participants who are taking anticoagulant or immunosuppressive medications, and those who have used steroids in the 30 days before the PET scan. If you are on these medications, you may need to stop taking them to participate.

What data supports the effectiveness of the drug 11C-ER176 and 18F-florbetaben for Alzheimer's disease?

The research shows that microglial activation, which can be imaged using PET scans, is linked to Alzheimer's disease progression. The use of imaging agents like 18F-PBR06 and 18F-FDG helps in understanding brain changes in Alzheimer's, suggesting that similar imaging drugs like 11C-ER176 and 18F-florbetaben could be effective in studying and potentially managing the disease. ^{1 2 3 4 5}

Is the treatment generally safe for humans?

The treatment using 18F-florbetaben (Neuraceq) has been generally well tolerated in clinical trials, with only mild to moderate side effects like injection site irritation. No serious adverse reactions have been reported. ^{1 6 7 8 9}

Research Team

Philip De Jager, MD

Principal Investigator

Columbia University

Eligibility Criteria

This trial is for white, non-Hispanic or Latino individuals aged 50+, fluent in English, with mild Alzheimer's or no cognitive impairment. Participants must have a certain Clinical Dementia Rating and be able to consent. They need prior AD biomarker results or will undergo a PET scan. Exclusions include severe medical conditions, MRI contraindications, recent excessive research radiation exposure, chronic inflammatory/infectious diseases, and other brain disorders.

Inclusion Criteria

In the opinion of the investigator, the subject must be considered likely to comply with the study protocol and to have a high probability of completing the study

Subjects must be able to provide informed consent

Able to participate in all scheduled evaluations and to complete all required tests and procedures

Exclusion Criteria

I have a history of brain disorders other than mild cognitive impairment or Alzheimer's.

You have participated in a clinical trial for a drug that changes the course of Alzheimer's disease in the past year.

I have a chronic inflammatory or infectious disease like MS, IBD, RA, psoriasis, lupus, or HIV.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

PET Imaging and Genetic Analysis

Participants undergo PET imaging with 11C-ER176 and genome-wide genetic analysis

1-2 weeks

1 visit (in-person)

Annual Clinical Evaluation

Participants undergo annual clinical evaluation and blood sample collection to establish the trajectory of AD-related serum biomarkers and syndromic diagnoses

5 years

5 visits (in-person, annually)

Follow-up

Participants are monitored for safety and effectiveness after the main study activities

4 weeks

Treatment Details

Interventions

• 11C-ER176 (Radiopharmaceutical)
• 18F-florbetaben (Radiopharmaceutical)

Trial Overview The study tests how gene variants affect microglial activation in Alzheimer's using PET imaging agents: 11C-ER176 and 18F-florbetaben. It aims to validate known genetic influences on activated microglia proportion and discover new gene loci related to this process while assessing the functional impact of these variants.

Participant Groups

Group I: Cognitive Impairment Experimental Treatment 2 Interventions

Subjects diagnosed with Alzheimer's disease (AD) or mild cognitive impairment (MCI) will have one PET scan with 11C-ER176, with arterial sampling. If the subject lacks known AD-biomarkers, they may undergo a 18F-florbetaben PET scan prior to the 11C-ER176 PET scan. Genome-wide genetic analysis will be performed. Participants will undergo an annual clinical evaluation and blood sample collection for 5 years to establish the trajectory of AD-related serum biomarkers and syndromic diagnoses.

Group II: No Cognitive Impairment Active Control 2 Interventions

Healthy volunteers who are cognitively normal will have one PET scan with 11C-ER176, with arterial sampling. If the subject lacks known AD-biomarkers, they may undergo an 18F-florbetaben PET scan prior to the 11C-ER176 PET scan. Genome-wide genetic analysis will be performed. Participants will undergo an annual clinical evaluation and blood sample collection for 5 years to establish the trajectory of AD-related serum biomarkers and syndromic diagnoses.

Who Is Running the Clinical Trial?

William Charles Kreisl

Lead Sponsor

Trials

7

Recruited

520+

Edward D Huey, MD

Lead Sponsor

Trials

1

Recruited

250+

Columbia University

Lead Sponsor

Trials

1,529

Recruited

2,832,000+

Dr. Katrina Armstrong

Columbia University

Chief Executive Officer

MD from Johns Hopkins University, MS in Epidemiology from Harvard School of Public Health

Dr. Katrina Armstrong

Columbia University

Chief Medical Officer

MD from Harvard Medical School

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Dr. Richard J. Hodes

National Institute on Aging (NIA)

Chief Executive Officer since 1993

MD from Harvard Medical School

Dr. Marie Bernard

National Institute on Aging (NIA)

Chief Medical Officer

MD from Harvard Medical School

Findings from Research

The use of 18 F-PBR06 PET imaging revealed increased glial activation in specific brain regions of a 69-year-old woman diagnosed with Alzheimer's disease, indicating a potential biomarker for disease progression.

Over a 6-year follow-up, the patient's cognitive impairment worsened from mild to moderate, highlighting the progressive nature of Alzheimer's disease and the importance of monitoring brain changes over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of Microglial Activation in Alzheimer Disease Using 18 F-PBR06 PET. Carter, K., Cicero, S., Rissanen, E., et al.[2023]

In a study of 24 participants with varying stages of Alzheimer's disease, increased microglial activation was observed in the hippocampus of those classified as progressors or symptomatic, indicating a potential link between neuroinflammation and disease progression.

Higher baseline levels of microglial activation, measured by the [11C]PK11195 PET imaging, were predictive of cognitive decline over time, suggesting that monitoring neuroinflammation could be important for understanding Alzheimer's disease progression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Baseline Microglial Activation Correlates With Brain Amyloidosis and Longitudinal Cognitive Decline in Alzheimer Disease. Wang, Q., Chen, G., Schindler, SE., et al.[2023]

In a study of 93 Alzheimer's disease patients, significant associations were found between certain genetic variants (APOEɛ4 and PTK2B rs28834970) and the presence of cerebral amyloid angiopathy (CAA), a common pathology in Alzheimer's.

The research also indicated that variants in PTK2B, PICALM, and CR1 may influence microglial activation in white matter, suggesting these genetic factors could modify disease progression through their effects on amyloid-β metabolism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Associations of Alzheimer's Disease Risk Variants that Are Highly Expressed in Microglia with Neuropathological Outcome Measures. Sakae, N., Heckman, MG., Vargas, ER., et al.[2021]

In a study involving two individuals with sporadic Alzheimer's disease (AD) and 107 control subjects, F-FDG PET imaging revealed that brain glucose metabolism declined significantly faster in the AD subjects (approximately 9% over 9-12 years) compared to the control group (2.2% per decade due to aging).

The decline in F-FDG uptake began 4 years and 2 years before memory loss was observed in the two AD subjects, suggesting that cognitive decline may occur sooner in sporadic AD than previously thought in dominantly inherited forms of the disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Longitudinal 18F-FDG Images in Patients With Alzheimer Disease Over More Than 9 Years From a Preclinical Stage. Ishibashi, K., Onishi, A., Wagatsuma, K., et al.[2021]

In an Alzheimer's disease (AD) animal model, increased glucose uptake in the hippocampus was linked to altered microglial metabolism, suggesting that microglia play a significant role in the disease's progression.

Human brain imaging data indicated that higher hippocampal glucose uptake, measured by FDG PET, correlates with soluble TREM2 levels and can predict the conversion from mild cognitive impairment to Alzheimer's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hippocampal glucose uptake as a surrogate of metabolic change of microglia in Alzheimer's disease. Choi, H., Choi, Y., Lee, EJ., et al.[2022]

[(18)F]florbetaben is a highly accurate PET imaging agent that effectively detects β-amyloid plaques in the brain, demonstrating high sensitivity and specificity in identifying Alzheimer's disease and other cognitive impairments based on a phase III study.

The agent is generally well tolerated, with only mild to moderate adverse reactions reported, primarily related to the injection site, and no serious adverse events associated with its use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[(18)F]Florbetaben: a review in β-amyloid PET imaging in cognitive impairment. Syed, YY., Deeks, E.[2022]

In the ongoing phase 1b PRIME study involving patients with prodromal or mild Alzheimer's disease, aducanumab treatment led to significant reductions in amyloid PET SUVR, indicating a decrease in amyloid plaque burden over time and with higher doses.

The choice of reference regions for calculating SUVR significantly influenced effect sizes, with subcortical white matter and the pons yielding the largest effect sizes, while using the anterior cingulate cortex as a target ROI provided better results than a composite cortex approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Reference and Target Region Selection on Amyloid PET SUV Ratios in the Phase 1b PRIME Study of Aducanumab. Chiao, P., Bedell, BJ., Avants, B., et al.[2019]

Florbetapir (18F) is a promising PET tracer that effectively binds to amyloid-β plaques, allowing for the differentiation of Alzheimer's disease patients from healthy individuals, as demonstrated in phase I and II clinical trials with clear imaging results.

The tracer shows fast kinetics, with optimal imaging quality achieved within 5 to 10 minutes post-injection, and has a strong correlation with postmortem assessments of amyloid deposition, indicating its potential for early detection of Alzheimer's disease without serious adverse events reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Florbetapir (18F), a PET imaging agent that binds to amyloid plaques for the potential detection of Alzheimer's disease. Okamura, N., Yanai, K.[2016]

Florbetapir PET imaging effectively distinguishes between amyloid levels in individuals with probable Alzheimer's disease (AD), mild cognitive impairment (MCI), and older healthy controls (OHCs), with significant differences in amyloid burden observed among these groups.

The study established specific thresholds for florbetapir SUVRs that indicate pathological amyloid levels associated with AD, providing a reliable method for assessing amyloid presence in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using positron emission tomography and florbetapir F18 to image cortical amyloid in patients with mild cognitive impairment or dementia due to Alzheimer disease. Fleisher, AS., Chen, K., Liu, X., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Assessment of Microglial Activation in Alzheimer Disease Using 18 F-PBR06 PET. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Baseline Microglial Activation Correlates With Brain Amyloidosis and Longitudinal Cognitive Decline in Alzheimer Disease. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Evaluation of Associations of Alzheimer's Disease Risk Variants that Are Highly Expressed in Microglia with Neuropathological Outcome Measures. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Longitudinal 18F-FDG Images in Patients With Alzheimer Disease Over More Than 9 Years From a Preclinical Stage. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Hippocampal glucose uptake as a surrogate of metabolic change of microglia in Alzheimer's disease. [2022]

6. New Zealand pubmed.ncbi.nlm.nih.gov

[(18)F]Florbetaben: a review in β-amyloid PET imaging in cognitive impairment. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Impact of Reference and Target Region Selection on Amyloid PET SUV Ratios in the Phase 1b PRIME Study of Aducanumab. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Florbetapir (18F), a PET imaging agent that binds to amyloid plaques for the potential detection of Alzheimer's disease. [2016]

9. United States pubmed.ncbi.nlm.nih.gov

Using positron emission tomography and florbetapir F18 to image cortical amyloid in patients with mild cognitive impairment or dementia due to Alzheimer disease. [2022]