A Clinical Study to Assess the Safety, Tolerability, and Activity of Oral SRT2104 Capsules Administered for 28 Days to Subjects With Type 2 Diabetes Mellitus

• To study the effects of SRT2104 vs. placebo on insulin sensitivity including hepatic and muscular insulin sensitivity. [ Time Frame: HEGC procedures including indirect calorimetry will be performed on Days 0, 29, and 43 to study the effects on insulin sensitivity and energy expenditure. OGTT will be used to assess insulin sensitivity on Days -1, 28 and 42. ]
• To determine the safety and tolerability of 28 days of dosing with 2.0 g SRT2104 in subjects with type 2 diabetes mellitus in a fed state [ Time Frame: Safety will be monitored by AEs, VS, physical exam, labs and ECGs during the study. ]

• To determine the pharmacokinetics of 28 days of dosing with 2.0 g SRT2104 in subjects with type 2 diabetes mellitus in a fed state. [ Time Frame: PK samples will be collected on Days 1 and 28 at pre-dose and at 15 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 8 hours, 12 hours, and 24 hours post-dose on Days 2 and 29. ]
• To study the effects of SRT2104 vs. placebo on energy expenditure. [ Time Frame: HEGC procedures including indirect calorimetry will be performed on Days 0, 29, and 43 to study the effects of SRT2104 vs. placebo on energy expenditure. ]
• To study the effects of SRT2104 vs. placebo on muscle histology and biomarkers of oxidative capacity. [ Time Frame: Muscle biopsies obtained on Days -1 and 28 will be used to analyze muscle histology and/or biomarkers of oxidative capacity and/or gene expression profiles. ]
• To study the effects of SRT2104 vs. placebo on biomarkers of glucose control and inflammation. [ Time Frame: Serum/plasma research sample(s) will be collected on Days 0, 29, and 43 to measure biomarkers of glucose control and inflammation. ]
• To study the effects of SRT2104 vs. placebo on biological markers of bone turnover. [ Time Frame: Serum/plasma sample(s) will be collected on Days 0, 29, and 43. Starting in the morning on Days -1, 28, and 42, subjects will have 24-hour urine samples collected to measure biological markers of bone turnover. ]
• To study the effects of SRT2104 vs. placebo on biomarkers of oxidative stress. [ Time Frame: Serum/plasma sample(s) will be collected on Days 0, 29, and 43. Starting in the morning on Days -1, 28, and 42, subjects will have 24-hour urine samples collected to measure biological markers of oxidative stress. ]

Randomized, placebo-controlled, parallel-group, double-blind, multiple-dose, activity and safety clinical study of SRT2104 administered orally once daily for 28 consecutive days. This will be an inpatient/outpatient study to assess the safety and pharmacokinetics of SRT2104 in type 2 diabetic male and female subjects on an existing, stable, background metformin therapy. Approximately 80 subjects will be enrolled. Subjects will be evenly randomized to receive SRT2104 2.0 g/day or placebo in the fed state.

Subjects will be required to stay overnight at the study center on Days -2, -1, 0, 1 (optional discharge at investigator's discretion), 27, 28, 41, and 42. During these admissions, pharmacokinetic, biomarker and glycated albumin samples will be collected, and glucose profiling, OGTT, glucose stabilization, hyperinsulinemc euglycemic clamp (HEGC) studies with indirect calorimetry and various other safety and activity procedures will be performed. On Day 1 of the study, subjects will be randomized to receive SRT2104 or placebo. Day 43 will be the last day of the study and subjects will be released. In addition, subjects will be asked to return to the study center on Day 14 for interim safety assessments.

During the dosing period, study personnel will contact subjects by telephone on Days 7 and 21 to conduct a safety assessment. Subjects will be required to monitor their fasting blood glucose and complete a daily diary for the outpatient portion of the study between Days 1 and 28. A follow-up, safety phone call will occur 30 days following their final dose of SRT2104 or placebo (Day 58 of the study) to identify any possible additional adverse events or concomitant medications.

Randomized, placebo-controlled, parallel-group, double-blind, multiple-dose, activity and safety clinical study of SRT2104 administered orally once daily for 28 consecutive days. This will be an inpatient/outpatient study to assess the safety and pharmacokinetics (PK) of SRT2104 in type 2 diabetic (T2D) male and female subjects on an existing, stable, background metformin therapy. Approximately 112 subjects aged 18-65 years, who fulfill the inclusion/exclusion criteria, will be screened for this study to enroll approximately 80 subjects. Subjects will be evenly randomized to receive SRT2104 2.0 g/day or placebo approximately 15 minutes following consumption of a standardized morning meal. Subjects will remain on a fixed dose of test material for all dosing days in the study.

Subjects will sign the informed consent form at the Screening Visit, and will undergo screening assessments to verify eligibility for the study. If eligible and willing to participate, subjects will return to the clinic within 21 days of the Screening Visit to participate in the pre-dosing phase of the study. On Day 1 of the study, subjects will be randomized to receive SRT2104 or placebo. Subjects will be required to stay overnight at the study center on Days -2, -1, 0, 1 (optional discharge at investigator's discretion), 27, 28, 41, and 42 for testing, to assess safety, and to gather required biomarker samples. In addition, subjects will be asked to return to the study center on Day 14 for interim safety assessments. The subject will be telephoned on Days 7 and 21 to assess safety. Subjects will be required to monitor their fasting blood glucose and complete a daily diary for the outpatient portion of the study between Days 1 and 28. A follow-up, safety phone call will occur 30 days following their final dose of SRT2104 or placebo (Day 58 of the study) to identify any possible additional adverse events (AEs) or concomitant medications.

• Drug: Placebo
  For placebo product, the SRT2104 drug substance will be replaced by microcrystalline cellulose (Avicel® PH 105) to match the SRT2104 investigational product.
• Drug: SRT2104
  SRT2104 will be supplied as hard gelatin capsules, with each containing 250mg SRT2104.

• Active Comparator: 2.0g SRT2104
  The 2.0g SRT2104 treatment group will be administered eight SRT2104 capsules per day. 2.0g SRT2104 will be administered orally once daily for twenty-eight consecutive days. During non-clinic days, the subject will self-administer the test material approximately 15 minutes following consumption of a standard morning meal at home (200 cc of Ensure Plus®).
  Intervention: Drug: SRT2104
• Placebo Comparator: Placebo
  The placebo treatment group will be administered eight placebo capsules per day. Placebo will be administered orally once daily for twenty-eight consecutive days. During non-clinic days, the subject will self-administer the test material approximately 15 minutes following consumption of a standard morning meal at home (200 cc of Ensure Plus®).
  Intervention: Drug: Placebo

Inclusion Criteria:

• Able and willing to provide written informed consent to participate in the study
• Ambulatory male and female subjects (of any race) with T2D within the age range of 18-65 years (inclusive) at the time of screening

• All female subjects must be of non-childbearing potential. All male subjects must agree with their partners to use double-barrier birth control or abstinence while participating in the study and for 12 weeks following the last dose of investigational product. For the purposes of this study, non-childbearing is defined as:

  • Amenorrheic for at least 12 consecutive months; menopausal status in amenorrheic females will be confirmed by demonstrating levels of follicle stimulating hormone (FSH) >40-138 mIU/mL and estradiol < 30 pg/mL at entry. In the event a subject's menopause status has been clearly established (for example, the subject indicates she has been amenorrheic for 10 years), but FSH and/or estradiol levels are not consistent with a post-menopausal condition, determination of subject eligibility will be at the discretion of the principal investigator with agreement of the independent medical monitor
  • At least 6 weeks post-surgical bilateral oophorectomy (with or without hysterectomy) or post tubal ligation
• The subject must be on stable metformin monotherapy for a minimum of 3 months prior to the Screening visit.
• HbA1c of 6.5%-9.5% (inclusive)
• Body Mass Index (BMI) of 22-38 kg/m^2 (inclusive)
• Resting supine blood pressure (BP) < 160/90 mmHg

• Have a normal 12-lead electrocardiogram (ECG) or one with changes considered to be clinically insignificant on medical review and QTc intervals as defined below:

  • QTcB must be <450 msec for males and <470 msec for females (based on single or average QTc value of triplicate ECGs obtained over a brief period)
  • QTcB must be <480 msec in subjects with Bundle Branch Block
• Comprehension of the nature and purpose of the study and able to comply with the protocol requirements
• Able to communicate in person and by telephone in a manner that allows all protocol procedures to be carried out safely and reliably in the opinion of the investigative site staff

Exclusion Criteria:

• Any major illness in the 3 months prior to study entry or any significant ongoing chronic medical illness not related to diabetes (e.g., recent myocardial infarction, unstable angina, stroke, or transient ischemic attack) which in the opinion of the principal investigator or medical monitor could risk subject safety or interpretation of the results

• Renal or liver impairment, defined as:

  • Serum creatinine level of ≥ 1.4 mg/dL for females and ≥ 1.5 mg/dL for males
  • AST and ALT ≥ 2xULN
  • alkaline phosphatase and bilirubin > 1.5xULN (an isolated bilirubin >1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin is <35%)
• A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody result within 3 months of Screening
• A positive test for HIV antibody
• History of or current gastrointestinal diseases influencing drug absorption as judged by the investigator
• Significant history of alcoholism or drug/chemical abuse, or a positive result of the urine drug/alcohol screen at the Screening Visit, or consuming more than 28 units of alcohol per week (one unit of alcohol equals about 250 mL of beer or lager, one glass of wine, or 20 mL spirits)
• Participation in any clinical trial within 3 months prior to the first dose of investigational product in the current study
• History of difficulty in donating blood or accessibility of veins in left or right arm
• Donation or loss of blood (more than 500 mL) within 3 months prior to receiving the first dose of investigational product
• Use of any prescription drug therapy, with the exception of any prescription medication administered at a stable dose for at least 6 weeks prior to Screening, provided the medication is not contraindicated by the metformin label (see Appendix A for Glucophage® Summary of Product Characteristics)
• Use of any anti-diabetic therapy other than metformin, within 3 months of the first dose of investigational product
• Use of any dietary or herbal supplements within 3 weeks prior to the first dose of investigational product
• History of sensitivity to any of the study medications, or components thereof or a history of drug or other allergy that, in the opinion of the investigator or medical monitor, contraindicates their participation
• Active neoplastic disease or history of neoplastic disease within 5 years of study entry (except for basal cell carcinoma of the skin or carcinoma in situ)
• Increased risk of thrombosis, e.g., subjects with a history of deep leg vein thrombosis or family history of deep leg vein thrombosis, as judged by the investigator