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HERV-K Suppression Using Antiretroviral Therapy in Volunteers With Amyotrophic Lateral Sclerosis (ALS)

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ClinicalTrials.gov Identifier: NCT02437110
Recruitment Status : Recruiting
First Posted : May 7, 2015
Last Update Posted : September 30, 2019
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) )

Brief Summary:

Background:

- Some people with Amyotrophic Lateral Sclerosis (ALS) have a high level of the virus HERV-K in their blood. Researchers do not think this virus causes ALS. But they don t know why some people with ALS have a high level of it. They want to know if HERV-K can be suppressed by drugs that are used to treat HIV infection.

Objectives:

- To learn how drugs usually taken for HIV infection affect people with Amyotrophic Lateral Sclerosis (ALS).

Eligibility:

- Adults at least 18 years old with ALS and high levels of HERV-K but no HIV.

Design:

  • Interested participants can contact the study team and, if eligible, the study team will arrange for a screening blood draw to determine the HERV-K level.
  • Participants with a high HERV-K level will be screened with medical history, physical exam, questionnaires, nerve conduction test, lumbar puncture, and blood and breathing tests.
  • After screening, participants will start taking the 4 study drugs..
  • Participants will have study visits at Weeks 1and then every 4 weeks until Week 24. They will be asked how they are feeling and have an exam and blood drawn. At 3 visits, they will have tests of nerve conduction, breathing, and their ALS symptoms.
  • At Week 24, they will stop taking the study drugs and have a repeat lumbar puncture.
  • After the Week 36 visit, their participation is finished.

Condition or disease Intervention/treatment Phase
Amyotrophic Lateral Sclerosis Drug: Darunavir Drug: Ritonavir Drug: dolutegravir Drug: Tenofovir alafenamide (TAF) Phase 1

Detailed Description:

Objective:

In this Phase I, proof-of-concept study, we aim to determine whether an antiretroviral regimen approved to treat human immunodeficiency virus (HIV) infection would also suppress levels of Human Endogenous Retrovirus-K (HERV-K) found to be activated in a subset of patients with amyotrophic lateral sclerosis (ALS). We propose to measure the of blood levels of HERV-K by quantitative PCR before, during, and after treatment with an antiretroviral regimen. We will evaluate the safety of the antiretroviral regimen for participants with ALS and also explore clinical and neurophysiological outcomes of ALS symptoms, quality of life, and pulmonary function.

Study Population:

We will study a subset of ALS patients who have a ratio of HERV-K:RPP30 greater than or equal to 13. About 30% of ALS patients may have detectable levels of HERV-K; about 20% of patients with ALS have a level >1000 copies/ml. To show whether the HERV-K could be suppressed, we will recruit from the approximately 20% of patients with the high levels so that the antiretroviral effect can be determined.

Design:

This is an open-label study of a combination antiretroviral therapy for 24 weeks in 20 HIV-negative, HTLV-negative ALS patients with high ratio of HERV-K:RPP30 . The study duration for each participant will be up to 60 weeks. Participants will be followed regularly for safety, clinical, and neurophysiological outcomes.

Outcome Measures:

The primary outcome measure will be the percent decline HERV-K concentration measured by quantitataive PCR. Percent decline for a patient is measured by: 100 x (screening visit - week 24 visit measurement) / screening visit. The safety of antiretrovirals in volunteers with ALS as measured by the frequency and type of AEs, the ability to remain on assigned treatment (tolerability), physical examinations, laboratory test results, vital signs, and weight/body mass index (BMI). Efficacy will be explored by measuring the change in mean scores of: the ALS Functional Rating Scale-Revised (ALSFRS-R), the ALS Specific Quality of Life Inventory-Revised (ALSSQOL-R), the ALS Cognitive Behavioral Screen (ALS-CBS), vital capacity and maximal inspiratory pressure as measured by handheld spirometer, electrical impedance myography (EIM), the change in neurofilament levels in blood and/or CSF, and the change in uring p75ECD levels.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 200 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: HERV-K Suppression Using Antiretroviral Therapy in Volunteers With Amyotrophic Lateral Sclerosis (ALS)
Study Start Date : April 23, 2015
Estimated Primary Completion Date : February 1, 2022
Estimated Study Completion Date : February 1, 2022


Arm Intervention/treatment
Experimental: ALS
20 participants with ALS and a level of HERV-K >1000 copies/ml
Drug: Darunavir
Orally-administered medication approved for HIV treatment. MOA is as a protease inhibitor. Dose is 600mg twice daily.

Drug: Ritonavir
Orally-administered, FDA-approved medication for HIV treatment. Used in combination with darunavir. Dose is 100 mg twice daily.

Drug: dolutegravir
Orally-administered, FDA-approved medication to treat HIV. It acts as an integrase inhibitor. Dose is 50 mg once daily.

Drug: Tenofovir alafenamide (TAF)
Orally-administered, FDA-approved medication used to treat HIV. It acts as a nucleoside reverse transcriptase inhibitor. Dose is 25 mg once daily.




Primary Outcome Measures :
  1. To assess whether an antiretroviral regimen of darunavir + ritonavir, dolutegravir, and TAF for 24 weeks will suppress blood levels of HERV-K RNA below the limit of detection (1000 copies/ml) in patients with HERV-K-positive ALS. [ Time Frame: one year ]
    HERV-K Level


Secondary Outcome Measures :
  1. To assess the safety of an antiretroviral regimen of darunavir + ritonavir, dolutegravir, and TAF in patients with ALS. [ Time Frame: 24 weeks ]


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:

Subjects must meet all of the following inclusion criteria to be eligible to participate in this study:

  • Age 18 years or older at the time of the screening visit.
  • Able to provide informed consent and comply with study procedures.
  • ALS diagnosed as probable, laboratory-supported probable or definite according to the World Federation of Neurology El Escorial revised criteria32 as determined by a neurologist with neuromuscular subspecialty training.
  • A ratio of HERV-K:RPP greater than or equal to 13 measured by quantitative PCR at the screening visit.
  • Time from diagnosis less than 2 years.
  • If taking riluzole or edaravone, must be on a stable dose for at least 30 days prior to the screening visit, or stopped taking riluzole or edaravone at least 30 days prior to the screening visit.
  • Subject has a competent caregiver who can and will be responsible for administering study drug. If there is no caregiver, another qualified individual must be available to do this.
  • Subject has established care with a neurologist and will maintain this clinical care throughout the study.
  • Subject has had neuroimaging within the last 18 months.

EXCLUSION CRITERIA:

A participant will be excluded if he or she has any of the following:

  • Dependence on daytime mechanical ventilation (invasive or non-invasive, including Continuous Positive Airway Pressure (CPAP) or Bilevel Positive Airway Pressure (BiPap) at the time of the screening visit.
  • History of having undergone gastrostomy at the time of screening.
  • Participation in any other investigational drug trial or using investigational drug (within 12 weeks prior to Screening and thereafter).
  • Known sulfonamide allergy.
  • History of positive test or positive result at screening for HIV or HTLV-1.
  • Participants must not be able to become pregnant (e.g., post-menopausal for at least one year, surgically sterile, or using adequate methods of contraception) or breastfeed for the duration of the study. Adequate methods of contraception include: implanted contraception, intrauterine device in place for at least 3 months, or barrier method in conjunction with spermicide. Participants of

childbearing potential must have a negative pregnancy test at screening and be non-lactating.

  • Presence of any of the following clinical conditions at the time of screening:

    • Drug abuse or alcoholism
    • Unstable medical disease (such as unstable angina or chronic obstructive pulmonary disease), or active infectious disease (such as Hepatitis C or tuberculosis), or current malignancy
    • Unstable psychiatric illness defined as psychosis or untreated major depression within 90 days of the screening visit
    • Dementia
    • Diabetes mellitus
    • Hemophilia
  • Use of contraindicated medications: amiodarone, dronedarone, lovastatin, simvastatin, rifampin, rifapentine, rifabutin, cisapride, pimozide, midazolam, triazolam, dihydroergotamine, ergonovine, ergotamine, methylergonovine, St. John s wort, alfuzosin, salmeterol, sildenafil for pulmonary arterial hypertension, oxcarbazepine, phenobarbital, phenytoin or dofetilide.
  • Safety Laboratory Criteria at the screening visit:

    • Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 3.0 times the upper limit of normal for the NIH Clinical Center.
    • Serum creatinine, serum phosphorous, urine glucose, urine protein, total bilirubin, triglycerides, amylase, or lipase greater than 2.0 times the upper limit of normal for the NIH Clinical Center.
    • Estimated glomerular filtration rate <60mg/dl.
    • Creatine kinase greater than 3.0 times the upper limit of normal for the NIH Clinical Center.
    • Platelet concentration of <100,000/ (micro)l.
    • PT and PTT >1.2 times the upper limit of normal for the NIH Clinical Center.
    • Hemoglobin <10mg/dL.
    • Positive Hepatitis B Surface Antigen and Hepatitis C Virus Antibody

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02437110


Contacts
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Contact: Amanda M Wiebold (301) 594-5194 amanda.wiebold@nih.gov
Contact: Avindra Nath, M.D. (301) 496-1561 natha@mail.nih.gov

Locations
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United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
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Principal Investigator: Avindra Nath, M.D. National Institute of Neurological Disorders and Stroke (NINDS)

Additional Information:
Publications:
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Responsible Party: National Institute of Neurological Disorders and Stroke (NINDS)
ClinicalTrials.gov Identifier: NCT02437110     History of Changes
Other Study ID Numbers: 150126
15-N-0126
First Posted: May 7, 2015    Key Record Dates
Last Update Posted: September 30, 2019
Last Verified: September 26, 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) ):
Amyotrophic Lateral Sclerosis
Antiretroviral Therapy
Virus
Additional relevant MeSH terms:
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Motor Neuron Disease
Amyotrophic Lateral Sclerosis
Sclerosis
Pathologic Processes
Neurodegenerative Diseases
Nervous System Diseases
Neuromuscular Diseases
Spinal Cord Diseases
Central Nervous System Diseases
TDP-43 Proteinopathies
Proteostasis Deficiencies
Metabolic Diseases
Ritonavir
Darunavir
Tenofovir
Dolutegravir
Anti-Retroviral Agents
HIV Protease Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Antiviral Agents
Anti-Infective Agents
Cytochrome P-450 CYP3A Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Reverse Transcriptase Inhibitors
Nucleic Acid Synthesis Inhibitors
HIV Integrase Inhibitors
Integrase Inhibitors