Ignite Creation Date:
2024-07-17 @ 11:12 AM
Last Modification Date:
2024-10-26 @ 3:32 PM
Study NCT ID:
NCT06465823
Status:
RECRUITING
Last Update Posted:
2024-06-20
First Post:
2024-05-06
Brief Title:
Efficacy of Bumetanide to Improve Cognitive Functions in Down Syndrome
Sponsor:
Stefano Vicari
Organization:
Bambino Gesù Hospital and Research Institute
Study Overview
Official Title:
A Phase 2 Double Blind Placebo Controlled Study on the Efficacy of Bumetanide for Cognitive Improvement in Children and Adolescents With Down Syndrome
Status:
RECRUITING
Status Verified Date:
2024-06
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The aim of the study is to evaluate the clinical efficacy of a known diuretic drug Bumetanide in terms of improvement of memory and psychological functioning in children and adolescents with Down syndrome DS in order to develop therapeutic strategies for cognitive and psychopathology aspects associated with the syndrome The study also aims to identify possible predictors and biological and genetic markers related to the efficacy of the treatment Recently preliminary studies conducted on the animal model of Down syndrome have proven the efficacy of the drug Bumetanide in counteracting some brain anomalies related to communication between nerve cells synaptic transmission typical of the syndrome with the effect of improving memory skills Behaviour-enhancing effects have also been found in preliminary studies in humans with other neurodevelopmental disorders eg autism spectrum disorders The drug Bumetanide could therefore be useful in counteracting the biological mechanisms that cause some cognitive deficits associated with Down syndrome The potential of this therapeutic approach will be tested through a clinical trial in a population of children and adolescent patients with DS in a randomized placebo-controlled trial with a three-month treatment with Bumetanide Participants will be randomly assigned to the experimental group that will receive the treatment Bumetanide vs the controlcomparison group that will receive the placebo Bumetanide is a diuretic drug that has been widely used in humans in the past with few side effects is orally active and is very inexpensive 64 participants will be recruited
Detailed Description:
Down syndrome DS is a leading cause of genetically defined intellectual disability It is characterized by low IQ and cognitive deficits especially learning and memory Among the neurobiological causes of these deficits the increased generation of GABAergic interneurons in the forebrain during development is thought to impair learning and memory in Ts65Dn mice inducing excessive inhibition and a consequent imbalance of excitatoryinhibitory signals This derangement would affect cognition in Ts65Dn mice by altering hippocampal synaptic plasticity Indeed both LTP and cognitive deficits can be improved by reducing the GABA-mediated signal strength through GABAAR antagonist treatment Some studies on animal models have helped to demonstrate that the use of an inhibitor of the NKCC1 pump such as Bumetanide helps to restore the imbalance of the GABAergic signal and the synaptic plasticity of the hippocampus with a consequent improvement in memory and learning abilities even after only one treatment week Recently the modulation of the GABAergic signal by inhibiting the activity of the NKCC1 pump a specific inhibitor such as Bumetanide has demonstrated enormous potential for improving epileptic symptoms and autistic symptoms disorders associated with an imbalance of the excitatoryinhibitory synaptic signal in animal models and humans and of memory deficits in DS animal models The hypothesis of the study is therefore that the use of Bumetanide can counteract the alterations of the cerebral GABAergic signal in people with DS improving their cognitive and psychological abilities This is a non-profit phase II randomized placebo-controlled study involving 64 participants The study for each patient will be concluded at the end of treatment at 3 months and follow-up at 5 months In general the study will be concluded with the follow-up visit of the last 64th patient The enrollment of patients will last one year and will take place like all the visits foreseen by the trial only at the IRCCS Bambino Gesù Pediatric Hospital in Rome - Trials Complex Operative Unit For some biomarker analyses the study makes use of collaboration with the Italian Institute of Technology and the Giannina Gaslini Institute of Genoa Participation in the study includes an initial visit to verify that the subjects condition meets the criteria required by the study Subsequently six follow-up visits will be scheduled after 1 week 2 weeks 1 month 2 months 3 months end of treatment and 2 months after the end of treatment after 5 months from the start of treatment Bumetanide drug and placebo indistinguishable will be dispensed to participants during the first Day 1 second Day 7 1 and fourth visit Day 31 3 Participants in the Bumetanide group will be treated for three months with a dose of 002 mgkg twice a day orally Participants in the control group will take a placebo twice a day for three months orally All participants in the study will undergo instrumental and laboratory tests according to the schedule and times indicated below
Psychological and neuropsychological evaluation at the time of recruitment at the first visit - Day 1 at the end of treatment after three months - Day 31 3 and two months after the end of treatment after five months from the start of treatment - Day 150 4 This evaluation will be carried out through long-term memory tasks executive functions measures and adaptive level and through scales and interviews on the psychopathological aspects and will be important for evaluating the effects of the treatment The first visit includes cognitive level assessment Day 1
Questionnaire on quality of life sleep and stool and the analysis of vital signs will be performed at the first visit on Day 1 after one week Day 7 1 after one month Day 31 3 after three months Day 90 3 and after two months from the conclusion five months from the start of treatment - Day 150 4
Physical examination in the first visit Day 1 after one week Day 7 1 after one month Day 31 3 after three months Day 90 3 after two months from the conclusion of the treatment five months from the beginning of the treatment- Day 150 4
Blood sampling specifically for the analysis of electrolytes and blood gas and for hemogenic and liver function tests during all visits Day 1 Day 7 1 Day 15 1 Day 31 3 Day 61 3 Day 90 3 Day 150 4 Urine analysis at first visit Day 1 during all visits Day 1 Day 7 1 Day 15 1 Day 31 3 Day 61 3 Day 90 3 Day 150 4
Audiometric test at the start of treatment Day 1 after one month Day 31 3 after three months end of treatment - Day 90 3 and two months after the end of treatment five months after start of treatment - Day 150 4 Electrocardiogram ECG at the first visit Day 1 after one week Day 7 1 after one month Day 31 3 after three months end of treatment - Day 90 3 and two months after the end of treatment five months after starting treatment - Day 150 4
Electroencephalogram EEG at the first visit Day 1 after one month Day 31 3 after three months end of treatment - Day 90 3 and two months after the end of treatment five months after the start of treatment - Day 150 4
Nephrological evaluation at first visit Day 1 after one week Day 7 1 after two weeks Day 15 1 after one month Day 31 3 after two months and at the end of treatment after three months - Day 90 3
Pregnancy test for girls before starting treatment Day-1
The study also predict safety measures Adverse events will be recorded using the UKU side effect rating scale Furthermore participants will be closely monitored by Investigators during critical periods before during and after the treatment
Psychological and neuropsychological evaluation at the time of recruitment at the first visit - Day 1 at the end of treatment after three months - Day 31 3 and two months after the end of treatment after five months from the start of treatment - Day 150 4 This evaluation will be carried out through long-term memory tasks executive functions measures and adaptive level and through scales and interviews on the psychopathological aspects and will be important for evaluating the effects of the treatment The first visit includes cognitive level assessment Day 1
Questionnaire on quality of life sleep and stool and the analysis of vital signs will be performed at the first visit on Day 1 after one week Day 7 1 after one month Day 31 3 after three months Day 90 3 and after two months from the conclusion five months from the start of treatment - Day 150 4
Physical examination in the first visit Day 1 after one week Day 7 1 after one month Day 31 3 after three months Day 90 3 after two months from the conclusion of the treatment five months from the beginning of the treatment- Day 150 4
Blood sampling specifically for the analysis of electrolytes and blood gas and for hemogenic and liver function tests during all visits Day 1 Day 7 1 Day 15 1 Day 31 3 Day 61 3 Day 90 3 Day 150 4 Urine analysis at first visit Day 1 during all visits Day 1 Day 7 1 Day 15 1 Day 31 3 Day 61 3 Day 90 3 Day 150 4
Audiometric test at the start of treatment Day 1 after one month Day 31 3 after three months end of treatment - Day 90 3 and two months after the end of treatment five months after start of treatment - Day 150 4 Electrocardiogram ECG at the first visit Day 1 after one week Day 7 1 after one month Day 31 3 after three months end of treatment - Day 90 3 and two months after the end of treatment five months after starting treatment - Day 150 4
Electroencephalogram EEG at the first visit Day 1 after one month Day 31 3 after three months end of treatment - Day 90 3 and two months after the end of treatment five months after the start of treatment - Day 150 4
Nephrological evaluation at first visit Day 1 after one week Day 7 1 after two weeks Day 15 1 after one month Day 31 3 after two months and at the end of treatment after three months - Day 90 3
Pregnancy test for girls before starting treatment Day-1
The study also predict safety measures Adverse events will be recorded using the UKU side effect rating scale Furthermore participants will be closely monitored by Investigators during critical periods before during and after the treatment
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
False
Is an FDA AA801 Violation?:
None