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Fragile X Associated Tremor/Ataxia Syndrome (Fxtas) (Diagnosis)NCT05233579

Open-Label Trial of Sulforaphane in Premutation Carriers With FXTAS

A study testing Sulforaphane in people with Fragile X Associated Tremor/Ataxia Syndrome (Fxtas) (Diagnosis), run by University of California, Davis at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

FXTAS is a rare genetic progressive neurodegenerative disorder, linked to a trinucleotide repeat expansion in the FMR1 gene. FXTAS is characterized by tremor and ataxia in addition to atrophy and white matter disease in the central nervous system (CNS). Read more about this study

Who is it for?
Ages 50 to 85 years
What is being tested?
Sulforaphane
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
15 participants
Where
1 siteUnited States
Study dates
25 Jun 2021to 1 Jan 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosis of FXTAS
  • Presence of a FMR1 premutation (55 to 200 CGG repeats)

Who cannot join

  • Individuals with severe renal failure (GFR is <60 ml/min/1.73 m^2)
  • Significant and current reported substance abuse
  • Individuals with substance use disorder (meets 6 or more symptoms of substance use disorder criteria)
  • Any subject on hospice or on home oxygen
  • Individuals who are pregnant

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UC Davis MIND Institute

    Sacramento, California, 95817

Other trials in United States

About this study

Official title: Open-Label Trial of Sulforaphane in Premutation Carriers With FXTAS to Find Biomarkers

FXTAS is a rare genetic progressive neurodegenerative disorder, linked to a trinucleotide repeat expansion in the FMR1 gene. FXTAS is characterized by tremor and ataxia in addition to atrophy and white matter disease in the central nervous system (CNS). In addition to the major clinical observations of intention tremor and gait dysfunction, minor symptoms of parkinsonism, neuropathy, and cognitive decline also significantly impact individuals with FXTAS.

The dietary supplement being tested in this study is called Sulforaphane. It is found in broccoli and similar cruciferous vegetables and may cause some gas and discomfort. This is not a study looking at clinical efficacy but instead a study of molecular outcome measures. Investigators want to get more information about how Sulforaphane affects specific biomolecular markers captured in blood.

In this study, participants will be taking an increasing amount of the Sulphoraphane supplement pills (238mg/tablet), starting at 1 and increasing to 6, every morning at breakfast for 6 months. In addition, there will be a total of 3 visits (Initial, 3-month and 6-month) to the MIND Institute where participants will be evaluated. At each visit (3 total) participants will undergo a battery of medical and neurologic exams which make take 2-3 days to complete each time. Participants and/or their caregivers will also be asked to fill out questionnaires/surveys. At the initial visit and at 6 months, we will collect blood for analysis. Two MRI scans will be done, also at the initial visit and at 6 months.

Being tested
Sulforaphane
Keywords
Sulforaphane
Medical subject headings
Fragile X Tremor Ataxia Syndrome, Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SulforaphaneDietary supplement

    Also called Avmacol

    Sulforaphane will be taken one tablet in the morning with breakfast and then every 2 weeks, the dose will be increased by one tablet until a total of 6 tablets are taken in the morning. The supplement should be taken around the same time each day.

Study groups in NCT05233579
Study groupRoleWhat they receive
Sulforaphane 1 TabletExperimentalParticipants are taking 1 tablet per day. All participants will start with 1 tablet and continue with 1 tablet for 2 weeks before increasing dose.
Receives: Dietary Supplement: Sulforaphane
Sulforaphane 2 TabletsExperimentalParticipants will increase dosage to 2 tablets per day after 2 weeks from the start of study participation. Participants will continue to take 2 tablets for 2 addiitonal weeks before increasing dose. If participants experience adverse side effects, participants will decrease dosage to 1 tablet.
Receives: Dietary Supplement: Sulforaphane
Sulforaphane 3 TabletsExperimentalParticipants will increase dosage to 3 tablets per day at 4 weeks from the start of study participation. Participants will continue to take 3 tablets for 2 addiitonal weeks before increasing dose. If participants experience adverse side effects, participants will decrease dosage to 2 tablets.
Receives: Dietary Supplement: Sulforaphane
Sulforaphane 4 TabletsExperimentalParticipants will increase dosage to 4 tablets per day at 6 weeks from the start of study participation. Participants will continue to take 4 tablets for 2 addiitonal weeks before increasing dose. If participants experience adverse side effects, participants will decrease dosage to 3 tablets.
Receives: Dietary Supplement: Sulforaphane
Sulforaphane 5 TabletsExperimentalParticipants will increase dosage to 5 tablets per day at 8 weeks from the start of study participation. Participants will continue to take 5 tablets for 2 addiitonal weeks before increasing dose. If participants experience adverse side effects, participants will decrease dosage to 4 tablets.
Receives: Dietary Supplement: Sulforaphane
SulforaphaneExperimentalParticipants will increase dosage to 6 tablets per day at 10 weeks from the start of study participation. Participants will continue to take 6 tablets for 2 addiitonal weeks before increasing dose. If participants experience adverse side effects, participants will decrease dosage to 5 tablets.
Receives: Dietary Supplement: Sulforaphane

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes in mitochondrial function via mitochondrial membrane potential and mass.

    Primary measures are performed on PBMCs. Mitochondrial mass and membrane potential will use selected floors and either plate readers or analytical flow cytometry.

    Measured: Baseline, 6 months

  2. Changes in mitochondrial function via ATP production

    Using PMBCs we will observe in changes in ATP production of various segments of the electron transport chain by utilizing different substrates and coupling between electron transport and ATP production.

    Measured: Baseline, 6 months

  3. Observing changes in candidate molecular biomarkers in FXTAS and mitochondrial dysregulation: GRP78

    Observing levels in potential molecular biomarkers that affect mitochondrial dysregulation. GRP78 is a master controller of the mitochondrial ER stress response. It helps improve Ca2+ transfer and mitochondrial function. Its level will be measured via ELISA

    Measured: Baseline, 6 months

  4. Observing changes in candidate molecular biomarkers in FXTAS and mitochondrial dysregulation: CHOP level

    Observing levels in potential molecular biomarkers that affect mitochondrial dysregulation. CHOP is a common downstream indicator of mitochondrial ER stress signals. It helps improve Ca2+ transfer and mitochondrial function. Its level will be measured via ELISA

    Measured: baseline, 6 months

  5. Observing changes in candidate molecular biomarkers in FXTAS and mitochondrial dysregulation: Bax/Bcl-2 ratio

    Observing levels in potential molecular biomarkers that affect mitochondrial dysregulation. Bax/Bcl-2 is a common measure of mitochondrial dysfunction. It helps improve Ca2+ transfer and mitochondrial function. It will be measure via Elisa.

    Measured: baseline, 6 months

Secondary outcomes (18)
  1. Changes in clinical staging of FXTAS

    The standardized neurological examination including frontal release signs, snout, jaw jerk, and palmomental reflex; sensory examination of pinprick and vibration sense; and assessment of alternating movements and cranial nerves. These measures constitute the FXTAS Rating Scale (FXTAS-RS).

    Measured: Baseline, 6 months

  2. Changes in subcortical brain structures damaged in FXTAS through MRI imaging

    The measurements will include anatomic volume for quantifying atrophy. We have developed a robust and efficient method for accurate segmentation of the cerebellum and brainstem and have applied this method to segment the hippocampus, amygdala, basal ganglia, and corpus callosum accurately. We will continue using this method for quantifying volumes of the white matter in individual lobes and subcortical structures, including the corpus callosum, midbrain, pons, and cerebellar white matter, and calibrating iron depositions in subcortical nuclei (i.e., dentate nucleus, substantia nigra, putamen, and globus pallidus)

    Measured: Baseline, 6 months

  3. Changes in FLAIR hypersensitivity volume for subcortical lesions

    The measurements will include FLAIR hyperintensity volume for subcortical lesions. Subcortical hyperintensities will be segmented automatically using Lesion Prediction Algorithm (LPA) from SPM12, which also co-registers FLAIR images to T1 images. To calculate regional FLAIR hyperintensity volume, we will threshold the generated lesion probability maps at 0.7 and superimpose subcortical and white matter masks to the probability maps using fslmaths from FSL.

    Measured: Baseline, 6 months

  4. Changes in Neurological Quality of Life using the Neuro-QoL upper extremity function fine motor scale

    The upper extremity function fine motor scale measures the neurological quality of life related to one's ability to carry out various activities involving digital, manual, and reach-related functions ranging from fine motor to self-care. The assessment is administered as a self-report questionnaire and responses are recorded on a scale of 1 (unable to do) to 5 (without any difficulty). The assessment will be administered at baseline and at 6 months and any changes in scaled responses will measure changes in neurological quality of life related to the upper extremity functioning.

    Measured: Baseline, 6 months

  5. Changes in Neurological Quality of Life using the Neuro-QoL lower extremity functioning mobility scale

    The lower extremity function mobility scale measures the neurological quality of life related to one's ability to carry out various activities involving the trunk region and increasing degrees of bodily movement, ambulation, balance, and endurance. The assessment is administered as a self-report questionnaire and response are recorded on a scale of 1 (unable to do/can't do) to 5 (without any difficulty/no difficulty). The assessment will be administered at baseline and 6 months and any changes in scaled responses will measure change in neurological quality of life related to the lower extremity functioning.

    Measured: Baseline, 6 months

  6. Changes in psychological Issues

    The Symptom Checklist-90-Revised (SCL-90-R) is a 90 item self-report psychometric questionnaire created to capture a broad range of psychological problems and has been shown to be sensitive in capturing emotional issues in carriers both with and without FXTAS.

    Measured: Baseline, 6 months

  7. Changes in Grip Strength

    For the NIH Toolbox Grip Strength Test, participants squeeze the Jamar Plus Digital dynamometer as hard as they can for a count of three. The dynamometer provides a digital reading of force in pounds.

    Measured: Baseline, 6 months

  8. Changes in gait variability

    Gait variability will be measured using the GAITRite in which participants will traverse the GAITRite walkway across 6 walking trials for each condition with minimal interruption.

    Measured: Baseline, 6 months

  9. Changes in dexterity, tremor, and bradykinesia abnormalities

    The Purdue Pegboard test will measure abnormalities in dexterity, tremor, and bradykinesia.

    Measured: Baseline, 6 months

  10. Changes in kinetic, postural, and rest tremor upper extremity bradykinesia, hypokinesia, dysrhythmia, and dyskinesias

    Participants will perform pre-defined tasks for the Kinesia One test (e.g., finger to nose, finger tapping, wrist rotation, holding arms extended, arms resting on the legs, and hand grasps).

    Measured: Baseline, 6 months

  11. Changes in cognitive dysfunction using MoCA

    The Montreal Cognitive Assessment (MoCA) will be administered at baseline and 6 months and the MoCA is scored on a scale of 0-30 points. Changes in the participant's score from the MoCA administered at baseline and the MoCA administered at 6 months will measure whether there are changes in cognitive dysfunction.

    Measured: Baseline, 6 months

  12. Changes in cognitive dysfunction using MMSE

    The Mini Mental State Exam (MMSE) will be administered at baseline and 6 months. MMSE is scored on a scale of 0-30 points. Changes in participant's score from MMSE administered at baseline and MMSE administered at 6 months will measure whether there are changes in mild cognitive dysfunction.

    Measured: Baseline, 6 months

  13. Changes in executive function deficits using BDS-2

    The Behavioral Dysfunction Scale 2 (BDS-2) is a 9-item assessment of simple motor tasks that scores the participant's completion of each item/task on a scale of 0 (patient demonstrates a complete lack of insight into the accuracy of his or her performance and fails to recognize that errors are being made) to 3 (patient demonstrates good performance with no errors). The BDS-2 is administered at baseline and 6 months and changes in participant scores will measure changes in executive function deficits.

    Measured: Baseline, 6 months

  14. Changes in executive function deficits using COWAT

    The Controlled Oral Word Association Test (COWAT) measures executive functioning deficits using verbal fluency and word retrieval tasks. One's score is calculated by the total number of words listed (1 word = 1 point) Changes in the participant's score from the COWAT administered at baseline and the COWAT administered at 6 months will measure changes in executive function deficits.

    Measured: Baseline, 6 months

  15. Changes in frontal executive planning

    The Stocking of Cambridge subtest from the CANTAB assessment will be administered to measure deficits in frontal executive planning.

    Measured: Baseline, 6 months

  16. Changes in Hippocampus-mediated memory deficits

    The Spatial Working Memory and Paired Associates Learning subtest from the CANTAB assessment will be used to measure hippocampus-mediated memory deficits

    Measured: Baseline, 6 months

  17. Changes in motor movements

    The Choice Reaction Time subtest from the CANTAB assessment will be used to measure motor changes and bradykinesia.

    Measured: Baseline, 6 months

  18. Changes in cognitive ability

    Cognitive ability will be measured using the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV).

    Measured: Baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Feb 2022
  2. Study start25 Jun 2021
  3. Primary completion1 Jan 2023
  4. Study completion1 Jan 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Non-randomised
Intervention model
Sequential
Masking
None (open label)
Enrolment
15 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05233579
Sponsor's protocol ID
1743661
Status last verified
Jul 2023
First submitted
20 Oct 2021
Last updated
12 Jul 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Napoli E, Flores A, Mansuri Y, Hagerman RJ, Giulivi C. Sulforaphane improves mitochondrial metabolism in fibroblasts from patients with fragile X-associated tremor and ataxia syndrome. Neurobiol Dis. 2021 Sep;157:105427. doi: 10.1016/j.nbd.2021.105427. Epub 2021 Jun 19.

    PubMed 34153466
  • Uddin MS, Mamun AA, Jakaria M, Thangapandiyan S, Ahmad J, Rahman MA, Mathew B, Abdel-Daim MM, Aleya L. Emerging promise of sulforaphane-mediated Nrf2 signaling cascade against neurological disorders. Sci Total Environ. 2020 Mar 10;707:135624. doi: 10.1016/j.scitotenv.2019.135624. Epub 2019 Nov 21.

    PubMed 31784171
  • Berry-Kravis EM, Harnett MD, Reines SA, Reese MA, Ethridge LE, Outterson AH, Michalak C, Furman J, Gurney ME. Inhibition of phosphodiesterase-4D in adults with fragile X syndrome: a randomized, placebo-controlled, phase 2 clinical trial. Nat Med. 2021 May;27(5):862-870. doi: 10.1038/s41591-021-01321-w. Epub 2021 Apr 29.

    PubMed 33927413

Questions about this trial

What is this clinical trial studying?

A study testing Sulforaphane in people with Fragile X Associated Tremor/Ataxia Syndrome (Fxtas) (Diagnosis), run by University of California, Davis at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes in mitochondrial function via mitochondrial membrane potential and mass. (time frame: Baseline, 6 months). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05233579, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jul 2023.

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