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The Safety and Tolerability of Kinetin, in Patients With Familial Dysautonomia

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ClinicalTrials.gov Identifier: NCT02274051
Recruitment Status : Completed
First Posted : October 24, 2014
Last Update Posted : June 18, 2019
Sponsor:
Information provided by (Responsible Party):
NYU Langone Health

Brief Summary:
This is a study of kinetin, a nutritional supplement that corrects the mRNA splicing defect in patients with familial dysautonomia (FD, also known as Riley Day syndrome or hereditary sensory and autonomic neuropathy type III). FD is a rare fatal autosomal recessive disease in which the growth and development of selective neuronal populations is impaired. The disease is the result of a point mutation in the gene sequence that encodes for kinase complex associated protein (IKAP) in chromosome 9q31. The mutation, at the start of the non-encoding intron 20, weakens the splice site, causing the spliceosome to wrongly join together exons 19 and 21 when transcribing the mRNA strand and miss out exon 20. The mutated mRNA produces a short unstable IKAP protein that is quickly degraded. Interestingly, the mutation does not lead to a complete loss of function. Instead, it results in a tissue specific deficiency in splicing efficiency with both normal (wild type) and mutant IKAP mRNA being expressed in different ratios in different tissues. Some cells, like fibroblasts, produce mostly normal mRNA and protein, where as others, like neurons, produce mostly mutant mRNA and almost no functional protein product.

Condition or disease Intervention/treatment Phase
Familial Dysautonomia Dietary Supplement: Kinetin Phase 1

Detailed Description:

Familial dysautonomia (FD, also called Riley Day syndrome or hereditary sensory and autonomic neuropathy type III) is an autosomal recessive disease caused by a point mutation in the kinase complex associated protein (IKAP) gene sequence (1, 2). This leads to a tissue specific splicing defect with variable "skipping" of exon 20 (1, 3, 4). The consequence is a devastating congenital sensory neuropathy, affecting pain and temperature perception (5) as well as afferent information from the viscera (6). As a result, patients suffer recurrent aspiration pneumonias, respiratory insufficiency, proprioceptive ataxia, scoliosis and the long-term consequences of volatile blood pressure including renal failure (7) and left ventricular hypertrophy (8).

In-vitro studies have shown that the plant hormone kinetin corrects the splicing defect and increases the production of normal IKAP protein levels in FD derived cell lines (9, 10). Preliminary studies in heterozygous carriers of the IKAP mutation showed that dietary supplementation with kinetin increased the production of correctly spliced IKAP mRNA, in white blood cells (11). Preliminary studies in patients with FD have demonstrated that kinetin also increases the expression of correctly spliced IKAP mRNA extracted from white blood cells. However, the effect of kinetin on mRNA levels in neuronal tissue is unknown.

The overall objective of this study is to assess the safety and tolerability of administering kinetin in patients with FD. The specific aim of this proposal is to determine the safety of a once daily dose of kinetin in patients with FD using a dose ascending titration and to determine the long-term safety and tolerability during 3-years of receiving a maximum tolerated steady state dose of kinetin. The investigators hope to also demonstrate early proof of concept that kinetin enhances the ability of neuronal tissue to correctly splice IKAP mRNA.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 15 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: The Safety and Tolerability of Kinetin, a Nutritional Supplement That Corrects the Splicing Defect, in Patients With Familial Dysautonomia
Study Start Date : November 2009
Actual Primary Completion Date : May 4, 2019
Actual Study Completion Date : May 4, 2019


Arm Intervention/treatment
Experimental: Kinetin

Kinetin titration phase to 30mg/kg dose or individual max dose taken once daily.

Patients will then proceed to steady state long-term phase at maximum individual dose of kinetin over a 3 year period.

Dietary Supplement: Kinetin
Titration of Kinetin to maximum individualized dose, then steady state over a 3 year period once daily dose.




Primary Outcome Measures :
  1. Change in Safety blood labs [ Time Frame: At baseline and after each 6 months period and at 36 months ]
    safety blood labs (CBC, metabolic panel)

  2. Change in vital signs [ Time Frame: At baseline and after each 6 months period and at 36 months ]
    Sitting and standing blood pressure measurements and heart rate

  3. Change in ECG [ Time Frame: At baseline and after each 6 months period and at 36 months ]
    12 lead ECG measures

  4. Number of participants with adverse events [ Time Frame: At baseline and after each 6 months period and at 36 months ]
    Number of adverse events



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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male of female patients aged 16 and older
  2. Confirmed diagnosis of familial dysautonomia by genetic testing
  3. Written informed consent to participate in the trial and understanding that they can withdraw consent at anytime without affecting their future care.
  4. Ability to comply with the requirements of the study procedures.

Exclusion Criteria:

  1. Patients who have taken other nutritional supplements that may affect IKAP mRNA splicing within the last 30 days
  2. Patients with a known hypersensitivity to any component of the nutritional supplement kinetin
  3. Patients with atrial fibrillation, angina or an electrocardiogram documenting significant abnormality that may jeopardize the patient's health.
  4. Patients with significant pulmonary, liver, renal (creatinine >2.5 mg/ml) or cardiac illness
  5. Women who are pregnant or lactating
  6. Women of childbearing potential who are not using medically accepted methods of contraception.
  7. Patients who have a significant abnormality on clinical examination that may, in the investigator's opinion, jeopardize their healthy participating in this pilot trial.
  8. Patients taking allopurinol, other xanthine oxidase inhibitors or other compounds that may interfere with the metabolism of kinetin including oral calcium supplements.

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): NCT02274051


Locations
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United States, New York
NYU Langone Medical Center
New York, New York, United States, 10016
Sponsors and Collaborators
NYU Langone Health
Investigators
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Principal Investigator: Horacio Kaufmann, MD NYU School of Medicine

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Responsible Party: NYU Langone Health
ClinicalTrials.gov Identifier: NCT02274051     History of Changes
Other Study ID Numbers: 09-0762
First Posted: October 24, 2014    Key Record Dates
Last Update Posted: June 18, 2019
Last Verified: June 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Primary Dysautonomias
Autonomic Nervous System Diseases
Dysautonomia, Familial
Nervous System Diseases
Hereditary Sensory and Autonomic Neuropathies
Nervous System Malformations
Heredodegenerative Disorders, Nervous System
Neurodegenerative Diseases
Polyneuropathies
Peripheral Nervous System Diseases
Neuromuscular Diseases
Congenital Abnormalities
Genetic Diseases, Inborn
Kinetin
Plant Growth Regulators
Growth Substances
Physiological Effects of Drugs