The Effect of Urolithin A (Mitopure®) on Alzheimer's Disease

Alzheimer's disease (AD) is one of the leading causes of dementia and, eventually, death in the elderly. Although AD has been known for generations, its causes have proven to be quite elusive, slowing the development of treatment options and limiting the progression of the disease through its various stages.

Researchers have identified that the inability of the brain to clear amyloid-beta (Aβ) and tau filaments is a core hallmark of progressive disease in the AD brain. One potential cause of this inability to clear the filaments is a lack of available energy, and the main cause is likely the mitochondria's natural reduction in the production of NAD+, the primary energy source for cellular respiration.

Recently, naturally derived chemicals have moved to the forefront of research as the search for causes and cures moves forward. Many naturally derived molecules are showing good promise in the support of the mitochondria, including urolithin A (UA), a natural post-biotic produced by the gut microbiome after consuming pomegranates, nuts, and other berries, which has been shown to support control of symptoms associated with AD in both animal models and human neural cells.

This Phase II clinical trial seeks to evaluate the efficacy of UA in reducing levels of core AD biomarkers (including p-Tau217), biomarkers of non-specific processes involved in AD pathophysiology (such as neuroinflammation and oxidative stress), and biomarkers of autophagy/mitophagy function, and in slowing cognitive decline in patients with AD. This strategy lays the groundwork for the development of a novel dietary intervention strategy targeting mitochondria through nutritional supplementation.

For this study, Mitopure®/urolithin A and its matching placebo have been supplied by Amazentis/Timeline.

Inclusion criteria

IN-1. Participants must be between 55 and 85 years of age at the time of inclusion.

IN-2. Participants must meet the National Institute on Aging-Alzheimer's Association (NIA-AA) diagnostic criteria for Alzheimer's disease (AD)

IN-3. Participants must have evidence of AD pathology, confirmed by either a positive amyloid PET imaging result or cerebrospinal fluid (CSF) biomarkers reflecting amyloid pathology (e.g., decreased Aβ42 levels or decreased Aβ42/40 ratio, and increased levels of p-Tau181, and total Tau)

IN-4. Participants must have a Mini-Mental State Examination (MMSE) score of ≥24.

IN-5. Participants must have been on stable doses of FDA-approved AD medications (e.g., cholinesterase inhibitors) for at least 8 weeks prior to screening

IN-6. Participants must possess adequate visual and auditory acuity to complete testing

IN-7. Participants must speak fluent Czech.

IN-8. Participants must have a reliable study partner.

IN-9. Participants must have the ability to provide written consent to participate.

IN-10. Participants must be capable of giving signed informed consent as described in Appendix 1, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol

Exclusion criteria

EX-1. Participants will be excluded if they do not have clinically diagnosed AD.

EX-2. Participants will be excluded if they have significant neurological conditions other than AD (e.g., Parkinson's disease, frontotemporal dementia, or vascular dementia), a history of head trauma with persistent neurological deficits, or baseline neuroimaging indicating cortical stroke or severe ischemic disease

EX-3. Participants will be excluded if they have suffered from psychiatric conditions such as major depressive disorder (within the past year), bipolar disorder, or schizophrenia will be excluded

EX-4. Participants will be excluded if they have had recent substance use disorder (past 2 years)

EX-5. Participants will be excluded if they have unstable systemic illnesses including hepatic or renal failure

EX-6. Participants will be excluded if they have decompensated diabetes

EX-7. Participants will be excluded if they are taking medications with anticholinergic effects

EX-8. Participants will be excluded if they are taking dietary supplements containing nicotinamide mononucleotide (NMN) or nicotinamide riboside (NR)

EX-9. Participants will be excluded if they have significant spinal disease complicating lumbar puncture or with anticoagulant therapy (only for the CSF group)

EX-10. Participants will be excluded if they have participated in another investigational trial within the past 3 months or have medical conditions that could jeopardise their safety or affect study results, as judged by the investigator