Down syndrome (DS), or trisomy 21, is caused by a triplication of chromosome 21. This chromosome encodes many genes including amyloid protein precursor (APP), which expresses ?-Amyloid (A?). Consequently, this results in excess production of A?. Virtually all people affected with DS show the neuropathological changes related to A? by age 40. The amyloid plaques found at autopsy in individuals with DS is identical to those found in individuals with Alzheimer's disease in the non-DS population. Therefore people with DS doubtlessly represent predictable AD cases. This raises the question as to whether individuals with DS could benefit from ongoing efforts to develop disease modifying anti- amyloid interventions for sporadic AD. And, in turn, provide important insights about the efficacy and timing of such interventions targeting sporadic AD in the general population. ACI-24 is a vaccine composed of a palmitoylated A? peptide anchored in liposomes and mixed with the monophosphoryl lipid A (MPLA) adjuvant. ACI-24 induces antibodies against A? and thereby lowers soluble A?. In addition, ACI-24 induces an anti-A? antibody response that is largely independent from T- cell activation and, therefore, is expected to exert a favorable safety profile As a proof-of-concept study, Ts65Dn mice have been immunized with ACI-DS-01 (murine equivalent of ACI-24), and a robust antibody response and an improvement in memory capacity has been observed. This work has demonstrated the beneficial effect of ACI-24 as anti-A? vaccine for the treatment of cognitive decline in DS. The preclinical safety data as well as the ongoing Phase I/II clinical trial in AD indicate a favorable safety profile for ACI-24. The propose study will investigate the safety, tolerability, as well as immunogenicity of the ACI-24 vaccine in a Phase I clinical trial in adults with DS aged 35-55. Effects on cognitive function and AD biomarkers will be secondary endpoints. This project will be testing the first immunotherapy for the treatment of Alzheimer's disease in Down syndrome.
R01 PAR (PAR-11-100) - Project narrative (relevance) Down syndrome (DS) is a population highly enriched for people who will, with very high probability, develop Alzheimer's disease (AD). This raises the possibility that individuals with DS could benefit from ongoing efforts to develop disease modifying anti-amyloid interventions for sporadic AD and, in turn, provide important insights about the efficacy and timing of such interventions targeting sporadic AD in the general population. With this proposal, the Alzheimer's Disease Cooperative Study (ADCS) aims to evaluate the first anti-amyloid immunotherapy for adults with DS in a Phase I, randomized, double-blind, placebo-controlled, clinical trial (ACI-24-1301) using the active immunotherapeutic ACI-24.