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Parkinson DiseasePhase 2/3NCT04287543

Melatonin on Clock Genes in Parkinson's Disease

A Phase 2/3 study testing Melatonin in people with Parkinson Disease, run by Instituto Mexicano del Seguro Social at 1 site in Mexico.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Parkinson's disease (PD) is the second most important neurodegenerative disease that affects about 2% of the population over 60 years of age. About 40% of the Mexican population with PD suffer from sleep disorders, which has been linked to a deregulation of the circadian cycle and therefore of the clock genes. Read more about this study

Who is it for?
Ages 20 years and older
Conditions the study is for
Parkinson Disease
What is being tested?
Melatonin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
0 participants
Where
1 siteMexico
Study dates
May 2021to Aug 2022
Phase
Phase 2/3
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 20 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with diagnosis of PD in stages 1-3 of the classification by stages of Hoehn \& Yahr
  • Go with a companion to the appointments
  • Patients who agree to participate in the study and sign the Informed Consent letter

Who cannot join

  • Patients with movement disorder other than PD
  • Prior pallidotomy, thalamotomy or deep brain stimulation
  • Pregnant
  • Patients who consume alcohol or coffee
  • Patients who consume an antioxidant supplement

Trial locations and contacts

1 site in 1 country.

Mexico1 site

  • Instituto Mexicano del Seguro Social

    Guadalajara, Jalisco, 44340

Other trials in Mexico

About this study

Official title: Effect of Melatonin Administration on the PER1 and BMAL1 Clock Genes in Patients With Parkinson's Disease

Parkinson's disease (PD) is the second most important neurodegenerative disease that affects about 2% of the population over 60 years of age. About 40% of the Mexican population with PD suffer from sleep disorders, which has been linked to a deregulation of the circadian cycle and therefore of the clock genes. Melatonin is a hormone produced by the pineal gland that regulates the sleep-wake cycle, at pharmacological doses, it is used to decrease sleep disorders; it is suggested that is used could also normalize the levels of the clock genes expression. In rats with PD, a decrease in clock genes levels has been observed, which are restored by administering melatonin. The aim of the study is to evaluate the effect of melatonin on the expression of the PER1 and BMAL1 clock genes in patients with PD during 12 months. A controlled, double-blind, randomized clinical trial will be carried out in patients with a diagnosis of PD. A survey will be applied in order to know the course of the disease and two more tests to rule out some sleep disorder, at the beginning of the study, at the 6th month and at the 12th month. A blood sample (approximately 15 ml) will be taken every 3 months for a year. By random assignment, the participant will be given Melatonin or placebo, which should be taken every day in the morning and evening after meals for one year.

Read the detailed description

A controlled, double-blind, randomized clinical trial will be carried out in 58 patients with a diagnosis of PD. Twenty-nine patients will receive Melatonin and 29 placebo. A blood sample will be taken to determine the expression levels of the PER1 and BMAL1 clock genes by a real-time quantitative polymerase chain reaction (RT-qPCR), and as secondary variables, to determine the activity of the mitochondrial complex 1, the levels of malondialdehyde (MDA) and 4-hydroxyalkene (4-HDA) and the production of nitric oxide will be quantified by spectrophotometric methods. The SCOPA-Sleep and EPWORTH questionnaires will be applied to assess sleep. To evaluate the clinical evolution of PD in each patient, the UPDRS scale will be used. It will be given the assigned treatment, with the printed patient code. They will be supplemented with 50 mg of Melatonin at a dose of 25 mg orally every 12 hours for 12 months. The double-blind of the medication for this study will be maintained by the use of gels identical to the Melatonin supplement. The blind's break will only be authorized in case of emergency events that require it, and the date, time and reason for the break should be noted. It will be given a follow-up diary, and the patient will be explained how they should take the treatment and that they should record the date and time of administration, the description of adverse events that may occur, raising the patient's awareness that It is important to keep the diary and take it at each appointment to assess the attachment to treatment. Concerning the medications that patients ingest, before entering the protocol, it will be indicated to follow their usual administration. Finally, the patient will be instructed to schedule their appointment 3,6, 9 and 12 months later of starting treatment.

Being tested
Melatonin, Placebos
Keywords
melatonin, clock genes, BMAL1 gene, PER1 gene
Medical subject headings
Parkinson Disease

What participants receive

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

  • MelatoninDrug

    25 mg of melatonin gel at noon and 25 mg of melatonin gel 30 minutes before sleeping for 12 months

  • PlacebosDrug

    25 mg of placebo gel at noon and 25 mg of placebo gel 30 minutes before sleeping for 12 months

Study groups in NCT04287543
Study groupRoleWhat they receive
Melatonin groupExperimentalPatients with PD who will receive 25 mg of melatonin gel at 12 hours a day and half an hour before sleeping for 12 months
Receives: Drug: Melatonin
Placebo groupPlacebo comparatorPatients with PD who will receive 25 mg of placebo gel at 12 hours a day and half an hour before sleeping for 12 months
Receives: Drug: Placebos

What is being measured

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

  1. Expression levels of clock genes

    Relative ratio of messenger ribonucleic acid (mRNA) expression of PER1 and BMAL1 genes corresponding to a control (GAPDH) for each sample, measured by an RT-qPCR.

    Measured: Change from baseline at third, sixth, ninth and twelfth month

Secondary outcomes (7)

  1. SCOPA-Sleep scale

    It is a specific instrument for the evaluation of sleep disorders in patients with PD. It is self-applicable and consists of two subscales; the first assess nighttime sleep and the second daytime sleepiness during the last month. The score greater than seven of five points respectively indicates abnormal sleepiness. Additionally, the SCOPA-Sleep scale has a question of global sleep evaluation.

    Measured: Change from baseline at third, sixth, ninth and twelfth month

  2. Epworth scale

    Is an eight-item self-applicable instrument developed to assess the propensity to fall asleep in eight situations, mostly monotonous. A total score of less than 10 was considered normal, 10-12 as indicative of marginal drowsiness and above 12 suggestive of excessive drowsiness.

    Measured: Change from baseline at third, sixth, ninth and twelfth month

  3. Progression of PD

    For the longitudinal follow-up of the PD course, the Unified Parkinson's Disease Rating Scale (UPDRS) will be applied through an interview. The scale is composed by four parts: mental, behavioral and mood; activities of daily living; motor evaluation; and motor complications. The scoring range is from 0 to 199, where "199" represents total disability and "0" without disability.

    Measured: Change from baseline at third, sixth, ninth and twelfth month

  4. Anxiety

    To assess the severity of a person's anxiety symptoms and discriminate between anxiety and depression symptoms the Beck anxiety inventory will be use.

    The rating is made through a likert scale of 0 to 3, where 0 means absence of the symptom and 3 maximum severity. The total score is obtained from the sum of the 21 reagents, 0 is the minimum and 63 is the maximum. In the Mexican population, a score of 0-5 points will be minimal anxiety, 6-15 mild anxiety, 16-30 moderate anxiety and 31-63 severe anxiety.

    Measured: Change from baseline at third, sixth, ninth and twelfth month

  5. Depression

    To evaluate the severity of depression symptoms the Beck's depression inventory will be use. The rating is made through a likert scale of 0 to 3, where 0 means absence of the symptom and 3 maximum severity. The total score is obtained from the sum of the 21 reagents, 0 is the minimum and 63 is the maximum. In the Mexican population, a score of 0-9 points will be considered normal, 10-16 mild depression, 17-29 moderate depression, and 30-63 severe depression.

    Measured: Change from baseline at third, sixth, ninth and twelfth month

  6. Activity of the mitochondrial complex 1

    To measure the mitochondrial complex I, a spectrophotometric assay will be used, it measures the oxidation of rotenone-sensitive nicotinamide-adenine dinucleotide (NADH) at 340 nm in mitochondria-enriched fractions

    Measured: Change from baseline at third, sixth, ninth and twelfth month

  7. Oxidative stress

    Products of nitric oxide metabolism and products of lipoperoxidation such as malondialdehyde and 4-hydroxyalkene by spectrophotometry will be measured

    Measured: Change from baseline at third, sixth, ninth and twelfth month

Timeline

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

  1. First posted27 Feb 2020
  2. Study startMay 2021 (estimated)
  3. Primary completionJul 2022 (estimated)
  4. Study completionAug 2022 (estimated)

Why it stopped: Due to the COVID-19 pandemic, we were unable to begin the study

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 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04287543
Sponsor's protocol ID
R-2018-785-019
Status last verified
Jul 2020
First submitted
21 Feb 2020
Last updated
4 Aug 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: It is planned to inform the patient individually about their results; if the results are favorable it will be considered to apply them to the Clinical of Movement Disorders patients. All data will be published in an article.

Publications

  • Poewe W, Seppi K, Tanner CM, Halliday GM, Brundin P, Volkmann J, Schrag AE, Lang AE. Parkinson disease. Nat Rev Dis Primers. 2017 Mar 23;3:17013. doi: 10.1038/nrdp.2017.13.

    PubMed 28332488

  • Barzilai A, Melamed E. Molecular mechanisms of selective dopaminergic neuronal death in Parkinson's disease. Trends Mol Med. 2003 Mar;9(3):126-32. doi: 10.1016/s1471-4914(03)00020-0.

    PubMed 12657434

  • Shadrina MI, Slominsky PA, Limborska SA. Molecular mechanisms of pathogenesis of Parkinson's disease. Int Rev Cell Mol Biol. 2010;281:229-66. doi: 10.1016/S1937-6448(10)81006-8.

    PubMed 20460187

  • Chung S, Bohnen NI, Albin RL, Frey KA, Muller ML, Chervin RD. Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. J Clin Sleep Med. 2013 Nov 15;9(11):1131-7. doi: 10.5664/jcsm.3150.

    PubMed 24235893

  • Breen DP, Vuono R, Nawarathna U, Fisher K, Shneerson JM, Reddy AB, Barker RA. Sleep and circadian rhythm regulation in early Parkinson disease. JAMA Neurol. 2014 May;71(5):589-595. doi: 10.1001/jamaneurol.2014.65.

    PubMed 24687146

  • Cai Y, Liu S, Sothern RB, Xu S, Chan P. Expression of clock genes Per1 and Bmal1 in total leukocytes in health and Parkinson's disease. Eur J Neurol. 2010 Apr;17(4):550-4. doi: 10.1111/j.1468-1331.2009.02848.x. Epub 2009 Nov 12.

    PubMed 19912323

  • Videnovic A, Willis GL. Circadian system - A novel diagnostic and therapeutic target in Parkinson's disease? Mov Disord. 2016 Mar;31(3):260-9. doi: 10.1002/mds.26509. Epub 2016 Jan 30.

    PubMed 26826022

  • Cardinali DP, Pagano ES, Scacchi Bernasconi PA, Reynoso R, Scacchi P. Melatonin and mitochondrial dysfunction in the central nervous system. Horm Behav. 2013 Feb;63(2):322-30. doi: 10.1016/j.yhbeh.2012.02.020. Epub 2012 Feb 25.

    PubMed 22391273

  • Videnovic A, Golombek D. Circadian Dysregulation in Parkinson's Disease. Neurobiol Sleep Circadian Rhythms. 2017 Jan;2:53-58. doi: 10.1016/j.nbscr.2016.11.001. Epub 2016 Nov 12.

    PubMed 28713867

  • Elbaz A, Carcaillon L, Kab S, Moisan F. Epidemiology of Parkinson's disease. Rev Neurol (Paris). 2016 Jan;172(1):14-26. doi: 10.1016/j.neurol.2015.09.012. Epub 2015 Dec 21.

    PubMed 26718594

  • Perfeito R, Cunha-Oliveira T, Rego AC. Reprint of: revisiting oxidative stress and mitochondrial dysfunction in the pathogenesis of Parkinson disease-resemblance to the effect of amphetamine drugs of abuse. Free Radic Biol Med. 2013 Sep;62:186-201. doi: 10.1016/j.freeradbiomed.2013.05.042. Epub 2013 Jun 3.

    PubMed 23743292

  • Abou-Sleiman PM, Muqit MM, Wood NW. Expanding insights of mitochondrial dysfunction in Parkinson's disease. Nat Rev Neurosci. 2006 Mar;7(3):207-19. doi: 10.1038/nrn1868.

    PubMed 16495942

  • Mattam U, Jagota A. Daily rhythms of serotonin metabolism and the expression of clock genes in suprachiasmatic nucleus of rotenone-induced Parkinson's disease male Wistar rat model and effect of melatonin administration. Biogerontology. 2015 Feb;16(1):109-23. doi: 10.1007/s10522-014-9541-0. Epub 2014 Nov 28.

    PubMed 25430725

  • Ortiz GG, Benitez-King GA, Rosales-Corral SA, Pacheco-Moises FP, Velazquez-Brizuela IE. Cellular and biochemical actions of melatonin which protect against free radicals: role in neurodegenerative disorders. Curr Neuropharmacol. 2008 Sep;6(3):203-14. doi: 10.2174/157015908785777201.

    PubMed 19506721

  • Ortiz GG, Pacheco-Moises FP, Gomez-Rodriguez VM, Gonzalez-Renovato ED, Torres-Sanchez ED, Ramirez-Anguiano AC. Fish oil, melatonin and vitamin E attenuates midbrain cyclooxygenase-2 activity and oxidative stress after the administration of 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine. Metab Brain Dis. 2013 Dec;28(4):705-9. doi: 10.1007/s11011-013-9416-0. Epub 2013 May 24.

    PubMed 23703110

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Melatonin in people with Parkinson Disease, run by Instituto Mexicano del Seguro Social at 1 site in Mexico.

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 3 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: withdrawn, as of the sponsor's last update on 4 Aug 2020. 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 Mexico. 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. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

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?

Expression levels of clock genes (time frame: Change from baseline at third, sixth, ninth and twelfth month). 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 NCT04287543, which also lists 40 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 4 Aug 2020.

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