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Arterial StiffnessPhase 2ACENCT05741060

Effect of Equol Supplementation on Arterial Stiffness and Cognition in Healthy Volunteers

A Phase 2 study testing S-equol in people with Arterial Stiffness and White Matter Lesions, run by Akira Sekikawa at 3 sites in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The ACE Trial, funded by the National Institute on Ageing/National Institutes of Health (NIH), is a multicenter clinical trial. The ACE Trial will determine if taking the dietary supplement Equol could slow the progression of stiffening of the arteries, small blood vessel disease in the brain and memory decline. Read more about this study

Who is it for?
Ages 65 to 85 yearsHealthy volunteers can take part
What is being tested?
S-equol
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
369 participants
Where
3 sitesUnited States
Study dates
29 Jun 2023to 31 Jan 2027
Phase
Phase 2
Are there results?
Not yet: the study is under way

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 65 to 85 years
  • All sexes
  • Healthy volunteers accepted
  • Older adult

Who may be able to join

  • Men and women age between 65 and 85 at entry of European Americans or African Americans
  • Individuals who are able to provide informed consent
  • Individuals who are willing to be randomized to the intervention or placebo group

Who cannot join

  • Individuals who are regularly taking isoflavone supplements or eat soy product ≥ 2 times a week (by specific questionnaire)
  • Individuals who do not agree to maintain isoflavone supplements or soy product intake described above during the study period.
  • Individuals who have allergy or intolerance to soy isoflavones.
  • Individuals whose score for the Telephone Interview for Cognitive Status is 22 and below.
  • Individuals with stroke, neurological disorders, bipolar disease whether or not under medical treatment, cancer treatment in the past 6 months, head trauma or other condition which is not appropriate for the study (e.g., contraindication to magnetic resonance imaging (MRI)).
  • Individuals with untreated depression
Show all 45Show fewer
  • Individuals with atrial fibrillation
  • Individuals with heart failure
  • Individuals with heart attack or coronary intervention in the past 6 months
  • Individuals with carotid endarterectomy or peripheral artery disease
  • Individuals currently undergoing treatment for pulmonary embolism or deep vein thrombosis
  • Individuals with aortic (abdominal, thoracic) aneurysm
  • Individuals with inflammatory bowel diseases
  • Individuals currently undergoing hemodialysis
  • Women with a past or family history of breast cancer.*1
  • Women on estrogen replacement therapy
  • Individuals unable to lay supine for 30-60 minutes
  • Individuals with weight ≥300 lbs
  • Individuals who are planning to move out of the area in the next 2 years
  • Individuals who participated in another clinical trial in the past 3 months
  • Individuals with Quick Dementia Rating System (QDRS) score ≥ 6.0
  • Individuals who are regularly taking isoflavone supplements or eat soy product ≥ 2 times a week (by specific questionnaire)
  • Individuals who do not agree to maintain isoflavone supplements or soy product intake described above during the study period.
  • Individuals who have allergy or intolerance to soy isoflavones.
  • Blood pressure (BP) - systolic BP ≥ 180 mmHg or diastolic BP ≥ 110 mmHg
  • Heart rate ≥110 or ≤40
  • Hemoglobin \<10 g/dL
  • HbA1c ≥ 7.5%
  • Blood creatinine \> 2.0 mg/dL
  • Liver function tests \> 2 X upper limit of normal
  • Abnormal thyroid function (Thyroid Stimulating Hormone)
  • Vitamin B12 levels ≤ 210 pg/mL
  • Hematocrit \<30%
  • White blood cell count \<3,000 or \>15,000
  • Platelet count \<100,000 or \>600,000
  • Urinary protein ≥ + by dipstick
  • Any condition or therapy which, in the opinion of the investigator, might pose a risk to the participant or make participation in the study not in the participant's best interest
  • In addition, individuals with the following condition will be excluded because these conditions do not allow subjects to undergo examinations the investigators proposed in the project:
  • Those who are contraindicated for 3 Tesla (3T) structural brain magnetic resonance imaging (MRI) such as pacemakers.
  • Atrial fibrillation because pulse wave velocity is not accurately measured.
  • Hearing impairment which interferes with cognitive testing
  • Vision impairment which interferes with cognitive testing
  • Exclusion criteria at structural brain MRI Any other conditions which, in the opinion of the investigator, might pose a risk to the participant or make participation in the study not in the participant's best interest
  • 1 Few studies have investigated the association of equol, a metabolite of soy isoflavone daidzein, with breast cancer. These studies reported no significant association of serum or urine equol with the risk of breast cancer. Dietary intake of soy and soy isoflavones is generally considered to have benefits for menopausal symptoms, cardiovascular health, bone health, and cancers of the breast and prostate. Observational studies show that soy consumption is associated with a reduced risk of many cancers including breast cancer. Moreover, a prospective cohort study of 6,000+ North American women with breast cancer showed that dietary intake of soy and isoflavones was associated with reduced all-cause mortality. However, there is little evidence to support that the use of supplements containing soy isoflavones or soy protein powder to reduce cancer risk. A recent large prospective cohort study in France reported that supplementation of soy isoflavones increased the risk of estrogen receptor-negative breast cancer, especially among women who had a history of breast cancer in first-degree relatives.
  • The investigators recruit subjects without dementia. Thus, at the initial screening by phone, the investigators exclude individuals whose score for the Telephone Interview for Cognitive Status is 22 and below. Then, at the screening visit, investigators will exclude individuals with a Quick Dementia Rating System score ≥ 6.0.

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • Emory University

    Atlanta, Georgia, 30322

  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15213

  • Wake Forest University Health Sciences

    Winston-Salem, North Carolina, 27157

Other trials in United States

About this study

Official title: Arterial Stiffness, Cognition and Equol

The ACE Trial, funded by the National Institute on Ageing/National Institutes of Health (NIH), is a multicenter clinical trial. The ACE Trial will determine if taking the dietary supplement Equol could slow the progression of stiffening of the arteries, small blood vessel disease in the brain and memory decline. Equol is a soy-based supplement that has plant estrogen-like compounds in it.

Equol is a metabolite of soy isoflavone. Our studies in Japan and other studies suggest that Equol may slow mechanisms related to memory decline. No previous studies in the United States have tested the effect of Equol on these mechanisms or memory decline. Supplementation of Equol in the ACE Trial is approved by the Food and Drug Administration (FDA).

Read more

Researchers at the University of Pittsburgh, Pittsburgh, Pennsylvania, Wake Forest University, Winston-Salem, North Carolina, and Emory University, Atlanta, Georgia, are recruiting participants.

The ACE Trial will ask participants to complete 7 clinic visits over a two-year period. The participants are asked to take Equol tablets daily for 24 months. Clinic procedures include Pulse Wave Velocity (to measure arterial stiffness), Magnetic Resonance Imaging (MRI) of the brain and tests of awareness and thinking.

Read the detailed description

The ACE trial is an early-stage multi-center randomized controlled trial (RCT) designed to test the effect of a 24-month intervention of 10 mg/day equol supplementation on arterial stiffness, white matter lesions (WMLs) in the brain and cognitive decline among 400 individuals aged 65 and 85 without dementia. Recent studies in Japan reported that a diet high in soy and soy isoflavones is inversely associated with incident cognitive impairment and dementia. The Women's Isoflavone Soy Health (WISH) in the US, an RCT of soy isoflavones, however, showed no significant effect on cognition. We posit that the discrepant result is due to the difference in equol-producing capability. Equol, a metabolite of soy isoflavone daidzein transformed by the gut microbiome, is the most bioactive among all soy isoflavones and their metabolites. 50-70% of Japanese convert daidzein to equol in contrast to 20-30% of Americans. Arterial stiffness, a significant predictor of cognitive decline, is significantly improved in a short-duration RCT of 10 mg/day equol supplementation in middle-aged subjects. WMLs are a risk factor for age-related cognitive decline and dementia. We reported a longitudinal association of equol-producing status with WML% (WML volume normalized to total brain volume) in cognitively normal elderly in Japan. The subgroup analysis of WISH showed that equol producers had better cognition than the control group, suggesting that equol may slow cognitive decline. No previous study has tested the effect of equol supplementation on arterial stiffness, WMLs or cognitive decline in older adults.

Being tested
S-equol, Placebo
Keywords
s-equol, white matter lesion volume, vascular contributions to cognitive impairment and dementia, arterial stiffness, Alzheimer's disease and related dementias, estrogen receptor-beta agonist
Medical subject headings
Cognitive Dysfunction, Dementia, Alzheimer Disease

What participants receive

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

  • S-equolDrug

    Also called Equelle

    Experimental drug

  • PlaceboDrug

    Placebo - 10 mg per day for 24 months of tablets that will be the same size/shape/color as the s-equol tablets.

Study groups in NCT05741060
Study groupRoleWhat they receive
Equol ArmExperimentalS-equol - 10 mg per day tablet for 24 months.
Receives: Drug: S-equol
Placebo ArmPlacebo comparator10 mg per day for 24 months of tablets that will be of the same size/shape/color as the experimental tablet.
Receives: Drug: Placebo

What is being measured

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

  1. Change in arterial stiffness

    Arterial stiffness describes the rigidity of the arterial wall and is a significant predictor of cognitive decline. Arterial stiffness will be measured by pulse wave velocity (m/s) with a SphygmoCor device (Sydney, Australia). The range of pulse wave velocity is from 5 to 20 m/s.

    Measured: Change from baseline in arterial stiffness at 12 months

  2. Change in arterial stiffness

    Arterial stiffness describes the rigidity of the arterial wall and is a significant predictor of cognitive decline. Arterial stiffness will be measured by pulse wave velocity (m/s) with a SphygmoCor device (Sydney, Australia). The range of pulse wave velocity is from 5 to 20 m/s.

    Measured: Change from baseline in arterial stiffness at 24 months

Secondary outcomes (3)
  1. Change in white matter lesion (WML) volume percent

    WMLs are a significant predictor of cognitive decline. WMLs will be measured using an automated brain magnetic resonance imaging method. WML volume percent will be calculated by dividing WML volume by total brain volume as a percentage. The range of WML volume percent is from 0 to 4.2%.

    Measured: Change from baseline in WML volume percent at 24 months

  2. Change in cognitive score measured by the Preclinical Alzheimer's Cognitive Composite-5 (PACC-5) score

    The PACC-5 is a composite neuropsychological measure optimized to detect subtle changes over time in cognitively unimpaired older adults. The range of PACC-5 score is from -3 to 3.

    Measured: Change from baseline in cognitive score measured by the PACC-5 at 12 months

  3. Change in cognitive score measured by the Preclinical Alzheimer's Cognitive Composite-5 (PACC-5) score.

    The PACC-5 is a composite neuropsychological measure optimized to detect subtle changes over time in cognitively unimpaired older adults. The range of PACC-5 score is from -3 to 3 where 3 represents better cognition.

    Measured: Change from baseline in cognitive score measured by the PACC-5 at 24 months

Timeline

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

  1. First posted23 Feb 2023
  2. Study start29 Jun 2023
  3. Primary completion29 Oct 2026
  4. Study completion31 Jan 2027 (estimated)

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
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
The ACE Trial is an early stage multi-center randomized, parallel, double-blind placebo-controlled trial of 10 mg/day of equol for 24 months.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
369 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05741060
Sponsor's protocol ID
STUDY22010165
Other IDs
R01AG074971
Acronym
ACE
Status last verified
Aug 2026
First submitted
13 Feb 2023
Last updated
5 Nov 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: The Center for Clinical Trial \& Data Coordination (CCDC), University of Pittsburgh, has rich experience as the Data Core (DC) for other NIH-funded studies, in reporting to and providing final datasets for an NIH Central Data Repository. The final dataset(s) will include demographic and clinical data at baseline, study arm assignment, and all primary and secondary outcomes for the ACE trial. The final dataset(s) will be completely de-identified. These data will be released to an NIH Central Data Repository no later than 1 year after the end of the clinical activity (final patient follow-up, etc.) or immediately after the main paper of the trial has been published, whichever comes first. The files available will include original copies of the case report forms, a detailed codebook of variable names, value labels, formats, missing data reports, and linkage files for samples. The analytic dataset may also include derived variables that were created during the analytic process.

Publications

  • Sekikawa A, Wharton W, Butts B, Veliky CV, Garfein J, Li J, Goon S, Fort A, Li M, Hughes TM. Potential Protective Mechanisms of S-equol, a Metabolite of Soy Isoflavone by the Gut Microbiome, on Cognitive Decline and Dementia. Int J Mol Sci. 2022 Oct 7;23(19):11921. doi: 10.3390/ijms231911921.

    PubMed 36233223
  • Sekikawa A, Wharton W, Murray-Krezan C, Wu M, Chang Y, Snitz BE, Coccari M, Yang S, Love ML, Cusick D, Wang R, Li M, Park C, Li J, DeConne TM, Smith C, Verble DD, Lancet MQ, Foroud T, Kim T, Nadkarni NK, Mettenburg JM, Zamora E, Lopez OL, Hughes TM. ACE trial design: Equol targeting estrogen receptor-beta in vascular and cognitive aging. Alzheimers Dement (N Y). 2025 Aug 18;11(3):e70144. doi: 10.1002/trc2.70144. eCollection 2025 Jul-Sep.

    PubMed 40838083

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing S-equol in people with Arterial Stiffness and White Matter Lesions, run by Akira Sekikawa at 3 sites 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 3 inclusion and 45 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: under way, not looking for participants, as of the sponsor's last update on 5 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites 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. 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 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.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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?

Change in arterial stiffness (time frame: Change from baseline in arterial stiffness at 12 months). The study lists 2 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 NCT05741060, which also lists 2 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 5 Nov 2026.

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