Deoxynucleosides Pyrimidines as Treatment for Mitochondrial Depletion Syndrome

NCT04802707 | Recruiting Phase 2 DMC

• 1 other identifier: 2021-7654 dC-dT-MDS
• Study Type: interventional
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

Mitochondrial DNA (mtDNA) depletion syndromes (MDS) are a genetically and clinically heterogeneous group of autosomal recessive disorders that are characterized by a severe reduction in mtDNA content leading to impaired energy production in affected tissues and organs. MDS are due to defects in mtDNA maintenance caused by mutations in nuclear genes that function in either mitochondrial nucleotide synthesis. MDS are phenotypically heterogeneous and usually classified as myopathic, encephalomyopathic, hepatocerebral or neurogastrointestinal. No efficacious therapy is available for any of these disorders. Affected individuals should have a comprehensive evaluation to assess the degree of involvement of different systems. Treatment is directed mainly toward providing symptomatic management. No treatment for MDS. Clinical trials studies and in vitro/in vivo research studies showed that the enhancement of the salvage pathway by increasing the availability of deoxyribonucleosides needed for each specific genetic defect prevents mtDNA depletion. Early recognition and immediate therapy to restore mitochondrial function could potentially improve clinical course. Confirming the benefit of deoxynucleosides as a safe and potentially efficacious therapy, will lead to the availability of the first specific and effective treatment for Mitochondria Depletion Disorders. In this phase II Trial a mix of Deoxynucleosides Pyrimidine (Deoxycytidine dC and Deoxythymidine dT) will be used as early treatment of MDS. The dose used has been already used in other clinical trials, and appears to effective and well-tolerated. The subjects included are children (0-18Y), with positive MDS diagnosis and express mutations in one of the following genes: POLG, POLG2, C10orf2, RRM2B, MPV17, SUCLA2, SUCLG1, FBXL4, DTYMK. Subjects with MDS expressing neurological phenotypes dysfunction.

Conditions

Mitochondrial Diseases; Mitochondrial Encephalomyopathy; Mitochondrial Encephalopathy; Mitochondrial DNA Depletion; Mitochondrial Metabolism Disorders

Keywords

Deoxycytidine; Deoxythymidine; Deoxynucleoside; Pyrimidine; Mitochondria; mtDNA; Depletion

Outcome Measures

Primary Outcomes (1)

• Rate of Responder versus Non-Responder Status with investigational product

  There is no estimation of sample size, the number will depend on subjects enrolled. We assume we can include about 50 to 100 subjects with mitochondrial depletion disorder. This study is designed as Phase II trial case series, the data will be presented graphically The IP of study will be considered positive if more than 2 responders are observed in 5 subjects. This design yields a marginal one-sided type I error rate (α) of 5% and power of 80%. For more than one participant engages in a study, the spaghetti plot showing all of their data in the same figure will be used as tool for visualization. Visual analysis of graphed data has been the traditional method for evaluating treatment effects in series cases research.

  260 weeks

Secondary Outcomes (1)

• Number of participants experiencing dose-limiting toxicities, adverse events (AEs), serious adverse events (SAEs)

  260 weeks

Study Arms (1)

dC/dT100-400 Arm

EXPERIMENTAL

Children \& Adult (0-60 Y), who takes the investigational product deoxynucleosides pyrimidine (mix of deoxycytidine and deoxythymidine), following the protocol.

Combination Product: deoxycytidine and deoxythymidine

Interventions

deoxycytidine and deoxythymidine COMBINATION_PRODUCT

The Investigational Product (IP) dC/dT100-400 will be administered orally every day (QD) and the dose is divided over trid or bid for the daily dose of 100 mg/kg from Day 1-7, 200 mg/kg from Day 8-14, 300 mg/kg from Day 15- 21 and 400 mg/kg from Day 22 to 1825. Doses was chosen according to the safety and efficacy doses used in the literature.

dC/dT100-400 Arm

Eligibility Criteria

• Age: 1 Month - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Children \& Adults (0 -60 Y)
• Written informed consent obtained,
• Clinical Diagnosis of a Mitochondrial Depletion Disorder.
• Pathogenic variant(s) Homozygote and Heterozygote in one of the following genes: POLG, POLG2, C10orf2, RRM2B, MPV17, SUCLA2, SUCLG1, FBXL4, DTYMK
• Females of childbearing age:
• Negative urinary pregnancy test at screening Agree to use effective contraception for the duration of the study

You may not qualify if:

• Inability of a parent or legal guardian to give informed consent for any reason
• Chronic severe diarrhea

Sponsors & Collaborators

• Kenneth Myers, MD: lead

Study Sites (1)

Research InstituMcGill University Health Centre - Children Hospital of Montreal

Montreal, Quebec, H4A 3J1, Canada

RECRUITING

Related Publications (68)

• Osellame LD, Blacker TS, Duchen MR. Cellular and molecular mechanisms of mitochondrial function. Best Pract Res Clin Endocrinol Metab. 2012 Dec;26(6):711-23. doi: 10.1016/j.beem.2012.05.003. Epub 2012 Jun 23.

  PMID: 23168274 BACKGROUND

• Miller FJ, Rosenfeldt FL, Zhang C, Linnane AW, Nagley P. Precise determination of mitochondrial DNA copy number in human skeletal and cardiac muscle by a PCR-based assay: lack of change of copy number with age. Nucleic Acids Res. 2003 Jun 1;31(11):e61. doi: 10.1093/nar/gng060.

  PMID: 12771225 BACKGROUND

• DiMauro S, Schon EA. Mitochondrial respiratory-chain diseases. N Engl J Med. 2003 Jun 26;348(26):2656-68. doi: 10.1056/NEJMra022567. No abstract available.

  PMID: 12826641 BACKGROUND

• Huang CC, Hsu CH. [Mitochondrial disease and mitochondrial DNA depletion syndromes]. Acta Neurol Taiwan. 2009 Dec;18(4):287-95. Chinese.

  PMID: 20329599 BACKGROUND

• Rusecka J, Kaliszewska M, Bartnik E, Tonska K. Nuclear genes involved in mitochondrial diseases caused by instability of mitochondrial DNA. J Appl Genet. 2018 Feb;59(1):43-57. doi: 10.1007/s13353-017-0424-3. Epub 2018 Jan 17.

  PMID: 29344903 BACKGROUND

• Viscomi C, Zeviani M. MtDNA-maintenance defects: syndromes and genes. J Inherit Metab Dis. 2017 Jul;40(4):587-599. doi: 10.1007/s10545-017-0027-5. Epub 2017 Mar 21.

  PMID: 28324239 BACKGROUND

• Blazquez-Bermejo C, Carreno-Gago L, Molina-Granada D, Aguirre J, Ramon J, Torres-Torronteras J, Cabrera-Perez R, Martin MA, Dominguez-Gonzalez C, de la Cruz X, Lombes A, Garcia-Arumi E, Marti R, Camara Y. Increased dNTP pools rescue mtDNA depletion in human POLG-deficient fibroblasts. FASEB J. 2019 Jun;33(6):7168-7179. doi: 10.1096/fj.201801591R. Epub 2019 Mar 8.

  PMID: 30848931 BACKGROUND

• El-Hattab AW, Scaglia F. Mitochondrial DNA depletion syndromes: review and updates of genetic basis, manifestations, and therapeutic options. Neurotherapeutics. 2013 Apr;10(2):186-98. doi: 10.1007/s13311-013-0177-6.

  PMID: 23385875 BACKGROUND

• Nogueira C, Almeida LS, Nesti C, Pezzini I, Videira A, Vilarinho L, Santorelli FM. Syndromes associated with mitochondrial DNA depletion. Ital J Pediatr. 2014 Apr 3;40:34. doi: 10.1186/1824-7288-40-34.

  PMID: 24708634 BACKGROUND

• Basel D. Mitochondrial DNA Depletion Syndromes. Clin Perinatol. 2020 Mar;47(1):123-141. doi: 10.1016/j.clp.2019.10.008. Epub 2019 Oct 31.

  PMID: 32000920 BACKGROUND

• Rahman S, Poulton J. Diagnosis of mitochondrial DNA depletion syndromes. Arch Dis Child. 2009 Jan;94(1):3-5. doi: 10.1136/adc.2008.147983. No abstract available.

  PMID: 19103785 BACKGROUND

• Spinazzola A, Invernizzi F, Carrara F, Lamantea E, Donati A, Dirocco M, Giordano I, Meznaric-Petrusa M, Baruffini E, Ferrero I, Zeviani M. Clinical and molecular features of mitochondrial DNA depletion syndromes. J Inherit Metab Dis. 2009 Apr;32(2):143-58. doi: 10.1007/s10545-008-1038-z. Epub 2008 Dec 27.

  PMID: 19125351 BACKGROUND

• Suomalainen A, Isohanni P. Mitochondrial DNA depletion syndromes--many genes, common mechanisms. Neuromuscul Disord. 2010 Jul;20(7):429-37. doi: 10.1016/j.nmd.2010.03.017. Epub 2010 May 4.

  PMID: 20444604 BACKGROUND

• Copeland WC. Defects in mitochondrial DNA replication and human disease. Crit Rev Biochem Mol Biol. 2012 Jan-Feb;47(1):64-74. doi: 10.3109/10409238.2011.632763.

  PMID: 22176657 BACKGROUND

• Khan NA, Govindaraj P, Meena AK, Thangaraj K. Mitochondrial disorders: challenges in diagnosis & treatment. Indian J Med Res. 2015 Jan;141(1):13-26. doi: 10.4103/0971-5916.154489.

  PMID: 25857492 BACKGROUND

• Hikmat O, Eichele T, Tzoulis C, Bindoff LA. Understanding the Epilepsy in POLG Related Disease. Int J Mol Sci. 2017 Aug 24;18(9):1845. doi: 10.3390/ijms18091845.

  PMID: 28837072 BACKGROUND

• El-Hattab AW, Craigen WJ, Scaglia F. Mitochondrial DNA maintenance defects. Biochim Biophys Acta Mol Basis Dis. 2017 Jun;1863(6):1539-1555. doi: 10.1016/j.bbadis.2017.02.017. Epub 2017 Feb 16.

  PMID: 28215579 BACKGROUND

• El-Hattab AW, Craigen WJ, Wong LJC, Scaglia F. Mitochondrial DNA Maintenance Defects Overview. 2018 Mar 8. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews(R) [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2026. Available from http://www.ncbi.nlm.nih.gov/books/NBK487393/

  PMID: 29517884 BACKGROUND

• Copeland WC. Defects of mitochondrial DNA replication. J Child Neurol. 2014 Sep;29(9):1216-24. doi: 10.1177/0883073814537380. Epub 2014 Jun 30.

  PMID: 24985751 BACKGROUND

• Spinazzola A, Zeviani M. Disorders from perturbations of nuclear-mitochondrial intergenomic cross-talk. J Intern Med. 2009 Feb;265(2):174-92. doi: 10.1111/j.1365-2796.2008.02059.x.

  PMID: 19192035 BACKGROUND

• Cohen, B.H., P.F. Chinnery, and W.C. Copeland, POLG-Related Disorders, in GeneReviews((R)), M.P. Adam, et al., Editors. 1993: Seattle (WA).

  BACKGROUND

• Milone M, Benarroch EE, Wong LJ. POLG-related disorders: defects of the nuclear and mitochondrial genome interaction. Neurology. 2011 Nov 15;77(20):1847-52. doi: 10.1212/WNL.0b013e318238863a. No abstract available.

  PMID: 22084276 BACKGROUND

• Rahman S, Copeland WC. POLG-related disorders and their neurological manifestations. Nat Rev Neurol. 2019 Jan;15(1):40-52. doi: 10.1038/s41582-018-0101-0.

  PMID: 30451971 BACKGROUND

• Anagnostou ME, Ng YS, Taylor RW, McFarland R. Epilepsy due to mutations in the mitochondrial polymerase gamma (POLG) gene: A clinical and molecular genetic review. Epilepsia. 2016 Oct;57(10):1531-1545. doi: 10.1111/epi.13508. Epub 2016 Aug 24.

  PMID: 27554452 BACKGROUND

• Engelsen BA, Tzoulis C, Karlsen B, Lillebo A, Laegreid LM, Aasly J, Zeviani M, Bindoff LA. POLG1 mutations cause a syndromic epilepsy with occipital lobe predilection. Brain. 2008 Mar;131(Pt 3):818-28. doi: 10.1093/brain/awn007. Epub 2008 Jan 30.

  PMID: 18238797 BACKGROUND

• Horvath R, Hudson G, Ferrari G, Futterer N, Ahola S, Lamantea E, Prokisch H, Lochmuller H, McFarland R, Ramesh V, Klopstock T, Freisinger P, Salvi F, Mayr JA, Santer R, Tesarova M, Zeman J, Udd B, Taylor RW, Turnbull D, Hanna M, Fialho D, Suomalainen A, Zeviani M, Chinnery PF. Phenotypic spectrum associated with mutations of the mitochondrial polymerase gamma gene. Brain. 2006 Jul;129(Pt 7):1674-84. doi: 10.1093/brain/awl088. Epub 2006 Apr 18.

  PMID: 16621917 BACKGROUND

• Hikmat O, Tzoulis C, Chong WK, Chentouf L, Klingenberg C, Fratter C, Carr LJ, Prabhakar P, Kumaraguru N, Gissen P, Cross JH, Jacques TS, Taanman JW, Bindoff LA, Rahman S. Correction: The clinical spectrum and natural history of early-onset diseases due to DNA polymerase gamma mutations. Genet Med. 2019 Apr;21(4):1027. doi: 10.1038/s41436-018-0098-1.

  PMID: 30228318 BACKGROUND

• Lim A, Thomas RH. The mitochondrial epilepsies. Eur J Paediatr Neurol. 2020 Jan;24:47-52. doi: 10.1016/j.ejpn.2019.12.021. Epub 2020 Jan 7.

  PMID: 31973983 BACKGROUND

• Ashley N, Adams S, Slama A, Zeviani M, Suomalainen A, Andreu AL, Naviaux RK, Poulton J. Defects in maintenance of mitochondrial DNA are associated with intramitochondrial nucleotide imbalances. Hum Mol Genet. 2007 Jun 15;16(12):1400-11. doi: 10.1093/hmg/ddm090. Epub 2007 May 3.

  PMID: 17483096 BACKGROUND

• Gandhi VV, Samuels DC. A review comparing deoxyribonucleoside triphosphate (dNTP) concentrations in the mitochondrial and cytoplasmic compartments of normal and transformed cells. Nucleosides Nucleotides Nucleic Acids. 2011 May;30(5):317-39. doi: 10.1080/15257770.2011.586955.

  PMID: 21774628 BACKGROUND

• Gonzalez-Vioque E, Torres-Torronteras J, Andreu AL, Marti R. Limited dCTP availability accounts for mitochondrial DNA depletion in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). PLoS Genet. 2011 Mar;7(3):e1002035. doi: 10.1371/journal.pgen.1002035. Epub 2011 Mar 31.

  PMID: 21483760 BACKGROUND

• Absalon MJ, Harding CO, Fain DR, Li L, Mack KJ. Leigh syndrome in an infant resulting from mitochondrial DNA depletion. Pediatr Neurol. 2001 Jan;24(1):60-3. doi: 10.1016/s0887-8994(00)00226-5.

  PMID: 11182283 BACKGROUND

• Keshavan N, Abdenur J, Anderson G, Assouline Z, Barcia G, Bouhikbar L, Chakrapani A, Cleary M, Cohen MC, Feillet F, Fratter C, Hauser N, Jacques T, Lam A, McCullagh H, Phadke R, Rotig A, Sharrard M, Simon M, Smith C, Sommerville EW, Taylor RW, Yue WW, Rahman S. The natural history of infantile mitochondrial DNA depletion syndrome due to RRM2B deficiency. Genet Med. 2020 Jan;22(1):199-209. doi: 10.1038/s41436-019-0613-z. Epub 2019 Aug 29.

  PMID: 31462754 BACKGROUND

• Shaibani A, Shchelochkov OA, Zhang S, Katsonis P, Lichtarge O, Wong LJ, Shinawi M. Mitochondrial neurogastrointestinal encephalopathy due to mutations in RRM2B. Arch Neurol. 2009 Aug;66(8):1028-32. doi: 10.1001/archneurol.2009.139.

  PMID: 19667227 BACKGROUND

• Bourdon A, Minai L, Serre V, Jais JP, Sarzi E, Aubert S, Chretien D, de Lonlay P, Paquis-Flucklinger V, Arakawa H, Nakamura Y, Munnich A, Rotig A. Mutation of RRM2B, encoding p53-controlled ribonucleotide reductase (p53R2), causes severe mitochondrial DNA depletion. Nat Genet. 2007 Jun;39(6):776-80. doi: 10.1038/ng2040. Epub 2007 May 7.

  PMID: 17486094 BACKGROUND

• Kollberg G, Darin N, Benan K, Moslemi AR, Lindal S, Tulinius M, Oldfors A, Holme E. A novel homozygous RRM2B missense mutation in association with severe mtDNA depletion. Neuromuscul Disord. 2009 Feb;19(2):147-50. doi: 10.1016/j.nmd.2008.11.014. Epub 2009 Jan 12.

  PMID: 19138848 BACKGROUND

• El-Hattab AW, Wang J, Dai H, Almannai M, Scaglia F, Craigen WJ, Wong LJC. MPV17-Related Mitochondrial DNA Maintenance Defect. 2012 May 17 [updated 2018 May 17]. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews(R) [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2026. Available from http://www.ncbi.nlm.nih.gov/books/NBK92947/

  PMID: 22593919 BACKGROUND

• El-Hattab AW, Wang J, Dai H, Almannai M, Staufner C, Alfadhel M, Gambello MJ, Prasun P, Raza S, Lyons HJ, Afqi M, Saleh MAM, Faqeih EA, Alzaidan HI, Alshenqiti A, Flore LA, Hertecant J, Sacharow S, Barbouth DS, Murayama K, Shah AA, Lin HC, Wong LC. MPV17-related mitochondrial DNA maintenance defect: New cases and review of clinical, biochemical, and molecular aspects. Hum Mutat. 2018 Apr;39(4):461-470. doi: 10.1002/humu.23387. Epub 2018 Jan 13.

  PMID: 29282788 BACKGROUND

• El-Hattab AW, Scaglia F. SUCLA2-Related Mitochondrial DNA Depletion Syndrome, Encephalomyopathic Form with Methylmalonic Aciduria. 2009 May 26 [updated 2023 Sep 28]. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews(R) [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2026. Available from http://www.ncbi.nlm.nih.gov/books/NBK6803/

  PMID: 20301762 BACKGROUND

• El-Hattab AW, Scaglia F. SUCLG1-Related Mitochondrial DNA Depletion Syndrome, Encephalomyopathic Form with Methylmalonic Aciduria. 2017 Mar 30. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews(R) [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2026. Available from http://www.ncbi.nlm.nih.gov/books/NBK425223/

  PMID: 28358460 BACKGROUND

• Almannai M, Dai H, El-Hattab AW, Wong LJC. FBXL4-Related Encephalomyopathic Mitochondrial DNA Depletion Syndrome. 2017 Apr 6. In: Adam MP, Bick S, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews(R) [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2026. Available from http://www.ncbi.nlm.nih.gov/books/NBK425540/

  PMID: 28383868 BACKGROUND

• Saada A. Deoxyribonucleotides and disorders of mitochondrial DNA integrity. DNA Cell Biol. 2004 Dec;23(12):797-806. doi: 10.1089/dna.2004.23.797.

  PMID: 15684706 BACKGROUND

• Wang L. Mitochondrial purine and pyrimidine metabolism and beyond. Nucleosides Nucleotides Nucleic Acids. 2016 Dec;35(10-12):578-594. doi: 10.1080/15257770.2015.1125001.

  PMID: 27906631 BACKGROUND

• Akanuma J. [Mitochondrial DNA depletion syndrome]. Nihon Rinsho. 2002 Apr;60 Suppl 4:398-401. No abstract available. Japanese.

  PMID: 12013896 BACKGROUND

• Zipursky A. The genetics of childhood disease and development. Pediatr Res. 2003 Jan;53(1):3. doi: 10.1203/00006450-200301000-00003. No abstract available.

  PMID: 12508073 BACKGROUND

• Filosto M, Scarpelli M, Tonin P, Lucchini G, Pavan F, Santus F, Parini R, Donati MA, Cotelli MS, Vielmi V, Todeschini A, Canonico F, Tomelleri G, Padovani A, Rovelli A. Course and management of allogeneic stem cell transplantation in patients with mitochondrial neurogastrointestinal encephalomyopathy. J Neurol. 2012 Dec;259(12):2699-706. doi: 10.1007/s00415-012-6572-9. Epub 2012 Jun 19.

  PMID: 22711161 BACKGROUND

• Hirano M, Marti R, Casali C, Tadesse S, Uldrick T, Fine B, Escolar DM, Valentino ML, Nishino I, Hesdorffer C, Schwartz J, Hawks RG, Martone DL, Cairo MS, DiMauro S, Stanzani M, Garvin JH Jr, Savage DG. Allogeneic stem cell transplantation corrects biochemical derangements in MNGIE. Neurology. 2006 Oct 24;67(8):1458-60. doi: 10.1212/01.wnl.0000240853.97716.24. Epub 2006 Sep 13.

  PMID: 16971696 BACKGROUND

• Yavuz H, Ozel A, Christensen M, Christensen E, Schwartz M, Elmaci M, Vissing J. Treatment of mitochondrial neurogastrointestinal encephalomyopathy with dialysis. Arch Neurol. 2007 Mar;64(3):435-8. doi: 10.1001/archneur.64.3.435.

  PMID: 17353390 BACKGROUND

• Hasselmann O, Blau N, Ramaekers VT, Quadros EV, Sequeira JM, Weissert M. Cerebral folate deficiency and CNS inflammatory markers in Alpers disease. Mol Genet Metab. 2010 Jan;99(1):58-61. doi: 10.1016/j.ymgme.2009.08.005.

  PMID: 19766516 BACKGROUND

• Rodriguez MC, MacDonald JR, Mahoney DJ, Parise G, Beal MF, Tarnopolsky MA. Beneficial effects of creatine, CoQ10, and lipoic acid in mitochondrial disorders. Muscle Nerve. 2007 Feb;35(2):235-42. doi: 10.1002/mus.20688.

  PMID: 17080429 BACKGROUND

• Saito K, Kimura N, Oda N, Shimomura H, Kumada T, Miyajima T, Murayama K, Tanaka M, Fujii T. Pyruvate therapy for mitochondrial DNA depletion syndrome. Biochim Biophys Acta. 2012 May;1820(5):632-6. doi: 10.1016/j.bbagen.2011.08.006. Epub 2011 Aug 11.

  PMID: 21855607 BACKGROUND

• Wong LJ, Naviaux RK, Brunetti-Pierri N, Zhang Q, Schmitt ES, Truong C, Milone M, Cohen BH, Wical B, Ganesh J, Basinger AA, Burton BK, Swoboda K, Gilbert DL, Vanderver A, Saneto RP, Maranda B, Arnold G, Abdenur JE, Waters PJ, Copeland WC. Molecular and clinical genetics of mitochondrial diseases due to POLG mutations. Hum Mutat. 2008 Sep;29(9):E150-72. doi: 10.1002/humu.20824.

  PMID: 18546365 BACKGROUND

• Lara MC, Valentino ML, Torres-Torronteras J, Hirano M, Marti R. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): biochemical features and therapeutic approaches. Biosci Rep. 2007 Jun;27(1-3):151-63. doi: 10.1007/s10540-007-9043-2.

  PMID: 17549623 BACKGROUND

• Lara MC, Weiss B, Illa I, Madoz P, Massuet L, Andreu AL, Valentino ML, Anikster Y, Hirano M, Marti R. Infusion of platelets transiently reduces nucleoside overload in MNGIE. Neurology. 2006 Oct 24;67(8):1461-3. doi: 10.1212/01.wnl.0000239824.95411.52. Epub 2006 Sep 13.

  PMID: 16971699 BACKGROUND

• Camara Y, Gonzalez-Vioque E, Scarpelli M, Torres-Torronteras J, Marti R. Feeding the deoxyribonucleoside salvage pathway to rescue mitochondrial DNA. Drug Discov Today. 2013 Oct;18(19-20):950-7. doi: 10.1016/j.drudis.2013.06.009. Epub 2013 Jun 28.

  PMID: 23817075 BACKGROUND

• Uusimaa J, Evans J, Smith C, Butterworth A, Craig K, Ashley N, Liao C, Carver J, Diot A, Macleod L, Hargreaves I, Al-Hussaini A, Faqeih E, Asery A, Al Balwi M, Eyaid W, Al-Sunaid A, Kelly D, van Mourik I, Ball S, Jarvis J, Mulay A, Hadzic N, Samyn M, Baker A, Rahman S, Stewart H, Morris AA, Seller A, Fratter C, Taylor RW, Poulton J. Clinical, biochemical, cellular and molecular characterization of mitochondrial DNA depletion syndrome due to novel mutations in the MPV17 gene. Eur J Hum Genet. 2014 Feb;22(2):184-91. doi: 10.1038/ejhg.2013.112. Epub 2013 May 29.

  PMID: 23714749 BACKGROUND

• Dalla Rosa I, Camara Y, Durigon R, Moss CF, Vidoni S, Akman G, Hunt L, Johnson MA, Grocott S, Wang L, Thorburn DR, Hirano M, Poulton J, Taylor RW, Elgar G, Marti R, Voshol P, Holt IJ, Spinazzola A. MPV17 Loss Causes Deoxynucleotide Insufficiency and Slow DNA Replication in Mitochondria. PLoS Genet. 2016 Jan 13;12(1):e1005779. doi: 10.1371/journal.pgen.1005779. eCollection 2016 Jan.

  PMID: 26760297 BACKGROUND

• Bulst S, Holinski-Feder E, Payne B, Abicht A, Krause S, Lochmuller H, Chinnery PF, Walter MC, Horvath R. In vitro supplementation with deoxynucleoside monophosphates rescues mitochondrial DNA depletion. Mol Genet Metab. 2012 Sep;107(1-2):95-103. doi: 10.1016/j.ymgme.2012.04.022. Epub 2012 May 3.

  PMID: 22608879 BACKGROUND

• Franzolin E, Salata C, Bianchi V, Rampazzo C. The Deoxynucleoside Triphosphate Triphosphohydrolase Activity of SAMHD1 Protein Contributes to the Mitochondrial DNA Depletion Associated with Genetic Deficiency of Deoxyguanosine Kinase. J Biol Chem. 2015 Oct 23;290(43):25986-96. doi: 10.1074/jbc.M115.675082. Epub 2015 Sep 4.

  PMID: 26342080 BACKGROUND

• Akman HO, Dorado B, Lopez LC, Garcia-Cazorla A, Vila MR, Tanabe LM, Dauer WT, Bonilla E, Tanji K, Hirano M. Thymidine kinase 2 (H126N) knockin mice show the essential role of balanced deoxynucleotide pools for mitochondrial DNA maintenance. Hum Mol Genet. 2008 Aug 15;17(16):2433-40. doi: 10.1093/hmg/ddn143. Epub 2008 May 8.

  PMID: 18467430 BACKGROUND

• Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshe SL, Perucca E, Wiebe S, French J. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010 Jun;51(6):1069-77. doi: 10.1111/j.1528-1167.2009.02397.x. Epub 2009 Nov 3.

  PMID: 19889013 BACKGROUND

• Dominguez-Gonzalez C, Madruga-Garrido M, Mavillard F, Garone C, Aguirre-Rodriguez FJ, Donati MA, Kleinsteuber K, Marti I, Martin-Hernandez E, Morealejo-Aycinena JP, Munell F, Nascimento A, Kalko SG, Sardina MD, Alvarez Del Vayo C, Serrano O, Long Y, Tu Y, Levin B, Thompson JLP, Engelstad K, Uddin J, Torres-Torronteras J, Jimenez-Mallebrera C, Marti R, Paradas C, Hirano M. Deoxynucleoside Therapy for Thymidine Kinase 2-Deficient Myopathy. Ann Neurol. 2019 Aug;86(2):293-303. doi: 10.1002/ana.25506. Epub 2019 Jun 17.

  PMID: 31125140 BACKGROUND

• Hernandez-Voth A, Sayas Catalan J, Corral Blanco M, Castano Mendez A, Martin MA, De Fuenmayor Fernandez de la Hoz C, Villena Garrido V, Dominguez-Gonzalez C. Deoxynucleoside therapy for respiratory involvement in adult patients with thymidine kinase 2-deficient myopathy. BMJ Open Respir Res. 2020 Nov;7(1):e000774. doi: 10.1136/bmjresp-2020-000774.

  PMID: 33246973 BACKGROUND

• Purine and pyrimidine metabolism. Ciba Found Symp. 1977;(48):331-55. No abstract available.

  PMID: 245993 BACKGROUND

• Bory C, Chantin C, Boulieu R. Abnormal purine and pyrimidine metabolism in inherited superactivity of PRPP synthetase. Adv Exp Med Biol. 1994;370:15-8. doi: 10.1007/978-1-4615-2584-4_4. No abstract available.

  PMID: 7660879 BACKGROUND

• Castellanos M, Wilson DB, Shuler ML. A modular minimal cell model: purine and pyrimidine transport and metabolism. Proc Natl Acad Sci U S A. 2004 Apr 27;101(17):6681-6. doi: 10.1073/pnas.0400962101. Epub 2004 Apr 16.

  PMID: 15090651 BACKGROUND

• Khan I, Sarker SJ, Hackshaw A. Smaller sample sizes for phase II trials based on exact tests with actual error rates by trading-off their nominal levels of significance and power. Br J Cancer. 2012 Nov 20;107(11):1801-9. doi: 10.1038/bjc.2012.444.

  PMID: 23169334 BACKGROUND

• Pekeles H, Berrahmoune S, Dassi C, Cheung ACT, Gagnon T, Waters PJ, Eberhard R, Buhas D, Myers KA. Safety and efficacy of deoxycytidine/deoxythymidine combination therapy in POLG-related disorders: 6-month interim results of an open-label, single arm, phase 2 trial. EClinicalMedicine. 2024 Jul 18;74:102740. doi: 10.1016/j.eclinm.2024.102740. eCollection 2024 Aug.

  PMID: 39091670 DERIVED

MeSH Terms

Conditions

Mitochondrial Diseases; Mitochondrial Encephalomyopathies; Mitochondrial encephalopathy

Interventions

Deoxycytidine; Thymidine

Condition Hierarchy (Ancestors)

Metabolic Diseases; Nutritional and Metabolic Diseases; Mitochondrial Myopathies; Muscular Diseases; Musculoskeletal Diseases; Brain Diseases, Metabolic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neuromuscular Diseases

Intervention Hierarchy (Ancestors)

Cytidine; Pyrimidine Nucleosides; Pyrimidines; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Deoxyribonucleosides; Nucleosides; Nucleic Acids, Nucleotides, and Nucleosides

Study Officials

• Kenneth Alexis MD Myers, MD PhD FRCPC

  RI-MUHC, Children Hospital of Montreal (MUHC), McGill University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Kenneth Alexis MD Myers, MD PhD FRCPC

CONTACT

514-934-1934; kenneth.myers@mcgill.ca

Saoussen Dr Berrahmoune, PhD

CONTACT

514-934-1934; saoussen.berrahmoune@rimuhc.ca

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Phase II, One Site, Open label study in the pediatric and adult population

Study Record Dates

• First Submitted: March 10, 2021
• First Posted: March 17, 2021
• Study Start: October 18, 2021
• Primary Completion (Estimated): June 30, 2029
• Study Completion (Estimated): December 30, 2029
• Last Updated: May 31, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: 104 weeks
• Access Criteria: Research Staff, Principal Investigator (PI), Co-Investigator, regulation authority and clinical research associate (CRA) for monitoring are authorized to access to the data's for CRA (anonymous data's)

Locations

CA (1)