NCT06282965

Brief Summary

The goal of this clinical trial is to test the safety of the drug Angiotensin (1-7) and learn whether it works well as a treatment in people who have suffered a moderate to severe traumatic brain injury (TBI). The main questions this trial aims to answer are:

  • Is Angiotensin (1-7) safe?
  • Does Angiotensin (1-7) improve mental functioning and reduce physical signs of brain damage in people who have suffered a moderate to severe TBI? Participants will:
  • Complete 21 days of study treatment consisting of a once-daily injection.
  • Provide blood samples.
  • Undergo two magnetic resonance imaging (MRI) scans of the brain.
  • Complete specific tasks and questionnaires that allow researchers to evaluate the participant's brain and psychological functioning. Researchers will compare three groups: two groups that receive different doses of Angiotensin (1-7) and one group that receives a look-alike treatment with no active drug. This will allow researchers to see if the drug has any negative effects and whether it improves mental functioning and physical signs of brain damage after a TBI.

Trial Health

77
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
90

participants targeted

Target at P75+ for phase_1

Timeline
16mo left

Started May 2024

Typical duration for phase_1

Geographic Reach
1 country

1 active site

Status
recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Progress60%
May 2024Sep 2027

First Submitted

Initial submission to the registry

December 19, 2023

Completed
2 months until next milestone

First Posted

Study publicly available on registry

February 28, 2024

Completed
3 months until next milestone

Study Start

First participant enrolled

May 28, 2024

Completed
3.3 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

September 1, 2027

Expected
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

September 1, 2027

Last Updated

July 31, 2025

Status Verified

July 1, 2025

Enrollment Period

3.3 years

First QC Date

December 19, 2023

Last Update Submit

July 28, 2025

Conditions

Keywords

renin angiotensin systemcognition

Outcome Measures

Primary Outcomes (2)

  • Number of participants with adverse events

    The number of participants with adverse events in each group will be compared in order to determine whether Angiotensin (1-7) is significantly associated with the occurrence of adverse events.

    At 21 days

  • Performance on the Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog)

    The Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-Cog) is a brief neuropsychological assessment consisting of eleven tasks. It is used to assess cognitive function. Errors in each task are summed for a total score ranging from 0 to 70. Higher scores represent greater cognitive dysfunction, with a score of 0 representing the least impairment and a score of 70 representing the greatest impairment.

    90 days

Secondary Outcomes (8)

  • Cognitive functions after Angiotensin (1-7) treatment as measured by the Montreal Cognitive Assessment (MoCA)

    90 days

  • Function after Angiotensin (1-7) treatment, as measured by the Alzheimer's Disease Cooperative Study - Activities of Daily Living (ADCS-ADL)

    90 days

  • Effects of Angiotensin (1-7) on acute CNS damage biomarker phosphorylated tau (p-tau)

    Enrollment to 21 days

  • Effects of Angiotensin (1-7) on CNS damage biomarker phosphorylated tau (p-tau) after 90 days

    Enrollment to 90 days

  • Effects of Angiotensin (1-7) on brain white matter integrity

    MRI baseline to 90 days

  • +3 more secondary outcomes

Study Arms (3)

Ang 1-7 100 mcg/kg/day

EXPERIMENTAL

Angiotensin I/II (1-7) acetate will be delivered as a subcutaneous injection at a dose of 100 micrograms per kilogram per day for 21 days.

Drug: Angiotensin (1-7)

Ang 1-7 200 mcg/kg/day

EXPERIMENTAL

Angiotensin I/II (1-7) acetate will be delivered as a subcutaneous injection at a dose of 200 micrograms per kilogram per day for 21 days.

Drug: Angiotensin (1-7)

Placebo

PLACEBO COMPARATOR

Sterile saline (NaCl) will be delivered as a subcutaneous injection for 21 days.

Drug: Sterile saline

Interventions

The drug will be dissolved in 0.9% USP/NF grade sterile for injection saline (NaCl) and prepared in a concentration that aligns with the participant's weight.

Also known as: Angiotensin I/II (1-7) acetate
Ang 1-7 100 mcg/kg/dayAng 1-7 200 mcg/kg/day

Sterile solution of 0.9% NaCl in water.

Also known as: Sterile sodium chloride
Placebo

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Participant or representative willing to provide informed consent.
  • Age 18 years or older at time of enrollment.
  • Traumatically induced head injury resulting from insult to head from an external force.
  • Clinical diagnosis of acute intracranial lesion based on neuroradiologist report. CT scan and report must be available.
  • Moderate or severe traumatic brain injury (TBI) defined as Glasgow Coma Scale (GCS) score on trauma presentation of 12 or less. In general: Moderate TBI will be defined as loss of consciousness between 30 minutes and 24 hours and GCS between 9 and 12. Severe TBI will be defined as loss of consciousness \> 24 hours and GCS ≤ 9.
  • Enrollment within 48 hours of TBI.

You may not qualify if:

  • Time of injury cannot be determined.
  • Neurosurgery within the last 30 days.
  • History of neurodegenerative disease or disorder including dementia, Parkinson's disease, multiple sclerosis, seizure disorder, or brain tumors that would impact cognitive testing.
  • Contraindication to having an MRI.
  • Pregnant or lactating female.
  • Female of childbearing potential or sexually active male who is not willing to use an acceptable method of birth control for the treatment period and 7 days after the last dose of the study drug.
  • Participation in another clinical study involving investigational product within 30 days prior to study enrollment.
  • If in the opinion of the investigator, candidate is unsuitable for participation in the study.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

University of Arizona

Tucson, Arizona, 85724, United States

RECRUITING

Related Publications (27)

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    PMID: 29338452BACKGROUND
  • Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury. J Neurol. 2019 Nov;266(11):2878-2889. doi: 10.1007/s00415-019-09541-4. Epub 2019 Sep 28.

    PMID: 31563989BACKGROUND
  • McGinn MJ, Povlishock JT. Pathophysiology of Traumatic Brain Injury. Neurosurg Clin N Am. 2016 Oct;27(4):397-407. doi: 10.1016/j.nec.2016.06.002. Epub 2016 Aug 10.

    PMID: 27637392BACKGROUND
  • Povlishock JT. The classification of traumatic brain injury (TBI) for targeted therapies. J Neurotrauma. 2008 Jul;25(7):717-8. doi: 10.1089/neu.2008.9964. No abstract available.

    PMID: 18627251BACKGROUND
  • Kelley BJ, Lifshitz J, Povlishock JT. Neuroinflammatory responses after experimental diffuse traumatic brain injury. J Neuropathol Exp Neurol. 2007 Nov;66(11):989-1001. doi: 10.1097/NEN.0b013e3181588245.

    PMID: 17984681BACKGROUND
  • Hellmich HL, Capra B, Eidson K, Garcia J, Kennedy D, Uchida T, Parsley M, Cowart J, DeWitt DS, Prough DS. Dose-dependent neuronal injury after traumatic brain injury. Brain Res. 2005 May 24;1044(2):144-54. doi: 10.1016/j.brainres.2005.02.054. Epub 2005 Apr 13.

    PMID: 15885213BACKGROUND
  • Woodcock T, Morganti-Kossmann MC. The role of markers of inflammation in traumatic brain injury. Front Neurol. 2013 Mar 4;4:18. doi: 10.3389/fneur.2013.00018. eCollection 2013.

    PMID: 23459929BACKGROUND
  • Israelsson C, Kylberg A, Bengtsson H, Hillered L, Ebendal T. Interacting chemokine signals regulate dendritic cells in acute brain injury. PLoS One. 2014 Aug 25;9(8):e104754. doi: 10.1371/journal.pone.0104754. eCollection 2014.

    PMID: 25153123BACKGROUND
  • Halliwell B. Role of free radicals in the neurodegenerative diseases: therapeutic implications for antioxidant treatment. Drugs Aging. 2001;18(9):685-716. doi: 10.2165/00002512-200118090-00004.

    PMID: 11599635BACKGROUND
  • Rudolph JL, Ramlawi B, Kuchel GA, McElhaney JE, Xie D, Sellke FW, Khabbaz K, Levkoff SE, Marcantonio ER. Chemokines are associated with delirium after cardiac surgery. J Gerontol A Biol Sci Med Sci. 2008 Feb;63(2):184-9. doi: 10.1093/gerona/63.2.184.

    PMID: 18314455BACKGROUND
  • Ramlawi B, Rudolph JL, Mieno S, Feng J, Boodhwani M, Khabbaz K, Levkoff SE, Marcantonio ER, Bianchi C, Sellke FW. C-Reactive protein and inflammatory response associated to neurocognitive decline following cardiac surgery. Surgery. 2006 Aug;140(2):221-6. doi: 10.1016/j.surg.2006.03.007.

    PMID: 16904973BACKGROUND
  • Raizada MK, Ferreira AJ. ACE2: a new target for cardiovascular disease therapeutics. J Cardiovasc Pharmacol. 2007 Aug;50(2):112-9. doi: 10.1097/FJC.0b013e3180986219.

    PMID: 17703127BACKGROUND
  • Vickers C, Hales P, Kaushik V, Dick L, Gavin J, Tang J, Godbout K, Parsons T, Baronas E, Hsieh F, Acton S, Patane M, Nichols A, Tummino P. Hydrolysis of biological peptides by human angiotensin-converting enzyme-related carboxypeptidase. J Biol Chem. 2002 Apr 26;277(17):14838-43. doi: 10.1074/jbc.M200581200. Epub 2002 Jan 28.

    PMID: 11815627BACKGROUND
  • Massaad CA, Klann E. Reactive oxygen species in the regulation of synaptic plasticity and memory. Antioxid Redox Signal. 2011 May 15;14(10):2013-54. doi: 10.1089/ars.2010.3208. Epub 2010 Oct 28.

    PMID: 20649473BACKGROUND
  • Santos RA, Ferreira AJ, Verano-Braga T, Bader M. Angiotensin-converting enzyme 2, angiotensin-(1-7) and Mas: new players of the renin-angiotensin system. J Endocrinol. 2013 Jan 18;216(2):R1-R17. doi: 10.1530/JOE-12-0341. Print 2013 Feb.

    PMID: 23092879BACKGROUND
  • Doobay MF, Talman LS, Obr TD, Tian X, Davisson RL, Lazartigues E. Differential expression of neuronal ACE2 in transgenic mice with overexpression of the brain renin-angiotensin system. Am J Physiol Regul Integr Comp Physiol. 2007 Jan;292(1):R373-81. doi: 10.1152/ajpregu.00292.2006. Epub 2006 Aug 31.

    PMID: 16946085BACKGROUND
  • Bunnemann B, Fuxe K, Metzger R, Mullins J, Jackson TR, Hanley MR, Ganten D. Autoradiographic localization of mas proto-oncogene mRNA in adult rat brain using in situ hybridization. Neurosci Lett. 1990 Jul 3;114(2):147-53. doi: 10.1016/0304-3940(90)90063-f.

    PMID: 2203997BACKGROUND
  • Hellner K, Walther T, Schubert M, Albrecht D. Angiotensin-(1-7) enhances LTP in the hippocampus through the G-protein-coupled receptor Mas. Mol Cell Neurosci. 2005 Jul;29(3):427-35. doi: 10.1016/j.mcn.2005.03.012.

    PMID: 15950155BACKGROUND
  • Regenhardt RW, Mecca AP, Desland F, Ritucci-Chinni PF, Ludin JA, Greenstein D, Banuelos C, Bizon JL, Reinhard MK, Sumners C. Centrally administered angiotensin-(1-7) increases the survival of stroke-prone spontaneously hypertensive rats. Exp Physiol. 2014 Feb;99(2):442-53. doi: 10.1113/expphysiol.2013.075242. Epub 2013 Oct 18.

    PMID: 24142453BACKGROUND
  • Zubcevic J, Waki H, Raizada MK, Paton JF. Autonomic-immune-vascular interaction: an emerging concept for neurogenic hypertension. Hypertension. 2011 Jun;57(6):1026-33. doi: 10.1161/HYPERTENSIONAHA.111.169748. Epub 2011 May 2. No abstract available.

    PMID: 21536990BACKGROUND
  • Bruhns RP, Sulaiman MI, Gaub M, Bae EH, Davidson Knapp RB, Larson AR, Smith A, Coleman DL, Staatz WD, Sandweiss AJ, Joseph B, Hay M, Largent-Milnes TM, Vanderah TW. Angiotensin-(1-7) improves cognitive function and reduces inflammation in mice following mild traumatic brain injury. Front Behav Neurosci. 2022 Aug 4;16:903980. doi: 10.3389/fnbeh.2022.903980. eCollection 2022.

    PMID: 35990729BACKGROUND
  • Janatpour ZC, Symes AJ. The extended renin-angiotensin system: a promising target for traumatic brain injury therapeutics. Neural Regen Res. 2020 Jun;15(6):1025-1026. doi: 10.4103/1673-5374.270304. No abstract available.

    PMID: 31823875BACKGROUND
  • Rodgers KE, Oliver J, diZerega GS. Phase I/II dose escalation study of angiotensin 1-7 [A(1-7)] administered before and after chemotherapy in patients with newly diagnosed breast cancer. Cancer Chemother Pharmacol. 2006 May;57(5):559-68. doi: 10.1007/s00280-005-0078-4. Epub 2005 Aug 12.

    PMID: 16096787BACKGROUND
  • Pham H, Schwartz BM, Delmore JE, Reed E, Cruickshank S, Drummond L, Rodgers KE, Peterson KJ, diZerega GS. Pharmacodynamic stimulation of thrombogenesis by angiotensin (1-7) in recurrent ovarian cancer patients receiving gemcitabine and platinum-based chemotherapy. Cancer Chemother Pharmacol. 2013 Apr;71(4):965-72. doi: 10.1007/s00280-013-2089-x. Epub 2013 Jan 31.

    PMID: 23370663BACKGROUND
  • Petty WJ, Miller AA, McCoy TP, Gallagher PE, Tallant EA, Torti FM. Phase I and pharmacokinetic study of angiotensin-(1-7), an endogenous antiangiogenic hormone. Clin Cancer Res. 2009 Dec 1;15(23):7398-404. doi: 10.1158/1078-0432.CCR-09-1957. Epub 2009 Nov 17.

    PMID: 19920106BACKGROUND
  • Hay M, Vanderah TW, Samareh-Jahani F, Constantopoulos E, Uprety AR, Barnes CA, Konhilas J. Cognitive impairment in heart failure: A protective role for angiotensin-(1-7). Behav Neurosci. 2017 Feb;131(1):99-114. doi: 10.1037/bne0000182. Epub 2017 Jan 5.

    PMID: 28054808BACKGROUND
  • Hoyer-Kimura C, Konhilas JP, Mansour HM, Polt R, Doyle KP, Billheimer D, Hay M. Neurofilament light: a possible prognostic biomarker for treatment of vascular contributions to cognitive impairment and dementia. J Neuroinflammation. 2021 Oct 15;18(1):236. doi: 10.1186/s12974-021-02281-1.

    PMID: 34654436BACKGROUND

MeSH Terms

Conditions

Brain Injuries, Traumatic

Interventions

angiotensin I (1-7)Acetates

Condition Hierarchy (Ancestors)

Brain InjuriesBrain DiseasesCentral Nervous System DiseasesNervous System DiseasesCraniocerebral TraumaTrauma, Nervous SystemWounds and Injuries

Intervention Hierarchy (Ancestors)

Acids, AcyclicCarboxylic AcidsOrganic ChemicalsFatty Acids, VolatileFatty AcidsLipids

Study Officials

  • Bellal Joseph, MD

    University of Arizona

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Clinical Research Coordinator

CONTACT

Study Design

Study Type
interventional
Phase
phase 1
Allocation
RANDOMIZED
Masking
TRIPLE
Who Masked
PARTICIPANT, CARE PROVIDER, INVESTIGATOR
Masking Details
Investigators, study site staff, participants, and caregivers will be unaware of the participant treatment assignments for the duration of the study. The pharmacist will prepare the study treatment and will be unmasked.
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
SPONSOR

Study Record Dates

First Submitted

December 19, 2023

First Posted

February 28, 2024

Study Start

May 28, 2024

Primary Completion (Estimated)

September 1, 2027

Study Completion (Estimated)

September 1, 2027

Last Updated

July 31, 2025

Record last verified: 2025-07

Locations