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3/12/2018
1
Master Slide
Developing Targeted Therapeutics in Autism: Challenges for Clinical Trial Readiness
Alexander Kolevzon, MDClinical Director, Seaver Autism Center
Director, Child and Adolescent Psychiatry
Mount Sinai Health System
Disclosures of Potential Conflicts
Source Research funding
Advisor/consultant
Employee Speakers’ Bureau
Books, Intellectual Property
In-Kind Services
Stock of Equity
Honorarium
SeaverFoundation
X
NIH X
Autism Science
Foundation
X
SimonsFoundation
X
American Psychiatric Publishing
X
New York Community
Trust
X
Vencerx X
Ovid X
AACAP x
*Mount Sinai and Joseph Buxbaum hold a shared patent for IGF-1 in Phelan-McDermid syndromeThe following presentation contains information concerning a use that has not been approved by the U.S. Food and Drug Administration
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Symptom Domains and Associated Features of ASD
Restricted,Repetitive Behaviors
Social/Communication
Deficits
Sensory Sensitivity
Obsessive Compulsive
Disorder
AUTISMSPECTRUM DISORDER
Impulsivity/Aggression
Expressive/Receptive Language Disorders
EEG Abnormalities
ADHD Symptoms
Variable Faces of ASD
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Autism
Pathophysiology
Drug Development
Novel Therapeutics
Gene Discovery
Model Systems
Developing Novel Therapeutics
Genomic architecture of ASD
Dolen & Bear, 2009
De Rubeis et al., Nature, 2014
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Autism as a Synaptopathy
Phelan-McDermid syndrome
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Before After
A new view on autism spectrum disorder
Phelan-McDermid Syndrome
global developmental delay
intellectual disability
absent or severely delayed speech
hypotonia
dysmorphic features
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Gene Discovery - SHANK3
SHANK3 is a master scaffolding protein which forms a framework for the connections between nerve cells
SHANK3 protein induces the formation of nerve cells and promotes growth
SHANK3 and associated proteins represent novel targets for drug intervention
Model Systems –Synaptic Deficits in PMS
Bozdagi et al, 2010
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Costales & Kolevzon, 2016
Effect of IGF-1 on Synaptic Deficits
Bozdagi et al, 2013
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Reversal of motor deficits in Shank3-deficient mice (Het) after treatment with IGF-1
Bozdagi et al, 2013
Jamie Simon, Salk Institute for Biological Studies
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A Double‐Blind Placebo‐Controlled Crossover Trial of IGF‐1 in Children with Phelan‐McDermid
Syndrome
Placebo Placebo
IGF-1 IGF-1
12 weeks 12 weeks
wash-out
4 weeks
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Change in scores at week 12in social withdrawal and restricted behavior
Change in scores at week 12in hyperactivity
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Change in scores at week 12in sensory reactivity
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IGF-1 in ASD
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Biomarkers for Clinical Trials
Electrophysiological Markers
Identify subtypes of neurodevelopmental disorders based on excitatory/inhibitory (E/I) profiles
Inform personalized treatment approaches
Monitor treatment response and determine optimal responders
Identify associations between neurophysiological responses and clinical outcomes
Paige Siper, PhD Jennifer Foss-Feig, PhD
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Transient VEPs in PMS
Siper, PM
VEP Quiz
Siper, PM
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VEP Quiz
Siper, PM
Effects of IGF‐1 on neural responses
n=6
Band # Hz
1 6‐10
2 12‐28
3 30‐36
4 38‐48
Siper, PM
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Improvement in VEPs after treatment with IGF-1 in PMS
n=6; p=.048
Improvement in VEPs after treatment with OXT in ASD
n=7
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VEP in PMS and ASD
A subset of ~30% of iASD patients fall within 1 SD of the PMS P60-N75 mean and are defined as “PMS-like”
Siper, PMFoss-Feig, J
Clinician‐administered observation and corresponding caregiver interview capturing DSM‐5 sensory reactivity symptoms in children with neurodevelopmental disorders
Sensory Assessment for Neurodevelopmental Disorders (SAND)
Siper, PM et al., 2017
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Sensory Reactivity in PMS – SAND
Siper, PM
Effects of IGF‐1 on Sensory Reactivity
n=6, p = .037
Siper, PM
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Auditory Event Related Potentials
Jennifer Foss-Feig, PhD
Eye Tracking in PMS
Rose et al, 2013
Visual Paired Comparison
Gap-Overlap Task
Elison et al, 2013
Flicker Detection
Farzin et al, 2011
Pilar Trelles
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• 18 subjects with PMS underwent comprehensive evaluations.
• Over 542 hours of audio recording from the home environment was collected using LENA.
• 3 hours of audio was randomly selected for each participant and analyzed by human transcribers
FindingsHow accurately does LENA distinguish the Key Child
from all others?
k = 0.449 (p <.001), 95% CI (0.443, 0.455).
Rankine et al., 2017
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FindingsHow accurately does LENA distinguish Key Child speech‐related vocalizations from non‐speech
sounds?
k = 0.455 (p <.001), 95% CI (0.437, 0.473).
Rankine et al., 2017
FindingsWhat factors impact LENA performance?
Rankine et al., 2017
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Gait AnalysisPerformed in real time and captured at 240 Hz
using 16 electro‐magnetic sensors
All output kinematic features of movement trajectories are analyzed from the head and upper/lower extremities.
Gait is measured during two exercises: 1) walking spontaneously along a six foot marked path; 2) walking along the identical path circumventing a waist‐high obstacle.
n = 16 PMS; 11 controls
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Summary
Need validated measures specific to syndrome/phenotype
Develop/validate biomarkers
Carefully phenotype and select for target symptom/s of interest
Focus on functional improvements (e.g., motor skills; language; cognition)
Include younger subjects
Increase duration of treatment
Acknowledgments
• Seaver Foundation• Joseph Buxbaum• Paige Siper• Danielle Halpern• Michelle Gorenstein• Yitzchak Frank• Jennifer Foss‐Feig• Pilar Trelles• Silvia De Rubeis• Hala Harony‐Nicolas• Michael Breen• Lynn Hendrickson• Emily Isenstein• Jordana Norry• Kristin Meyering• Allison Durkin• Elyana Feldman