Nilotinib Effects in Parkinson's disease and Dementia with Lewy bodies

Abstract

Background: We evaluated the effects of low doses of the tyrosine kinase Abelson (Abl) inhibitor Nilotinib, on safety and pharmacokinetics in Parkinson's disease dementia or dementia with Lewy bodies.

Objectives: The primary outcomes of this study were safety and tolerability; pharmacokinetics and target engagement were secondary, while clinical outcomes were exploratory.

Methods: Twelve subjects were randomized into 150 mg (n = 5) or 300 mg (n = 7) groups and received Nilotinib orally every day for 24 weeks.

Results: This study shows that 150 mg and 300 mg doses of Nilotinib appear to be safe and tolerated in subjects with advanced Parkinson's disease. Nilotinib is detectable in the cerebrospinal fluid (CSF) and seems to engage the target Abl. Motor and cognitive outcomes suggest a possible beneficial effect on clinical outcomes. The CSF levels of homovanillic acid are significantly increased between baseline and 24 weeks of treatment. Exploratory CSF biomarkers were measured.

Conclusions: This small proof-of-concept study lacks a placebo group and participants were not homogenous, resulting in baseline differences between and within groups. This limits the interpretations of the biomarker and clinical data, and any conclusions should be drawn cautiously. Nonetheless, the collective observations suggest that it is warranted to evaluate the safety and efficacy of Nilotinib in larger randomized, double-blind, placebo-controlled trials.

Keywords: Lewy bodies; Nilotinib; Parkinson; dopamine; homovanillic acid; synuclein; tau.

Fig.1

Design and milestones of an open-label, phase I clinical trial to evaluate the safety and efficacy of 150 mg and 300 mg Nilotinib for 24 weeks in patients with Parkinson’s disease (PD) with dementia (PDD) or PD with mild cognitive impairment (PD-MCI) or dementia with Lewy bodies (DLB). Cerebrospinal fluid (CSF), Mini Mental State Examination (MMSE), Abelson (Abl), homovanillic acid (HVA), β-amyloid (Aβ), Scales for Outcomes in Parkinson’s Disease-Cognition (SCOPA-Cog), Neuron Specific Enolase (SNE).

Fig.2

Pharmacokinetics and pharmacodynamics. Graph shows Nilotinib levels in (A) plasma, (B) CSF and (C) ratio of CSF: plasma of Nilotinib in a population analysis (N = 33 data points) collected at baseline, 1, 2, 3, 4 or 5hrs after oral administration. Plasma was collected 30 min before CSF. Graph (D) is level of Abl inhibition via de-phosphorylation in the same sample population showing the level of pan-tyrosine phosphorylated Abl (active) in the CSF. (E) is non-compartmental analysis of 150 mg and 300 mg of CSF and plasma Nilotinib. Nilotinib was quantified in reference to ¹³C Nilotinib standard and biological samples were centrifuged to obtain unbound Nilotinib. Cerebrospinal fluid (CSF), Abelson (Abl). Graph shows absorbance levels (ABS) of pan-tyrosine phosphorylated Abl in the CSF of individual participants at baseline and after oral dosing of Nilotinib in the 150 mg (F) and 300 mg (G) groups.