The study, identified as VIX001-PACS-01, is a Phase 1, open-label, dose-escalation trialevaluating the safety, tolerability, preliminary efficacy, and dose effect of VIX001, anamniotic fluid product, in patients with Post-Acute COVID-19 Syndrome (PACS) andcognitive impairment. Conducted at the University of Miami Hospital and Clinics, thetrial aims to enroll up to nine participants, or up to 18 using a 3+3 dose escalationdesign. Intravenous injections of VIX001 will be administered at three ascending doses (1ml, 3 ml, or 10 ml), and participants will be assessed for safety, cognitive impairment,pain, activity, and quality of life at baseline and various timepoints. The primaryobjective is to evaluate the safety of VIX001, while secondary objectives includeassessing its potential efficacy and patient-reported outcomes. The study duration isexpected to last approximately 18 months, including enrollment, evaluation, andpost-study observation periods. The findings will contribute to understanding VIX001'ssafety and efficacy in treating PACS-related cognitive impairment.
Study Title: A Phase 1, Open-label Dose-Escalation Study to Assess the Safety,
Tolerability, Preliminary Efficacy, and Dose Effect of VIX001 Amniotic Fluid Product in
Patients with Post-Acute COVID-19 Syndrome (PACS) Associated with Neurological Symptoms
of Cognitive Impairment
Study Number: VIX001-PACS-01
Study Design: This is a Phase 1, open-label, dose-escalation trial aimed at evaluating
the safety, tolerability, preliminary efficacy, and dose effect of VIX001, an amniotic
fluid product, in patients with Post-Acute COVID-19 Syndrome (PACS) who are experiencing
neurological symptoms of cognitive impairment. The study will follow a 3+3 dose
escalation design, with up to nine participants enrolled initially, and a possibility of
expanding to up to 18 participants if toxicities occur within the predefined dosing
range.
Study Objectives: The primary objective of the study is to assess the safety of VIX001
when administered intravenously to patients with PACS and cognitive impairment. The
secondary objectives include evaluating the preliminary efficacy of VIX001 on cognitive
impairment, pain, activity, and quality of life in these patients.
Study Center: The study will be conducted at the University of Miami Hospital and
Clinics.
Study Duration: The anticipated duration of the study is approximately 18 months. This
includes a six-month enrollment period, a six-month evaluation period for each
participant, and a six-month post-study observation period.
Participant Eligibility Criteria: To be eligible for the study, participants must have a
prior laboratory-confirmed SARS-CoV-2 infection, a recent negative SARS-CoV-2 test, and
have experienced moderate or severe post-COVID-19 symptoms for a minimum of three months.
Participants should exhibit reduced physical functioning compared to their pre-COVID-19
status and present with neurological impairment, as indicated by a score of ≤ 24 on the
Montreal Cognitive Assessment (MoCA).
Investigational Product: VIX001 is an amniotic fluid product derived from qualified
donors. It will be administered intravenously at three ascending doses: 1 ml, 3 ml, or 10
ml. VIX001 will be diluted in clinical standard saline for administration.
Study Procedures: Participants will receive intravenous injections of VIX001 at the
assigned dose level. Safety evaluations, including medical history, physical
examinations, and selected laboratory tests, will be conducted at specified timepoints.
Cognitive impairment, pain, activity, and quality of life will also be assessed using
validated measures at baseline and at multiple timepoints during the study.
Endpoints: The primary endpoint of the study is the safety of VIX001, which will be
evaluated by monitoring treatment-emergent adverse events. The secondary endpoints
include changes in cognitive impairment and various patient-reported outcomes related to
PACS, such as pain, activity levels, and quality of life.
Planned Participant Number: The study aims to enroll up to nine participants initially,
or up to 18 participants if toxicities occur within the predefined dosing range.
This Phase 1 clinical trial aims to assess the safety, tolerability, preliminary
efficacy, and dose effect of VIX001, an amniotic fluid product, in patients with PACS and
cognitive impairment. The findings will contribute to understanding the potential of
VIX001 as a therapeutic intervention for patients with neurological symptoms associated
with PACS.
Drug: VIX001
This study utilizes a dose-escalation design with three arms or cohorts to evaluate the
safety, tolerability, preliminary efficacy, and dose effect of VIX001, an amniotic fluid
product, in patients with Post-Acute COVID-19 Syndrome (PACS) associated with
neurological symptoms of cognitive impairment.
In all arms, the intervention will be administered at baseline and participants will be
assessed at specified timepoints for safety, cognitive impairment, pain, activity, and
quality of life. The primary objective is to evaluate the safety of VIX001, while the
secondary objectives include assessing its potential efficacy and patient-reported
outcomes.
Other Name: Purified Amniotic Fluid
Inclusion Criteria:
1. Age ≥ 18 years.
2. Has had prior laboratory-confirmed SARS-CoV-2 infection as determined by an approved
polymerase chain reaction (PCR) or an approved antigen test of any specimen, which
did not require intubation or mechanical or non-invasive ventilation to address the
SARS-CoV-2 infection. Only those who had COVID-19 and who were not hospitalized for
their infection and are eligible for this study.
3. Has had a recent (within a week) negative SARS-CoV-2 test (an approved PCR or
antigen test).
4. Has had at least moderate or severe post-COVID-19 symptoms for at least 3 months
which have resulted in reduced functioning compared to pre-COVID-19 status, and a
working diagnosis of post-acute COVID-19 syndrome (PACS).
5. Ability to comply with the requirements of the study, including anticipated ability
to attend all scheduled visits.
6. Ability to understand and provide written informed consent.
7. All participants of reproductive age/capacity will be required to use adequate
contraception, defined as two forms of highly effective contraceptives, with any
partners during the study period and for at least three months beyond the study
period for safety.
8. The primary presenting symptom impeding daily function is neurological.
9. Severity of cognitive impairment/brain fog measured by MoCA score of ≤ 24 [40] that
was not present prior to contracting COVID-19. A score of 18-26 indicates mild
cognitive impairment. A score of 17 or less may indicate moderate impairment. This
study will enroll patients with so-called "brain fog," or mild impairment to the
degree that would not affect capacity to consent. A careful history will be taken to
ensure that the symptoms of cognitive impairment found to be limiting by the patient
and their family (if applicable) have developed subsequent to the COVID-19
infection, and were not present previously. If the temporal course of the clinical
history is not clearly related to the acute infection, the patient will not be
considered for inclusion. In parallel, the following neurological symptoms will be
assessed and monitored as exploratory endpoints, but are not inclusion criteria:
- Objective assessment of orthostatic intolerance as determined by a change of 30
in pulse or blood pressure on NASA 10-Minute Lean Test in patients who had no
prior history of autonomic dysfunction;
- Symptomatic depression (defined as a score of <10 on the PHQ-8 patient reported
outcome questionnaire) at the time of screening that must have been controlled
on a stable therapy (pharmacological or in the care of a therapist) for three
months prior to planned infusion, are under the active care of a mental health
provider during the study period, and was not present prior to contracting
COVID-19.;
- Anxiety on GAD-7 with a score of ≥10 and ≤ 15 that was not present prior to
contracting COVID-19; and
- Sleep disturbance on PROMIS-SD with a score of ≥30 that was not present prior
to contracting COVID-19.
Exclusion Criteria:
1. Significant concurrent medical conditions (verified by medical records as needed),
including the following:
- Poorly controlled diabetes mellitus, defined as HbA1C>8.5.
- Medical History of Chronic kidney disease (CKD) diagnosis and/or screening
results of eGFR < 60mL/min/1.73m2.
- Presence of New York Heart Association (NYHA) Class III/IV heart failure during
screening visit.
- Blood pressure > 180/110 mm/Hg during screening visit.
- Chronic obstructive pulmonary disease (COPD).
- Participants with HIV, Hepatitis B and Hepatitis C.
2. Participants with a prior history of stroke, neurogenerative disease, dementia, or
developmental delay.
3. Participants with < 18 on MoCA will be excluded, as well as any who have an active
power of attorney or other legal basis to be deemed to lack capacity.
4. Participants who require ongoing oxygen ventilation.
5. Other clinically significant, ongoing illness or medical condition, that in the
opinion of the investigator constitutes a safety risk for participation in the study
or that could interfere with achieving the study objectives, conduct or evaluation,
including a history of thromboembolic events.
6. Participants who are pregnant or lactating.
7. Active alcohol or substance abuse or any other reason that makes it unlikely that
the participant will comply with study procedures.
8. Infusion of any other investigational agents within 6 months of randomization.
9. All subjects with PHQ-8 score >10 at the time of enrollment screening will be
excluded from the study.
10. Participants with a psychiatric illness or condition, which, in the opinion of the
investigation, would interfere with the conduct of the study or the interpretation
of study results. Participants with stable anxiety and depression (PHQ-8 score of
<10) defined as being on stable doses of antidepressant and anxiety drugs for the
last 3 months and for which no dose changes are expected during the study can be
included. Participants who are not under the active care of a mental health provider
during the study period will be excluded.
11. Participants with autoimmune disease or a known history of having Acquired
Immunodeficiency Syndromes (AIDS) or Human Immunodeficiency Virus (HIV).
12. Participant has known alcoholic addiction or dependency, uses alcohol daily, or has
current substance use or abuse.
13. Participant has any active malignancy, including evidence of cutaneous basal,
squamous cell carcinoma, or melanoma.
14. Participant was either diagnosed with or reasonably believed to have had Chronic
Fatigue Syndrome, Sleep Apnea, Insomnia, or any other sleep disorder prior to
contracting COVID-19.
15. Significant laboratory abnormalities, including any of the following
- White blood cell count < 3000/mm3.
- Platelet count < 125,000 mm3.
- Absolute neutrophil count < 1500/mm3.
- Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > upper
limit of normal (ULN) x 1.5.
- any other laboratory abnormality, which, in the opinion of the investigator
poses a safety risk or will prevent the participant for completing the study.
- Uncontrolled Hyperthyroidism or Hypothyroidism or any other Thyroid disease
reflected by abnormal TSH per local laboratory. Those with abnormal TSH in
conjunction with either an abnormal T3 or Free T4 will be excluded.
16. Recent vaccination against SARS-CoV-2 within the last 30 days.
Not Provided
Roger Alvarez, DO, MPH
305-243-7888
rogeralvarez@med.miami.edu
Mercedes Kweh, PhD
305-502-5790
mercedes.kweh@neobiosis.com
Roger Alvarez, DO, MPH, Principal Investigator
University of Miami