Patent Application
20220313170
The present disclosure relates to the field of treatment for cogitative function
There is a need in the art for treatments that increase cognitive function, including working memory, reasoning/problem solving, and attention/vigilance.
Pre-treatment analysis of electroencephalogram (EEG) data of subjects subsequently administered a glutamate receptor agonist indicates that treatment with a glutamate receptor agonist increases cognitive function in human subjects. Moreover, analysis of EEG data identifies subsets of subjects in which glutamate receptor agonist has an especially strong effect on cognitive function.
Accordingly, provided herein is, in various embodiments, a method of increasing cognitive function and/or treating a disease or disorder associated with decreased cognitive function in a subject, comprising administering an effective amount of a glutamate receptor agonist. The subject may be a healthy subject or may suffer from or be at risk for a mental disorder.
Further provided are, in various embodiments, a non-transitory processor-readable medium storing code representing instructions to be executed by a processor, the code comprising code to cause the processor to receive electroencephalogram (EEG) signals recorded from one or more brain locations of the subject; transform the EEG signals into one or more EEG metrics; and execute a model configured to receive the one or more EEG metrics and identify the subject as a glutamate receptor agonist responder based on the one or more EEG metrics.
Non-limiting examples of various aspects and variations of the embodiments are described herein and illustrated in the accompanying drawings.
In one aspect, the disclosure provides methods of increasing cognitive function and/or treating a disease or disorder associated with decreased cognitive function in a subject, comprising administering an effective amount of a glutamate receptor agonist.
The method may include identifying the subject as a glutamate receptor agonist responder by obtaining or having obtained electroencephalogram (EEG) signals from the subject. They include measuring or having measuring one or more EEG metrics, thereby identifying the subject as a glutamate receptor agonist responder, and if the subject is a glutamate receptor agonist responder, then administering the glutamate receptor agonist.
In another aspect, one or more embodiments described herein generally relate to apparatus, methods, and systems for dynamically processing structured and semi-structured data, and in particular, apparatus, methods, and systems that use a model (e.g. a neural network model) to efficiently and reliably predict an outcome based on the structured and semi-structured-data. Apparatus, methods and systems of treatment-response prediction are disclosed. In some embodiments, treatment-response can be used to process, for example, EEG signals in form of time series, stationary data, non-stationary-data, linear data, non-linear data, and/or the like.
Described herein are treatment-response prediction apparatuses and methods that predict treatment response based on EEG signals collected from a subject. By enabling identification of a subject as an glutamate receptor agonist responder, prior to treatment, the methods described herein may avoid unnecessary adverse events and side effects of treatment. Moreover, the methods described herein may increase the response rate to the glutamate receptor agonist. In particular embodiments, the methods described herein enable safe and effective use of the pomaglumetad, pomaglumetad methionil or a pharmaceutically acceptable salt thereof in the treatment of psychiatric disorders (e.g., psychotic disorders). In some embodiments, individual EEG metrics predictive of glutamate receptor agonist responder status are disclosed. In some embodiments, responder prediction is improved by training a machine-learning model on multiple EEG metrics.
The treatment-response prediction device 110 includes a memory 111, a communication interface 112, and a processor 113. The treatment-response prediction device 110 can receive data including EEG signals from an EEG machine (not shown) that records activities of a subject's brain. In some instances, the activities of the subject's brain can be/include electrical activities and the activities can be recorded as EEG signals by a set of electrodes connected to the EEG machine that may be operatively coupled to the treatment-response prediction device 110. The EEG machine can transmit the set of EEG signals to the treatment-response prediction device 110. The EEG signals can be recorded in the memory 111 and analyzed by the processor 113 for treating a subject with a glutamate receptor agonist.
The network 150 can be a digital telecommunication network of servers and/or compute devices. The servers and/or compute device on the network can be connected via one or more wired or wireless communication networks (not shown) to share resources such as, for example, data storage and/or computing power. The wired or wireless communication networks between servers and/or compute devices of the network 150 can include one or more communication channels, for example, a radio frequency (RF) communication channel(s), an extremely low frequency (ELF) communication channel(s), an ultra-low frequency (ULF) communication channel(s), a low frequency (LF) communication channel(s), a medium frequency (MF) communication channel(s), an ultra-high frequency (UHF) communication channel(s), an extremely high frequency (EHF) communication channel(s), a fiber optic commination channel(s), an electronic communication channel(s), a satellite communication channel(s), and/or the like. The network 150 can be, for example, the Internet, an intranet, a local area network (LAN), a wide area network (WAN), a metropolitan area network (MAN), a worldwide interoperability for microwave access network (WiMAX®), a virtual network, any other suitable communication system and/or a combination of such networks.
The server compute device 160 can be/include compute device mediums specialized for data storage purposes and/or computing purposes that can include, for example, a network of electronic memories, a network of magnetic memories, a server(s), a blade server(s), a storage area network(s), a network attached storage(s), deep learning computing servers, deep learning storage servers, and/or the like. Each server device 160 can include a memory (not shown), a communication interface (not shown) and/or a processor (not shown). The communication interface can receive/transmit data from/to the prediction device 110 via the network 150, the memory can store the data, and the processor can analyze the data. In some instances, the server compute device 160 can be a biobank server that stores the data for a long period of time (e.g. 2 years, 5 years, 10 years, 100 years, and/or the like).
The clinician compute device 170 and/or the subject compute device 180 can be/include compute devices operatively coupled and configured to transmit and/or receive data and/or analytical models to the treatment-response prediction device 110. A user of subject compute device 180 and/or the clinician compute device 170 can use the treatment-response prediction device 110 (partially or fully) for selecting a treatment and/or a treatment-response prediction. In some instances, the subject compute device 180 and/or the clinician compute device 170 can be/include, for example, a personal computer, a laptop, a smartphone, a custom personal assistant device, and/or the like, each including a memory (not shown), a communication interface (not shown) and/or a processor (not shown). The processor of the subject compute device 180 and/or the clinician compute device 170 can include a hardware based integrated circuit (IC) or any other suitable processing device configured to run and/or execute a set of instructions or code. The memory of the subject compute device 180 and/or the clinician compute device 170 can include a hardware based charge storage electronic device or any other suitable data storage medium configured to store data for long term or batch processing of the data by the processor. The communication interface of the subject compute device 180 and/or the clinician compute device 170 can include a hardware based device configured to receive/transmit electric signals, electromagnetic signals, and/or optical signals.
The memory 111 of the treatment-response prediction device 110 can be, for example, a memory buffer, a random access memory (RAM), a read-only memory (ROM), a hard drive, a flash drive, a secure digital (SD) memory card, a compact disk (CD), an external hard drive, an erasable programmable read-only memory (EPROM), an embedded multi-time programmable (MTP) memory, an embedded multi-media card (eMMC), a universal flash storage (UFS) device, and/or the like. The memory 111 can store, for example, one or more software modules and/or code that includes instructions to cause the processor 113 to execute one or more processes or functions (e.g., a signal analyzer 114, a data preprocessor 115, a predictor model 116, and/or the like).
The memory 111 can store a set of files associated with (e.g., generated by executing) the signal analyzer 114, the data preprocessor 115, and/or the predictor model 116. The set of files associated with the signal analyzer 114, the data preprocessor 115, and/or the predictor model 116 can include data generated by the signal analyzer 114, the data preprocessor 115, and/or the predictor model 116 during the operation of the treatment-response prediction device 110. In some instances, the predictor model 116 can be/include a machine learning model. The machine learning model can store temporary variables, return memory addresses, variables, a graph of the machine learning model (e.g., a set of arithmetic operations or a representation of the set of arithmetic operations used by the machine learning model), the graph's metadata, assets (e.g., external files), electronic signatures (e.g., specifying a type of the machine learning model being exported, and the input/output arrays and/or tensors), and/or the like, in the memory 111.
The communication interface 112 of the treatment-response prediction device 110 can include a software component (e.g., executed by processor 113) and/or a hardware component of the treatment-response prediction 110 to facilitate data communication between the treatment-response prediction 110 and external devices (e.g., the server compute device 160, the clinician platform 170, the subject compute device 180, and/or the like) or internal components of the treatment-response prediction 110 (e.g., the memory 111, the processor 113). The communication interface 112 is operatively coupled to and used by the processor 113 and/or the memory 111. The communication interface 112 can be, for example, a network interface card (NIC), a Wi-Fi™ module, a Bluetooth® module, an optical communication module, and/or any other suitable wired and/or wireless communication interface. In some instances, the communication interface 112 can facilitate receiving or transmitting data via the network 150. More specifically, in some implementations, the communication interface 112 can facilitate receiving or transmitting data containing EEG signals, models, and/or the like through the network 150 from/to the server compute device 160, the clinician platform 170, the subject compute device 180, and/or the like, each of which are communicatively coupled to the treatment-response prediction 110 via the network 150. In some instances, the communication interface 112 can facilitate receiving or transmitting data from the EEG machine.
The processor 113 can be, for example, a hardware based integrated circuit (IC) or any other suitable processing device configured to run or execute a set of instructions or a set of code. For example, the processor 113 can include a general purpose processor, a central processing unit (CPU), an accelerated processing unit (APU), an application specific integrated circuit (ASIC), a field programmable gate array (FPGA), a programmable logic array (PLA), a complex programmable logic device (CPLD), a programmable logic controller (PLC), a graphics processing unit (GPU), a neural network processor (NNP), and/or the like. The processor 113 can be operatively coupled to the memory 111 through a system bus (for example, address bus, data bus, and/or control bus, not shown).
The processor 113 includes a signal analyzer 114, a data preprocessor 115, and a predictor model 116. Each of the signal analyzer 114, the data preprocessor 115, and/or the predictor model 116 can include software stored in the memory 111 and executed by the processor 113. For example, a code to cause the signal analyzer 114 to fetch/process the high dimensional and high volume data can be stored in the memory 111 and executed by the processor 113. Alternatively, each of the signal analyzer 114, the data preprocessor 115, and/or the predictor model 116 can be a hardware-based device. For example, a process to predictor model 116 to predict a clinical outcome can be implemented on an individual integrated circuit chip (e.g., an ASIC).
The signal analyzer 114 can receive the EEG signals and perform signal analysis on the EEG signal. In some instances, the signal analyzer can perform a Fourier analysis (e.g., used for stationary signals) and/or wavelet analysis (e.g., used for non-stationary signals) to transform the EEG signals from time domain to frequency domain. The transformed EEG signals can be further analyzed by the signal analyzer 114 to extract significant frequency components of the EEG signals. Fourier analysis of an EEG signal produces a power spectrum that includes an indication of which frequencies are present in the EEG signals, and relative strength (or power) of the frequencies. Known power spectrum analysis of EEG or magnetoencephalographic (MEG) signals has not revealed particular frequency peaks that robustly differentiates schizophrenic subjects from controls.
The signal analyzer 114 can further generate EEG metrics. In some instances, the EEG metrics can include an index that is based on a ratio of an EEG signal power at a first frequency to the EEG signal power at a second frequency (e.g., a ratio of power at 20 Hz/power at 40 Hz power). The first and/or the second frequencies can be picked from a frequency band or multiple frequency bands. In some instances, the EEG metrics can include a power law exponent (also referred to as ‘1/f noise’ or ‘fractal exponent’) of the EEG signals. A power spectrum of EEG signals (at resting state or under stimulation), when viewed in the frequency domain (that is, with frequency of oscillation plotted on the x-axis and power on the y-axis), may be approximated by a straight line, when viewed on a log-log plot (see
Oscillatory activity at a number of frequencies and brain locations can be observed in human brain. The EEG signals recorded by the EEG machine can be collected for the frequencies and the brain locations. The brain locations can be based on an EEG electrode map. The frequencies can be in the delta band (1-3 cycles per second [Hz]), the theta band (4-7 Hz), the alpha band (8-12 Hz), the beta band (12-30 Hz), the gamma band (40-80 Hz), and/or the like.
The data preprocessor 115 can be used to receive the data (e.g., including analyzed signals by the signal analyzer 114) and further prepare the data for processing by the predictor model 116. In some implantations, the data preprocessor 115 can normalize the data, perform feature extraction, dimension reduction, and/or the like. In some instances, normalizing the data may involve amplitude matching, frequency matching, file format (e.g., txt format, CSV format, and/or the like) adjustment, data format (e.g., comma separated, semicolon separated, etc.) adjustment, and/or the like.
In some instances, the data preprocessor 115 can be configured to receive a set of signals, convert a format of the set of signals, remove measurement artifacts (e.g., generated due to eye blinks or scalp muscle movements of a subject from whom the set of signals are taken from), and/or filter the set of signals (e.g., to reduce noise in the set of (denoise) signals). Also, the data preprocessor 115 can be configured to perform an independent component analyses (ICA) to decompose the set of signals into functionally and spatially separated signals.
The predictor model 116 (also referred to as ‘the model’) can be/include a machine learning model, as described in further details herein. The predictor model 116 may include a feed-forward machine learning model, a convolutional neural network (CNN), a graph neural network (GNN), an auto encoder, a transformer neural network, a logistic regression model, a Naive Bayes classifier, a support vector machine (SVM), a random forest, a decision tree, an extreme gradient boosting (XGBoost) model, and/or the like. The predictor model 116 can be configured to include a set of model parameters including a set of weights, a set of biases, and/or a set of activation functions that, once trained, may be executed to generate a prediction of clinical outcome (e.g., responder, non-responder, 20% responder, 99% responder, a response score, and/or the like) of the EEG signals. For example the predictor model 116 can be configured to predict glutamate receptor agonist treatment responders.
In some embodiments, the clinical outcome can be categorized as “responder” vs. “non-responder”. Such categorization can be defined in multiple ways including:
In all the above cases, percentage improvement from baseline will be taken as the outcome measure. “Response” can be defined using a number of different cutoffs (e.g., improvement of 20%, 30%, 40%, 50% and 60%).
In one example, the predictor model 116 can be/include a feed forward neural network or a deep learning model that includes an input layer, an output layer, and multiple hidden layers (e.g., 5 layers, 10 layers, 20 layers, 50 layers, 100 layers, 200 layers, etc.). The multiple hidden layers may include normalization layers, fully connected layers, activation layers, convolutional layers, recurrent layers, and/or any other layers that are suitable for representing a correlation between the EEG signals and the clinical outcome, each score representing an energy term.
In one example, the predictor model 116 can be an XGBoost model that includes a set of hyper-parameters such as, for example, a number of boost rounds that defines the number of boosting rounds or trees in the XGBoost model, maximum depth that defines a maximum number of permitted nodes from a root of a tree of the XGBoost model to a leaf of the tree, and/or the like. The XGBoost model may include a set of trees, a set of nodes, a set of weights, a set of biases, and other parameters useful for describing the XGBoost model.
In some implementations, the predictor model 116 can be configured to iteratively receive EEG signals and/or EEG metrics and generate an output predicting the clinical outcome (e.g., a binary response in which 1 represents responder and 0 represents non-responder). The EEG signals and/or EEG metrics can be associated with one clinical outcome. True clinical outcomes can be compared to outputs from the predictor model 116 using an optimization model and an objective function (also referred to as ‘cost function’) to generate a training loss value. The objective function may include, for example, a mean square error, a mean absolute error, a mean absolute percentage error, a logcosh, a categorical cross entropy, and/or the like. The set of model parameters of the predictor model 116 can be modified in multiple iterations and the first objective function can be executed at each iteration until the training loss value converges to a first predetermined training threshold (e.g. 80%, 85%, 90%, 97%, etc.).
In some embodiments, the predictor model 116 can integrate the EEG metrics and/or EEG signals to generate a composite score that identifies the subject as an glutamate receptor agonist responder. In some instances, the composite score can be a normalized range of 0 to 100. A threshold within the normalized range can be set to determine whether a subset of EEG metric and/or EEG signals of a subject can identify the subject as an glutamate receptor agonist responder.
The method 300 can further include identifying 304 l a set of EEG metrics that have statistical significance (can be calculated and represented by p-value as shown in Table 1A and Table 1B) in a set of clinical treatment outcomes. Each EEG metric can be identified/generated based on (a) power at a particular frequency band (e.g., the delta band, the beta band, the gamma band, and/or the like), (b) a ratio of the power of two different frequency bands (eg, a first power at the beta band/a second power at the gamma band), (c) the power law exponent, (d) power of the EEG signal at the driven frequency (i.e., stimulation frequency), and/or (e) the ratio of the powers at two different driven frequencies. In some instances, a principal component analysis (PCA) can be carried out to arrive at a set of principal components (PCs) that included 75% variance of independent variables (e.g., pre-treatment EEG indexes) from the EEG metric. In some instances, a multivariate analysis of covariance (MANCOVA) can be carried out with all clinical outcomes as dependent variables, and independent factors of (i) treatment class, indicating treatment with pomaglumetad vs. placebo; (ii) principal components (PC); and (iii) interaction between (i) and (ii). This determines whether or not there was a relationship between any principal component and any clinical response and, more importantly, if there was a significant interaction—which would indicate a difference between treated and non-treated subjects. A significance level of p<0.05 can be used.
In some instances, for PCs that showed significant interactions above, an analysis of covariance (ANCOVA) can be conducted to determine whether there was a significant relationship (e.g., p<0.05) between the PC and any number of clinical outcome measures, for treated subjects. For those clinical outcome measures identified in step above, correlation between that outcome measure and the independent variables (e.g., a particular EEG index at a particular EEG electrode) for that sub-analysis can be determined. All predictor variables that showed a correlation with the outcome measure at a significance level of p<0.05 can be considered for analysis. These can be ranked from lowest (most significant) to highest, and the relationship(s) showing the highest level of significance for each sub-analysis can be examined in more details by constructing a topographic cortical map including electrode-level correlation and significance levels for that independent variable-dependent variable pair.
The method 300 can further include training 305 a machine learning model based on the set of EEG metrics and the set of clinical treatment outcomes, each EEG metrics from the set of EEG metrics being associated with a clinical treatment outcome from the set of clinical treatment outcomes. The method 300 can further include executing 306, after the training, the machine learning model to generate a clinical treatment outcome based on a EEG metric.
In one aspect, the disclosure provides methods of treating a subject with a glutamate receptor agonist. The methods include identifying the subject as a glutamate receptor agonist responder by obtaining or having obtained a electroencephalogram (EEG) signals from the subject. They include measuring or having measuring one or more EEG metrics, thereby identifying the subject as an glutamate receptor agonist responder, and if the subject is an glutamate receptor agonist responder, then administering the glutamate receptor agonist.
As used herein, the term “subject” refers to a human subject suffering from or at risk for a psychiatric disorder. The subject presents one or more symptoms of a mental disorder. Illustrative psychiatric disorders are described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.) (2013), which is incorporated by reference for the purpose of defining mental disorders and symptoms by which subjects can be identified as suffering from or at risk for a mental disorder. In some embodiments, the mental disorder is schizophrenia spectrum or other psychotic disorder.
The term “effective amount” refers to the amount or dose of a glutamate receptor agonist, or pharmaceutically acceptable salt, upon which single or multiple dose administration to a patient, provides the desired treatment and/or increasing in cognitive function.
According to the methods of the disclosure, a subject may be identified as a likely responder to a glutamate receptor agonist. Other factors, including symptoms of the mental disorder, may be considered by the treating physician or other healthcare worker. The methods of the disclosure are not limited to schizophrenia spectrum or other psychotic disorders, as it will be understood that glutamate receptor agonist may be used to treat other disorders. Without being bound by theory, it is believed that the EEG metrics disclosed herein are predictive of response due the correlation between EEG signals and the underlying biochemistry of the human brain. Features of the brain physiology underlying responsiveness to treatment in psychotic subjects may extend to other disorders, including neurodevelopment disorders, bipolar and related disorders, depressive disorders, anxiety disorders, and others.
Given the observed prediction of response to treatment in particular clinical domains (attention-vigilance, reasoning-problem solving, and working memory), the methods of the disclosure may be applied to mental disorders that affect these clinical domains, including but not limited to schizophrenia spectrum and other psychotic disorders.
Glutamate receptor agonists have to date failed to achieve the clinical utility expected from preclinical studies. The methods of the disclosure, with associated computational methods and apparatuses, provide for successful treatment with glutamate receptor agonists that otherwise could not be safe and effective.
Illustrative glutamate receptor agonists include D-serine, CTP-692 (deuterated D-serine), SAGE-718 (positive allosteric modulator [PAM] at the NMDA receptor). sarcosine (GlyT-1 inhibitor; also increases glycine), LY379268, eglumegad, pomaglumetad (LY2140023), and pomaglumetad methionil, or pharmaceutically acceptable salts thereof.
In some embodiments, the glutamate receptor agonist is D-serine or a pharmaceutically acceptable salt thereof.
In some embodiments, the glutamate receptor agonist is CTP-692 or a pharmaceutically acceptable salt thereof.
In some embodiments, the glutamate receptor agonist is SAGE-718 or a pharmaceutically acceptable salt thereof.
In some embodiments, the glutamate receptor agonist is a GlyT-1 inhibitor or a pharmaceutically acceptable salt thereof. In some embodiments, the glutamate receptor agonist is a Bitopertin, PF-3463275,GSK1018921, Org25935, AMG747, SSR504734, SSR103800, DCCCyB, R231857, R213129. ASP2535, or a derivative of any of the foregoing, or a pharmaceutically acceptable salt thereof. The chemical structures of these molecules are provided below:
In some embodiments, the glutamate receptor agonist is sarcosine or a pharmaceutically acceptable salt thereof. Sarcosine is a GlyT-1 inhibitor; it also increases glycine.
In some embodiments, the glutamate receptor agonist is LY379268 or a pharmaceutically acceptable salt thereof.
In some embodiments, the glutamate receptor agonist is eglumegad or a pharmaceutically acceptable salt thereof.
In some embodiments, the glutamate receptor agonist is pomaglumetad or a pharmaceutically acceptable salt thereof.
In some embodiments, the glutamate receptor agonist is pomaglumetad methionil or a pharmaceutically acceptable salt thereof.
Pomaglumetad is an amino acid analog drug that acts as a highly selective agonist for the metabotropic glutamate receptor group II subtypes mGluR2 and mGluR3. Human studies investigating therapeutic use of pomaglumetad have focused on the prodrug pomaglumetad methionil, since pomaglumetad exhibits low oral absorption and bioavailability in humans. The dosage of pomaglumetad methionil given to subjects has varied by clinical trial, though dosages have typically ranged between 10 mg and 40 mg twice daily (BID). In an early phase II monotherapy trial, the dosage shown to be efficacious was 40 mg BID. Later trials investigating the use of pomaglumetad methionil as an adjuvant to the glutamate receptor agonist medications already used by subjects participating in the study utilized a lower dose of 20 mg BID. If treatment was well tolerated after a week at this target dose, the dose was increased to 40 mg BID. However, if the 20 mg dose was not well tolerated, the dose was decreased to 10 mg.
Clinical studies of pomaglumetad methionil were halted because the glutamate receptor agonist was not significantly more efficacious than the placebo as determined with PANS S total scores. The apparatuses and methods of the present disclosure relate to the surprising discovery that EEG metrics, alone or combined using machine learning-based models, can select subjects that respond to glutamate receptor agonist (e.g., pomaglumetad methionil) therapy and/or can predict clinical outcome based on the EEG metrics.
Depending on the specific conditions being treated, such agents may be formulated into liquid (e.g., solutions, suspensions, or emulsions) or solid dosage forms (capsules or tablets) and administered systemically or locally. The agents may be delivered, for example, in a timed-, controlled, or sustained-slow release form as is known to those skilled in the art. Techniques for formulation and administration may be found in Remington: The Science and Practice of Pharmacy (20th ed.) Lippincott, Williams & Wilkins (2000). Suitable routes may include oral, buccal, by inhalation spray, sublingual, rectal, transdermal, vaginal, transmucosal, nasal or intestinal administration; parenteral delivery, including intramuscular, subcutaneous, intramedullary injections, as well as intrathecal, direct intraventricular, intravenous, intra-articullar, intra-sternal, intra-synovial, intra-hepatic, intralesional, intracranial, intraperitoneal, intranasal, or intraocular injections or other modes of delivery. In some embodiments, the pharmaceutical composition is administered orally. In some embodiments, the pharmaceutical composition is administered intravenously. In some embodiments, the pharmaceutical composition is administered intramuscularly. In some embodiments, the pharmaceutical composition is administered intrathecally. In some embodiments, the pharmaceutical composition is administered subcutaneously.
The pharmaceutical composition or combination of the present invention can be in a unit dosage form (e.g., tablet, capsule, caplet or particulate), wherein the appropriate dosage of the active ingredient may vary depending upon a variety of factors, such as, for example, the age, weight, sex, the route of administration or salt employed.
In general, the presently disclosed methods of treatment result in a decrease in the severity of a disease or condition in a subject. The term “decrease” is meant to inhibit, suppress, attenuate, diminish, arrest, or stabilize a symptom of a disease or condition.
The term “treat” “treating” “treatment” or “therapy”, as used herein, means obtaining beneficial or desired results, for example, clinical results. Beneficial or desired results can include, but are not limited to, alleviation of one or more symptoms of mental disorder. One aspect of the treatment is, for example, that said treatment should have a minimal adverse effect on the subject, e.g., it should have a high level of safety. The term “alleviation”, for example in reference to a symptom of a condition, as used herein, refers to reducing at least one of the frequency and amplitude of a symptom of a condition in a subject. In one embodiment, the term “method for the treatment”, as used herein, refers to “method to treat.”
In some embodiments of the methods of the disclosure, the glutamate receptor agonist is administered in an amount effective to cause the desired therapeutic effect (i.e., in a therapeutically effective amount).
The term “antipsychotic”, as used herein, refers to a neuroleptic drug used to treat a psychotic disorder, such as schizophrenia. In one embodiment, the antipsychotic is, for example, selected from the group comprising a typical antipsychotic and an atypical antipsychotic. In another embodiment, the antipsychotic is a typical antipsychotic. In yet another embodiment, the antipsychotic is an atypical antipsychotic.
The term “typical antipsychotic”, as used herein, refers to a first-generation antipsychotic, for example selected from the group comprising a butyrophenone (e.g., haloperidol), a diphenylbutylpiperidine (e.g., pimozide), a phenothiazine (e.g., chlorpromazine, fluphenazine, perphenazine, prochlorperazine, trifluoperazine), and a thioxanthene (e.g., thiothixene). In one embodiment, the typical antipsychotic is selected from the group comprising haloperidol, pimozide, chlorpromazine, fluphenazine, perphenazine, prochlorperazine, trifluoperazine, and thiothixene; or salts thereof.
The term “atypical antipsychotic”, as used herein, refers to a second-generation antipsychotic, for example selected from the group comprising a benzamide (e.g., sultopride), a benzisoxazole/benzisothiazole (e.g., lurasidone, paliperidone, risperidone), a phenylpiperazine/quinolinone (e.g., aripiprazole, brexpiprazole, cariprazine) a tricyclic (e.g., clozapine, olanzapine, quetiapine, asenapine, zotepine). In one embodiment, the atypical antipsychotic is selected from the group comprising sultopride, lurasidone, paliperidone, risperidone, brexpiprazole, cariprazine, clozapine, olanzapine, quetiapine, asenapine and zotepine; or salts thereof
Definitions of specific clinical domains of cognition and standard tests in humans to evaluate these are well known in the art.Test batteries developed for schizophrenia—e.g., the MATRICS (National Institute for Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus, Cognitive Battey (“MCCB”)—may be used. (Nuechterlein et al., Am J Psychiatry 165(2):203-213 (2008).) The MCCB has 7 subdomains: speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. In embodiments of the present disclosure, increasing memory/cognition in response to administration of a glutamate receptor agonist may be evaluated using one or more of the criteria below (listed in recommended order):
Further known in the art is that mouse and rat experimental tasks map onto the MCCB battery as a “preclinical MATRICS”. In embodiments of the present disclosure, effectiveness of a glutamate receptor agonist in improving cognitive function may be evaluated pre-clinically with the following sven rodent tasks: 5-choice serial reaction task (for attention/vigilance), olfactory discrimination (for speed of processing), attentional set-shifting (for reasoning/problem solving), novel object recognition test (for visual learning/memory), radial arm maze (for working memory-spatial), odor span task (for working memory-non spatial), and social interaction task (for social cognition).
In some embodiments, the subject suffers from or is at risk for a disease or disorder associated with decreased cognitive function. In some embodiments, the disease or disorder associated with decreased cognitive function is dementia, Alzheimer's disease, MAJOR depression, bipolar depression, post-traumatic stress disorder (PTSD), panic disorder, generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), Parkinson's disease, schizophrenia, an autism spectrum disorder (ASD), or obsessive compulsive disorder (OCD). In some embodiments, the subject suffers from intellectual disability, including but not limited to intellectual disability caused by Down Syndrome or Fragile X syndrome.
The following specific examples are illustrative and do not limit the scope of the invention as claimed.
After receiving the data, the format of the data can be converted (e.g., change of file format). The data can be further processed to remove measurement artifacts (e.g., due to eye blinks or scalp muscle movements), and filter it. In addition or alternatively, independent component analyses (ICA) can be performed. ICA is a process that allows one to decompose the recorded EEG data into functionally and spatially separated signals (Onton et al. (2006) Neurosci Biobehav Rev 30(6):808-822.); this can also serve to denoise the signals. The analytic techniques that follow can be applied to the filtered, artifact-free data, as well as the estimated sources as revealed by ICA.
Oscillatory activity at a number of different frequencies has been observed in human brain. These are conventionally divided into the slow frequency ranges of delta (1-3 cycles per second [Hz]) and theta (4-7 Hz); the intermediate frequencies, alpha (8-12 Hz) and beta (12-30 Hz); and the gamma band (40-80 Hz).
Fourier analysis of an EEG signal produces a so-called power spectrum—that is, an indication of which frequencies are present, and their relative strength (or power). To our knowledge, this power spectrum analysis has never successfully been used to predict medication response, or to subcategorize schizophrenic subjects.
In some instances, wavelet analysis can be used to analyze the EEG signal. The wavelet analysis is a methodology that provides similar information, but uses a rolling time window to determine frequencies present. This is particularly well suited for sets of shorter (<10 sec) data segments that can result after artifact removal.
The power spectrum of resting state EEG signals, when viewed in the frequency domain (that is, with frequency of oscillation on the x-axis and power on the y-axis), forms roughly a straight line, when viewed on a log-log plot; see FIG.5 (from Miller et al. (2019) PLoS Comput Biol 5(12): e1000609)
Mathematically, this can be expressed as log (P)=k−βlog (f), or equivalently, P αf−β1/fβ), where P=power, f=frequency, −β is the slope of the fitted line, and k is a constant. This phenomenon is known by various terms, such as a “power law” spectrum or “1/f noise”. It is often referred to as “scale invariant” or “fractal” behavior (Lowen and Teich, 2005), as the power law exponent, β, is constant regardless of the resolution at which it is calculated.
Response to treatment is determined by calculating change from baseline in key clinical outcome measures, as follows:
Positive and Negative Symptom Scale (PANS S). Correlations are made up of the Positive subscale (which ranges from 7 to 49), the Negative subscale (7 to 49) the general psychopathology subscale (16 to 112), and the PANNS total score (30 to 210).
Clinical Global Impression Severity Scale (CGI-S). This measures overall severity of subjects' symptoms and ranges from 1 to 7.
16-Item Negative Symptoms Assessment (NSA-16). Total score, ranging from 16 to 96, is used.
Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). This assesses cognitive functioning in 7 domains (speed of processing, working memory, verbal leaning, visual learning, reasoning and problem solving, attention/vigilance, and social cognition).
Personal and Social Performance (PSP) scale. Total score, which ranges to 100 and assesses four domains of functioning, is used.
Pomaglumetad methionil (LY-2140023, or “poma”) is an experimental glutamate receptor agonist which is an agonist at metabotropic (mGluR2/3) glutamate receptors, and has no known effects on dopamine receptors. Multiple phase II and III clinical trials suggested that while this agent may not be effective for subjects with schizophrenia as a whole, there may be particular subgroups for whom it is uniquely helpful. Our objective was to develop novel EEG biomarkers to identify subjects who are more likely to show a positive response to treatment with poma. Furthermore, we examined additional EEG measures—e.g., response to photic stimulation, magnitude of power law exponent (PLE)—that, to our knowledge, have not been used in prior predictive studies.
This study used data from clinical trials NCT00845026 (N=117) and NCT01052103 (N=196), which studied male and female subjects with schizophrenia treated with poma vs. antipsychotic agent standard of care. EEG recordings were taken in the pre-treatment period using a standard 19-lead montage (
Response to poma treatment was operationalized as percentage change from baseline to trial endpoint on several clinical outcome measures, including the Positive and Negative Symptom Scale (PANSS), and the MATRICS Consensus Cognitive Battery (MCCB) and its seven individual cognitive domain scales. We performed statistical analysis to determine whether there was a significant relationship between any of our calculated EEG metrics in the pre-treatment condition and treatment outcomes. The positive symptom of the PANNSS can include delusions, conceptual disorganization, hallucinations, excitement, grandiosity, suspiciousness/persecution, hostility, and/or the like. The negative symptom of the PANNSS can include blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation, stereotyped thinking, and/or the like.
Surprisingly, we identified a number of pre-treatment EEG metrics that correlated with clinical outcomes and predict response to treatment with poma (Table 1A and Table 1B).
For example: (1) In the 30 Hz photically stimulated condition, there was a positive correlation between pre-treatment low gamma (30 Hz) activity in EEG lead T6 and post-treatment improvement in cognition, as measured by the attention-vigilance domain score of the MCCB (r=0.385, p=0.000001) (line 6 of Table 1A). Correlation coefficients ranged from 0.34 to 0.39 with similar levels of significance at other occipital and inferior leads (
Taking this effect (pre-treatment PLE at left central electrode C3) as an example and using improvement in WM performance of 50% as the definition of treatment response, receiver operator curve (ROC) analysis revealed that PLE at lead C3 could identify poma responders with a sensitivity of 0.750 and a specificity of 0.897 (AUC=0.809, p=0.039) (
In sum, this data demonstrates there are subject subgroup(s) which shows unique benefit in terms of cognitive improvement, and that may be characterized by particular EEG “spectral fingerprints.”
We have identified individual EEG-based pre-treatment metrics that serve as a priori biomarkers of treatment outcome. The methodology described here could be applied to other psychoactive medications, beyond poma, and for a variety of conditions aside from schizophrenia, as these also may result in unique patterns of EEG activity in responders vs. non-responders that may be difficult to appreciate with known methods alone. In treatment settings, the ability to pinpoint likely medication responders, and therefore decrease time and resources devoted to pharmacologic trial and error would have clear value. Also, markers of the kind we have developed could be used to enrich subject samples for clinical trials, potentially resulting in smaller studies and shorter trials, and overall lower drug development costs.
The particular brain phenotype that is uniquely responsive to poma is characterized by a combination of the effects described in Examples 1 and 2. We have developed an artificial intelligence (AI) approach using deep learning artificial neural nets (ANNs) to identify such patterns. This methodology is well-suited to complex, non-linear, pattern recognition tasks with multiple inputs. The resultant “composite biomarker” takes into account all of the effects identified, and is a more robust predictor than any one singly.
We propose to create a deep neural network consisting of four layers: an input layer of 23 nodes, each corresponding to one of the biomarkers of Table 1; two hidden layers—hidden layer one consisting of 33 nodes and the hidden layer two consisting of 7 nodes—and an output layer consisting of one node, representing “responder” when active, and “non-responder” when inactive. The model can be a four layer model and number of nodes in the first and second hidden layers layer can be:
√{square root over ((m+2)N)}+2√{square root over (N/(m+2))} and m√{square root over (N/(m+2))}
nodes, respectively, where m is the number of output neurons, and N is the number of samples to be learned. The transfer function to be used will be the so-called rectified linear unit (ReLU), (f(z)=max(z, 0)).
Achieving optimal network architecture (e.g., number of layers, number of nodes per layer) can be approached as an optimization challenge. A number of different methodologies have been suggested to address this problem (Thomas and Suhner, 2015), such as the “evolutionary approach”, “constructive approach” or the “pruning approach” (which the method we have chosen to use). According to this approach, one begins with an oversized network. In the course of training, it may become clear that particular parameters are not being utilized (e.g., some connection weights go to zero or near-zero); these are then eliminated. While this approach can result in very effective networks, a downside is that this process can be computationally demanding. Given the 72 processor computer cluster that our lab owns, and that will be used to run these models, this is not a major consideration. If the pruning approach fails to produce adequate results, other model-construction approaches can be used: this is necessarily a trial-and-error process.
Our analysis (detailed in Examples 1-3, above) indicated that there are subgroups of patients that show significant improvement in cognitive function in measures of working memory, reasoning/problem solving, and attention/vigilance when given pomaglumetad methionil, and our methodology allows one to identify such subgroups. Significantly, the novel metrics we have developed which point to these functional subgroups make sense from neurocognitive standpoint. Because of this apparent preferential effect of pomaglumetad methionil, we propose a novel usage for this drug: as a nootropic, or memory enhancing, agent in normal (not psychiatrically ill) subjects.
Pre-clinical studies of glutamate receptor agonists as agents that increase cognitive function are performed using pomaglumetad methionil (LY-2140023, or “poma”) as representative of the class as a whole. Results are extended to other agents by testing them in the same or similar animal models. Animal models used include those described in Dahhan et al. Front. Behay. Neurosci., 14 (2019) doi:10.3389/fnbeh.2019.00048 which is incorporated by reference herein.
Testing of pomaglumetad methionil and other glutamate receptor agonists includes the following:
Morris Water Task. This test is used to evaluate learning and memory in rodents. The apparatus consists of a water-filled pool with a hidden escape platform beneath the surface of the water. When the animal is released into the water, it seeks the platform to escape from the water. Spatial memory is separately assessed in a probe trial without the platform.
Y Maze. This test to assesses spatial learning and memory. The spontaneous alteration test is used to assess hippocampal damage, quantify the cognitive deficits in transgenic mice, and evaluate the effects of drugs on cognition. The recognition memory test is used to test memory functions in mice.
Radial Arm Maze. This test assesses reference memory and working memory. Animals are placed on the central platform of the radial arm maze and allowed to explore the maze for reinforcers (baits) placed at the end of each arm. Failure to visit the arms of the maze containing the reward is regarded as reference memory error. Failure to reenter the arms is regarded as a working memory error.
Novel Object Recognition (NOR)Task. The test evaluates the effect of drug candidates on short-term memory, intermediate-term memory, and long-term memory. It measures the amount of time for which animals must retain memory of the sample objects placed during the recognition phase before the test phase when one of the familiar objects is replaced by a novel one.
Fear Conditioning Test. This test assesses associative fear learning and memory and may be used to evaluate a drug compounds' ability to reverse drug-induced deficits in memory.
Passive Avoidance Test. This test is fear-motivated test to assess long-term memory based on negative reinforcement. Memory performance is assessed by recording the latency to escape from the white compartment.
Elevated Plus Maze. This test is used to assess drugs affecting learning and memory. It uses transfer latency (TL) as a parameter for acquisition and retention of memory process.
Clinical studies of glutamate receptor agonists as agents that increase cognitive function are performed using pomaglumetad methionil (LY-2140023, or “poma”) as representative of the class as a whole. Clinical trial endpoints may include:
Clinical Global Impression Severity Scale (CGI-S). Clinical Global Impression Severity Scale (CGI-S). This measures overall severity of patients' symptoms, and ranges from 1 to 7.
16-Item Negative Symptoms Assessment (NSA-16). Total score, ranging from 16 to 96, will be used.
Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB). This assesses cognitive functioning in 7 domains (speed of processing, working memory, verbal leaning, visual learning, reasoning and problem solving, attention/vigilance, and social cognition)
Dose escalation studies are performed to identify effective amounts of the glutamate receptor agonist for each candidate agonist.
This application is based on, claims priority to U.S. Provisional Application Ser. No. 62/895,081, filed Sept. 3, 2019, and entitled “EEG Biomarkers,” the disclosure of which is incorporated by reference herein in its entirety.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2020/049283 | 9/3/2020 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 62895081 | Sep 2019 | US |
