A Phase 1 interventional study of Souroubea-Platanus Preparation and Placebo in Anxiety and Stress, Psychological, sponsored by University of Ottawa. Completed at 1 site in Canada. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2020-02-11.
Sponsored by University of Ottawa · Phase 1, Interventional, and Treatment
Souroubea sympetala extracts have shown anxiolytic properties in animal models. Souroubea and its active principle betulinic acid appear to exert these effects by acting as an agonist for the benzodiazepine (BZD) binding site of the GABAA receptor with no withdrawal effects on food intake, locomotor activity, or other symptoms typically associated with BZD agonism. As such, this may offer a valuable source for an alternative anti-anxiety treatment.
The primary objective of this study is to (1) to evaluate the safety and tolerability of a single daily dose of an extract of a mixture of Souroubea spp. leaf and small branch material and Platanus spp. bark when administered orally over two weeks in healthy volunteers. Based on its safety in canine trials, we hypothesize that Souroubea-Platanus (SP) preparation will be well tolerated with adverse event profile similar to placebo.
The secondary objective is (2) to establish whether some of the anxiolytic properties of Souroubea-platanus seen in animal models will translate to human participants. We hypothesize that Souroubea-Platanus preparation will demonstrate anxiolytic and/or stress-reduction properties as indicated by salivary cortisol levels and self-report measures of anxiety.
Background
Within Latin American indigenous communities tea brewed from fresh or dried crushed Souroubea leaves is used to treat Susto, a culture-bound syndrome resembling manifestations of Anxiety Disorders. Souroubea sympetala (Ss) leaf extract has shown to be effective as an anxiolytic in animal models, and betulinic acid (BA) is one of the active molecules responsible for mediating this effect.
Plant-based natural products are sought by many individuals as alternatives or supplements to standard medical care. As a result, more research is required in order to develop botanical treatments that are evidence-based, safe and guided by health practitioners. Souroubea-Platanus may offer such alternative.
Safety
Evidence suggests that Souroubea-Platanus was well tolerated in Beagles in a 28-day pilot study at 8x recommended dose, producing significant reductions in plasma cortisol 1h post-administration without any adverse reactions, except slightly reduced platelet count in 2 animals attributed to infection with Ehrlichia canis, likely contracted prior to the study onset. In a follow-up 16 beagles and up to 5x the recommended does for 28 days such decrease in platelet count was not observed, no there were any other adverse events. No adverse events have been reported in animals for the animal health product version of the drug (Zentrol) that has been on the market for 2 years. The naturalistic observations of Souroubea consumption suggest that it is safe for human use, however, this has not been established in a formal study. In addition, drug interactions have occurred with some herbal products, particularly those that strongly inhibit or induce CYP enzymes. As Souroubea may act on the BDZ binding site of the GABAA receptor, possible side-effects and symptoms similar to those associated with benzodiazepine anxiolytics are possible.
Clinical Relevance
The study has significant clinical relevance for anxiety and stress-related disorders and may lead to developing a new anxiolytic agent or supplement with more selective effects and reduced risks for the patients.
Overview of study design
Forty-five healthy adult volunteers will be enrolled in the single-center, randomized, double-blind, parallel group study. Power analysis revealed that to achieve a power of 0.80, with an estimated effect size of 0.40 (estimate based on rodent studies), a total sample size of 42 would be required. Accounting for approximately 10% predicted participant dropout rate per group, it is expected that 45 participants will be enrolled in the study.
Participants will be randomly assigned to one of the 3 treatment groups with 15 individuals in each for detecting a dose-response effect. Treatment groups will be either (a) 190mg extract (b) 380mg extract, or (c) inert placebo, all in identical vegicaps.
Capsules containing the placebo and the extracts will be produced under GMP conditions. In accordance with Health Canada guidelines, extract will conform to the acceptable limits for heavy metal and biological contamination. The placebo will consist of microcrystalline cellulose suitable for use in foods.
The capsules will be taken once a day in the morning with water for 2 consecutive weeks. The safety evaluations will be conducted at screening and repeated at the end of the 2-week study period. Adverse events will be evaluated after 1 week and 2 weeks of treatment and 1 week after discontinuation. The participants will be asked to maintain their regular lifestyle and diet during the study period so long as those habits do not violate the study exclusion criteria.
Participants will be asked to take the capsules at the same time every morning. Compliance will be facilitated by daily reminders by e-mail, text, or phone call and a review of the returned medication vials.
The participants will have 24-hour phone access to the study physician for emergencies.
Participant Compensation
Participants will be reimbursed for their time in participation, as well as for transportation and parking costs on prorated basis corresponding to minimal hourly wage.
Randomization and blinding
Blinded treatment will be used to reduce potential bias during data collection and evaluation of clinical endpoints. Participant numbers will be assigned in sequential order as participants enroll in the study. All participants will be asked to come in at the same time for all testing periods after screening (Days 1, 7, 14, and 21) in order to account for time-of-day effects on cortisol.
Participants will be assigned to one of the treatment groups according to a computer generated randomization schedule prepared by contracted pharmacy personnel. The randomization will be balanced by using permuted blocks. Pharmacy personnel will package and label study drug for each participant.
The study investigator or his/her designate and study participant will remain blind to the participants' group until the completion of the study. The blind should be broken only if in emergency requiring knowing the treatment status of the participant.
Study procedures
Baseline screening will include:
Safety evaluations:
The following laboratory parameters will be measured:
Pregnancy testing in females will consist of a serum test (for convenience, since other blood samples are already being collected during screening; this should not normally require additional venipuncture).
Saliva samples will be collected using sterile saliva sample tubes. Blood and urine samples will be collected at the clinical laboratory. Blood samples will be drawn by venipuncture.
Records of health data identifying participants will be kept on record for 25 years before being destroyed; all records will be kept confidential during that time.
Behavioural evaluations
Data analysis
Statistical means and standard deviations will be calculated for each continuous variable. ANOVA followed by post hoc Tukey's test will be used to evaluate significant differences among dose groups and different days. A P-value of 0.05 will be considered as the level of significant difference in the analysis of the data. Behavioural variables will be analyzed using mixed effects ANOVA for repeated measures where appropriate.
Transformations for non-normality and/or corrective procedures will be applied if data is found to be non-normally distributed or otherwise in violation of the assumptions of the statistical tests.
STAI: the total sum scores (T-scores); analysis - max changes from baseline and group x time effects and interactions.
Cortisol: salivary concentration; analysis - difference between pre- and 1 h post dose on Day 1, max changes from baseline and group x time effects and interactions.
Safety evaluations will be based on the baseline to treatment-period differences in laboratory tests, physical examinations, vital signs and the incidence of adverse events.
Adverse events reporting
All adverse events (AE) regardless of casual relationship with investigational treatment will be recorded. An AE will be considered treatment-emergent if it is new in onset or aggravated in severity or frequency following administration of the investigational agent. All treatment emergent AE will be followed until resolution or a stable clinical endpoint.
Serious AE, e.g. any AE that is fatal, immediately life threatening, requires or prolongs hospitalization, causes permanent or significant disability will be reported to Health Canada and IRB and immediately addressed medically as appropriate.
Participants will be encouraged to report AEs spontaneously or in response to general, non-directed questioning. All treatment-emergent AEs will be recorded in the source document using medical terminology.
783 studies on the registry are indexed under Stress, Psychological; 128 are open to participants now.
This study's enrollment of 45 is below the median of 85 across 632 interventional studies indexed under Stress, Psychological.
Browse Stress, Psychological studies →University of Ottawa is the lead sponsor of 123 studies on the registry; 33 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
190 mg souroubea-platanus preparation in vegicap. Administered once daily for 14 days.
Other: Souroubea-Platanus Preparation
380 mg souroubea-platanus preparation in vegicap. Administered once daily for 14 days.
Other: Souroubea-Platanus Preparation
Inert placebo in an identical vegicap to the experimental treatment groups. Administered once daily for 14 days.
Other: Placebo
Extracts of S. Sympetala and P. occidentalis.
Placebo
Weight
Participant weight (kilograms)
Time frame: Change from baseline weight (screening) in kg until day 14 of the protocol.
Heart rate
Heart rate (bpm)
Time frame: Change from baseline (screening) bpm until day 14 of the protocol.
Blood pressure
Systolic and Diastolic Blood pressure (mmhg)
Time frame: Change from baseline (screening) blood pressure until day 14 of the protocol.
Body temperature
Body temperature (degrees Fahrenheit).
Time frame: Change from baseline (screening) body temperature in degrees Fahrenheit until day 14 of the protocol.
White blood cell (WBC) count (per L)
White blood cell (WBC) count (per L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Red blood cell (RBC) count (per L)
Red blood cell (RBC) count (per L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Hemoglobin (g/L)
Hemoglobin (g/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Hematocrit (vol%)
Hematocrit (vol%)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Platelet count (per L)
Platelet count (per L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Blood Glucose (mg/dL)
Blood Glucose (mg/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum calcium (mg/dL)
Serum calcium (mg/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum potassium (mEq/L)
Serum potassium (mEq/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum sodium (mEq/L)
Serum sodium (mEq/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum chloride (mEq/L)
Serum chloride (mEq/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
BUN; blood urea nitrogen (mg/dL)
BUN; blood urea nitrogen (mg/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Creatinine (mg/dL)
Creatinine (mg/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum albumin (g/dL)
Serum albumin (g/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum total protein (g/dL)
Serum total protein (g/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum ALP; Alkaline phosphatase (U/L)
Serum ALP; Alkaline phosphatase (U/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum GGT; Gamma glutamyl transferase (U/L)
Serum GGT; Gamma glutamyl transferase (U/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum AST; Aspartate aminotransferase (U/L)
Serum AST; Aspartate aminotransferase (U/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum ALT ; Alanine aminotransferase (U/L)
Serum ALT ; Alanine aminotransferase (U/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum CK; Creatinine Kinase (U/L)
Serum CK; Creatinine Kinase (U/L)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Serum Bilirubin (mg/dL)
Serum Bilirubin (mg/dL)
Time frame: Change from baseline (screening) in any parameters until day 14 of the protocol.
Urinary Glucose (mmol/L)
Urinary Glucose (mmol/L)
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinary ketones (mg/dL)
Urinary ketones (mg/dL)
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinary protein (mg/dL)
Urinary protein (mg/dL)
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinalysis; visual inspection
Urinalysis; visual inspection, and microscopic visual examination if abnormal results present during visual inspection or on any of the chemistry panels.
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinary pH
Urinary pH
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinary leukocytes (U/L)
Urinary leukocytes (U/L)
Time frame: Change from baseline (screening) until day 14 of the protocol.
UBG; Urobilinogen (mg/dL)
UBG; Urobilinogen (mg/dL)
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinary nitrites
Urinary nitrites
Time frame: Change from baseline (screening) until day 14 of the protocol.
Urinary specific gravity (S.G.)
Urinary specific gravity (S.G.)
Time frame: Change from baseline (screening) until day 14 of the protocol.
DSM-5 Self-rated Level 2 Anxiety
The DSM-5 Level 2 Anxiety Adult measure has 7 items that assesses the domain of anxiety in individuals age 18 and older. All items are rated on a 5-point scale. Higher scores indicate greater anxiety. The DSM-5 Self-rated Level 2 Anxiety has a minimum score of 7 and a maximum score of 35.
Time frame: DSM-5 Self-rated Level 2 Anxiety to be completed on days 1, 7, and 14 of the 21-day protocol.
State-Trait Anxiety Inventory for Adults (STAI-AD)
The State-Trait Anxiety Inventory (STAI) has 20 items for assessing trait anxiety and 20 for state anxiety. All items are rated on a 4-point scale. Higher scores indicate greater anxiety. The STAI has a score range of 20-80, with a minimum score of 20 and a maximum score of 80.
Time frame: Change from baseline until day 21 of the protocol.
Concentration of cortisol in saliva, measured in ng/sample
Concentration of cortisol in saliva, measured in ng/sample
Time frame: Change from baseline unil day 21 of the protocol.
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