A Phase 1 interventional study of PALI-2108 in Fibrostenotic Crohn's Disease, sponsored by Palisade Bio. Active, not recruiting at 1 site in Canada. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-02-23.
Sponsored by Palisade Bio · Phase 1, Interventional, and Treatment
This is a Phase 1b, open-label, exploratory study designed to evaluate the pharmacodynamic effects of PALI-2108, a phosphodiesterase-4 (PDE4) inhibitor, in patients with fibrostenotic Crohn's disease (FSCD). The study will assess molecular, cellular, and histologic changes in intestinal tissue and peripheral blood following short-term oral administration of PALI-2108.
Eligible participants with FSCD will undergo paired ileal pinch biopsies and peripheral blood collection at baseline and after 14 days of PALI-2108 treatment. The primary objective is to elucidate the mechanism of action of PALI-2108 in modulating inflammatory and fibrotic pathways relevant to FSCD pathobiology. Analyses will include single-nucleus RNA sequencing (snRNA-seq) of intestinal biopsies and single-cell RNA sequencing (scRNA-seq) of PBMCs to profile treatment-induced transcriptomic changes across immune and stromal cell populations.
The FSCD cohort is part of a larger, multi-part study that also includes a completed Phase 1a first-in-human portion in healthy volunteers and an ulcerative colitis (UC) cohort evaluating clinical and biomarker responses to PALI-2108 treatment.
This Phase 1b exploratory study will investigate the pharmacodynamic and mechanistic effects of short-term oral administration of PALI-2108, a selective phosphodiesterase-4 (PDE4) inhibitor, in patients with fibrostenotic Crohn's disease (FSCD). The FSCD cohort builds upon the safety, tolerability, and pharmacokinetic findings from the completed Phase 1a first-in-human study and complements the ongoing ulcerative colitis (UC) cohort that assesses clinical and biomarker responses to PALI-2108 in active disease.
Fibrostenotic Crohn's disease is characterized by chronic inflammation and progressive fibrosis of the intestinal wall leading to luminal narrowing, strictures, and obstructive symptoms. Current medical therapies inadequately address the fibrotic component of disease, underscoring the need for interventions targeting both immune and stromal pathways. PDE4 inhibition represents a validated anti-inflammatory approach with emerging evidence for modulation of profibrotic signaling.
In this study, patients with ileal or ileocolonic FSCD will receive PALI-2108 orally once daily for 14 days. Paired ileal pinch biopsies and peripheral blood samples will be collected at baseline (Day 1) and at the end of treatment (Day 14). The primary objective is to characterize molecular and cellular changes induced by PDE4 inhibition in intestinal and immune compartments.
Transcriptomic profiling will be performed using single-nucleus RNA sequencing (snRNA-seq) on intestinal biopsies and single-cell RNA sequencing (scRNA-seq) on peripheral blood mononuclear cells (PBMCs). Analyses will evaluate treatment-associated changes in gene expression, cell-type composition, and pathway activation, with a focus on immune, epithelial, fibroblast, and myofibroblast populations implicated in FSCD pathology. Secondary and exploratory endpoints will include assessment of safety, tolerability, pharmacokinetics, and biomarker correlations across tissue and blood compartments.
Data from this FSCD cohort are expected to provide mechanistic insights into the biological effects of PDE4 inhibition in fibrostenotic disease and to inform dose selection, biomarker strategies, and patient segmentation for subsequent clinical development programs of PALI-2108.
If male, meets one of the following criteria:
Is able to procreate and agrees to use one of the accepted contraceptive regimens and not to donate sperm from the first study drug administration to at least 90 days after the last study drug administration. An acceptable method of contraception includes one of the following:
If female, meets one of the following criteria:
Is of childbearing potential and agrees to use an acceptable contraceptive method. Acceptable contraceptive methods include:
Use of 1 highly effective method in combination with 1 effective method of contraception.
Male partner vasectomized at least 6 months prior to the Screening visit
Diagnosis of ileal or ileocolonic CD based on supporting guideline criteria established at least 3 months prior to Screening, i.e.:
c) Clinically symptomatic fibrostenosing Crohn's disease, defined by ≥1 obstructive symptom attributable to the index ileal stricture within the prior 12 weeks and corroborated at Screening by the Stricturing Crohn's Disease patient-reported questionnaire (SPRO).
d) Symptoms must be accompanied by an ileal stricture within reach of the endoscope.
Exclusion Criteria
PALI-2108 All participants receive once-daily oral PALI-2108 for 14 days in the fed state. Two sentinel subjects receive a titrated regimen from 5 mg to 20 mg. After 7 days of sentinel dosing, the Safety Review Committee (SRC) reviews safety data and assigns the subsequent two patients to a target dose of 25 mg, with a predefined titration schedule. If the 25 mg dose is judged to be safe, all remaining subjects receive a target daily dose of 30 mg, also with a predefined titration scheme. Dose reductions may occur if safety profile is not judged adequate by SRC. Dosing is site-administered except on protocol-specified days when self-administration at home is permitted.
Drug: PALI-2108
Oral PALI-2108 administered once daily for 14 days. Sentinel subjects titrate from 5 mg to 20 mg. Subsequent patients receive a target dose between 10-30 mg based on SRC review, following protocol-specified titration schedules. Dose reductions are permitted for safety. All doses are taken in the fed state. PALI-2108 is an oral, gut-activated PDE4 inhibitor prodrug designed to release its active metabolite (PALI-0008) locally via bacterial β-glucuronidase. This targeted delivery limits systemic exposure and reduces CNS-related effects associated with systemic PDE4 inhibitors, providing localized anti-inflammatory and anti-fibrotic activity in intestinal tissue.
Safety and tolerability of PALI-2108 administered for 14 days.
Adverse events in FSCD patients receiving PALI-2108
Time frame: 14 days
Safety and tolerability of PALI-2108
Incidence of clinically significant laboratory abnormalities
Time frame: 14 Days
Safety and tolerability of PALI-2108
Incidence of clinically significant ECG findings
Time frame: 14 Days
Safety and tolerability of PALI-2108
Incidence of clinically significant vital signs findings
Time frame: 14 Days
Maximum Concentration (Cmax)
Maximum plasma concentrations of PALI-2108 and its metabolites (PALI-0008 and PALI-0708 ) following dosing with PALI-2108
Time frame: Day 1
Concentration at 12 hours (C12)
Plasma concentrations of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) at 12 hours following dosing with PALI-2108
Time frame: Day 1
Time to Cmax (Tmax)
Time to reach maximum plasma concentrations of PALI-2108 and its metabolites (PALI-0008 and PALI-0708)
Time frame: Day 1
Area under the plasma concentration-time curve (AUC0-24)
Area under the plasma concentration-time curve of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) during the first 24 hours period after first dosing with PALI-2108
Time frame: Day 1
Terminal half-life (t1/2)
Plasma elimination half-life of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) after first dose of PALI-2108
Time frame: Day 1 and Day 13
Trough plasma concentration (Ctrough)
Plasma concentration of PALI-2108 and its metabolites (PALI-0008 and PALI-070) measured in the morning, before PALI-2108 dosing
Time frame: Day 2 through Day 14
Maximal concentration at steady state (Css)
Maximal plasma concentration of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) measured at plasma drug steady state
Time frame: Day 13
Area under the plasma concentration-time curve (AUC0-12)
Area under the plasma concentration-time curve of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) during the first 12 hours period after dosing with PALI-2108
Time frame: Day 13
Area under the plasma concentration-time curve (AUC0-8)
Area under the plasma concentration-time curve of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) during the first 8 hours period after last dosing with PALI-2108
Time frame: Day 14
Tissue concentration
Concentrations of of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) in ileal, ascending and descending colonic tissue at plasma steady state.
Time frame: Day 14
Tissue/plasma concentration ratio
Ratio between tissue and plasma concentrations of PALI-2108 and its metabolites (PALI-0008 and PALI-0708) in ileal, ascending and descending colonic tissue at plasma steady state.
Time frame: Day 14
Change in PDE-4 expression and related molecular pathways in ileal tissue.
Expression of inflammatory and fibrotic biomarkers via snRNA-seq and bulk RNA-seq (log fold change)
Time frame: Baseline to Day 14.
Change in endoscopic severity using the Simple Endoscopic Score for Crohn's Disease (SES-CD).
Change in endoscopic severity using the Simple Endoscopic Score for Crohn's Disease (SES-CD).
Time frame: Screening to Day 14 ileocolonoscopy
Change in intestinal ultrasound (IUS) parameters of ileal strictures (inflammatory and fibrotic features).
Change in intestinal ultrasound (IUS) parameters of ileal strictures (inflammatory and fibrotic features).
Time frame: Baseline to Day 13
Change in symptom scores based on the Stricturing Crohn's Disease Questionnaire (SPRO v1.0).
Change in symptom scores based on the Stricturing Crohn's Disease Questionnaire (SPRO v1.0).
Time frame: Screening to Day 13
Changes in fibrosis and inflammation biomarkers in plasma.
hsCRP, CPa9-HNE, PRO-C3, PRO-C6, PRO-C11, PRO-C16, XTX-III\_HP, C3M\_HP, C4M\_HP, C7M, PRO-C22, VICM\_HP, and transcriptomic signatures from PBMC mRNA-seq
Time frame: Baseline to Day 13.
Change From Baseline in Histology Score Using Robarts Histology Index (RHI) in ileum biopsy tissue
The RHI is an evaluative index, derived from the Geboes score and is designed to be reproducible and responsive to clinically meaningful change in disease activity over time. The total RHI score ranges from 0 (no disease activity) to 33 (severe disease activity). A negative change from baseline indicates improvement.
Time frame: Baseline to Day 14
Change From Baseline in Histology Score Using Nancy Histology Index (NHI) in ileum biopsy tissue
NHI is a validated index for assessing histological disease activity in UC. It is composed of three histological items defining five grades of disease activity: absence of significant histological disease (Grade 0), chronic inflammatory infiltrate with no acute inflammatory infiltrate (Grade 1), mildly active disease (Grade 2), moderately active disease (Grade 3), and severely active disease (Grade 4). The presence of ulceration on the biopsy specimen corresponds to severely active disease (Grade 4). A decrease of the NHI grading system to Grades 0 or 1 would indicate improvement.
Time frame: Baseline to Day 14
Change From Baseline in Histology Score Using Global Histologic Disease Activity Score (GHAS) in ileum biopsy tissue
GHAS is a validated histologic scoring assessment that evaluates the overall severity of mucosal inflammation in ulcerative colitis based on microscopic features (e.g., architectural distortion, chronic inflammatory infiltrate, neutrophils, erosions/ulceration). Minimum score: 0, Maximum score: 22. Higher scores indicate greater histologic disease activity.
Time frame: Baseline to Day 14
Change From Baseline in Ileum Biopsy Tissue Histological Assessment of Fibrocytes/Fibroblasts
The assessment measures the density and distribution of stromal cells involved in extracellular matrix production, wound healing, and fibrotic remodeling. There is no fixed minimum or maximum value. Higher values indicate increased stromal activation or fibrogenic activity.
Time frame: Baseline to Day 14
Change From Baseline in Ileum Biopsy Tissue Histological Assessment of Collagen
The assessment measures the extent and distribution of extracellular matrix collagen as an indicator of tissue remodeling or fibrotic activity. There is no fixed minimum or maximum value. Higher values reflect greater collagen accumulation.
Time frame: Baseline to Day 14
Change From Baseline in Ileum Biopsy Tissue Histological Assessment of Muscularis Mucosa Thickening
This measure reflects structural remodeling of the mucosal wall, often associated with chronic inflammation, altered motility, or early fibrotic change. There is no fixed minimum or maximum value. Higher values indicate greater thickening of the muscularis mucosa.
Time frame: Baseline to Day 14
Change From Baseline in Simple Endoscopic Score for Crohn's Disease (SES-CD)
The SES-CD is a validated endoscopic scoring system that quantifies the severity of Crohn's disease based on colonoscopy findings. The minimum score is 0 (no endoscopic disease activity); the maximum score is 56 (severe ulceration, extensive affected surface, strictures in all segments).
Time frame: Baseline to Day 14
Change From Baseline in intestinal ultrasound (IUS) parameters of ileal strictures (inflammatory and fibrotic features)
IUS assessment of ileal strictures relies on quantitative measures (e.g., bowel wall thickness) and semi-quantitative features. The units are mm with higher values indicating more severity.
Time frame: Baseline to Day 14
Change From Baseline in symptom scores based on the Stricturing Crohn's Disease Questionnaire (SPRO v1.0)
The Stricturing Crohn's Disease Patient Reported Outcome (SPRO v1.0) is a validated PRO instrument developed by the STAR Consortium to measure symptoms and impacts associated with small bowel strictures in Crohn's disease. The instrument has a unitless score ranging from 0 (no symptoms) to 12 (worst symptoms).
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including
The Stricturing Crohn's Disease Patient Reported Outcome (SPRO v1.0) is a validated PRO instrument developed to measure symptoms and impacts associated with small bowel strictures in Crohn's disease. The instrument has a unitless score ranging from 0 (no symptoms) to 12 (worst symptoms).
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum High Sensitivity C Reactive Protein (hsCRPp)
hsCRP units of measure are mg/L with higher values indicating worse systemic inflammation.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Neutrophil Elastase-Degraded Type IX Collagen Fragment (Cpa9-HNE)
CPa9-HNE units of measure are ng/mL with higher values indicating worse neutrophil-driven tissue injury.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Type III Collagen Formation Fragment (PRO-C3)
PRO-C3 units of measure are ng/mL with higher values indicating worse collagen III formation / fibrogenesis.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Type VI Collagen Formation Fragment (Endotrophin) (PRO-C6)
PRO-C6 units of measure are ng/mL with higher values indicating worse collagen VI formation / fibrosis.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Type XI Collagen Formation Fragment (PRO-C11)
PRO-C11 units of measure are ng/mL with higher values indicating worse collagen XI formation / remodeling.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Type XVI Collagen Formation Fragment (PRO-C16)
PRO-C16 units of measure are ng/mL with higher values indicating worse collagen XVI formation / basement membrane remodeling.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Cross Linked Type III Collagen Fragment (High Precision) (XTX-III_HP)
XTX-III\_HP units of measure are ng/mL with higher values indicating worse cross linked collagen III turnover.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum MMP Degraded Type III Collagen Fragment (High Precision) (C3M_HP)
C3M\_HP units of measure are ng/mL with higher values indicating worse MMP mediated collagen III degradation.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum MMP Degraded Type IV Collagen Fragment (High Precision) (C4M_HP)
C4M\_HP units of measure are ng/mL with higher values indicating worse MMP mediated collagen IV degradation; basement membrane injury.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum MMP Degraded Type VII Collagen Fragment (C7M)
C7M units of measure are ng/mL with higher values indicating worse collagen VII degradation; epithelial barrier injury.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Type XXII Collagen Formation Fragment (PRO-C22)
PRO-C22 units of measure are ng/mL with higher values indicating worse collagen XXII formation; epithelial-stromal interface remodeling.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers Including Serum Citrullinated And MMP Degraded Vimentin Fragment (High Precision) (VICM_HP)
VICM\_HP units of measure are ng/mL with higher values indicating worse macrophage activation; citrullinated vimentin turnover.
Time frame: Baseline to Day 13
Change From Baseline In Biomarkers in PBMC and FSCD lesions (inflammatory region and fibrotic region including Whole Blood Composite Gene Expression Signature)
Transcriptomic signatures use a unitless composite score with no fixed range, The change of values is gene dependent and can be indicating disease progression by change in either direction
Time frame: Baseline to Day 13
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