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Effects of AFQ056 on language learning in fragile X syndrome.

ABSTRACT: BACKGROUNDFXLEARN, the first-ever large multisite trial of effects of disease-targeted pharmacotherapy on learning, was designed to explore a paradigm for measuring effects of mechanism-targeted treatment in fragile X syndrome (FXS). In FXLEARN, the effects of metabotropic glutamate receptor type 5 (mGluR5) negative allosteric modulator (NAM) AFQ056 on language learning were evaluated in 3- to 6-year-old children with FXS, expected to have more learning plasticity than adults, for whom prior trials of mGluR5 NAMs have failed.METHODSAfter a 4-month single-blind placebo lead-in, participants were randomized 1:1 to AFQ056 or placebo, with 2 months of dose optimization to the maximum tolerated dose, then 6 months of treatment during which a language-learning intervention was implemented for both groups. The primary outcome was a centrally scored videotaped communication measure, the Weighted Communication Scale (WCS). Secondary outcomes were objective performance-based and parent-reported cognitive and language measures.RESULTSFXLEARN enrolled 110 participants, randomized 99, and had 91 who completed the placebo-controlled period. Although both groups made language progress and there were no safety issues, the change in WCS score during the placebo-controlled period was not significantly different between the AFQ056 and placebo-treated groups, nor were there any significant between-group differences in change in any secondary measures.CONCLUSIONDespite the large body of evidence supporting use of mGluR5 NAMs in animal models of FXS, this study suggests that this mechanism of action does not translate into benefit for the human FXS population and that better strategies are needed to determine which mechanisms will translate from preclinical models to humans in genetic neurodevelopmental disorders.TRIAL REGISTRATIONClincalTrials.gov NCT02920892.FUNDING SOURCESNeuroNEXT network NIH grants U01NS096767, U24NS107200, U24NS107209, U01NS077323, U24NS107183, U24NS107168, U24NS107128, U24NS107199, U24NS107198, U24NS107166, U10NS077368, U01NS077366, U24NS107205, U01NS077179, and U01NS077352; NIH grant P50HD103526; and Novartis IIT grant AFQ056X2201T for provision of AFQ056.

SUBMITTER: Berry-Kravis E

PROVIDER: S-EPMC10904045 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Effects of AFQ056 on language learning in fragile X syndrome.

Berry-Kravis Elizabeth E Abbeduto Leonard L Hagerman Randi R Coffey Christopher S CS Cudkowicz Merit M Erickson Craig A CA McDuffie Andrea A Hessl David D Ethridge Lauren L Tassone Flora F Kaufmann Walter E WE Friedmann Katherine K Bullard Lauren L Hoffmann Anne A Veenstra-VanderWeele Jeremy J Staley Kevin K Klements David D Moshinsky Michael M Harkey Brittney B Long Jeff J Fedler Janel J Klingner Elizabeth E Ecklund Dixie D Costigan Michele M Huff Trevis T Pearson Brenda B

The Journal of clinical investigation 20230831 5

BACKGROUNDFXLEARN, the first-ever large multisite trial of effects of disease-targeted pharmacotherapy on learning, was designed to explore a paradigm for measuring effects of mechanism-targeted treatment in fragile X syndrome (FXS). In FXLEARN, the effects of metabotropic glutamate receptor type 5 (mGluR5) negative allosteric modulator (NAM) AFQ056 on language learning were evaluated in 3- to 6-year-old children with FXS, expected to have more learning plasticity than adults, for whom prior tri ...[more]

PMID: 37651202

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Project description:The current study investigated how individual differences among children affect the added value of social robots for teaching second language (L2) vocabulary to young children. Specifically, we investigated the moderating role of three individual child characteristics deemed relevant for language learning: first language (L1) vocabulary knowledge, phonological memory, and selective attention. We expected children low in these abilities to particularly benefit from being assisted by a robot in a vocabulary training. An L2 English vocabulary training intervention consisting of seven sessions was administered to 193 monolingual Dutch five-year-old children over a three- to four-week period. Children were randomly assigned to one of three experimental conditions: 1) a tablet only, 2) a tablet and a robot that used deictic (pointing) gestures (the no-iconic-gestures condition), or 3) a tablet and a robot that used both deictic and iconic gestures (i.e., gestures depicting the target word; the iconic-gestures condition). There also was a control condition in which children did not receive a vocabulary training, but played dancing games with the robot. L2 word knowledge was measured directly after the training and two to four weeks later. In these post-tests, children in the experimental conditions outperformed children in the control condition on word knowledge, but there were no differences between the three experimental conditions. Several moderation effects were found. The robot's presence particularly benefited children with larger L1 vocabularies or poorer phonological memory, while children with smaller L1 vocabularies or better phonological memory performed better in the tablet-only condition. Children with larger L1 vocabularies and better phonological memory performed better in the no-iconic-gestures condition than in the iconic-gestures condition, while children with better selective attention performed better in the iconic-gestures condition than the no-iconic-gestures condition. Together, the results showed that the effects of the robot and its gestures differ across children, which should be taken into account when designing and evaluating robot-assisted L2 teaching interventions.

Project description:BackgroundThe lack of robust and reliable clinical biomarkers in Fragile X Syndrome (FXS), the most common inherited form of intellectual disability, has limited the successful translation of bench-to-bedside therapeutics. While numerous drugs have shown promise in reversing synaptic and behavioral phenotypes in mouse models of FXS, none have demonstrated clinical efficacy in humans. Electroencephalographic (EEG) measures have been identified as candidate biomarkers as EEG recordings of both adults with FXS and mouse models of FXS consistently exhibit alterations in resting state and task-related activity. However, the developmental timing of these EEG differences is not known as thus far EEG studies have not focused on young children with FXS. Further, understanding how EEG differences are associated with core symptoms of FXS is crucial to successful use of EEG as a biomarker, and may improve our understanding of the disorder.MethodsResting-state EEG was collected from FXS boys with full mutation of Fmr1 (2.5-7 years old, n = 11) and compared with both age-matched (n = 12) and cognitive-matched (n = 12) typically developing boys. Power spectra (including aperiodic and periodic components) were compared using non-parametric cluster-based permutation testing. Associations between 30 and 50 Hz gamma power and cognitive, language, and behavioral measures were evaluated using Pearson correlation and linear regression with age as a covariate.ResultsFXS participants showed increased power in the beta/gamma range (~ 25-50 Hz) across multiple brain regions. Both a reduction in the aperiodic (1/f) slope and increase in beta/gamma periodic activity contributed to the significant increase in high-frequency power. Increased gamma power, driven by the aperiodic component, was associated with better language ability in the FXS group. No association was observed between gamma power and parent report measures of behavioral challenges, sensory hypersensitivities, or adaptive behaviors.LimitationsThe study sample size was small, although comparable to other human studies in rare-genetic disorders. Findings are also limited to males in the age range studied.ConclusionsResting-state EEG measures from this study in young boys with FXS identified similar increases in gamma power previously reported in adults and mouse models. The observed positive association between resting state aperiodic gamma power and language development supports hypotheses that alterations in some EEG measures may reflect ongoing compensatory mechanisms.

Project description:BackgroundThe evaluation of treatment efficacy for individuals with fragile X syndrome (FXS) or intellectual disability (ID) more generally has been hampered by the lack of adequate outcome measures. We evaluated expressive language sampling (ELS) as a procedure for generating outcome measures for treatment research in FXS. We addressed: (a) feasibility, (b) practice effects over two administrations, (c) test-retest reliability over the repeated administrations, and (d) construct validity. We addressed these issues for the full sample as well as for subgroups defined by age, IQ, and ASD status.MethodsParticipants were 106 individuals with FXS between ages 6 and 23 years who had IQs within the range of intellectual disability (IQ < 70). ELS procedures for collecting samples in conversation and narration were followed and analyzed separately. Five measures were derived from transcripts segmented into C-units (i.e., an independent clause and its modifiers): number of C-units per minute (talkativeness), number of different word roots (vocabulary), C-unit length in morphemes (syntax), percentage of C-units containing dysfluency (utterance planning), and percentage of C-units that were fully or partly unintelligible (articulatory quality). ELS procedures were administered twice at 4-week intervals for each participant. Standardized tests and informant reports were administered and provided measures for evaluating construct validity of ELS measures.ResultsWe found low rates of noncompliance, suggesting the task can be completed meaningfully by most individuals with FXS, although noncompliance was higher for younger, lower IQ, and more autistic participants. Minimal practice effects and strong test-retest reliability over the 4-week interval were observed for the full sample and across the range of ages, IQs, and autism symptom severity. Evidence of convergent construct validity was observed for the measures of vocabulary, syntax, and unintelligibility for the full sample and across the range of IQ and autism symptom severity, but not for participants under age 12. Conversation and narration yielded largely similar results in all analyses.ConclusionsThe findings suggest that the ELS procedures are feasible and yield measures with adequate psychometric properties for a majority of 6 to 23 years with FXS who have ID. The procedures work equally well regardless of level of ID or degree of ASD severity. The procedures, however, are more challenging and have somewhat less adequate psychometric properties for individuals with FXS under age 12.

Dataset Information

Effects of AFQ056 on language learning in fragile X syndrome.

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Effects of AFQ056 on language learning in fragile X syndrome.

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