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HOPE4MCI trial: First trial targeting reduction of hippocampal overactivity to treat mild cognitive impairment due to Alzheimer’s disease with AGB101

AD pathophysiological pathways involving both amyloid and tau have been functionally linked to excessive neural activity, with heightened neural activity causing dysfunction and progressive spread of pathology in the disease from an origin in the medial temporal lobe/hippocampus. Like hippocampal overactivity, recent evidence has demonstrated an association of amyloid and p‐tau 217 in early AD, with progressive elevation of p‐tau217 as the disease progresses. Substantial clinical evidence also indicates that hippocampal overactivity longitudinally predicts subsequent cognitive decline/conversion to dementia due to AD. AGB101 (low dose levetiracetam) demonstrates efficacy on a range of AD‐related molecular, synaptic, electrophysiological, functional and behavioral endpoints across models and species. Clinical proof of concept for this therapeutic hypothesis was demonstrated with AGB101 in a Phase 2A study that showed a reduction in hippocampal overactivity resulted in improvement in task related memory performance. To further examine this hypothesis, the HOPE4MCI trial is investigating the effects of AGB101 (low dose levetiracetam, 220 mg extended release) in a 78‐week protocol using tau biomarkers ([11C]MK 6420 pet imaging and p‐tau 217 plasma) alongside CDR‐SB (sole primary endpoint) for clinical/cognitive efficacy in MCI due to AD.