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Senolytic therapy to modulate the progression of Alzheimer’s Disease (SToMP-AD) – Outcomes from the first clinical trial of senolytic therapy for Alzheimer's disease
Open accessPreprint — published as 10.1038/s41591-023-02543-w · Paper page
Abstract
Cellular senescence has been identified as a pathological mechanism linked to tau and amyloid beta (Aβ) accumulation in mouse models of Alzheimer's disease (AD). Clearance of senescent cells using the senolytic compounds dasatinib (D) and quercetin (Q) reduced neuropathological burden and improved clinically relevant outcomes in the mice. Herein, we conducted a vanguard open-label clinical trial of senolytic therapy for AD with the primary aim of evaluating central nervous system (CNS) penetrance, as well as exploratory data collection relevant to safety, feasibility, and efficacy. Participants with early-stage symptomatic AD were enrolled in an open-label, 12-week pilot study of intermittent orally-delivered D+Q. CNS penetrance was assessed by evaluating drug levels in cerebrospinal fluid (CSF) using high performance liquid chromatography with tandem mass spectrometry. Safety was continuously monitored with adverse event reporting, vitals, and laboratory work. Cognition, neuroimaging, and plasma and CSF biomarkers were assessed at baseline and post-treatment. Five participants (mean age: 76±5 years; 40% female) completed the trial. The treatment increased D and Q levels in the blood of all participants ranging from 12.7 to 73.5 ng/ml for D and 3.29-26.30 ng/ml for Q. D levels were detected in the CSF of four participants ranging from 0.281 to 0.536 ng/ml (t(4)=3.123, p=0.035); Q was not detected. Treatment was well-tolerated with no early discontinuation and six mild to moderate adverse events occurring across the study. Cognitive and neuroimaging endpoints did not significantly differ from baseline to post-treatment. CNS levels of IL-6 and GFAP increased from baseline to post-treatment (t(4)=3.913, p=008 and t(4)=3.354, p=0.028, respectively) concomitant with decreased levels of several cytokines and chemokines associated with senescence, and a trend toward higher levels of Aβ42 (t(4)=-2.338, p=0.079). Collectively the data indicate the CNS penetrance of D and provide preliminary support for the safety, tolerability, and feasibility of the intervention and suggest that astrocytes and Aβ may be particularly responsive to the treatment. While early results are promising, fully powered, placebo-controlled studies are needed to evaluate the potential of AD modification with the novel approach of targeting cellular senescence.
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“14,27,28 To date, four human studies administering DQ as a combination senolytic therapy have been completed in various populations, including idiopathic pulmonary fi brosis, 29 diabetic kidney disease, 30 age-related osteoporosis, 31 and Alzheimer ’ s disease.”
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Ward, D. D., Flint, J. P., Littlejohns, T. J., Foote, I. F., Canevelli, M., Wallace, L. M. K., Gordon, E. H., Llewellyn, D. J., Ranson, J. M., Hubbard, R. E., et al. (2024) · JAMA Neurology · doi:10.1001/jamaneurol.2024.3774 · Cited by 75
Cellular senescence in Alzheimer’s disease: from physiology to pathology
Zhu, J., Wu, C., & Yang, L. (2024) · Translational Neurodegeneration · doi:10.1186/s40035-024-00447-4 · Cited by 71
Senescent-like microglia limit remyelination through the senescence associated secretory phenotype
Gross, P. S., Durán-Laforet, V., Ho, L. T., Melchor, G. S., Zia, S., Manavi, Z., Barclay, W. E., Lee, S. H., Shults, N., Selva, S., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-57632-w · Cited by 62
The Role of Glial Cell Senescence in Alzheimer's Disease
Alshaebi, F., Sciortino, A., & Kayed, R. (2025) · Journal of Neurochemistry · doi:10.1111/jnc.70051 · Cited by 60
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Self-citationEndothelial Cell Senescence Effect on the Blood-Brain Barrier in Stroke and Cognitive Impairment
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Cellular Senescence as a Targetable Risk Factor for Cardiovascular Diseases
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Senolytic Therapy Enabled by Senescent Cell‐Sensitive Biomimetic Melanin Nano‐Senolytics
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Chronic social stress induces p16-mediated senescent cell accumulation in mice
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Engineered Exosome‐Based Senolytic Therapy Alleviates Stroke by Targeting p21+CD86+ Microglia
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Targeting DNA damage in ageing: towards supercharging DNA repair
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A Critical Appraisal of the Utility of Targeting Therapy-Induced Senescence for Cancer Treatment
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Trajectories of cardiovascular ageing—from molecular mechanisms to clinical implementation
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Cellular Senescence Is a Central Driver of Cognitive Disparities in Aging
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A new clinical age of aging research
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Dasatinib and Quercetin Limit Gingival Senescence, Inflammation, and Bone Loss
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Endothelial senescent-cell-specific clearance alleviates metabolic dysfunction in obese mice
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Self-citationCellular senescence and frailty: a comprehensive insight into the causal links
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Fyn Kinase in Alzheimer’s Disease: Unraveling Molecular Mechanisms and Therapeutic Implications
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The context-dependent effect of cellular senescence: From embryogenesis and wound healing to aging
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Alzheimer Combination Therapies: Overview and Scenarios
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Cellular senescence of granulosa cells in the pathogenesis of polycystic ovary syndrome
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Senolytic Prodrugs: A Promising Approach to Enhancing Senescence‐Targeting Intervention
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Cellular senescence: A novel therapeutic target for central nervous system diseases
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Self-citationGarbarino, V. R., Palavicini, J. P., Melendez, J., Barthelemy, N. R., He, Y., Kautz, T. F., Lopez-Cruzan, M., Mathews, J. J., Xu, P., Zhang, B., et al. (2025) · Neurotherapeutics · doi:10.1016/j.neurot.2025.e00591 · Cited by 26
Self-citationFrom Neuron‐Centric to Glia‐Centric: How Aging Glial Networks Drive Neurodegenerative Disease
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Senescence, Aging and Disease Throughout the Gastrointestinal System
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Self-citationImmunosenescence and the Geriatric Giants: Molecular Insights into Aging and Healthspan
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Senotherapeutics for Brain Aging Management
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Senescent T Cells in Age-Related Diseases
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Translating cellular senescence research into clinical practice for metabolic disease
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Sex, senescence, senolytics, and cognition
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Metadata
- Authors
- Orr, M., Gonzales, M., Garbarino, V., Kautz, T., Palavicini, J., Lopez-Cruzan, M., Dehkordi, S. K., Mathews, J., Zare, H., Xu, P., Zhang, B., Franklin, C., Habes, M., Craft, S., Petersen, R., Tchkonia, T., Kirkland, J., Salardini, A., Seshadri, S., & Musi, N.
- Affiliations
- W. G. (Bill) Hefner VA Medical Center (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of Texas Health Science Center
- Icahn School of Medicine at Mount Sinai (US)
- Wake Forest University Health Sciences (US)
- Mayo Clinic (US)
- Mayo Clinic
- Boston University (US)
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Orr, Miranda
- Gonzales, Mitzi
- ORCID
- Venue
- Nature Medicine
- Published
- 2023-04-24
- Volume
- 29
- Issue
- 10
- Pages
- 2481-2488
- ISSN
- 1078-8956 (ISSN-L)
- PMC
- PMC10875739
- OpenAlex
- W4386499275
- Cited by
- 319
- References
- 64
- Citations by year
- 2026: 100 · 2025: 116 · 2024: 82 · 2023: 21
- FWCI
- 56.36
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Nature Medicine (publishedVersion)
- Research Square (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- PubMed Central (submittedVersion, cc-by)
- ScholarWorks @ UTRGV (The University of Texas Rio Grande Valley) (submittedVersion)
- Funders
- Hevolution Foundation
- U.S. Department of Health and Human Services (TR002647, RF1AG059421, T32-AG021890, P30 AG062677, R01AG068293, R37AG13925, U01AG22307, R01AG080821, UF1 NS125417, R21NS125171, U19AG024904, R01AG069690, P30 AG066546, U54AG07594, R33AG061456, U01 AG046170, 1R01AG065301, R01AG054076, R01NS017950, P01AG062413, P30-AG013319, R01AG077472, R01AG068030, R01AG075684, R01AG033193, U01 AG006786, U24AG059624, PG30AG044271, U19NS115388, P30AG044271, R01AG066524, 1R01AG0665241A, P30AG072947, R01AG057896, U24 AG057437, 1RF1AG063507, RF1NS112391)
- U.S. Department of Veterans Affairs (I01 BX005717, P30AG013319)
- Alzheimer's Association (PTC REG-20-651687)
- American Federation for Aging Research
- Alzheimer's Drug Discovery Foundation (AG059421, GC-201908-2019443)
- Cure Alzheimer's Fund
- McGill University
- GHR Foundation
- Noaber Foundation
- National Heart and Lung Institute (R01HL105756)
- National Institutes of Health (4r01ag065301-03, TL1TR002647)
- University of Texas Health Science Center at San Antonio (TR002647)
- National Institute on Aging (R24AG073199, 1R01AG0665241A, RF1AG065301, U01AG22307, AG054076, U01AG046170, R01AG066524, R01AG069690, U01AG006786, R37 AG13925, R01AG068030, U54AG07594, R01AG057896, R01AG054076, R01AG065839, R01AG013925, 1R01AG065301, R01 AG065301, AG059421, PG30AG044271, RF1AG063507, R01AG033193, T32AG021890, RF1AG059421, R33AG061456, P30AG013319, U01AG022307, R37AG013925, R01AG080821, R01AG077472, U24AG057437, U19AG024904, U24AG059624, U54AG079754, P01AG062413, P30AG062677, R01AG068293, P30AG044271, P30AG072947, R01AG075684, P30AG066546)
- National Heart, Lung, and Blood Institute (R01HL105756)
- National Institute of Neurological Disorders and Stroke (R21NS125171, U19NS115388, RF1NS112391, UF1NS125417, R01NS017950)
- National Center for Advancing Translational Sciences (TR002647)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Telomeres, Telomerase, and Senescence
- Keywords
- senolytic therapy, Alzheimer's disease, cellular senescence, dasatinib, quercetin, oral drug delivery, CNS penetration, cerebrospinal fluid drug concentration, drug safety and tolerability, interleukin-6, glial fibrillary acidic protein, amyloid-beta 42, aging biomarkers, early Alzheimer's disease
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