Therapeutics

GENUS

Overview

Name: GENUS
Synonyms: Gamma entrainment using sensory stimuli
Therapy Type: Combination, Procedural Intervention
Target Type: Amyloid-Related (timeline), Inflammation (timeline), Other (timeline)
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Phase 1)
Company: Cognito Therapeutics, Inc.

Background

GENUS refers to a non-invasive procedure, i.e., a "digital therapeutic, "being developed by Cognito Therapeutics. The company developed a device called GammaSense Stimulation, which delivers sensory stimuli at gamma band frequency in order to entrain gamma oscillations in the brain. An LED light flashing at 40 Hz for one hour boosts gamma power in the visual (V1), prefrontal, and somatosensory cortices, and hippocampal CA1. It also increases synchronization between V1 and the other regions. A second paradigm combines light and sound at 40 Hz to strengthen gamma oscillations throughout the auditory cortex, hippocampus, and medial prefrontal cortex.

In 5XFAD, APPPS1, and wild-type mice, one hour of light-based GENUS reportedly halved Aβ levels, and one week of GENUS in 6-month-old 5XFAD mice cut amyloid plaque load by two-thirds. In TauP301S, this regimen cut phosphorylated tau by 40 percent (Iaccarino et al., 2016).

Neuron numbers were maintained in TauP301S mice for three weeks with GENUS starting at 7.5 months of age, when neurodegeneration begins in this model. In the inducible p25 neurodegeneration mouse model, six weeks of GENUS preserved neuron number and cortical thickness. In both models, GENUS maintained neuronal expression of genes affecting synaptic transmission and vesicle trafficking, protected DNA, increased the density of mushroom spines, and improved performance in the Morris water maze. In all models tested, GENUS lowered microgliosis and inflammatory gene expression, while increasing internalization of Aβ (Adaikkan et al., 2019). The combination of light and sound at 40 Hz in 6-month-old 5XFAD mice had similar effects to light alone, but reached more brain areas (Martorell et al., 2019).

A separate study linked acoustic stimulation to lowered amyloid plaques and increased microglial numbers in the hippocampi of 5XFAD mice (Lee et al., 2018). For reviews on gamma band neural stimulation, aka gamma entrainment, see McDermott et al., 2018Adaikan and Tsai, 2020.

Findings

In a brief, independent pilot study conducted without Cognito Therapeutics, 10 days of 40 Hz light therapy did not affect amyloid load, as measured by PiB PET, in 10 AD patients (Ismail et al., 2018).

In April 2018, Cognito Therapeutics began a Phase 1 trial called Overture to evaluate combined auditory and visual GENUS in 60 people with AD or mild cognitive impairment due to AD. Participants receive one hour of GENUS, or sham treatment, daily for six months, with a follow-up visit one month later to assess safety. The primary outcome is ADAS-Cog score, with amyloid imaging as a secondary outcome. The trial takes place at six sites in the U.S. and will run until August 2021.

In May 2018, a second Phase 1 study called Etude began comparing dosing paradigms for auditory and visual GENUS in 20 people with AD or mild cognitive impairment due to AD. These include one hour once per day, one hour twice per day, one hour every other day, and 30 or 120 minutes twice per day. The primary outcomes are amyloid PET and safety; secondary, ADAS-Cog.

From November 2018 to February 2020, a third study called Flicker evaluated the tolerability of a combined audio-visual stimulation for one hour per day on 10 people with AD. Five participants received eight weeks of GENUS; five received four weeks of no intervention followed by four weeks of intervention. Results have not yet been disclosed.

In January 2021, Cognito's GammaSense stimulation device received breakthrough status from the FDA. 

For all trials of GENUS, see clinicaltrials.gov.

Last Updated: 13 Jan 2021

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References

Research Models Citations

  1. 5xFAD (B6SJL)
  2. Tau P301S (Line PS19)

Paper Citations

  1. . The Effect of 40-Hz Light Therapy on Amyloid Load in Patients with Prodromal and Clinical Alzheimer's Disease. Int J Alzheimers Dis. 2018;2018:6852303. Epub 2018 Jul 30 PubMed.
  2. . Gamma frequency entrainment attenuates amyloid load and modifies microglia. Nature. 2016 Dec 7;540(7632):230-235. PubMed.
  3. . Gamma Entrainment Binds Higher-Order Brain Regions and Offers Neuroprotection. Neuron. 2019 Jun 5;102(5):929-943.e8. Epub 2019 May 7 PubMed.
  4. . Multi-sensory Gamma Stimulation Ameliorates Alzheimer's-Associated Pathology and Improves Cognition. Cell. 2019 Apr 4;177(2):256-271.e22. Epub 2019 Mar 14 PubMed.
  5. . 40 Hz acoustic stimulation decreases amyloid beta and modulates brain rhythms in a mouse model of Alzheimers disease. BioRχiv. August 20, 2018.
  6. . Gamma Band Neural Stimulation in Humans and the Promise of a New Modality to Prevent and Treat Alzheimer's Disease. J Alzheimers Dis. 2018;65(2):363-392. PubMed.
  7. . Gamma Entrainment: Impact on Neurocircuits, Glia, and Therapeutic Opportunities. Trends Neurosci. 2020 Jan;43(1):24-41. Epub 2019 Dec 10 PubMed.

Other Citations

  1. APPPS1

External Citations

  1. clinicaltrials.gov

Further Reading

Papers

  1. . Gamma Entrainment: Impact on Neurocircuits, Glia, and Therapeutic Opportunities. Trends Neurosci. 2020 Jan;43(1):24-41. Epub 2019 Dec 10 PubMed.