New Experimental Medicine Studies: Fast-Fail Trials in Mood and Anxiety

FAST-MAS计划将专注于新的分子和临床靶点，这些靶点可能跨越情绪和焦虑光谱中的诊断类别，也可能与其他精神障碍相关。情绪和焦虑症谱系障碍，如DSM-IV-TR所示，是心理健康从业者治疗的最常见和最严重的障碍之一。这些疾病包括重度抑郁障碍、心境恶劣障碍(一种慢性、轻度抑郁)和双相情感障碍(也称为躁郁症)。有各种各样的焦虑症，包括广泛性焦虑症、创伤后应激障碍、强迫症和特殊恐惧症。 这一举措旨在迅速测试和分析新的干预措施(即化合物)及其分子和/或临床目标，以治疗与传统情绪和焦虑谱系障碍相关的精神病理学的临床层面(例如，快感缺乏、认知功能、社交参与)。特别令人感兴趣的是情绪和焦虑谱性障碍的特征，如目前的DSM-IV-TR诊断实体中所描述的，但通常不被确定为当前临床治疗的主要目标。如上所述，人们有兴趣研究跨越传统障碍类别的机制，其中相关机制和临床目标是直接评估的，而不是通过分配特定诊断来推断的。 这一倡议的结果预计将通过这种新的干预措施加强对特定目标参与的理解，从而为与传统情绪和焦虑谱系障碍相关的精神病理学的临床层面开发创新的治疗方法。在这方面，新的干预措施(即化合物)可以是指新的化学实体(NCEs)，也可以是指正在考虑从其他适应症重新利用的化合物。如果最近的基础研究发现表明化合物(S)有可能影响导致精神障碍的生物机制，并且以前没有在临床研究中进行测试，那么对已被FDA批准用于其他适应症(重新用途)的化合物的测试是有意义的。作用于分子靶点的化合物复制了目前市场上销售的精神药物的分子靶点，对本合同不感兴趣。 这份合同的主要目标是迅速进行小规模的I期和/或IIa期临床试验(例如，首个人类临床试验)，以证明这些有希望的化合物在健康受试者和/或具有与传统情绪和焦虑谱系障碍相关的临床病理特征的患者中的靶向性、安全性和早期疗效迹象。根据可供选择用于测试的化合物的试验数据，每个试验可能是一项单点或多点研究，有许多受试者足以成功地解决主要目标(例如，药物剂量范围、人体安全性、分子和/或临床靶点参与、潜在生物标记物、生物效应、疗效的早期迹象)，并为判断特定化合物是否需要进一步评估提供信息。

The FAST-MAS initiative will focus will be on novel molecular and clinical targets that may cut across diagnostic categories within the mood and anxiety spectrum, and may also be relevant to other mental disorders. Mood and anxiety spectrum disorders, as represented in the DSM-IV-TR, are among the most common and serious disorders treated by mental health practitioners. These include major depressive disorder; dysthymic disorder (a chronic, mild depression); and bipolar disorder (also called manic depression). There are a wide variety of anxiety disorders, including generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and special phobias. This initiative seeks to expeditiously test and analyze novel interventions (i.e., compounds) and their molecular and/or clinical targets for treating clinical dimensions of psychopathology (e.g., anhedonia, cognitive function, social engagement) associated with traditional mood and anxiety spectrum disorders. Of particular interest are features of mood and anxiety spectrum disorders as described in the current DSM-IV-TR diagnostic entities, but not typically identified as the primary target of current clinical therapeutics. As described above, there is interest in the study of mechanisms that cut across traditional disorder categories and where relevant mechanisms and clinical targets are assessed directly rather than being inferred through assignment of a particular diagnosis. The outcome of this initiative is expected to lead to enhanced understanding of specific target engagement by such novel interventions, leading to development of innovative treatment approaches for clinical dimensions of psychopathology associated with traditional mood and anxiety spectrum disorders. In this context, novel interventions (i.e., compounds) may refer either to new chemical entities (NCEs) or to compounds that are being considered for re-purposing from other indications. Testing of compounds that have been FDA-approved for other indications (re-purposing) is of interest if recent basic research discoveries suggest that the compound(s) have the potential to affect a biological mechanism contributing to mental disorders and that has previously been untested in clinical studies. Compounds acting on molecular targets that replicate those of currently marketed psychiatric pharmaceuticals are not of interest for this contract. The primary objective of this contract is to expeditiously perform small-scale Phase I and/or Phase IIa clinical trials (e.g., First In Human (FIH), Proof of Clinical Mechanism (POCM), Proof of Concept (POC)) to demonstrate target engagement, safety, and early signs of efficacy of such promising compounds in healthy subjects and/or a well-characterized cohort of patients with clinical dimensions of psychopathology associated with traditional mood and anxiety spectrum disorders. Depending on pilot data available for compounds selected for testing, each trial may be a single-site or multisite study with a number of subjects adequate to successfully address the primary aims (e.g., pharmacologic dose range, safety in humans, molecular and/or clinical target engagement, potential biomarkers, biological effects, early signs of efficacy) and inform a judgment whether the particular compound warrants further evaluation.