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Sulforaphane Treatment of Children With Autism Spectrum Disorder (ASD)

Sulforaphane Treatment of Children With Autism Spectrum Disorder (ASD)

Status
Completed
Phases
Phase 1Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02561481
Enrollment
60
Registered
2015-09-28
Start date
2015-12-31
Completion date
2020-01-31
Last updated
2020-12-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Autism Spectrum Disorder

Brief summary

ASD is a diverse disorder starting in early childhood and characterized by social communication impairment as well as restricted interests and repetitive behaviors. It affects 1:68 children and is an enormous medical and economic problem for which there is no established, mechanism-based treatment. Sulforaphane is an isothiocyanate derived from broccoli, and has potent activity in transcriptionally up-regulating genes that control mechanisms whereby aerobic cells protect themselves against oxidative stress, mitochondrial dysfunction, and inflammation. This study is a clinical trial of oral sulforaphane (as broccoli seed powder) in 50 boys and girls (3-12 years) with ASD in 3 phases over 36 weeks. In Phase 1, 25 children will receive active drug and 25 will receive placebo for 15 weeks; in Phase 2, all children will receive sulforaphane from 15-30 weeks; in Phase 3, children will receive no treatment for 6 weeks. Study visits will take place at screening, 7, 15, 22, 30 and 36 weeks, when the Ohio Autism Clinical Clinical Impressions Scale - Severity and Improvement (OACIS-S and OACIS-I), Aberrant Behavior Checklist (ABC) and Social Responsiveness Scale (SRS) will be recorded. Children will be monitored with physical examinations and for toxicity with clinical laboratory studies and examine possible biomarkers: Nuclear factor-erythroid factor 2 (Nrf2), oxidative stress and mitochondrial function, the mechanistic target of rapamycin (mTOR) pathway and cytokine expression. In addition, prior to the main clinical trial, a pilot study will be carried out in 10 children with ASD, 6-12 years of age, who will receive sulforaphane, 2.2 micromoles/kg daily for 14 days. Blood and urine samples before and at the end of treatment will be collected, in order to measure several parameters that are likely to demonstrate expected effects of sulforaphane, to standardize the assays and procedures, and to determine the most effective measures.

Detailed description

Background: ASD is a diverse disorder starting in early childhood and characterized by social communication impairment as well as restricted interests and repetitive behaviors. It affects 1:68 children and is an enormous medical and economic problem for which there is no established, mechanism-based treatment. Sulforaphane is an isothiocyanate derived from broccoli, and has potent activity in transcriptionally up-regulating genes that control mechanisms whereby aerobic cells protect themselves against oxidative stress, mitochondrial dysfunction, and inflammation. Hypothesis: Based on the observation that fever is frequently associated with behavioral improvements in children with ASD, it is hypothesized that sulforaphane might lead to functional improvements in ASD because it can up-regulate cell-protective responses, such as heat shock proteins and related mechanisms that are also up-regulated during fever. These mechanisms are central to multiple cellular processes in the central nervous system, including synaptic transmission, and may improve long-range cerebral cortical connectivity, which is depressed in ASD. Specific aims: The 3 specific aims in this study are: 1) To determine if there are measurable effects on social responsiveness and problem behaviors during treatment of children with sulforaphane; 2) To determine if treatment with sulforaphane in children is safe and well tolerated; and 3) To elucidate cellular biomarkers that respond to treatment with sulforaphane. Design: This is a randomized, double blind, single-arm crossover phase 1/2 clinical trial of orally administered sulforaphane (as broccoli seed powder) in 50 boys and girls (3-12 years) with ASD in 3 phases over 36 weeks. In Phase 1, 25 children will receive active drug and 25 will receive placebo for 15 weeks; in Phase 2, all children will receive sulforaphane from 15-30 weeks; in Phase 3, children will receive no treatment for 6 weeks. Study visits will take place at screening, 7, 15, 22, 30 and 36 weeks, when the Ohio Autism Clinical Clinical Impressions Scale - Severity and Improvement (OACIS-S and OACIS-I), Aberrant Behavior Checklist (ABC) and Social Responsiveness Scale (SRS) will be recorded. The children will be monitored with physical examinations and for toxicity with clinical laboratory studies and examine possible biomarkers: Nrf2, oxidative stress and mitochondrial function, mTOR pathway and cytokine expression. In addition, prior to the main clinical trial, a pilot study will be performed in 10 children with ASD, 6-12 years of age, who will receive sulforaphane, 2.2 micromoles/kg daily for 14 days. Blood and urine samples before and at the end of treatment will be collected, in order to measure several parameters that are likely to demonstrate expected effects of sulforaphane, to standardize the assays and procedures, and to determine the most effective measures.

Interventions

DRUGSulforaphane

See under active arm description

DRUGPlacebo

See under placebo arm description

Sponsors

Congressionally Directed Medical Research Programs
CollaboratorFED
Johns Hopkins University
CollaboratorOTHER
University of Massachusetts, Worcester
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
3 Years to 12 Years
Healthy volunteers
No

Inclusion criteria

* Autism Spectrum Disorder (ASD) diagnosis of moderate or greater severity * Age 3 through 12 years inclusive

Exclusion criteria

* Absence of a parent or legal guardian and consent * Inability to speak/understand English language * Seizure within 1 year of screening: This exclusion is based on the theoretical concern that cellular activation by sulforaphane might exacerbate seizures in patients with known seizure disorders. As noted in our previous trial of sulforaphane in young adult males, a seizure occurred in each of 2 participants: one during treatment (in a participant with a previously undisclosed seizure), the other 3 weeks after discontinuing sulforaphane. * Impaired renal function (serum creatinine \> 1.2 mg/dl), impaired hepatic function (SGOT/SGPT\> 2x upper limit of normal), impaired thyroid function (Thyroid Stimulating Hormone (TSH) outside normal limits): This exclusion is based on a theoretical possibility of activation of underlying cellular metabolic abnormalities by sulforaphane. Current infection or treatment with antibiotics: this exclusion is to avoid complications of inter-current illness that may occur due to the clinical trial or obscure possible effects of sulforaphane. * Medications that may modify the course or testing of ASD parameters (e.g., prednisone): This exclusion is necessary in order not to interfere with or complicate effects of sulforaphane. * Chronic medical disorder (e.g., cardiovascular disease, stroke or diabetes) or major surgery within 3 months prior to enrollment: Serious medical illness in the child may be complicated by the clinical trial and make it difficult to discern a change in ASD associated with treatment. * Less than 3 years or more than 13 years of age: this age range was selected to cover the ages from usual diagnosis of ASD up to adolescence. * A diagnosis of autism spectrum disorder of mild severity (for example, earlier categories of Asperger disorder, Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)), according to Autism Diagnostic Observation Schedule (ADOS) criteria. * Prisoners * Pregnant women

Design outcomes

Primary

MeasureTime frameDescription
Change in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeksThe Ohio Autism Clinical Impressions Scale-Severity (OACIS-S) rates severity of symptoms in 10 categories: general level of autism, social interaction, aberrant and repetitive behavior, verbal and nonverbal communication, hyperactivity, anxiety, sensory sensitivities and restricted and narrow interests. Each category is rated from 1 (normal) to 7 (most severe). The OACIS-S was a reference at follow up visits when the OACIS-Improvement was compared to the OACIS-S, from 1 to 7: 4 was no change; 3 to 1 minimal to marked improvement and 5 to 7 minimal to marked worsening. The numerical score of the OACIS-S is independent and unrelated quantitatively to the OACIS-I. For analysis, the OACIS-I general score and subscale values were recoded, in which 4 (no change) was recoded as 0; 3 to 1 were recoded as +1 to +3 to denote improvement, and 5 to 7 were recoded as -1 to -3 for worsening.

Secondary

MeasureTime frameDescription
Free GSH:GSSG and Total GSH:GSSG Ratios at Week 15Week 15Ratios of free GSH:GSSG and total GSH:GSSG were calculated by obtaining ratios of f-statistic scores from baseline to week 15 between free reduced GSH and GSSG and between total GSH and GSSG.
Comparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15Week 0 and Week 15F-statistic calculated by comparison of Free Reduced GSH, Total GSH and oxidized Glutathione (GSSG) of Week 15 to Week 0.
OACIS-I Response Rate on Aberrant Behaviors Subscale7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeksSee above in the primary outcome measure for a description of OACIS-I scale. This section describes the change from baseline of the OACIS-I subdomain of aberrant behaviors. This subdomain has a range of 1 to 7 - 1 is extremely improved from baseline, 7 is extremely worse from baseline, and 4 is no change. For analysis, the OACIS-I general score and subscale values were recoded, in which 4 (no change) was recoded as 0; 3 to 1 were recoded as +1 to +3 to denote improvement, and 5 to 7 were recoded as -1 to -3 for worsening.
OACIS-I Response Rate on Social Communication Subscale7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeksSee above in the primary outcome measure for a description of OACIS-I scale. This section describes the change from baseline of the OACIS-I subdomain of social communication. This subdomain has a range of 1 to 7 - 1 is extremely improved from baseline, 7 is extremely worse from baseline, and 4 is no change. For analysis, the OACIS-I general score and subscale values were recoded, in which 4 (no change) was recoded as 0; 3 to 1 were recoded as +1 to +3 to denote improvement, and 5 to 7 were recoded as -1 to -3 for worsening.
Change in Total Aberrant Behavior Checklist Score From Baseline7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeksAberrant Behavior Checklist (ABC) is a 58 item scale that primarily evaluates how aberrant or abnormal a patient's daily behaviors are. The items evaluate behaviors as they pertain to irritability, lethargy/social withdrawal, stereotypic behavior, hyperactivity/noncompliance, and inappropriate speech. Each item is scored on a scale of 0 to 3, with 0 being better outcome and 3 being worse outcome. The score from each item is added up to calculate a total score. This outcome describes change in total ABC score from baseline at each follow up visit. The scores from all items are added to calculate a total score (0 to 174). This outcome describes change in total ABC score from baseline at each follow up visit.
Change in Total SRS-2 Score From Baseline7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeksThe Social Responsiveness Scale-2 (SRS-2) is a 65-item scale that measures total scores as well as subscales: four social behaviors (awareness, cognition, communication and motivation) and autistic mannerisms. Each item is rated from 1 to 4 (not true to almost always true) on worksheets that are blinded to the rater with respect to values. Total and subscale scores are calculated as raw scores and can be converted to T-scores. Raw scores (range 0-180) are reported here (unadjusted for general population, since all children had ASD). Higher or lower values at follow up visits compared to baseline indicated worsening or improvement, respectively.
Dithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 0, Week 7, Week 15, Week 22, Week 30, Week 36Sulforaphane (and other isothiocyanates, ITC) are conjugated by glutathione (GSH) which then undergoes further enzymatic modifications to give rise sequentially to the cysteinylglycine-, cysteine- and N-acetylcysteine-ITC conjugates, all of which are dithiocarbamates (DTC) and are detected in the cyclocondensation reaction-HPLC assay.

Other

MeasureTime frameDescription
Cox-2Week 0, Week 15, Week 30Cox-2 (cyclooxygenase-2): a nuclear factor-kappa B - regulated inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
TNF-αWeek 0, Week 15, Week 30TNF-α (Tumor necrosis factor alpha), a cytokine as inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
NQO1: NAD(P)H:Quinone Oxidoreductase-1Week 0, Week 15, Week 30Cytoprotective enzyme regulated by nuclear factor erythroid 2-related factor 2 (Nrf2), the master regulator of cellular redox homeostasis and an inhibitor of a key pro-inflammatory pathway, of which both functions are critical factors in the neuropathology of ASD. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
xCTWeek 0, Week 15, Week 30xCT (SLC7A11): Cystine/glutamate antiporter encoded by the SLC7A11 gene.Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
HO-1 (Heme Oxygenase 1)Week 0, Week 15, Week 30HO-1 (heme oxygenase 1): an essential and Nrf2-dependent enzyme in heme catabolism. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
HSP70Week 0, Week 15, Week 30HSP70 (Heat shock protein 70) was examined because it is upregulated by SF in vitro. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
HSP27Week 0, Week 15, Week 30.HSP27 (Heat shock protein 27) was examined because it is upregulated by SF in vitro. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
IL-6Week 0, Week 15, Week 30IL-6 (interleukin 6) cytokine gene expression, a nuclear factor-kappa B - regulated inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.
IL-1βWeek 0, Week 15, Week 30IL-1β: Interleukin-1 beta cytokine gene expression, a nuclear factor-kappa B - regulated inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Countries

United States

Participant flow

Participants by arm

ArmCount
Sulforaphane
Sulforaphane (SF) will be administered once a day orally in an approximate dose of 1 µmol/lb (2.2 kg µmol/kg) body weight. Each SF tablet will contain 125 mg broccoli seed powder (equivalent to \ 15 µmol SF). The total dose per day will depend on participants' body weight: 30-50 lb: 3 tablets (45 µmol/day) 50-70 lb: 4 tablets (60 µmol/day) 70-90 lb: 6 tablets (90 µmol/day) 90-110 lb: 7 tablets (105 µmol/day) 110-130 lb: 8 tablets (120 µmol/day) For pilot study, all participants (n=10) will receive SF for 14 days. For main clinical trial, 25 participants will randomly receive SF for 15 weeks (phase 1). During phase 2, a single-arm crossover from placebo to sulforaphane arm will take place, and all participants will receive SF from 15-30 weeks. Sulforaphane: See under active arm description
22
Placebo
Placebo tablets identical in size and similar in appearance to the active tablets will be used. Number of placebo tablets will be equivalent to the active tablets depending on participants' body weight. For the main clinical trial, 25 participants will be randomly allocated to receive placebo for 15 weeks (phase 1). During phase 2, a single-arm crossover from placebo arm to sulforaphane arm will take place, and all participants will receive sulforaphane from 15-30 weeks. Placebo: See under placebo arm description
23
Total45

Baseline characteristics

CharacteristicSulforaphanePlaceboTotal
Age, Continuous7.4 years
STANDARD_DEVIATION 3
7.0 years
STANDARD_DEVIATION 2.5
7.2 years
STANDARD_DEVIATION 2.8
Race/Ethnicity, Customized
Other (asian, mixed, and unknown)
5 Participants8 Participants13 Participants
Race/Ethnicity, Customized
White
17 Participants15 Participants32 Participants
Region of Enrollment
United States
22 participants23 participants45 participants
Sex: Female, Male
Female
2 Participants3 Participants5 Participants
Sex: Female, Male
Male
20 Participants20 Participants40 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 320 / 23
other
Total, other adverse events
8 / 320 / 23
serious
Total, serious adverse events
0 / 321 / 23

Outcome results

Primary

Change in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline

The Ohio Autism Clinical Impressions Scale-Severity (OACIS-S) rates severity of symptoms in 10 categories: general level of autism, social interaction, aberrant and repetitive behavior, verbal and nonverbal communication, hyperactivity, anxiety, sensory sensitivities and restricted and narrow interests. Each category is rated from 1 (normal) to 7 (most severe). The OACIS-S was a reference at follow up visits when the OACIS-Improvement was compared to the OACIS-S, from 1 to 7: 4 was no change; 3 to 1 minimal to marked improvement and 5 to 7 minimal to marked worsening. The numerical score of the OACIS-S is independent and unrelated quantitatively to the OACIS-I. For analysis, the OACIS-I general score and subscale values were recoded, in which 4 (no change) was recoded as 0; 3 to 1 were recoded as +1 to +3 to denote improvement, and 5 to 7 were recoded as -1 to -3 for worsening.

Time frame: 7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeks

Population: Patients started dropping out at subsequent visits so the number analyzed at latter visits is less

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline15 weeks0.28 score on a scaleStandard Deviation 0.57
SulforaphaneChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline30 weeks0.47 score on a scaleStandard Deviation 0.67
SulforaphaneChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline22 weeks0.47 score on a scaleStandard Deviation 0.72
SulforaphaneChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline36 weeks0.29 score on a scaleStandard Deviation 0.73
SulforaphaneChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline7 weeks0.28 score on a scaleStandard Deviation 0.67
PlaceboChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline36 weeks0.29 score on a scaleStandard Deviation 0.61
PlaceboChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline7 weeks0.28 score on a scaleStandard Deviation 0.57
PlaceboChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline15 weeks0.33 score on a scaleStandard Deviation 0.69
PlaceboChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline22 weeks0.59 score on a scaleStandard Deviation 0.71
PlaceboChange in Ohio Autism Clinical Impressions Scale - Improvement (OACIS-I) Average Score From Baseline30 weeks0.69 score on a scaleStandard Deviation 0.77
Secondary

Change in Total Aberrant Behavior Checklist Score From Baseline

Aberrant Behavior Checklist (ABC) is a 58 item scale that primarily evaluates how aberrant or abnormal a patient's daily behaviors are. The items evaluate behaviors as they pertain to irritability, lethargy/social withdrawal, stereotypic behavior, hyperactivity/noncompliance, and inappropriate speech. Each item is scored on a scale of 0 to 3, with 0 being better outcome and 3 being worse outcome. The score from each item is added up to calculate a total score. This outcome describes change in total ABC score from baseline at each follow up visit. The scores from all items are added to calculate a total score (0 to 174). This outcome describes change in total ABC score from baseline at each follow up visit.

Time frame: 7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeks

Population: Patients started dropping out at subsequent visits so the number analyzed at later visits is less

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneChange in Total Aberrant Behavior Checklist Score From Baseline15 weeks-22.6 score on a scaleStandard Deviation 10.34
SulforaphaneChange in Total Aberrant Behavior Checklist Score From Baseline30 weeks-22.8 score on a scaleStandard Deviation 13.5
SulforaphaneChange in Total Aberrant Behavior Checklist Score From Baseline22 weeks-36.33 score on a scaleStandard Deviation 14.55
SulforaphaneChange in Total Aberrant Behavior Checklist Score From Baseline36 weeks1.14 score on a scaleStandard Deviation 3.53
SulforaphaneChange in Total Aberrant Behavior Checklist Score From Baseline7 weeks-6 score on a scaleStandard Deviation 3.4
PlaceboChange in Total Aberrant Behavior Checklist Score From Baseline36 weeks-7.8 score on a scaleStandard Deviation 5.56
PlaceboChange in Total Aberrant Behavior Checklist Score From Baseline7 weeks-16.23 score on a scaleStandard Deviation 14.02
PlaceboChange in Total Aberrant Behavior Checklist Score From Baseline15 weeks-11.68 score on a scaleStandard Deviation 5.4
PlaceboChange in Total Aberrant Behavior Checklist Score From Baseline22 weeks-22.4 score on a scaleStandard Deviation 15.45
PlaceboChange in Total Aberrant Behavior Checklist Score From Baseline30 weeks-10.29 score on a scaleStandard Deviation 9.97
Secondary

Change in Total SRS-2 Score From Baseline

The Social Responsiveness Scale-2 (SRS-2) is a 65-item scale that measures total scores as well as subscales: four social behaviors (awareness, cognition, communication and motivation) and autistic mannerisms. Each item is rated from 1 to 4 (not true to almost always true) on worksheets that are blinded to the rater with respect to values. Total and subscale scores are calculated as raw scores and can be converted to T-scores. Raw scores (range 0-180) are reported here (unadjusted for general population, since all children had ASD). Higher or lower values at follow up visits compared to baseline indicated worsening or improvement, respectively.

Time frame: 7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeks

Population: Patients dropped out (or families did not return forms) at subsequent visits so the number analyzed at later visits is less.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneChange in Total SRS-2 Score From Baseline36 weeks0.80 score on a scaleStandard Deviation 3.3
SulforaphaneChange in Total SRS-2 Score From Baseline7 weeks1.14 score on a scaleStandard Deviation 5.33
SulforaphaneChange in Total SRS-2 Score From Baseline15 weeks-16.86 score on a scaleStandard Deviation 10.56
SulforaphaneChange in Total SRS-2 Score From Baseline22 weeks-14.61 score on a scaleStandard Deviation 9.9
SulforaphaneChange in Total SRS-2 Score From Baseline30 weeks-19.83 score on a scaleStandard Deviation 15
PlaceboChange in Total SRS-2 Score From Baseline30 weeks-18.59 score on a scaleStandard Deviation 11.57
PlaceboChange in Total SRS-2 Score From Baseline22 weeks-13.67 score on a scaleStandard Deviation 11.23
PlaceboChange in Total SRS-2 Score From Baseline7 weeks-8.06 score on a scaleStandard Deviation 7.89
PlaceboChange in Total SRS-2 Score From Baseline36 weeks-19.59 score on a scaleStandard Deviation 10.17
PlaceboChange in Total SRS-2 Score From Baseline15 weeks-7.92 score on a scaleStandard Deviation 4.45
Secondary

Comparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15

F-statistic calculated by comparison of Free Reduced GSH, Total GSH and oxidized Glutathione (GSSG) of Week 15 to Week 0.

Time frame: Week 0 and Week 15

ArmMeasureGroupValue (NUMBER)
SulforaphaneComparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15Free Reduced GSH1.51 F-statistic
SulforaphaneComparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15Total GSH0.00 F-statistic
SulforaphaneComparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15GSSG1.97 F-statistic
PlaceboComparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15Free Reduced GSH0.11 F-statistic
PlaceboComparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15Total GSH0.08 F-statistic
PlaceboComparison of Free Reduced Glutathione (GSH), Total GSH, Oxidized Glutathione (GSSG) at Week 0 and 15GSSG0.46 F-statistic
Secondary

Dithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each Visit

Sulforaphane (and other isothiocyanates, ITC) are conjugated by glutathione (GSH) which then undergoes further enzymatic modifications to give rise sequentially to the cysteinylglycine-, cysteine- and N-acetylcysteine-ITC conjugates, all of which are dithiocarbamates (DTC) and are detected in the cyclocondensation reaction-HPLC assay.

Time frame: Week 0, Week 7, Week 15, Week 22, Week 30, Week 36

Population: Number analyzed varied due to participants who dropped out, their blood samples could not be obtained, or data could not be obtained from the assay.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 00.007 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.008
SulforaphaneDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 70.299 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.297
SulforaphaneDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 150.329 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.35
SulforaphaneDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 220.248 nmol DTC (Dithiocarbamates)/ml
SulforaphaneDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 300.165 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.183
SulforaphaneDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 360.015 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.024
PlaceboDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 300.214 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.228
PlaceboDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 00.006 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.008
PlaceboDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 220.205 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.253
PlaceboDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 70.003 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.005
PlaceboDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 360.008 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.012
PlaceboDithiocarbamate Plasma Concentration Detected by Cyclocondensation at Each VisitWeek 150.005 nmol DTC (Dithiocarbamates)/mlStandard Deviation 0.008
Secondary

Free GSH:GSSG and Total GSH:GSSG Ratios at Week 15

Ratios of free GSH:GSSG and total GSH:GSSG were calculated by obtaining ratios of f-statistic scores from baseline to week 15 between free reduced GSH and GSSG and between total GSH and GSSG.

Time frame: Week 15

ArmMeasureGroupValue (NUMBER)
SulforaphaneFree GSH:GSSG and Total GSH:GSSG Ratios at Week 15Free GSH:GSSG12.72 F-statistic
SulforaphaneFree GSH:GSSG and Total GSH:GSSG Ratios at Week 15Total GSH:GSSG5.16 F-statistic
PlaceboFree GSH:GSSG and Total GSH:GSSG Ratios at Week 15Free GSH:GSSG0.87 F-statistic
PlaceboFree GSH:GSSG and Total GSH:GSSG Ratios at Week 15Total GSH:GSSG0.03 F-statistic
Secondary

OACIS-I Response Rate on Aberrant Behaviors Subscale

See above in the primary outcome measure for a description of OACIS-I scale. This section describes the change from baseline of the OACIS-I subdomain of aberrant behaviors. This subdomain has a range of 1 to 7 - 1 is extremely improved from baseline, 7 is extremely worse from baseline, and 4 is no change. For analysis, the OACIS-I general score and subscale values were recoded, in which 4 (no change) was recoded as 0; 3 to 1 were recoded as +1 to +3 to denote improvement, and 5 to 7 were recoded as -1 to -3 for worsening.

Time frame: 7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeks

Population: Patients started dropping out at subsequent visits so the number analyzed at latter visits is less

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneOACIS-I Response Rate on Aberrant Behaviors Subscale15 weeks0.22 score on a scaleStandard Deviation 0.43
SulforaphaneOACIS-I Response Rate on Aberrant Behaviors Subscale30 weeks0.63 score on a scaleStandard Deviation 0.89
SulforaphaneOACIS-I Response Rate on Aberrant Behaviors Subscale22 weeks0.59 score on a scaleStandard Deviation 0.8
SulforaphaneOACIS-I Response Rate on Aberrant Behaviors Subscale36 weeks0.14 score on a scaleStandard Deviation 0.77
SulforaphaneOACIS-I Response Rate on Aberrant Behaviors Subscale7 weeks0.06 score on a scaleStandard Deviation 0.42
PlaceboOACIS-I Response Rate on Aberrant Behaviors Subscale36 weeks0.14 score on a scaleStandard Deviation 0.53
PlaceboOACIS-I Response Rate on Aberrant Behaviors Subscale7 weeks0.28 score on a scaleStandard Deviation 0.57
PlaceboOACIS-I Response Rate on Aberrant Behaviors Subscale15 weeks0.33 score on a scaleStandard Deviation 0.69
PlaceboOACIS-I Response Rate on Aberrant Behaviors Subscale22 weeks0.53 score on a scaleStandard Deviation 0.87
PlaceboOACIS-I Response Rate on Aberrant Behaviors Subscale30 weeks0.59 score on a scaleStandard Deviation 0.84
Secondary

OACIS-I Response Rate on Social Communication Subscale

See above in the primary outcome measure for a description of OACIS-I scale. This section describes the change from baseline of the OACIS-I subdomain of social communication. This subdomain has a range of 1 to 7 - 1 is extremely improved from baseline, 7 is extremely worse from baseline, and 4 is no change. For analysis, the OACIS-I general score and subscale values were recoded, in which 4 (no change) was recoded as 0; 3 to 1 were recoded as +1 to +3 to denote improvement, and 5 to 7 were recoded as -1 to -3 for worsening.

Time frame: 7 weeks, 15 weeks, 22 weeks, 30 weeks, 36 weeks

Population: Patients started dropping out at subsequent visits so the number analyzed at latter visits is less

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneOACIS-I Response Rate on Social Communication Subscale15 weeks0.44 score on a scaleStandard Deviation 0.7
SulforaphaneOACIS-I Response Rate on Social Communication Subscale30 weeks0.94 score on a scaleStandard Deviation 0.83
SulforaphaneOACIS-I Response Rate on Social Communication Subscale22 weeks0.65 score on a scaleStandard Deviation 0.79
SulforaphaneOACIS-I Response Rate on Social Communication Subscale36 weeks0.32 score on a scaleStandard Deviation 0.61
SulforaphaneOACIS-I Response Rate on Social Communication Subscale7 weeks0.33 score on a scaleStandard Deviation 0.69
PlaceboOACIS-I Response Rate on Social Communication Subscale36 weeks0.61 score on a scaleStandard Deviation 0.66
PlaceboOACIS-I Response Rate on Social Communication Subscale7 weeks0.56 score on a scaleStandard Deviation 0.7
PlaceboOACIS-I Response Rate on Social Communication Subscale15 weeks0.56 score on a scaleStandard Deviation 0.62
PlaceboOACIS-I Response Rate on Social Communication Subscale22 weeks1.35 score on a scaleStandard Deviation 0.61
PlaceboOACIS-I Response Rate on Social Communication Subscale30 weeks1.25 score on a scaleStandard Deviation 0.61
Other Pre-specified

Cox-2

Cox-2 (cyclooxygenase-2): a nuclear factor-kappa B - regulated inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneCox-2Week 15-0.07 log fold changeStandard Deviation 1.59
SulforaphaneCox-2Week 00.14 log fold changeStandard Deviation 0.86
SulforaphaneCox-2Week 30-0.46 log fold changeStandard Deviation 1.57
PlaceboCox-2Week 150.16 log fold changeStandard Deviation 0.66
PlaceboCox-2Week 0-0.20 log fold changeStandard Deviation 1.06
PlaceboCox-2Week 30-0.17 log fold changeStandard Deviation 1.17
Other Pre-specified

HO-1 (Heme Oxygenase 1)

HO-1 (heme oxygenase 1): an essential and Nrf2-dependent enzyme in heme catabolism. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneHO-1 (Heme Oxygenase 1)Week 00.10 log fold changeStandard Deviation 1.21
SulforaphaneHO-1 (Heme Oxygenase 1)Week 150.74 log fold changeStandard Deviation 0.69
SulforaphaneHO-1 (Heme Oxygenase 1)Week 300.74 log fold changeStandard Deviation 0.56
PlaceboHO-1 (Heme Oxygenase 1)Week 00.27 log fold changeStandard Deviation 0.98
PlaceboHO-1 (Heme Oxygenase 1)Week 150.55 log fold changeStandard Deviation 0.48
PlaceboHO-1 (Heme Oxygenase 1)Week 300.30 log fold changeStandard Deviation 1.4
Other Pre-specified

HSP27

HSP27 (Heat shock protein 27) was examined because it is upregulated by SF in vitro. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30.

Population: N varies due to missing data, variable clinic visits or assay failure

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneHSP27Week 30-0.47 log fold changeStandard Deviation 1.21
SulforaphaneHSP27Week 00.21 log fold changeStandard Deviation 0.46
SulforaphaneHSP27Week 150.21 log fold changeStandard Deviation 0.63
PlaceboHSP27Week 0-0.13 log fold changeStandard Deviation 0.98
PlaceboHSP27Week 15-0.83 log fold changeStandard Deviation 1.21
PlaceboHSP27Week 30-0.58 log fold changeStandard Deviation 1.46
Other Pre-specified

HSP70

HSP70 (Heat shock protein 70) was examined because it is upregulated by SF in vitro. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneHSP70Week 01.11 log fold changeStandard Deviation 0.29
SulforaphaneHSP70Week 151.33 log fold changeStandard Deviation 0.43
SulforaphaneHSP70Week 301.23 log fold changeStandard Deviation 0.34
PlaceboHSP70Week 301.20 log fold changeStandard Deviation 0.4
PlaceboHSP70Week 00.99 log fold changeStandard Deviation 0.43
PlaceboHSP70Week 151.14 log fold changeStandard Deviation 0.3
Other Pre-specified

IL-1β

IL-1β: Interleukin-1 beta cytokine gene expression, a nuclear factor-kappa B - regulated inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneIL-1βWeek 00.90 log fold changeStandard Deviation 1.16
SulforaphaneIL-1βWeek 151.45 log fold changeStandard Deviation 0.59
SulforaphaneIL-1βWeek 301.50 log fold changeStandard Deviation 0.49
PlaceboIL-1βWeek 301.59 log fold changeStandard Deviation 0.43
PlaceboIL-1βWeek 01.14 log fold changeStandard Deviation 1.11
PlaceboIL-1βWeek 151.47 log fold changeStandard Deviation 0.5
Other Pre-specified

IL-6

IL-6 (interleukin 6) cytokine gene expression, a nuclear factor-kappa B - regulated inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneIL-6Week 152.05 log fold changeStandard Deviation 0.28
SulforaphaneIL-6Week 01.76 log fold changeStandard Deviation 0.39
SulforaphaneIL-6Week 301.99 log fold changeStandard Deviation 0.23
PlaceboIL-6Week 01.82 log fold changeStandard Deviation 0.3
PlaceboIL-6Week 151.87 log fold changeStandard Deviation 0.42
PlaceboIL-6Week 302.08 log fold changeStandard Deviation 0.22
Other Pre-specified

NQO1: NAD(P)H:Quinone Oxidoreductase-1

Cytoprotective enzyme regulated by nuclear factor erythroid 2-related factor 2 (Nrf2), the master regulator of cellular redox homeostasis and an inhibitor of a key pro-inflammatory pathway, of which both functions are critical factors in the neuropathology of ASD. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneNQO1: NAD(P)H:Quinone Oxidoreductase-1Week 0 (baseline)2.23 log fold changeStandard Deviation 0.18
SulforaphaneNQO1: NAD(P)H:Quinone Oxidoreductase-1Week 152.19 log fold changeStandard Deviation 0.16
SulforaphaneNQO1: NAD(P)H:Quinone Oxidoreductase-1Week 302.15 log fold changeStandard Deviation 0.15
PlaceboNQO1: NAD(P)H:Quinone Oxidoreductase-1Week 0 (baseline)2.25 log fold changeStandard Deviation 0.22
PlaceboNQO1: NAD(P)H:Quinone Oxidoreductase-1Week 152.14 log fold changeStandard Deviation 0.2
PlaceboNQO1: NAD(P)H:Quinone Oxidoreductase-1Week 302.13 log fold changeStandard Deviation 0.11
Other Pre-specified

TNF-α

TNF-α (Tumor necrosis factor alpha), a cytokine as inflammatory biomarker. Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphaneTNF-αWeek 00.70 log fold changeStandard Deviation 1
SulforaphaneTNF-αWeek 150.98 log fold changeStandard Deviation 1.03
SulforaphaneTNF-αWeek 301.17 log fold changeStandard Deviation 0.79
PlaceboTNF-αWeek 151.08 log fold changeStandard Deviation 0.49
PlaceboTNF-αWeek 301.10 log fold changeStandard Deviation 0.73
PlaceboTNF-αWeek 00.91 log fold changeStandard Deviation 0.37
Other Pre-specified

xCT

xCT (SLC7A11): Cystine/glutamate antiporter encoded by the SLC7A11 gene.Total cellular RNA was isolated from peripheral blood mononuclear cells (PBMCs) and complementary DNAs (cDNA) were synthesized. Quantitative real-time PCR analysis was performed using the Applied Biosystems QuantStudio™ 3 Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). Relative mRNA expression was normalized to GAPDH. Gene expression was calculated using the comparative 2-ΔΔCT method.

Time frame: Week 0, Week 15, Week 30

Population: N varies due to missing data, variable clinic visits or assay failure.

ArmMeasureGroupValue (MEAN)Dispersion
SulforaphanexCTWeek 00.24 log fold changeStandard Deviation 0.94
SulforaphanexCTWeek 300.24 log fold changeStandard Deviation 1.02
SulforaphanexCTWeek 150.25 log fold changeStandard Deviation 0.65
PlaceboxCTWeek 00.40 log fold changeStandard Deviation 0.71
PlaceboxCTWeek 150.30 log fold changeStandard Deviation 0.95
PlaceboxCTWeek 300.27 log fold changeStandard Deviation 1

Source: ClinicalTrials.gov · Data processed: Feb 22, 2026