Blocking Toxic Oligomers: The Science and Strategy Behind Zervimesine

Tony Caggiano, MD, chief medical officer at Cognition Therapeutics, described the mechanism of action of CT-1812 (zervimesine) and outlined the company's clinical and regulatory strategy across dementia with Lewy bodies and Alzheimer disease.

Caggiano explained that CT-1812 operates through a fundamentally different mechanism than traditional antipsychotics.¹ As a small-molecule oral agent, it binds to proteins on the cell surface and prevents toxic oligomers—specifically amyloid oligomers in Alzheimer disease and alpha-synuclein oligomers in dementia with Lewy bodies and Parkinson disease—from binding to and stressing neurons, thereby reducing cell death. Caggiano noted that many patients with dementia with Lewy bodies harbor both amyloid and alpha-synuclein pathology simultaneously, making CT-1812's dual blocking capacity particularly well suited to the disease.

Caggiano situated the development of CT-1812 within a broader landscape of progress in neurodegeneration, drawing parallels to the recent approvals of lecanemab and donanemab in Alzheimer disease, and expressing hope that CT-1812 could be "the first to market with a drug that specifically addresses the symptoms of DLB." He credited the National Institutes of Health—specifically the National Institute on Aging—with providing early funding that enabled preclinical work and phase 1 and 2 studies, describing the program as an example of productive collaboration among government, academia, and industry.²

On the regulatory path forward, Caggiano confirmed plans to bring SHIMMER trial data to the FDA to agree on a registrational trial design, with the goal of demonstrating conclusive benefit-risk in subsequent studies and ultimately seeking approval in the United States and internationally. He also disclosed an ongoing 540-participant trial in early Alzheimer disease, funded by an $80 million NIH grant and conducted through the Alzheimer's Clinical Trials Consortium at the University of Southern California, with results anticipated in 2027.

Dr Caggiano is chief medical officer at Cognition Therapeutics.

References

1. Grundman M, Catalano S, Hamby ME, et al. Zervimesine (CT1812) treatment benefits patients with lower baseline plasma p‐tau217 across the mild‐to‐moderate AD spectrum. Alzheimers Dement. 2025;21(Suppl 5):e106858.

2. Cognition Therapeutics advancing zervimesine (CT1812) for dementia with Lewy bodies psychosis. Press release. March 2, 2026. Accessed May 7, 2026. https://ir.cogrx.com/press_releases/cognition-therapeutics-advancing-zervimesine-ct1812-for-dementia-with-lewy-bodies-dlb-psychosis/