Steroid-free and Long-term Calcineurin-free Trial in Islet Cell Transplantation

The recruitment status of this study is unknown because the information has not been verified recently.
Verified June 2008 by University of Miami.
Recruitment status was  Active, not recruiting
Sponsor:
Collaborator:
Juvenile Diabetes Research Foundation
Information provided by (Responsible Party):
Rodolfo Alejandro, University of Miami
ClinicalTrials.gov Identifier:
NCT00315627
First received: April 14, 2006
Last updated: November 26, 2013
Last verified: June 2008
  Purpose

The purposes of this study are:

  1. To reverse hyperglycemia and insulin dependency in patients with type 1 diabetes mellitus through islet transplantation utilizing steroid free, calcineurin-inhibitor free immunosuppression.
  2. To assess the long-term function of successful islet transplants in patients with type 1 diabetes mellitus utilizing islets that have undergone a period of culture.
  3. To determine whether the natural history of the microvascular, macrovascular, and neuropathic complications are altered following the successful transplantation of islets.

Condition Intervention Phase
Type 1 Diabetes Mellitus
Drug: Islet transplantation
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Steroid-free and Long-term Calcineurin-free Trial in Islet Cell Transplantation

Resource links provided by NLM:


Further study details as provided by University of Miami:

Primary Outcome Measures:
  • Steroid-free/calcineurin-free immunosuppression (Campath/sirolimus/mycophenolate mofetil [MMF]) will be as effective or better with less side effects than the use of the sirolimus/tacrolimus/daclizumab regimen. [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Secondary endpoints will include: partial graft function, as evidenced by basal C-peptide greater than 0.5 ng/ml; reduction in insulin requirements in those patients who do not achieve insulin independence [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • improvement in metabolic control as evidenced by improvement in: hemoglobin A1c [HbA1c] (should be < 6.5%) [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • mean glucose meter readings, elimination or reduction in the incidence of hypoglycemic coma or unawareness [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 12
Study Start Date: July 2005
Estimated Study Completion Date: December 2013
Estimated Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: islet transplantation Drug: Islet transplantation
Islet transplantation

Detailed Description:

STUDY DESIGN:

The initial proposal submitted to the JDRFI was to compare 3 different groups of patients receiving islet cell transplants utilizing steroid-free, calcineurin-free protocols. The 3 groups were as follows:

  1. Zenapax, Rapamycin & MMF
  2. Campath, Rapamycin & MMF, and
  3. Thymoglobulin, Rapamycin & MMF.

The grant was awarded in December 2003, however the recommendations were to focus on a single group (group 3 or 4) in order to determine the relative efficacy and toxicity of a new immunosuppressive drug combination. We elected to perform the group utilizing Campath, since we have a similar protocol utilizing the same immunosuppressive regimen with the addition of CD34+ enriched donor bone marrow cells (2000/0024). The results of this trial utilizing a steroid-free/calcineurin-free protocol will be compared with the standard "Edmonton Protocol" (2000/0196), which we are currently conducting (14 patients have been transplanted). In addition, the results will be compared with those in 2000/0024.

Protocol 2000/0024 (utilizing the same immunosuppressive regimen; Campath, Rapamycin, Tacrolimus-switched to MMF at 3 months) is being followed by a DSMB established at the NIH.

We propose to evaluate 12 patients with steroid free, long term calcineurin inhibitor free immunosuppression regimens which can be directly compared to our historical group of patients who underwent the Miami version of the Edmonton protocol (Islet Cell Transplantation Alone in Patients with Type 1 Diabetes Mellitus: Steroid-Free Immunosuppression - Protocol # 2000/196) and with the concurrent tolerogenic protocol (Islet Cell Transplantation Alone and CD34+ Enriched Donor Bone Marrow Cell Infusion in Patients with Type 1 Diabetes Mellitus; Steroid Free Regimen - Protocol # 2000/0024) which uses the same immunosuppressive regimen combined with CD34+ stem cell enriched donor bone marrow infusions.

The regimen will consist of Campath 1-H induction, maintenance immunosuppression with sirolimus and tacrolimus for 3 months with subsequent introduction of mycophenolate mofetil (MMF) and removal of tacrolimus completely and TNF-alpha inhibition (etanercept) in the peri-transplant period.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Potential candidates must have type 1 diabetes mellitus and fulfill one or more of the following:

  1. Manifest signs and symptoms that are severe enough to be incapacitating. Incapacitating signs and symptoms include hypoglycemic episodes requiring assistance by others and hypoglycemia unawareness (the inability to recognize low blood glucoses; glucoses < 54 mg/dl). These patients are at high risk for involvement in accidents (they can lose consciousness or act irrationally), thus causing harm to themselves and/or others.
  2. Patients with poor diabetes control (HbA1c > 8.0% but < 12%), despite intensive insulin therapy, as defined by: self monitoring of blood glucose ≥ 4 times/day, multiple insulin injections (≥ 3/day) or insulin pump, and close monitoring of blood glucose control by an endocrinologist. These patients can experience acute, rapid hyperglycemia secondary to several stress factors, that can lead to dehydration, disorientation, and in some instances, ketoacidosis.
  3. Progressive diabetic complications. These patients with chronically poor glycemic control are at higher risk for the development of a wide variety of complications (retinopathy, neuropathy, nephropathy, and cardiovascular disease) associated with diabetes.

Exclusion Criteria:

Potential candidates will be excluded as per the following criteria:

  1. Age < 18 or > 65 years
  2. Duration of diabetes < 5 years
  3. Do not have a physician that is monitoring diabetes for > 6 months
  4. Body mass index > 26
  5. Weight > 80 kg
  6. Insulin requirement > 1.0 u/kg/d
  7. HbA1c > 12%
  8. Stimulated or basal C-peptide > 0.3 ng/ml
  9. Corrected creatinine clearance < 60 ml/min
  10. Serum creatinine consistently above 1.6 mg/dl
  11. Macroalbuminuria (> 300 mg/24 hours)
  12. Anemia (hemoglobin < 12.0 g/dl for males; < 11 g/dl for females)
  13. Hyperlipidemia (fasting low-density lipoprotein [LDL] cholesterol > 130 mg/dl and/or fasting triglycerides > 200 mg/dl)
  14. Abnormal liver function tests (consistently > 1.5 x normal range)
  15. Serological evidence of HIV, HBsAg and/or HBcAb, HBsAb without history of vaccination, human t cell lymphotropic virus 1 (HTLV-1), or hepatitis C virus (HCV)
  16. Negative serology for Epstein-Barr virus (EBV) or evidence of acute or chronic infection (IgM ≥ IgG)
  17. Lack of updated immunizations per current Centers for Disease Control (CDC) guidelines (including lack of immunization against hepatitis B, pneumococcus and influenza - during season)
  18. Presence of panel reactive antibodies > 20%
  19. Prostate-specific antigen (PSA) > 4 ng/ml unless malignancy is ruled out
  20. Positive tuberculin test (unless proof of adequate treatment for latent tuberculosis can be provided)
  21. X-ray evidence of pulmonary infection or other significant pathology
  22. Gall stones and/or portal hypertension and/or hemangioma on liver ultrasound
  23. Abnormal abdominal or pelvic ultrasound (evidence of masses that are considered suspicious for malignancy or adenopathy)
  24. Active peptic ulcer disease
  25. Active infections
  26. Unstable cardiovascular status (including positive stress echocardiography if age > 35)
  27. Untreated or unstable proliferative diabetic retinopathy
  28. Previous/concurrent organ transplantation (except for failed islet cell or pancreas transplantation)
  29. Malignancy or previous malignancy
  30. Any medical condition requiring chronic use of steroids
  31. Active alcohol or substance abuse; smoking in the last 6 months.
  32. Sexually active females who are not:

    • post-menopausal,
    • surgically sterile, or
    • not using an acceptable method of contraception (oral contraceptives, Norplant, Depo-Provera, and barrier devices with spermicide are acceptable; condoms used alone are not acceptable)
  33. Positive pregnancy test or intent for future pregnancy, or male subject's intent to procreate
  34. Any condition or any circumstances that make it unsafe to undergo an islet cell transplant
  35. Psychogenically unable to comply
  36. Failed psychological evaluation
  37. Persistent leukopenia (white blood cell count < 3,000/uL on more than 3 occasions)
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00315627

Locations
United States, Florida
Diabetes Research Institute
Miami, Florida, United States, 33136
Sponsors and Collaborators
Rodolfo Alejandro
Juvenile Diabetes Research Foundation
Investigators
Principal Investigator: Rodolfo Alejandro, M.D. Diabetes Research Institute - University of Miami
  More Information

Additional Information:
No publications provided by University of Miami

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Rodolfo Alejandro, Professor of Medicine, University of Miami
ClinicalTrials.gov Identifier: NCT00315627     History of Changes
Other Study ID Numbers: 2004-0205
Study First Received: April 14, 2006
Last Updated: November 26, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Miami:
Islet Transplantation

Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases

ClinicalTrials.gov processed this record on October 02, 2014