Hydroxypropyl Beta Cyclodextrin for Niemann-Pick Type C1 Disease
- Hydroxypropyl beta cyclodextrin (HPBCD) is being tested for a disease called Niemann-Pick disease type C1 (NPC1). NPC1 is a genetic disorder that results in gradual loss of nervous system function. Cholesterol and other fats have trouble moving out of the brain cells, which makes the cells work poorly and leads to symptoms. There is no treatment currently approved in the US for NPC1. Researchers want to test if it is safe to use HPBCD for NPC1. They want to see if it can help brain cells process cholesterol better.
- To test the safety and effectiveness of HPBCD for NPC1.
- Individuals between 2 and 25 years of age who have been diagnosed with NPC1.
- Participants will be screened with a physical exam and medical history. They will provide blood and urine samples for screening. They will also have neurological tests, including tests of hearing, speech and movement.
- Participants will have an Ommaya reservoir placed under the scalp to allow the drug to be given into a cavity of the brain for treatment. This will require surgery. A brain scan will be performed to help place the equipment.
- Participants will receive doses of HPBCD through the Ommaya reservoir. They will receive one dose of HPBCD once a month. The length of the trial will be determined by the safety and efficacy information we obtain.
- Treatment will be monitored with frequent blood and urine tests, Cerebral Spinal Fluid tests, and neurological exams.
Niemann-Pick Disease, Type C1
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Intracerebroventricular 2-Hydroxypropyl-B-Cyclodextrin in Patients With Niemann-Pick Disease, Type C1|
- 24-hydroxycholesterol Area under the curve [ Time Frame: Days ] [ Designated as safety issue: No ]
- Hearing loss. [ Time Frame: Year ] [ Designated as safety issue: Yes ]
|Study Start Date:||November 2012|
|Estimated Study Completion Date:||December 2014|
|Estimated Primary Completion Date:||December 2014 (Final data collection date for primary outcome measure)|
Niemann-Pick disease type C (NPC) is a lethal, autosomal recessive, lysosomal storage disorder characterized by neurodegeneration in early childhood and death in adolescence. The causative genes NPC1 (about 95% of cases) and NPC2 (about 5% of cases) are involved in the intracellular trafficking of lipids and cholesterol. Mutations on either of these genes lead to progressive accumulation of unesterified cholesterol and other lipids in the central nervous system (CNS). The National Institutes of Health (NIH) Therapeutics for Rare and Neglected Diseases (TRND) program is developing 2-hydroxypropyl-beta-cyclodextrin (HP-beta-CD) for the treatment of patients with Niemann-Pick disease type C1 (NPC1) to slow progression of symptoms of the disease. In this Phase 1, non-randomized, open-label, single-center, study, we propose to administer HP-beta-CD intracerebroventricularly via an Ommaya reservoir to 3 cohorts of 3 patients at doses of 50 mg escalated to 100, 200, and 400 mg, in Cohorts 1,2, & 3 respectively. The objectives of this study are to assess the safety, tolerability, feasibility, and pharmacokinetics (PK) of intracerebroventricular (ICV) administered HP-beta-CD to NPC1 patients, to determine an active dose of HP-beta-CD as measured by changes in plasma 24-(S) hydroxycholesterol (24-HC) levels, and to evaluate the use of biomarkers and potential clinical outcomes of NPC1. All patients in the cohort will receive HP-beta-CD (n = 3) once monthly for at least 2 doses, and the decision to dose-escalate will be based on safety and on biochemical data. Safety will be assessed by adverse events (AEs), audiologic evaluation, clinical laboratory tests, vital signs, physical examinations, chest X-rays and electrocardiograms (ECGs). Biochemical efficacy will be measured by change from baseline in plasma 24-HC. PK will be assessed for both cerebrospinal fluid (CSF) and plasma HP-beta-CD.
|Contact: Nicole M Farhat, C.R.N.P.||(301) firstname.lastname@example.org|
|Contact: Forbes D Porter, M.D.||(301) email@example.com|
|United States, Maryland|
|National Institutes of Health Clinical Center, 9000 Rockville Pike||Recruiting|
|Bethesda, Maryland, United States, 20892|
|Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL) 800-411-1222 ext TTY8664111010 firstname.lastname@example.org|
|Principal Investigator:||Forbes D Porter, M.D.||Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)|