Gene Transfer Clinical Trial for LGMD2D (Alpha-sarcoglycan Deficiency) Using scAAVrh74.tMCK.hSGCA
Dose escalation study of self-complementary (sc) AAVrh74.tMCK.hSGCA delivered to single leg (low dose n=2) and bilaterally (n=6) via a major lower limb artery to the whole lower limb of limb girdle muscular dystrophy type 2D (LGMD2D; alpha-sarcoglycan deficient) patients.
Limb Girdle Muscular Dystrophy Type 2D (LGMD2D)
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Phase I/IIa Gene Transfer Clinical Trial for LGMD2D (Alpha-sarcoglycan Deficiency) Using scAAVrh74.tMCK.hSGCA|
- Safety with fewer than one grade 3 adverse events or fewer than two grade 2 adverse events [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]Safety will be measured based on fewer than one grade 3 adverse event or fewer than two grade 2 adverse events
- Change in Six-Minute-Walk-Test (6MWT) distance from baseline over two years [ Time Frame: 2 years ] [ Designated as safety issue: No ]Efficacy would be a significant improvement in distance walked in the 6 minute walk test.
|Study Start Date:||February 2015|
|Estimated Study Completion Date:||February 2017|
|Estimated Primary Completion Date:||February 2017 (Final data collection date for primary outcome measure)|
Experimental: Cohort 1A
Two (n=2) adult LGMD2D wheelchair-dependent subjects will receive self-complementary scAAVrh74.tMCK.hSGCA via single-limb perfusion at the low dose. Subjects will receive a dose of 1 x 10 12th vg/kg in a single limb with delivery to the whole limb.
Experimental: Cohort 1B
Three (n=3) LGMD2D subjects will receive self-complementary scAAVrh74.tMCK.hSGCA via bilateral whole limb perfusion at low dose of 1 x 10 12th vg/kg.
Experimental: Cohort 2
Three (n=3) LGMD2D subjects will receive self-complementary scAAVrh74.tMCK.hSGCA bilateral whole limb perfusion at high dose.Subjects will receive a total dose of 3 x 10 12th vg/kg per limb delivered to both extremities
The proposed clinical trial is a dose escalation study of self-complementary scAAVrh74.tMCK.hSGCA to LGMD2D (alpha-sarcoglycan deficient) subjects delivered via a major lower limb artery of each leg sequentially by isolated limb perfusion (ILP). Three cohorts (Cohorts 1A, 1B, and 2) will undergo gene transfer in a dose escalation scheme to establish maximum tolerated dose (MTD) using toxicity. Two (n=2) adult wheelchair-dependent patients will be enrolled in Cohort 1A and three (n =3) ambulatory subjects will be enrolled in Cohort 1B. Three (n =3) ambulatory subjects will be enrolled in Cohort 2. The first cohort (1A) will receive a dose of 1E12 vg/kg in a single limb with delivery to the whole limb. This same dose will be delivered to both limbs in Cohort 1B. Cohort 2 will receive a total dose escalation of 3E12vg/kg per limb delivered to both extremities. The vector will be infused into an indwelling catheter in the femoral artery. This will be a one-time vector infusion to an isolated limb with a 10-minute dwell time. The total vector genome dose for each subject will be adjusted by rounding down to the closest 10 kg.
Safety monitoring during infusion will include: activated clotting times, limb gases, real time monitoring of arterial and venous access pressures, and perfusate temperature. Safety endpoints will be assessed by changes in hematology, serum chemistry, urinalysis, immunologic response to rAAVrh74 and hSGCA, and reported history and observations of symptoms. Efficacy will be measured by the six minute walk test as well as direct muscle testing for strength (MVICT) of lower limb muscles. These quantitative measures will be done at baseline, day 30, 60, 90, 180, and at the end of 1st and 2nd years. Subjects will be evaluated at baseline, infusion visit (days 0-2), and return for follow up visits on days 7, 14, 30, 60, 90, and 180. On Day 180, subjects will undergo a muscle biopsy on the injected muscles in one leg to compare with the pre-treatment biopsy done at baseline screening in the opposite leg to establish the size of muscle fibers and any potential toxicity from gene transfer.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01976091
|United States, Ohio|
|Nationwide Children's Hospital|
|Columbus, Ohio, United States, 43205|