Autologous Hematopoietic Stem Cell Gene Therapy for Metachromatic Leukodystrophy and Adrenoleukodystrophy
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|ClinicalTrials.gov Identifier: NCT02559830|
Recruitment Status : Recruiting
First Posted : September 24, 2015
Last Update Posted : September 24, 2015
|Condition or disease||Intervention/treatment||Phase|
|Metachromatic Leukodystrophy Adrenoleukodystrophy||Genetic: transduced CD34+ hematopoietic stem cell||Phase 1 Phase 2|
This is a phase I/II protocol aiming at the assessment of the safety and efficacy of arylsulfatase A（ARSA) / adenosine-triphosphate-binding cassette, sub-family D (ABCD1) gene transfer into hematopoietic stem/progenitor cells for the treatment of metachromatic leukodystrophy/adrenoleukodystrophy.
Metachromatic Leukodystrophy (MLD) is an autosomal recessive Lysosomal Storage Disorder (LSD) characterized by severe and progressive dysmyelination affecting the central and peripheral nervous system. Adrenoleukodystrophy (also known as X-linked adrenoleukodystrophy, ALD, X-ALD), a disorder of peroxisomal fatty acid beta oxidation which results in the accumulation of very-long chain fatty acids (VLCFA) in tissues throughout the body, is caused by mutations in ABCD1.Both diseases are characterized by progressive neurodegenerative decline, leading to a devastating state without treatment.
Hematopoietic cell transplantation (HCT) is ineffective in ameliorating patients' phenotype or delaying disease evolution in many patients. No evidences of efficacy of enzyme replacement strategies are available at the moment. Transplantation of genetically corrected autologous hematopoietic stem cells (HSC) could represent a novel and potentially efficacious treatment for MLD/ALD patients.
Recently, an Italian group conducted a gene therapy clinical trial based on autologous HSC and advanced generation lentiviral vectors (LV) for patients affected by the most severe, early onset forms of the disease (ClinicalTrials.gov Identifier:
NCT01560182).The safety and efficacy of this gene therapy approach in MLD patients was evaluated.During 3 years of follow-up, they reported multilineage ARSA expression and ability to prevent and correct neurological disease manifestations.However, only pre-symptomatic late infantile/Pre- or early-symptomatic early juvenile patients were recruited into the trial. In most cases, MLD/ALD patients tend to be diagnosed at an advanced stage, missing the best timing of curable HSC intervention. In our study, we intend to recruit symptomatic patients for transduced cluster of differentiation 34 positive (CD34+) HSC treatment. In the treated patients, we will study the short-term and long-term safety of the administration of the autologous transduced HSC, their long-term engraftment, the expression of vector-derived ARSA/ABCD1, and the ability of the transduced cells to provide a clinical benefit to the patients. The treated patients will be followed for 3 years and thereafter monitored for the safety of gene therapy for additional 5 years. If successful, this study will provide key results on the safety and efficacy of gene therapy for MLD/ALD patients.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||50 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||A Phase I/II Clinical Trial of Lentiviral Hematopoietic Stem Cell Gene Therapy for Treatment of Developed Metachromatic Leukodystrophy and Adrenoleukodystrophy|
|Study Start Date :||January 2015|
|Estimated Primary Completion Date :||October 2025|
|Estimated Study Completion Date :||October 2025|
Experimental: transduced CD34+ hematopoietic stem cell
Transplantation of autologous CD34+ hematopoietic stem cells transduced with ARSA/ABCD1 encoding lentiviral vector. Dosage: 2x10^6/Kg （Minimum）to 20x10^6/Kg （Maximum） transduced CD34+ cells at bedside for infusion
Genetic: transduced CD34+ hematopoietic stem cell
Autologous hematopoietic stem cells (HSCs) collected from the mobilized peripheral blood and transduced ex vivo with a Lentiviral vector encoding the human ARSA(for MLD)/ABCD1(for ALD) cDNA（complementary DNA）. Dose: ≥ 2x10^6 transduced CD34+ cells/Kg (maximum 20x10^6) at bedside for infusion.
- The short-term safety and tolerability after hematopoietic stem cell transplanation [ Time Frame: 2 months ]The absence of engraftment failure or delayed hematopoietic reconstitution (prolonged aplasia), defined as Absolute Neutrophil Count (ANC)<500/μl with no evidence of Bone Marrow recovery, requiring cellular back-up administration.
- Incidence of Treatment-Emergent Adverse Events(For MLD) [ Time Frame: 72 hours ]It will be evaluated on the basis of adverse events reporting and monitoring of the systemic reactions to cell infusion (fever, tachycardia, nausea and vomiting, joint pain, skin rash).
- Incidence of Treatment-Emergent Adverse Events(For ALD) [ Time Frame: 72 hours ]It will be evaluated on the basis of adverse events reporting and monitoring of the systemic reactions to cell infusion (fever, tachycardia, nausea and vomiting, joint pain, skin rash).
- Neurologic deficit [ Time Frame: up to 5 years ]Before and after transplanation 1/2 year, 1 year, 3 years,and 5 years,Neurologic deficit will be scored according to previous publication from Peters et al. (2004) Blood 104(3):881-888 for patients
- Neuropsychological testing [ Time Frame: up to 5 years ]Before and after transplanation 1/2 year , 1 year, 3 years,and 5 years, the patients will be subjected to neuropsychologic testing by using age-matched Wechsler Intelligence Scale for Children(WISC-III score )system between 6-16 years. above 16 -90 years, patients will be scored by Wechsler Adult Intelligence Scale (WAIS).
- ARSA activity for MLD [ Time Frame: up to 5 years ]Before and after transplantation 1/2 year, 1 year, 3 years and 5 years, residual ARSA activity( nmol/mg Prot/hr) measured in peripheral blood mononuclear cell (PBMC) and/or bone marrow progenitors will be tested (For MLD).
- VLCFA level for ALD [ Time Frame: up to 5 years ]Before and after transplantation 1/2 year, 1 year, 3 years and 5 years, very long chain fatty acid(VLCFA) level ( C22,C24,C26 ,nmol/ml; C24/C22; C26/C22) in plasma will be measured (For ALD).
- The long-term safety of lentiviral-transduced cell infusion [ Time Frame: up to 5 years ]Before and after transplanation 1/2 year, 1 year, 3 years,and 5 years, following tests willbe performed : Replication Competent Lentivirus (RCL): ELISA for HIV p24 antigen (plasma) and DNA Polymerase Chain Reaction (PCR) for vesicular stomatitis virus G (VSV-G) (cells). Reverse Transcription-Polymerase Chain Reaction（RT-PCR） for HIV-pol RNA.
- Improvement in the nerve conduction velocity (NCV) Index [ Time Frame: up to 5 years ]Before and after transplantation 1/2 year , 1 year, 3 years and 5 years , nerve conduction velocity (NCV) Index for electromyography (ENG) will be scored .
- Magnetic Resonance imaging (MRI) score [ Time Frame: up to 5 years ]Before and after transplantation 1/2 year , 1 year, 3 years and 5 years , a detailed demerit scoring (0-34 points) developed by Dr. Loes will be performed in determining the extent of myelin injury in brain (eg, very early stage = MRI score 1-3; early stage = MRI score 4-8; late stage = MRI score 9-13; very late stage = MRI score greater than 13).
- Genomic lentiviral integration sites [ Time Frame: up to 5 years ]Before and after transplantation 1/2 year , 1 year, 3 years and 5 years , CD34+ cells , Myeloid cells (CD14 cells ) , Lymph B cells (CD19 cells) , lymph T cells (CD3 cells) from periheral blood will be seperated and DNA will be extracted, genomic lentiviral integration sites will be investigated according to previosu publications by Biffi etal (Science,2013) .
- immune responses against the transgene(For MLD) [ Time Frame: 5 years ]Before and after transplantation 1/2 year , 1 year, 3 years and 5 years ,treated patients will be monitored if generation of ARSA antiboy (MLD) by immunoblot analyses.
- immune responses against the transgene(For ALD) [ Time Frame: 5 years ]Before and after transplantation 1/2 year , 1 year, 3 years and 5 years ,treated patients will be monitored if generation of or ABCD1 antibody by immunoblot analyses.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02559830
|Contact: JiaCai zhou, M.D.,Ph.Demail@example.com|
|Contact: Qizhou Lian, M.D.,Ph.D.||firstname.lastname@example.org|
|Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University||Recruiting|
|Shenzhen, Guangdong, China, 518035|
|Contact: Qizhou Lian +8675583366388 email@example.com|
|Contact: Jiacai Zhuo +8675583366388 ext 8197 firstname.lastname@example.org|
|Principal Investigator:||Qizhou Lian, M.D.,Ph.D.||The University of Hong Kong|
|Principal Investigator:||Jiacai Zhuo||Shenzhen Second People's Hospital|
|Principal Investigator:||Xin Du, M.D.,Ph.D.||Shenzhen Second People's Hospital|
|Principal Investigator:||Hua Jiang, M.D,Ph.D||Guangzhou Women and Children's Medical Center|
|Principal Investigator:||GuangFu Chen, M.D.,Ph.D||Shenzhen Second People's Hospital|