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A Gene Therapy Study for Homozygous Familial Hypercholesterolemia (HoFH)

This study is currently recruiting participants.
See Contacts and Locations
Verified March 2017 by University of Pennsylvania
Sponsor:
Information provided by (Responsible Party):
University of Pennsylvania
ClinicalTrials.gov Identifier:
NCT02651675
First received: January 4, 2016
Last updated: March 15, 2017
Last verified: March 2017
  Purpose
Homozygous Familial Hypercholesterolemia (HoFH) is a rare genetic metabolic disorder characterized by absent or severely reduced capacity to catabolize circulating LDL particles by the hepatic LDL receptor. As a consequence, HoFH subjects present abnormal total plasma cholesterol (LDL-C) levels, resulting in severe atherosclerosis often leading to early onset of cardiovascular disease. Early initiation of aggressive treatment for these patients is therefore essential. Unfortunately, despite existing therapies, treated LDL-C levels could remain well above acceptable levels. Thus, the functional replacement of the defective LDLR via AAV-based liver-directed gene therapy may be a viable approach to treat this disease and improve response to current lipid-lowering treatments. This first-in-humans study is intended to evaluate the safety of this gene therapy investigational product and assess preliminary evidence of efficacy using plasma LDL-C levels as a surrogate biomarker for human LDLR transgene expression.

Condition Intervention Phase
Homozygous Familial Hypercholesterolemia Biological: AAV directed hLDLR gene therapy Phase 1 Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: A Phase 1/2a, Single Ascending IV Dose Clinical Trial Investigating Human Low Density Lipoprotein Receptor (LDLR) Gene Therapy in Subjects With Homozygous Familial Hypercholesterolemia (HoFH).

Resource links provided by NLM:


Further study details as provided by University of Pennsylvania:

Primary Outcome Measures:
  • Number of participants experiencing investigational product-related adverse events [ Time Frame: Up to 52 weeks ]
    Physical examinations; Clinical laboratory parameters; and adverse event reporting


Secondary Outcome Measures:
  • Percent change in LDL-C compared to baseline [ Time Frame: 12 weeks ]
  • Percent change in lipid parameters compared to baseline values [ Time Frame: 12 weeks ]
    total cholesterol (TC); non-high density lipoprotein cholesterol (non-HDL-C); HDL-C; fasting triglycerides (TG); overflow density lipoprotein cholesterol (VLDL-C); lipoprotein(a) (Lp(a)); apolipoprotein B (apoB) and apolipoprotein A-I (apo A-I)

  • Fractional catabolic rate (FCR) of LDL apoB [ Time Frame: 12 weeks ]
  • Number of investigational product-related adverse events [ Time Frame: 260 weeks ]
  • Percent change in lipid parameters compared to baseline values [ Time Frame: 260 weeks ]

Estimated Enrollment: 12
Study Start Date: March 2016
Estimated Study Completion Date: January 2019
Estimated Primary Completion Date: January 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: AAV directed hLDLR gene therapy
Single intravenous (IV) dose of human Low Density Lipoprotein Receptor (LDLR) Gene Therapy
Biological: AAV directed hLDLR gene therapy
A novel adeno-associated viral (AAV) vector with human low-density lipoprotein receptor (hLDLR) gene

Detailed Description:

Subjects will be asked to participate in an optional kinetics study. Subjects who agree will be admitted to the research inpatient unit at University of Pennsylvania or selected sites for the LDL kinetics study prior to vector administration.

The LDL kinetic assessment will be performed using a primed constant infusion of deuterated leucine for 12 hours with repeated blood draws up to 48 hours. 2- 14 days following the start of the leucine infusion, subjects will be admitted to the research inpatient unit at University of Pennsylvania where the AAV8.TBG.hLDLR gene therapy vector will be administered. Vital signs will be monitored frequently for 24 hours. Blood will be drawn for safety testing daily for 3 days up to 72 hours and then weekly up to 12 weeks. More comprehensive assessment of safety parameters will occur every 4 weeks up to 12 weeks. Twelve weeks after vector administration, subjects that participated in the first optional kinetics study will be re-admitted to the inpatient unit at University of Pennsylvania or selected sites for a repeat LDL kinetics study. After this visit subjects will be permitted to resume LDL apheresis and/or plasma exchange, and other lipid lowering treatments at the discretion of their caring physician. Subjects will have a safety visit with blood draw every 12 weeks up to 52 weeks, and will be followed with bi-annual telephone calls and annual lipid tests thereafter up to 260 weeks.

  Eligibility

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male or female ≥ 18 years of age
  • Untreated and/or treated LDL-C levels and clinical presentation consistent with the diagnosis of homozygous FH
  • Molecularly defined LDLR mutations at both LDLR alleles
  • Concurrent allowed lipid lowering medication must be stable for ≥ 4 weeks before the baseline visit and must remain stable until 12 weeks after vector administration. These include but are not limited to: statins, ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. Subjects on other lipid-lowering medications are eligible for the study but must wash out of these medications for the pre-specified time period.
  • Females of childbearing potential must have a negative pregnancy test at screening and baseline visits and be willing to have additional pregnancy tests during the study.
  • Sexually active subjects (both female and male) must be willing to use a medically accepted method of contraception from screening visit until 12 weeks after vector administration
  • A baseline serum AAV8 NAb titer ≤ 1:10.
  • Subjects must be able to comprehend and willing to provide a signed institutional review board/ethics committee (IRB/EC) approved Informed Consent Form.
  • Subjects must be willing to comply with all study-related procedures and be available for the duration of the study.

Exclusion Criteria

  • Unwilling to wash out of the following lipid lowering therapies for the pre-specified time period:
  • niacin > 250 mg/day: within 4 weeks of baseline
  • fibrates: within 4 weeks of baseline
  • Lomitapide: within 6 weeks of baseline
  • Mipomersen: within 24 weeks of baseline
  • Heart failure defined by the NYHA classification as functional Class III with history of hospitalization(s) within 12 weeks of the baseline visit or functional Class IV.
  • History within 12 weeks of the baseline visit of a myocardial infarction (MI), unstable angina leading to hospitalization, coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), uncontrolled cardiac arrhythmia, carotid surgery or stenting, stroke, transient ischemic attack, carotid revascularization, endovascular procedure or surgical intervention.
  • Uncontrolled hypertension defined as: systolic blood pressure >180 mmHg, diastolic blood pressure > 95 mmHg.
  • History of cirrhosis or chronic liver disease based on documented histological evaluation or non-invasive imaging or testing
  • Documented diagnosis of any of the following liver diseases:
  • Nonalcoholic steatohepatitis (biopsy-proven)
  • Alcoholic liver disease
  • Autoimmune hepatitis
  • Liver cancer
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Wilson's disease
  • Hemochromatosis
  • α1 anti-trypsin deficiency
  • Abnormal LFTs at screening (AST or ALT >2x upper limit of normal (ULN) and/or Total Bilirubin of >1.5x ULN unless patient has unconjugated hyperbilirubinemia due to Gilbert's syndrome).
  • Hepatitis B as defined by positive for HepB SAg, or Hep B Core Ab, and/or viral DNA
  • Chronic active Hepatitis C as defined by positive for HCV Ab and viral RNA.
  • History of alcohol abuse within 52 weeks
  • Certain prohibited medications known to be potentially hepatotoxic, especially those that can induce microvesicular or macrovesicular steatosis. These include but are not limited to: acutane, amiodarone, HAART medications, heavy acetaminophen use (2g/day > 3 x q week), isoniazid, methotrexate, tetracyclines, tamoxifen, valproate.
  • Current use of systemic corticosteroids or active tuberculosis, systemic fungal disease, or other chronic infection.
  • History of immunodeficiency diseases, including a positive HIV test result.
  • Chronic renal insufficiency defined as estimated GFR < 30 mL/min.
  • History of cancer within the past 5 years, except for adequately treated basal cell skin cancer, squamous cell skin cancer, or in situ cervical cancer.
  • Previous organ transplantation.
  • Participation in an investigational drug study within 6 weeks prior to the screening visit and until 52 weeks after receiving AAV8.TBG.hLDLR.
  • Any major surgical procedure occurring less than 3 months prior to the screening visit, or any planned future surgical procedure within 3 months of baseline.
  • Serious or unstable medical or psychological conditions that, in the opinion of the investigator, would compromise the subject's safety or successful participation in the study.
  • A baseline serum AAV8 Neutralizing Antibodies titer > 1:10
  • Any other medical condition or finding that would make it not in the subject's best interest to participate in the study
  • Study staff member or any direct family member
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02651675

Contacts
Contact: Marina Cuchel, MD, PhD 215-746-2834 mcuchel@mail.med.upenn.edu
Contact: Amanda Baer, MB, MBA 215-746-3423 baer2@mail.med.upenn.edu

Locations
United States, Florida
Excel Medical Clinical Trials, LLC Recruiting
Boca Raton, Florida, United States, 33434
Contact: Seth Baum, MD    561-756-8206    sjbaum@fpim.org   
Principal Investigator: Seth Baum, MD         
United States, Pennsylvania
University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Marina Cuchel, MD, PhD    215-746-2834    mcuchel@mail.med.upenn.edu   
Contact: Amanda Baer, MB, MBA    215-746-3423    baer2@mail.med.upenn.edu   
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Macrae Fort Linton, MD    615-936-1450      
Principal Investigator: Macrae Fort Linton, MD         
Canada, Quebec
Ecogene-21 Recruiting
Chicoutimi, Quebec, Canada, G7H7K9
Contact: Daniel Gaudet, MD, PhD    +1 418-541-1077    daniel.gaudet@umontreal.ca   
Montreal Heart Institute Recruiting
Montreal, Quebec, Canada, H1T 1C8
Contact: Jean Claude Tardif, MD    +1 514-376-3330    jean-claude.tardif@icm-mhi.org   
Centre Hospitalier de l'Université Laval (CHUL) Recruiting
Québec, Quebec, Canada, G1V 4G2
Contact: Jean Bergeron, MD    +1 418-525-4444 ext 42162    jeanbergeron@cmlq.net   
Sponsors and Collaborators
University of Pennsylvania
Investigators
Principal Investigator: Marina Cuchel, MD, PhD Research Associate Professor of Medicine
  More Information

Additional Information:
Publications:
Goldstein, J.L., H.H. Hobbs, and M.S. Brown, Familial hypercholesterolemia, in the Metabolic and Molecular Bases of Inherited Disease, C.R. Scriver, et al., Editors. 2001, McGraw-Hill Information Services Company: New York. p. 2863-2913.
Eder, A.F. and D.J. Rader, LDL-apheresis for severe refractory dyslipidemia. Today's Therapeutic Trends, 1996. 14: p. 165-179.

Responsible Party: University of Pennsylvania
ClinicalTrials.gov Identifier: NCT02651675     History of Changes
Other Study ID Numbers: 823176
Study First Received: January 4, 2016
Last Updated: March 15, 2017

Additional relevant MeSH terms:
Hypercholesterolemia
Hyperlipoproteinemia Type II
Hyperlipidemias
Dyslipidemias
Lipid Metabolism Disorders
Metabolic Diseases
Lipid Metabolism, Inborn Errors
Metabolism, Inborn Errors
Genetic Diseases, Inborn
Hyperlipoproteinemias

ClinicalTrials.gov processed this record on June 26, 2017