Human Penile Tissue Allotransplantation for Devastating Penile and Concomitant Genital Trauma

• ClinicalTrials.gov Identifier: NCT03240822
• Recruitment Status: Withdrawn
• First Posted: August 7, 2017
• Last Update Posted: April 14, 2021
• Sponsor: Wake Forest University Health Sciences
• Information provided by (Responsible Party): Wake Forest University Health Sciences

Study Description

Brief Summary:

This is a 4-year, non-randomized, single center, patient self-controlled, clinical trial (though enrolled subjects will be followed for life as are all transplant patients) for patients seeking allotransplantation of the male external genitalia (MEG), or penile tissue, as a feasible reconstructive strategy for the treatment of devastating and irreversible injuries to the genitalia. In addition to receiving penile allotransplantation and post-operative monitoring and support, enrolled patients will receive an innovative and clinically proven immunomodulatory protocol that combines lymphocyte depletion of the recipient with donor bone marrow cell infusion. Patients will be treated with lymphocyte depleting induction therapy, donor bone marrow cell infusion and tacrolimus. After the first year, maintenance immunosuppression will be modified gradually and cautiously (tapered dose reduction or spaced frequency dosing of tacrolimus) in selected patients based on a critical evaluation of clinical and immunologic outcomes. Outcomes will include but not be limited to functional metrics (sensation, erection, voiding), psychosocial (body integrity, adaptation to transplant) and health related quality of life (HRQOL) measures.

Condition or disease	Intervention/treatment	Phase
Urologic Injuries; Genital Diseases, Male; Amputation	Procedure: Penile Transplant; Biological: Monoclonal Antibody (Humanized Anti-CD52); Drug: Tacrolimus	Phase 1

Detailed Description:

Initial treatment with an antibody targeting recipient immune cells followed by triple-drug maintenance therapy represents the current standard in clinical VCA. Our protocol is different from the existing conventional drug treatments used in MEG allotransplantation in that it combines donor bone marrow infusion with an immunosuppression sparing protocol. The primary goal of this pilot clinical trial is to determine the feasibility of using allogeneic penile tissue to repair/replace irreversibly damaged external genitalia. Enrolled and transplanted subjects will be followed for their lifetime as a transplant patient.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 0 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Intervention Model Description: All subjects receive transplant and immunosuppression therapy
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Vascularized Composite Allotransplantation (VCA) for Devastating Penile and Concomitant Genital Trauma
• Actual Study Start Date: January 2017
• Estimated Primary Completion Date: December 2022
• Estimated Study Completion Date: December 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: Penile Allotransplant and Immunosuppression Treatment; Penile transplantation with monoclonal antibody induction therapy of humanized anti CD52 followed by donor bone marrow infusion and tacrolimus monotherapy.	Procedure: Penile Transplant; Penile Allotransplantation; Biological: Monoclonal Antibody (Humanized Anti-CD52); Drug: Tacrolimus

Outcome Measures

Primary Outcome Measures :

1. Need for Immunosuppressive drug therapy [ Time Frame: 6 months ]
   The amount of immunosuppressive drug therapy will be recorded.

Secondary Outcome Measures :

1. erectile function [ Time Frame: 6 months ]
   This will be assessed following intracorporal injection of vaso-active agents, such as prostaglandin, phentolamine, papaverine, or some mixture of these drugs (i.e. Trimix). and through high-resolution duplex Doppler ultrasonography
2. Assessment of sensory return and sensory thresholds [ Time Frame: 6 months ]
   This will be accomplished by penile biothesiometry
3. Determination of hemodynamic status [ Time Frame: 6 months ]
   Dynamic infusion pharmaco-cavernosometry and cavernosography will be utilized to better understand these changes
4. The Reintegration to Normal Living (RNL) Index [ Time Frame: 6 months ]
   The RNL is an 11-item questionnaire that asks how a person manages activities, roles, and relationships on a day-to-day basis.
5. The Situational Inventory of Body-Image Dysphoria (SIBID) [ Time Frame: 6 months ]
   The SIBID is a multidimensional body-image survey assessment of people's negative body-image emotions in everyday situations and physical experiences.
6. The Function and Body Image Survey [ Time Frame: 6 months ]
   This survey consists of six open-ended questions regarding personal thoughts, opinions, and experiences about the transplant, and the individual's current functional abilities.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 35 Years (Adult)
• Sexes Eligible for Study: Male
• Gender Based Eligibility: Yes
• Gender Eligibility Description: This is a male, penile transplantation study.
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria: For Recipients

1. Male
2. 18-40 years
3. Irreversible and devastating genitalia damage not amenable to conventional reconstruction.
4. Patent main vessels leading into the remaining penile stump, as confirmed by angiography.
5. Adequate penile stump (> 2.5cm) to facilitate placement of a tourniquet, debridement of the distal portion and sufficient distal mobilization of the structures requiring anastomosis
6. Eligible for long term standard of care coverage

Exclusion Criteria: For Recipients

1. Documented history of:

   1. cancer
   2. renal impairment
   3. hepatic disorders
   4. neurologic disorders (sensory or motor function deficits)
   5. severe scarring with poor host tissue bed
   6. penile resection or implant surgery
   7. diabetes
   8. hypertension
   9. hyperlipidemia
   10. coronary artery disease
   11. untreated genital cancer
   12. HIV, Hepatitis B or C, or any infectious disease
   13. erectile dysfunction
   14. Peyronie's disease
   15. urethral stricture disease
   16. balanitis
   17. xerotica obliterans
   18. pelvic embolization
   19. pelvic radiation
   20. untreated hypogonadism
   21. prior prostate surgery
   22. recurrent urinary tract infections (UTIs)
   23. nephrolithiasis
   24. connective tissue disease or collagen disease
   25. lipopolysaccharidosis or amyloidosis
2. Use of 5-alpha-reductase inhibitors
3. External signs, sequelae or positive serology of sexually transmitted disease (including HPV)
4. Active UTI, stones, urethral edema and other pathology that prevents urethral anastomosis
5. Current or past substance abuse
6. Current or past smoker (within past 3 months)
7. Use of any medications known to cause vasoconstriction
8. Psychiatric illness or psychological problems, or deemed unsuitable on psychiatric evaluation
9. Any condition that may prevent transplantation (positive cross match, high panel reactive antibody (PRA), etc.)
10. Uncontrolled bleeding disorder, platelet count > 50,000, hemophilia or any other inherited coagulopathy or need to routinely receive blood products for bleeding disorders
11. Concurrent participation in any other clinical investigation during the period of this investigation
12. Inability to undergo leukapheresis
13. Inability to participate in all necessary study activities due to physical or mental limitations
14. Inability or unwillingness to return for all required follow-up visits.
15. Inability or unwillingness to sign the patient informed consent document.

Contacts and Locations

Sponsors and Collaborators

Wake Forest University Health Sciences

Investigators

• Principal Investigator: Anthony Atala, MD; Professor

More Information

• Responsible Party: Wake Forest University Health Sciences
• ClinicalTrials.gov Identifier: NCT03240822
• Other Study ID Numbers: IRB00027539
• First Posted: August 7, 2017
• Last Update Posted: April 14, 2021
• Last Verified: July 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: No

Keywords provided by Wake Forest University Health Sciences:

Penile Trauma; Allotransplantation; Vascularized Composite Allotransplantation; VCA; Genital Trauma; Penile Transplantation; Amputation; Penile Injury

Additional relevant MeSH terms:

Wounds and Injuries; Antibodies; Antibodies, Monoclonal; Tacrolimus; Immunologic Factors; Physiological Effects of Drugs; Immunosuppressive Agents; Calcineurin Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action