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123I Radiolabeled 3BNC117

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ClinicalTrials.gov Identifier: NCT03468582
Recruitment Status : Recruiting
First Posted : March 16, 2018
Last Update Posted : April 10, 2018
Sponsor:
Information provided by (Responsible Party):
John O. Prior, University of Lausanne Hospitals

Brief Summary:

The conventional way to control HIV infection is the usage of a drug cocktail capable of suppressing the viral replication cycle, commonly known as antiretroviral therapy (ART). Despite effective ART it is not possible to eradicate HIV. The virus hides in particular cells to form the latent HIV-reservoir.[1-9] Studies that emphasise on revealing hidden reservoirs would aid in designing novel therapeutic strategies for controlling HIV infection. Molecular imaging by SPECT/CT has the potential to reveal hidden reservoirs of HIV virus that are not eliminated by currently used drugs capable of suppressing and thereby controlling the viral replication cycle in HIV infected patients. New approaches, necessary to prevent and treat HIV-1 infection, are gradually emerging. A new generation of highly potent broadly neutralizing antibodies (bN/Abs) may represent a promising approach to combating HIV-1 infection.[10] The broadly neutralizing antibody 3BNC117 antibody that can mimic human CD4 binding targeted against the HIV gp120 envelope protein has been tested in various clinical trials.[11-14] It has found to be safe and effective in reducing viraemia and to improve host humoral responses in HIV-1 infected individuals, and to have effect on viral rebound in patients who are kept off antiretroviral treatment briefly for experimental purpose.

Imaging of simian immunodeficiency virus (SIV) infection by PET/CT has been successfully performed in nonhuman primates with a 64Cu-labeled SIV gp120-specific antibody called 7D3.[15] This study aims to use a similar approach in human with the 3BNC117 antibody. The 3BNC117 antibody has been successfully radiolabeled with iodine 123. The half-life of this radioisotope is appropriate for antibody imaging in nuclear medicine. Radiolabeled 123I 3BNC117 was shown to keep a good immunoreactivity for gp120. By using state of the art SPECT scanner a semi-quantitative image will be obtained. In addition, the absence of any chelator and the well known use of iodine-123 in clinic make it suitable for human intervention.

No HIV imaging in human has been achieved yet, which is however fundamental to understand some key steps in the pathogenesis of HIV-induced immunodeficiency. This research opens promising opportunities for drug and vaccine development. Indeed, identification of virus reservoirs in treated patients would facilitate the development of strategies for eradicating these reservoirs or for extending latency period.


Condition or disease Intervention/treatment Phase
Human Immunodeficiency Virus Combination Product: 123I radiolabeled 3BNC117 Early Phase 1

Detailed Description:

The conventional way to control HIV infection is by use of a cocktail of drugs capable of suppressing the viral replication cycle, commonly known as antiretroviral therapy (ART). Despite effective ART it is not possible to eradicate HIV. The virus hides in particular cells to form the latent HIV-reservoir and antiviral agents have no effect on these latently infected HIV cells.[1-9] Studies by Chomont et al. identified particular CD4 T cell subsets that serve as key cellular compartment for latent HIV-1 reservoir in blood.[6] A later study has identified memory CD4 T cells with stem-cell like properties as a minor latent HIV-1 reservoir.[7] A major part of this reservoir is in the lymphoid tissue which constitute the predominant site for lymphocytes. One recent study has identified follicular T helper cells (TFH) of lymph nodes as major CD4 T cell compartments for HIV-1 replication, production and infection.[8] Further characterisation of the different CD4 T cell population has identified a specific cell population expressing PD-1(+) as the major CD4 T cell compartment in blood and lymph nodes for production of replication competent and infectious HIV-1.[9] Thus, studies that emphasise on revealing hidden reservoirs would aid in designing novel therapeutic strategies for controlling HIV infection. Molecular imaging by SPECT/CT has the potential to reveal hidden reservoirs of HIV virus that are not eliminated by use of currently used drugs capable of suppressing and thereby controlling the viral replication cycle in HIV infected patients.

As discussed above, even though ART can suppress virus replication and can limit disease progression, it fails to eradicate the virus, and suppression requires lifelong therapy, which may have side effects and poses a risk of the development of resistance. New approaches necessary to prevent and treat HIV-1 infection in order to restrict the epidemic and to strengthen nascent efforts in finding a cure are gradually emerging. A new generation of highly potent broadly neutralizing antibodies (bNAbs) may represent a promising approach to combating HIV-1 infection.[10] Many sites on the viral envelope can be recognized by bNAbs.

The broadly neutralising antibody 3BNC117 directed against the HIV gp120 envelope protein, can mimic human CD4 binding and can neutralize 195 out of 237 HIV-1 strains.[11] The first human phase I dose escalation study using 3BNC117, has shown to be safe and effective in transiently reducing viraemia in chronic HIV-1 infected individuals.[12] A subsequent study (ClinicalTrial.gov identifier:NCT02018510) demonstrated improved host humoral immune response in infected individuals treated with 3BNC117 antibody as compared to untreated individuals.[13] Furthermore, a phase IIa open labelled trial by the same group of researchers at Rockefeller University, NY has been carried out to evaluate the capacity of this antibody to suppress viral rebound in infected individuals during a brief treatment interruption of anti-retroviral therapy.[14] Another such trial is currently ongoing (ClinicalTrial.gov identifier: NCT02446847).

Imaging of simian immunodeficiency virus (SIV) infection by PET/CT has been successfully performed in nonhuman primates with a 64Cu-labeled SIV gp120-specific antibody called 7D3.[15] This study aims to use a similar approach in human with the 3BNC117 antibody. The 3BNC117 antibody has been successfully radiolabeled with iodine-123. The half-life of this radioisotope is appropriate for antibody imaging in nuclear medicine. Radiolabeled 123I-3BNC117 was shown to keep a good immunoreactivity in vitro for gp120. By using state of the art SPECT scanner a semi-quantitative image will be obtained. In addition, the well known use of iodine-123 in clinic and the absence of chelator makes it suitable for human intervention.

No HIV imaging in human has yet been achieved, which is however fundamental to understand some key steps in the pathogenesis of the HIV-induced immunodeficiency. This research opens promising opportunities for monitoring the size of the HIV reservoir and for drug and vaccine development. Indeed, identification of virus reservoirs in treated patients would facilitate the development of strategies for eradicating these reservoirs or for extending latency period.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 5 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Monocentric, open-label and uncontrolled study
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Pilot Study Using 123I Radiolabeled 3BNC117 SPECT/CT to Image HIV Reservoir in Chronically Infected HIV Patients
Actual Study Start Date : February 8, 2018
Estimated Primary Completion Date : February 7, 2019
Estimated Study Completion Date : February 7, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arm Intervention/treatment
Experimental: 123I radiolabeled 3BNC117
123I radiolabeled 3BNC117
Combination Product: 123I radiolabeled 3BNC117
123I radiolabeled 3BNC117




Primary Outcome Measures :
  1. Absorbed dose per Organ mGy/MBq [ Time Frame: 3 month ]
    Absorbed dose in the organs at risk is calculated from planar images after organ contouring using OLINDA / EXM software; additionally blood samples (2 mL) is taken before each gamma camera scan to estimate the dose to bone marrow. The blood samples are needed to derive the radiation dose exposure to the bone marrow through the measure of the count rate in the blood sample using a calibrated gamma counter. MIRD (medical internal radiation dosimetry) based methods will provide the contribution to the bone marrow radiation exposure from activity present into the blood.[19] No other additional analysis will be performed on these blood samples.


Secondary Outcome Measures :
  1. total number of lesions [ Time Frame: 3 month ]
    Accumulation of 123I-3BNC117 in target organs and HIV reservoirs is delineated in the patients before and after ART treatment.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Subject newly diagnosed with HIV in a chronic phase requiring the introduction of an antiretroviral treatment (ART)
  • Age 18 to 55
  • HIV-1 infection confirmed by ELISA and immunoblot
  • Plasma HIV-1 RN/A > 5000 copies/ml
  • Current CD4 cell count > 200 cells/μl
  • Ability and willingness to provide written informed consent

Exclusion Criteria:

  • Primary infected HIV
  • Currently on ART
  • Participation in another clinical study of an investigational product currently or within past 30 days
  • Pregnancy or lactation;
  • History of systemic corticosteroids, immunosuppressive anti-cancer, or other medications considered significant by the trial physician within the last 6 months;
  • Patient report, or chart history, of significant coronary artery disease, myocardial infarction, percutaneous coronary intervention with placement of cardiac stents;
  • Uncontrolled hypertension, as defined by a systolic blood pressure > 180 and/or diastolic blood pressure > 120, in the presence or absence of anti-hypertensive medications;
  • Any other clinically significant acute or chronic medical condition, such as autoimmune diseases, that in the opinion of the investigator would preclude participation;
  • Laboratory abnormalities in the parameters listed below:
  • Absolute neutrophil count ≤1 G/l
  • Hemoglobin ≤ 10 gm/dL
  • Platelet count ≤125 G/l
  • ALT ≥ 2.0 x ULN
  • AST ≥ 2.0 x ULN
  • Total bilirubin ≥ 1.5 ULN
  • Creatinine ≥ 1.1 x ULN
  • Coagulation parameters ≥ 1.5 x ULN

Information from the National Library of Medicine

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): NCT03468582


Contacts
Contact: John O. Prior, MD, PhD +41 (0)21-3144348 john.prior@chuv.ch

Locations
Switzerland
Centre Hospitalier Universitaire Vaudois Recruiting
Lausanne, Vaud, Switzerland, 1011
Contact: John O. Prior, MD, PhD    +41 (0)21-3144348    john.prior@chuv.ch   
Principal Investigator: John O. Prior, MD, PhD         
Sponsors and Collaborators
University of Lausanne Hospitals
Investigators
Study Director: Giuseppe Pantaleo, MD, PhD University of Lausanne Hospitals

Publications:

Responsible Party: John O. Prior, Head of nuclear medicine and molecular imaging department, University of Lausanne Hospitals
ClinicalTrials.gov Identifier: NCT03468582     History of Changes
Other Study ID Numbers: 2010-01003
First Posted: March 16, 2018    Key Record Dates
Last Update Posted: April 10, 2018
Last Verified: April 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Plan Description: Data will not be shared with third parties having lower protection standards then Switzerland.

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Immunologic Deficiency Syndromes
Acquired Immunodeficiency Syndrome
HIV Infections
Immune System Diseases
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Slow Virus Diseases