rAAV-Olig001-ASPA Gene Therapy for Treatment of Children With Typical Canavan Disease (CAN-GT)
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|ClinicalTrials.gov Identifier: NCT04833907|
Recruitment Status : Recruiting
First Posted : April 6, 2021
Last Update Posted : April 8, 2021
Canavan Disease is a congenital white matter disorder caused by mutations to the gene encoding for aspartoacylase (ASPA). Expression of aspa is restricted to oligodendrocytes, the sole white matter producing lineage in the brain. ASPA supports developmental myelination in the capacity of its sole known function, namely, the catabolism of N-acetylaspartate (NAA). Inherited mutations that result in loss of ASPA catabolic activity result in a typically severe phenotype characterized by chronically elevated brain NAA, gross motor abnormalities, hypomyelination, progressive spongiform degeneration of the brain, epilepsy, blindness and a short life expectancy. Disease severity is correlated with residual levels of enzyme activity. Reconstitution of ASPA function in oligodendrocytes of the brains of Canavan patients is expected to rescue NAA metabolism in its natural cellular compartment and support myelination/remyelination by resident white matter producing cells. This protocol directly targets oligodendrocytes in the brain, which are intimately involved with disease initiation and progression. Targeting oligodendrocytes offers the safest and most direct therapy for affected individuals.
The latest generation AAV viral vector (rAAV-Olig001-ASPA) will be administered to patients using a minimally invasive neurosurgical procedure which involves direct administration of gene therapy to affected regions of the brain. Outcome measures for the open label clinical trial include longitudinal clinical assessments and brain imaging.
Currently there is no effective treatment for Canavan Disease. The purpose of this study is to validate a new technology targeted to the cells most affected by Canavan Disease in the safest way possible.
The study investigators are committed to supporting the Rare Disease & Canavan Disease Communities. For more Information, please contact Ms. Jordana Holovach, Director, Global Patient Advocacy at PatientAdvocacy@CureRareDisease.com.
|Condition or disease||Intervention/treatment||Phase|
|Canavan Disease||Drug: rAAV-Olig001-ASPA Drug: Levetiracetam Drug: Prednisolone||Phase 1 Phase 2|
rAAV-Olig001-ASPA is the first gene therapy designed to target the oligodendrocytes, which are critical for myelination and brain development.
This study is a Phase 1/2 First-In-Human protocol designed to obtain safety, pharmacodynamics, and efficacy data following neurosurgical administration of a single dose of rAAV-Olig001-ASPA delivered intracerebroventricularly in up to 24 children with Canavan Disease.
Patients with a diagnosis of typical Canavan Disease who meet all eligibility criteria may be enrolled in this open-label, sequential cohort study of a single dose of rAAV-Olig001-ASPA.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||24 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Phase 1/2, Open Label, Sequential Cohort Study of a Single Intracranial Dose of AVASPA Gene Therapy for Treatment of Children With Typical Canavan Disease|
|Actual Study Start Date :||April 1, 2021|
|Estimated Primary Completion Date :||March 31, 2023|
|Estimated Study Completion Date :||March 31, 2024|
Experimental: 3.7 x 10^13 v.g. rAAV-Olig001-ASPA
3.7 x 10^13 v.g. of rAAV-Olig001-ASPA administered as a single dose neurosurgically to the brain via 4 pre-defined intracerebroventricular sites
Intracerebroventricular administration of a single dose
Other Name: AVASPA
Keppra daily dose (20-50 mg/kg/day divided twice daily administered orally or per G-tube) in the post-operative period and continued for 3 months per standard of care to prevent seizure activity.
Other Name: Keppra
Post-operatively, a 3-month steroid taper is planned to prevent or reduce possible delayed immunological responses. This tapering regimen will consist of 0.5mg/kg/day prednisone during weeks 1-4; followed by 0.3 mg/kg/day prednisone during weeks 5-8; and 0.1mg prednisone during weeks 9-12, then off. If there is evidence of new inflammation on MRI at 3-months on T2 FLAIR, the steroid taper will be extended for an additional 3 months or we will transition to steroid-sparing immunosuppression.
Other Name: Pediapred
- Safety evaluation [ Time Frame: up to 2 years ]Number, severity, and causal relationship of any adverse event (to either the gene therapy and/or surgical trial procedures required for vector administration) using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
- Myelination [ Time Frame: up to 2 years ]Change from baseline in fractional anisotropy (FA) post vector administration will be measured by cerebral Magnetic Resonance Imaging and special Diffusion Tensor Imaging sequences.
- Brain Atrophy [ Time Frame: up to 2 years ]Rate of whole brain atrophy (T2 - T0): Percentage brain volume change (PBVC) will be estimated from the 3D T-1 weighted acquisition
- N-Acetyl-Aspartate (NAA) concentrations in the Brain [ Time Frame: up to 2 years ]N-Acetyl-Aspartate concentrations will be assessed with nuclear Magnetic Resonance Spectroscopy (nMRS) between pre- and post-treatment and as compared to historical controls.
- Neurological Evaluation - Motor Function [ Time Frame: up to 2 years ]Motor Function will be analyzed using the Gross Motor Function Measure (GMFM)-88 scale for motor function assessment before and after vector administration and compared to historical controls. The GMFM consists of 5 scales: Lying and Rolling, Sitting, Crawling and Kneeling, Standing and Walking, Running and Jumping. The total scores range from 0 to 264. The lower the score on GMFM, the weaker the ability; the higher the score, the greater the ability.
- Neurological Evaluation - Neurocognitive Function [ Time Frame: up to 2 years ]Neurocognitive function will be assessed using the Mullen Scales of Early Learning (MSEL) before and after vector administration and compared to historical controls. The MSEL is a cognitive test to measure cognitive ability and language development. The MSEL test has five scales: Gross motor, Visual reception, Fine motor, Receptive language, and Expressive language. The total scores range from 0 to 197. The lower the score on MSEL, the weaker the ability; the higher the score, the greater the ability.
- Neurological Evaluation - Spasticity [ Time Frame: up to 2 years ]Will be assessed using the Canavan Neurological Evaluation before and after vector administration and compared to historical controls.
- Seizure Assessment [ Time Frame: up to 2 years ]Will be assessed using a Seizure Diary and Electroencephalograms alpha, beta, delta, and theta wave frequencies (Hz).
- Cerebrospinal Fluid Analysis (CSF) [ Time Frame: 12 months ]CSF will be collected via lumbar puncture and analyzed to assess concentrations of N-Acetyl-Aspartate.
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): NCT04833907
|Contact: Olga Flamini, MD, PhD||(917) 727-5695||Olgaflamini@CureRareDisease.com|
|Contact: Jordana Holovach||(917) firstname.lastname@example.org|
|United States, Ohio|
|Dayton Children's Hospital||Recruiting|
|Dayton, Ohio, United States, 45404|
|Contact: Trisha Faris 937-641-3461 email@example.com|
|Principal Investigator:||Christopher G Janson, MD||Dayton Children's Hospital|
|Principal Investigator:||Robert Lober, MD, PhD||Dayton Children's Hospital|