Now Available: Final Rule for FDAAA 801 and NIH Policy on Clinical Trial Reporting
Trial record 6 of 39 for:    neurology AND university of california, san francisco | Open Studies

A Single-Stage, Adaptive, Open-label, Dose Escalation Safety and Efficacy Study of AADC Deficiency in Pediatric Patients (AADC)

This study is currently recruiting participants. (see Contacts and Locations)
Verified August 2016 by University of California, San Francisco
Sponsor:
Collaborator:
National Institutes of Health (NIH)
Information provided by (Responsible Party):
Krystof Bankiewicz, University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT02852213
First received: July 20, 2016
Last updated: August 4, 2016
Last verified: August 2016
  Purpose
The overall objective of this study is to determine the safety and efficacy of AAV2-hAADC delivered to the substantia nigra pars compacta (SNc) and ventral tegmental area (VTA) in children with aromatic L-amino acid decarboxylase (AADC) deficiency.

Condition Intervention Phase
AADC Deficiency
Drug: AAV2-hAADC
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: SIngle-Stage, Open-Label, Safety and Efficacy Study of Adeno-Associated Virus Encoding Human Aromatic L-Amino Acid Decarboxylase by Magnetic Resonance MR-guided Infusion Into Midbrain in Pediatric Patients With AADC Deficiency

Resource links provided by NLM:


Further study details as provided by University of California, San Francisco:

Primary Outcome Measures:
  • Safety [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    Assessment of adverse events related to surgery (including intracerebral hemorrhage or stroke, CNS infection) and gene transfer (including severity of post-operative dyskinesia)

  • Efficacy [ Time Frame: 1 year ] [ Designated as safety issue: No ]
    Change in CSF neurotransmitter metabolite concentrations after gene transfer (increase in homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), and elevated 3-O-methyldopa (3-OMD) concentrations)


Secondary Outcome Measures:
  • Gross Motor Function Measure [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Increase in Gross Motor Function Measure-88 (GMFM-88) score

  • Symptom Diary created by PI [ Time Frame: 1 years ] [ Designated as safety issue: No ]
    Decrease in frequency and severity of oculogyric episodes

  • Fluorodopa PET scan [ Time Frame: Evaluated at 3 months and 2 years ] [ Designated as safety issue: No ]
    Increase in signal in the striatum on FDOPA-PET imaging as brain AADC activity measure


Estimated Enrollment: 6
Study Start Date: July 2016
Estimated Study Completion Date: December 2020
Estimated Primary Completion Date: December 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Single treatment arm

Single-stage dose-escalation, open-label safety study of AAV2-hAADC delivered by image-guided convection-enhanced delivery bilaterally into the substantia nigra pars compacta and the ventral tegmental area of pediatric patients with AADC deficiency.

6 subjects will be divided in 2 groups of 3. Primary aim is to determine the dose for future studies based on safety, biomarkers of pharmacological activity of AADC and clinical outcomes.

Subjects will be enrolled into 2 dose groups. Group 1 of 3 subjects will receive a single low dose of AAV2 hAADC. The total AAV2-hAADC dose will be infused via MR guided infusion into 4 sites in both the left and right SNc and VTA. Dosing intervals will be 90 days between the first 3 subjects. Group 2 dosing level will be determined by Group 1 results.

Drug: AAV2-hAADC

Subjects will be enrolled sequentially into 2 dose groups, Group 1 followed by Group 2. Initially, up to 3 subjects initially will be enrolled in Group 1 and treated with a single dose of AAV2 hAADC (1.3x10 11 vg, delivered as an infusate volume of up to 160 μL of vector at concentration of 8.3x10 11 vg/mL) on Day 0. Enrollment in Group 2 may commence after the last subject in Group 1 is treated and followed through Month 3 post-surgery, with the approval of the data safety monitoring board (DSMB).

The final safety and clinical outcome assessments will be performed 1 year post-surgery. A follow-up analysis will be performed for 2 years post-surgery. Thereafter, subjects will be enrolled in a long-term follow-up study to assess safety and clinical status updates.

Other Name: Adeno Virus Human Aromatic L-Amino Acid Decarboxylase

Detailed Description:

The Study will specifically address:

  • Safety, as measured by adverse events (AEs), safety laboratory tests, brain imaging, and the relationship of AEs to study/surgical procedures or to AAV2 hAADC.
  • Clinical responses to treatment with AAV2-hAADC. The primary clinical outcomes will reflect the predominant motor deficits of loss of motor function and dystonic movements.

Primary Endpoints Safety: Assessment of AE or severe AE (SAE) and its relationship to study surgery, infusion, or treatment effect (graded as definite, probable, possible, unlikely or unrelated).

  • Adverse Events and Serious Adverse Events
  • Post-operative MRI and/or CT (with contrast if clinically indicated)
  • Clinical laboratory assessments (hematology, chemistry, immunology) Biological Activity: Demonstration of effective restoration of AADC function by assays of cerebrospinal fluid (CSF) neurotransmitter metabolites and 18-fluoro-3,4-dihydroxyphenylalanine (F-DOPA) positron emission tomography (PET) imaging.

Secondary and Exploratory Endpoints To obtain preliminary data for clinical response by assessing the magnitude and variability of changes in specific outcomes.

The principal clinical outcome measures are:

  • Motor function, as assessed by the Gross Motor Function Measure (GMFM-88)
  • Frequency of oculogyric episodes, as measured by a Symptom Diary

Secondary clinical outcome measures include:

• Assessment of subject disability, as assessed using the Pediatric Evaluation of Disability Inventory (PEDI); adaptive behavior, as assessed using Vineland Adaptive Behavior Scale; Patient's Global Impression of Change (PGI-C); and quality of life, as determined using the Pediatric Quality of Life Inventory (PedsQL).

Although the investigators recognize that the utility of established developmental and cognitive assessments may be limited because of the study population's severe physical disability, the investigators will use the following:

  • Peabody Developmental Motor Scales 2nd edition (PDMS-2)
  • Bayley Scales of Infant Development, 3rd edition.
  Eligibility

Ages Eligible for Study:   5 Years to 18 Years   (Child, Adult)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Definite diagnosis of AADC deficiency, confirmed by at least two of the following criteria: (1) CSF neurotransmitter profile demonstrating reduced HVA and 5-HIAA, and elevated 3-OMD concentrations; (2) Plasma AADC activity less than or equal to 5 pmol/min/mL; (3) Molecular genetic confirmation of homozygous or compound heterozygous mutations in dopa decarboxylase (DDC), and (4) imaging findings consistent with the diagnosis of AADC deficiency.
  2. Age 5 years to 18 years (note: minimum age of first 3 patients will be 5 years).
  3. Failed to derive adequate benefit from standard medical therapy (dopamine agonists, monoamine oxidase inhibitor, pyridoxine or related form of Vitamin B6).
  4. Unable to ambulate independently (with or without assistive device)
  5. Cranium sufficiently developed, with sutures closed, to enable surgical placement of SmartFrame® system on the skull for MRI-guided stereotactic targeting.
  6. Brain MRI within the past 2 years does not show any conditions or malformations that are clinically significant with respect to risks for stereotactic brain surgery.
  7. Parent(s)/legal guardian(s) of the subject must agree to comply with the requirements of the study, including the need for frequent and prolonged follow-up.
  8. Parent(s)/legal guardian(s) with custody of subject must give their consent for subject to enroll in the study.
  9. Stable medication regimen for treatment of AADC deficiency: (i.e. no new medications introduced for at least 6 months, and no existing medication dose changes for at least 3 months prior to Baseline).
  10. Baseline hematology, chemistry, and coagulation values within the normal pediatric laboratory value ranges, unless in the Investigator's judgment, the out of range values are not clinically significant with respect to subject's suitability for surgery.

Exclusion Criteria:

  1. Intracranial neoplasm or any structural brain abnormality or lesion (e.g., severe brain atrophy, white matter degenerative changes), which, in the opinion of the study investigators, would confer excessive risk and/or inadequate potential for benefit.
  2. Presence of other significant medical or neurological conditions that would create an unacceptable operative or anesthetic risk (including congenital heart disease, respiratory disease with home oxygen requirement, history of serious anesthesia complications during previous elective procedures, history of cardiorespiratory arrest), liver or renal failure, malignancy, or HIV positive.
  3. Significant musculoskeletal abnormalities resulting from chronic, severe neurological impairment (scoliosis >45 degrees, severe joint deformity, joint contractures).
  4. Previous stereotactic neurosurgery.
  5. Coagulopathy, or need for ongoing anticoagulant therapy.
  6. Contraindication to sedation during surgery or imaging studies (SPECT, PET or MRI).
  7. Neutralizing antibody titer to AAV2 ≥ 1:1200.
  8. Receipt of any investigational agent within 60 days prior to Baseline and during study participation.
  9. Evidence of clinically active infection with adenovirus or herpes virus on physical examination.
  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: NCT02852213

Contacts
Contact: Jill A Imamura-Ching, RN, BSN 415-476-3446 Jill.Imamura-Ching@ucsf.edu
Contact: Tamara L Ryan, RN 415-476-3445 Tamara.Ryan@ucsf.edu

Locations
United States, California
University of California San Francisco, Benioff Children's Hospital Recruiting
San Francisco, California, United States, 94143
Contact: Jill A Imamura-Ching, RN, BSN    415-476-3446    Jill.Imamura-Ching@ucsf.edu   
Contact: Tamara L Ryan, RN    415-476-3445    Tamara.Ryan@ucsf.edu   
Principal Investigator: Nalin Gupta, MD         
Principal Investigator: Krystof Bankiewicz, MD         
Sponsors and Collaborators
Krystof Bankiewicz
National Institutes of Health (NIH)
Investigators
Principal Investigator: Krystof Bankiewicz, MD, PhD UCSF Professor of Neurosurgery and Neurology
Principal Investigator: Nalin Gupta, MD, PhD UCSF Professor of Neurosurgery
  More Information

Publications:
Haley, S., W. Coster, L. Ludlow, J. Haltiwanger and A. PA (1992). Pediatric Evaluation of Disability Inventory: Development, Standardization and Administration Manual. Boston, MA, Trustees of Boston University.
Russell, D. J., P. L. Rosenbaum, L. M. Avery and M. Lane (2002). The Gross Motor Function Measure (GMFM-66 & GMFM-88) User's Manual. London, Mac Keith Press.

Responsible Party: Krystof Bankiewicz, Sponsor, Principle Investigator, University of California, San Francisco
ClinicalTrials.gov Identifier: NCT02852213     History of Changes
Other Study ID Numbers: 15-17756  1R01NS094292-01 
Study First Received: July 20, 2016
Last Updated: August 4, 2016
Health Authority: United States: Food and Drug Administration
Individual Participant Data  
Plan to Share IPD: Yes
Plan Description: The investigators will share pertinent information with the subjects care team such that standard of care for the subject can be maintained.

Keywords provided by University of California, San Francisco:
AADC
gene therapy

Additional relevant MeSH terms:
Amino Acid Metabolism, Inborn Errors
Metabolism, Inborn Errors
Genetic Diseases, Inborn
Metabolic Diseases
Dopa Decarboxylase
Antiparkinson Agents
Anti-Dyskinesia Agents

ClinicalTrials.gov processed this record on December 09, 2016