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Exploiting Epigenome Editing in Kabuki Syndrome: a New Route Towards Gene Therapy for Rare Genetic Disorders (Epi-KAB)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03855631
Recruitment Status : Active, not recruiting
First Posted : February 27, 2019
Last Update Posted : September 18, 2019
Sponsor:
Collaborator:
Association Française contre les Myopathies Telethon
Information provided by (Responsible Party):
University Hospital, Montpellier

Brief Summary:

Starting from isolating primary cells from affected patients, an in vitro disease model system for KS will be developed. Using alternative strategies to obtain patient-derived mesenchymal stem cells, an integrative approach will be adopted for defining both the transcriptional and epigenetic regulatory networks perturbed upon the loss of function of KMT2D. Combining the self-renewal potential of mesenchymal stem cells (MSCs) with CRISPR/Cas9 technology, an epigenome editing approach as therapeutic strategy to rescue the activity of MLL4 will be developed.

A step forward is expected towards the understanding of those the molecular mechanisms governing the aetiology of Kabuki Syndrome (KS) and that the proposed in vitro disease model will provide to the scientific community an experimental system to study the KS. Importantly, the aim is to define the molecular bases of KS and to develop a therapeutic strategy that could ameliorate some of the abnormalities associated with KS.


Condition or disease Intervention/treatment
Kabuki Syndrome 1 Genetic: Intervention on primary cultured cells

Detailed Description:

Main and secondary objectives :

The main objective is to study the pathological role of ML mutations in KS to facilitate the identification and characterization of therapeutic strategies to improve the symptoms of patients with KS. Due to the lack of treatment in the KS, the aim is to develop a model of this disease from fibroblasts from patients and reprogram them into mesenchymal stem cells. This approach will generate a KS-specific stem cell bio-bank, allowing the identification of common disturbances caused by the loss of function (LoF) of KMT2D. The impact of the KMT2D LoF on transcription but also the epigenetic mechanisms activated during MSC differentiation will be described. Finally, the therapeutic potential of an epigenome "editing" approach to increase the expression of the wild KMT2D allele to restore the functional activity of MLL4 in treated MSCs will be evaluated.

The secondary objective is to evaluate the ability to return to normal after CRISPR/Case9 gene therapy treatment on patients' cells

Methodology (design study, population, description of groups (if applicable), inclusion criteria, non-inclusion, main and secondary judgment criteria, number of subjects to be included, statistical analysis...) :

Starting from primary cells isolated from affected patients, an in vitro model of the disease will be developed. An integrative but alternative strategy approach to obtain mesenchymal stem cells derived from patients to define normal and abnormal transcription and epigenetic circuits during KMT2D LoF will be adopted. By combining the autonomous renewal potential of MSCs with CRISPR/Cas9 technology, an approach to "editing" the epigenome for therapeutic purposes to restore MLL4 activity will be developed.

This project will represent a step forward in understanding the molecular mechanisms responsible for KS. The in vitro model will provide the scientific community with an experimental system to study KS. Finally, the aim is to define the molecular basis of KS and develop a therapeutic strategy to improve certain symptoms in patients with KS.

Process (number of visits, duration of inclusions, duration of follow-up):

8 people will be included: 4 patients with Kabuki syndrome authenticated by the molecular genetics study of the KMT2D gene.

4 parents of the same sex as the patient

Feasibility :

In the clinical genetics department of the Montpellier University Hospital, more than 40 patients with Kabuki syndrome are followed.

Impacts / prospects :

The identification of the consequences of mutations in the KMT2D gene on epigenetic mark changes and cellular structural changes as well as the attempt at gene correction by CRISPR/Cas9 will provide a better understanding of the disease (and the genes that are deregulated by post-KMT2D epigenetic changes) and will also open a promising path for gene therapy by CRISPR/Cas9 method.

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Study Type : Observational
Estimated Enrollment : 8 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Exploiting Epigenome Editing in Kabuki Syndrome: a New Route Towards Gene Therapy for Rare Genetic Disorders
Actual Study Start Date : February 22, 2019
Estimated Primary Completion Date : October 30, 2019
Estimated Study Completion Date : March 2020

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Kabuki syndrome/ unaffected parents
Intervention on primary cultured cells from 4 patients with KS and sex match parents
Genetic: Intervention on primary cultured cells
The intervention includes primary cultured cells, reprograming them into mesenchymal stem cells and CRISPR/Case9 gene therapy treatment on patients' cells




Primary Outcome Measures :
  1. success rate of fibroblasts culture [ Time Frame: one year maximum after inclusion ]
    The aim is to establish a model of KS disease from fibroblasts from patients


Secondary Outcome Measures :
  1. success rate of turning fibroblasts into mesenchymal stem cells [ Time Frame: one year maximum after inclusion ]
    The aim is to determine the success rate of turning fibroblasts into mesenchymal stem cells

  2. success rate of CRISPR/Case9 gene therapy treatment on patients' cells [ Time Frame: one year maximum after inclusion ]
    The aim is to evaluate the ability to return to normal after CRISPR/Case9 gene therapy treatment on patients' cells


Biospecimen Retention:   Samples Without DNA
Skin fibroblast from 4 KS patients with KMT2D mutation and sex matched parents


Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   6 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Pediatric population with KS and healthy adult (unaffected sex match parents of patients)
Criteria

Inclusion Criteria:

  1. For the patient = to have a Kabuki syndrome authenticated by molecular genetics (proof of mutation in the KMT2D gene)
  2. For parents = having the same sex as your child
  3. To be affiliated to a French social security system
  4. Authorize the participation of the study

Exclusion Criteria:

  1. Not be affiliated to a social security scheme (CMU is included)
  2. Existence of a significant coagulation ruble (especially thrombocytopenic purpura in Kabuki patients with platelet counts < 20,000 Units).
  3. Genetic skin disease responsible for poor healing
  4. Refusal to participate in the child's and/or parent's study

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): NCT03855631


Locations
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France
Arnaud de villeneuve Hospital
Montpellier, Herault, France, 34295
Sponsors and Collaborators
University Hospital, Montpellier
Association Française contre les Myopathies Telethon
Investigators
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Principal Investigator: Alessio Zippo, PhD Center of Integrative Biology

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Responsible Party: University Hospital, Montpellier
ClinicalTrials.gov Identifier: NCT03855631    
Other Study ID Numbers: RECHMPL18_0242
First Posted: February 27, 2019    Key Record Dates
Last Update Posted: September 18, 2019
Last Verified: February 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University Hospital, Montpellier:
Kabuki syndrome CRIPSR/Cas9 KMT2D
Additional relevant MeSH terms:
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Vestibular Diseases
Hematologic Diseases
Genetic Diseases, Inborn
Abnormalities, Multiple
Syndrome
Disease
Pathologic Processes
Congenital Abnormalities
Labyrinth Diseases
Ear Diseases
Otorhinolaryngologic Diseases