Thymus Transplantation With Immunosuppression (884)
Primary Purpose
DiGeorge Syndrome, DiGeorge Anomaly, Complete DiGeorge Anomaly
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Thymus Tissue for Transplantation
Sponsored by
About this trial
This is an interventional treatment trial for DiGeorge Syndrome focused on measuring Thymus Transplantation, DiGeorge Anomaly, DiGeorge Syndrome, Athymia, Low T cell numbers, Immunoreconstitution, Immunodeficiency, Complete DiGeorge, Typical DiGeorge, Atypical DiGeorge, Complete DiGeorge Anomaly
Eligibility Criteria
Transplant Inclusion
- No age limit
- Thyroid studies must be done and if abnormal, must be on therapy
DiGeorge diagnosis - must have 1 symptom from the following list:
- Heart defect
- Hypocalcemia requiring replacement
- 22q11 hemizygosity
- 10p13 hemizygosity
- CHARGE association
- Abnormal ears plus mother with diabetes (type I, type II, or gestational)
Atypical Diagnosis:
- Must have, or have had, a rash. If rash present, biopsy of rash must show T cells in skin. If rash & adenopathy resolved, must still have oligoclonal T cells.
- Within 1 month of tx must have PHA response >20 fold above background or >5,000 cpm, whichever is higher, or response can be < this.
- Circulating CD3+ T cells >50/mm3 but CD45RA+CD62L+CD3+ T cells <50/mm or <5% of CD3 count, whichever is higher (must be done 2x)
- Immunoscope with >40% oligoclonal TCRBV families. A 2nd test per sponsor discretion if T cell numbers increase or activation status changes.
- If TREC done pre-tx must have TRECs <100 per 100,000 CD3+ cells.
Typical Diagnosis:
- Circulating CD3+ CD45RA+ CD62L+ T cells and <50/mm3 or <5% of total T cells
- PHA response >20 fold above background or >5,000 cpm, whichever is higher.
- 2 studies must show similar immunological findings qualify for this study.
- TRECs, if done, should be <100/100,000 CD3 cells
Transplant Exclusion:
- Heart surgery <4 weeks pre-tx date
- Heart surgery anticipated w/in 3 months of proposed tx
- Rejection by surgeon or anesthesiologist as surgical candidates
- Lack of sufficient muscle tissue to accept 0.2 grams/kg transplant
Sites / Locations
- Duke University Medical Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
1
Arm Description
Thymus Tissue for Transplantation
Outcomes
Primary Outcome Measures
Safety & tolerability of Thymoglobulin and cyclosporine followed by thymus transplantation: Survival at 1 year post-transplantation.
Secondary Outcome Measures
Use of additional post transplant immunosuppression after that listed in the protocol.
Use of additional post transplant immunosuppression after that listed in the protocol.
Allograft biopsy used to evaluate graft rejection
Evidence of thymus allograft rejection by immunohistochemistry of biopsy
CD3 count
CD3 count in cells/mm3
Thymopoiesis
Evidence of thymopoiesis in thymus allograft by immunohistochemistry of a biopsy
CD4 count
CD4 count in cells/mm3
CD8 count
CD8 count in cells/mm3
naive CD4 count
naive CD4 count in cells/mm3
naive CD8 count
naive CD8 count in cells/mm3
Full Information
NCT ID
NCT00579709
First Posted
December 20, 2007
Last Updated
March 23, 2022
Sponsor
Enzyvant Therapeutics GmBH
Collaborators
National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
1. Study Identification
Unique Protocol Identification Number
NCT00579709
Brief Title
Thymus Transplantation With Immunosuppression
Acronym
884
Official Title
Thymus Transplantation With Immunosuppression, #884
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
July 2002 (undefined)
Primary Completion Date
December 2006 (Actual)
Study Completion Date
December 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Enzyvant Therapeutics GmBH
Collaborators
National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The research purpose is to determine if thymus transplantation with immunosuppression is a safe and effective treatment for complete DiGeorge anomaly. The research includes studies to evaluate whether thymus transplantation results in complete DiGeorge anomaly subjects developing a normal immune system.
Detailed Description
DiGeorge anomaly is a complex of cardiac defects, parathyroid deficiency, and thymus absence, resulting in profound T-cell deficiency. There is a spectrum of disease in DiGeorge anomaly with respect to all three defects. For complete DiGeorge anomaly subjects with severe T cell defect, the PI had shown that thymus transplantation is safe and efficacious without pretransplantation immunosuppression and with pretransplantation Thymoglobulin and cyclosporine.
Some DiGeorge patients have very poor T cell function and are at risk of death from infection or other immune problems; however, these patients have enough T cell function to reject grafts. This protocol was designed for these patients. Atypical phenotype and some typical phenotype DiGeorge subjects were included in this protocol.
Atypical complete DiGeorge anomaly patients have rash, lymphadenopathy, and oligoclonal T cell proliferations. The T cells have no markers of thymic function (they do not co-express CD45RA and CD62L; they do not contain T cell receptor rearrangement excision circles, TRECs).
Typical complete DiGeorge anomaly patients in this protocol are those whose PHA response >20 fold. Although these patients have very low T cell function, it may be enough to reject a transplant, so Thymoglobulin was used.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
DiGeorge Syndrome, DiGeorge Anomaly, Complete DiGeorge Anomaly, Complete DiGeorge Syndrome
Keywords
Thymus Transplantation, DiGeorge Anomaly, DiGeorge Syndrome, Athymia, Low T cell numbers, Immunoreconstitution, Immunodeficiency, Complete DiGeorge, Typical DiGeorge, Atypical DiGeorge, Complete DiGeorge Anomaly
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Actual)
8. Arms, Groups, and Interventions
Arm Title
1
Arm Type
Experimental
Arm Description
Thymus Tissue for Transplantation
Intervention Type
Biological
Intervention Name(s)
Thymus Tissue for Transplantation
Other Intervention Name(s)
IND 9836, Thymus Tissue Transplant
Intervention Description
3 Thymoglobulin doses given prior to thymus tx. Atypical subjects given Cyclosporine (Csa) pre-tx. Desired Csa concentration 180-300ng/ml. If post-tx T cell count remained <4000/cumm Csa weaned over 8 weeks. If T cell >4,000/cumm, Csa held at 180-300ng/ml.
Thymus tissue, donor, & mother of donor were screened for transplant safety. In operating room, thymic slices were transplanted into quadriceps muscle in 1 or both legs.
Subjects had routine blood research immune evaluations. 2-3 months post-tx, open biopsy of allograft. Immune blood studies continued on surviving subjects until January 2010. Biological Mother: Mother provided blood sample used for DNA extraction, to identify/look for maternal T cell presence in recipient pre-tx, and/or for immune testing post-tx.
Primary Outcome Measure Information:
Title
Safety & tolerability of Thymoglobulin and cyclosporine followed by thymus transplantation: Survival at 1 year post-transplantation.
Time Frame
1 year post-transplantation
Secondary Outcome Measure Information:
Title
Use of additional post transplant immunosuppression after that listed in the protocol.
Description
Use of additional post transplant immunosuppression after that listed in the protocol.
Time Frame
The post thymus transplantation period
Title
Allograft biopsy used to evaluate graft rejection
Description
Evidence of thymus allograft rejection by immunohistochemistry of biopsy
Time Frame
2 to 4 months post-transplant
Title
CD3 count
Description
CD3 count in cells/mm3
Time Frame
10 - 14 months post-transplantation
Title
Thymopoiesis
Description
Evidence of thymopoiesis in thymus allograft by immunohistochemistry of a biopsy
Time Frame
2-4 months after thymus transplantation
Title
CD4 count
Description
CD4 count in cells/mm3
Time Frame
10-14 months after thymus transplantation
Title
CD8 count
Description
CD8 count in cells/mm3
Time Frame
10-14 months after thymus transplantation
Title
naive CD4 count
Description
naive CD4 count in cells/mm3
Time Frame
10-14 months after thymus transplantation
Title
naive CD8 count
Description
naive CD8 count in cells/mm3
Time Frame
10-14 months after thymus transplantation
10. Eligibility
Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Transplant Inclusion
No age limit
Thyroid studies must be done and if abnormal, must be on therapy
DiGeorge diagnosis - must have 1 symptom from the following list:
Heart defect
Hypocalcemia requiring replacement
22q11 hemizygosity
10p13 hemizygosity
CHARGE association
Abnormal ears plus mother with diabetes (type I, type II, or gestational)
Atypical Diagnosis:
Must have, or have had, a rash. If rash present, biopsy of rash must show T cells in skin. If rash & adenopathy resolved, must still have oligoclonal T cells.
Within 1 month of tx must have PHA response >20 fold above background or >5,000 cpm, whichever is higher, or response can be < this.
Circulating CD3+ T cells >50/mm3 but CD45RA+CD62L+CD3+ T cells <50/mm or <5% of CD3 count, whichever is higher (must be done 2x)
Immunoscope with >40% oligoclonal TCRBV families. A 2nd test per sponsor discretion if T cell numbers increase or activation status changes.
If TREC done pre-tx must have TRECs <100 per 100,000 CD3+ cells.
Typical Diagnosis:
Circulating CD3+ CD45RA+ CD62L+ T cells and <50/mm3 or <5% of total T cells
PHA response >20 fold above background or >5,000 cpm, whichever is higher.
2 studies must show similar immunological findings qualify for this study.
TRECs, if done, should be <100/100,000 CD3 cells
Transplant Exclusion:
Heart surgery <4 weeks pre-tx date
Heart surgery anticipated w/in 3 months of proposed tx
Rejection by surgeon or anesthesiologist as surgical candidates
Lack of sufficient muscle tissue to accept 0.2 grams/kg transplant
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
M. Louise Markert, MD, PhD
Organizational Affiliation
Duke University Medical Center, Pediatrics, Allergy & Immunology
Official's Role
Principal Investigator
Facility Information:
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
12702512
Citation
Markert ML, Sarzotti M, Ozaki DA, Sempowski GD, Rhein ME, Hale LP, Le Deist F, Alexieff MJ, Li J, Hauser ER, Haynes BF, Rice HE, Skinner MA, Mahaffey SM, Jaggers J, Stein LD, Mill MR. Thymus transplantation in complete DiGeorge syndrome: immunologic and safety evaluations in 12 patients. Blood. 2003 Aug 1;102(3):1121-30. doi: 10.1182/blood-2002-08-2545. Epub 2003 Apr 17.
Results Reference
background
PubMed Identifier
20832849
Citation
Chinn IK, Olson JA, Skinner MA, McCarthy EA, Gupton SE, Chen DF, Bonilla FA, Roberts RL, Kanariou MG, Devlin BH, Markert ML. Mechanisms of tolerance to parental parathyroid tissue when combined with human allogeneic thymus transplantation. J Allergy Clin Immunol. 2010 Oct;126(4):814-820.e8. doi: 10.1016/j.jaci.2010.07.016. Epub 2010 Sep 15.
Results Reference
background
PubMed Identifier
15100156
Citation
Markert ML, Alexieff MJ, Li J, Sarzotti M, Ozaki DA, Devlin BH, Sedlak DA, Sempowski GD, Hale LP, Rice HE, Mahaffey SM, Skinner MA. Postnatal thymus transplantation with immunosuppression as treatment for DiGeorge syndrome. Blood. 2004 Oct 15;104(8):2574-81. doi: 10.1182/blood-2003-08-2984. Epub 2004 Apr 20.
Results Reference
result
PubMed Identifier
20236866
Citation
Markert ML, Devlin BH, McCarthy EA. Thymus transplantation. Clin Immunol. 2010 May;135(2):236-46. doi: 10.1016/j.clim.2010.02.007. Epub 2010 Mar 16.
Results Reference
result
Citation
Markert ML and Devlin BH. Thymic reconstitution (in Rich RR, Shearer WT, Fleischer T, Schroeder HW, Weyand CM, Frew A, eds., Clinical Immunology 3rd edn., Elsevier, Edinburgh) p 1253-1262, 2008.
Results Reference
result
PubMed Identifier
17284531
Citation
Markert ML, Devlin BH, Alexieff MJ, Li J, McCarthy EA, Gupton SE, Chinn IK, Hale LP, Kepler TB, He M, Sarzotti M, Skinner MA, Rice HE, Hoehner JC. Review of 54 patients with complete DiGeorge anomaly enrolled in protocols for thymus transplantation: outcome of 44 consecutive transplants. Blood. 2007 May 15;109(10):4539-47. doi: 10.1182/blood-2006-10-048652. Epub 2007 Feb 6.
Results Reference
result
PubMed Identifier
18333898
Citation
Selim MA, Markert ML, Burchette JL, Herman CM, Turner JW. The cutaneous manifestations of atypical complete DiGeorge syndrome: a histopathologic and immunohistochemical study. J Cutan Pathol. 2008 Apr;35(4):380-5. doi: 10.1111/j.1600-0560.2007.00816.x.
Results Reference
result
PubMed Identifier
18155964
Citation
Chinn IK, Devlin BH, Li YJ, Markert ML. Long-term tolerance to allogeneic thymus transplants in complete DiGeorge anomaly. Clin Immunol. 2008 Mar;126(3):277-81. doi: 10.1016/j.clim.2007.11.009. Epub 2007 Dec 26.
Results Reference
result
PubMed Identifier
18424759
Citation
Markert ML, Li J, Devlin BH, Hoehner JC, Rice HE, Skinner MA, Li YJ, Hale LP. Use of allograft biopsies to assess thymopoiesis after thymus transplantation. J Immunol. 2008 May 1;180(9):6354-64. doi: 10.4049/jimmunol.180.9.6354.
Results Reference
result
PubMed Identifier
18035553
Citation
Hudson LL, Louise Markert M, Devlin BH, Haynes BF, Sempowski GD. Human T cell reconstitution in DiGeorge syndrome and HIV-1 infection. Semin Immunol. 2007 Oct;19(5):297-309. doi: 10.1016/j.smim.2007.10.002. Epub 2007 Nov 26.
Results Reference
result
PubMed Identifier
18557726
Citation
Markert ML, Devlin BH, Chinn IK, McCarthy EA, Li YJ. Factors affecting success of thymus transplantation for complete DiGeorge anomaly. Am J Transplant. 2008 Aug;8(8):1729-36. doi: 10.1111/j.1600-6143.2008.02301.x. Epub 2008 Jun 28.
Results Reference
result
Citation
Markert ML, Devlin BH, McCarthy EA, Chinn IK, Hale LP. Thymus Transplantation in Thymus Gland Pathology: Clinical, Diagnostic, and Therapeutic Features. Eds Lavinin C, Moran CA, Morandi U, Schoenhuber R. Springer-Verlag Italia, Milan, 2008, pp 255-267.
Results Reference
result
PubMed Identifier
19066739
Citation
Markert ML, Devlin BH, Chinn IK, McCarthy EA. Thymus transplantation in complete DiGeorge anomaly. Immunol Res. 2009;44(1-3):61-70. doi: 10.1007/s12026-008-8082-5.
Results Reference
result
PubMed Identifier
20978268
Citation
Markert ML, Marques JG, Neven B, Devlin BH, McCarthy EA, Chinn IK, Albuquerque AS, Silva SL, Pignata C, de Saint Basile G, Victorino RM, Picard C, Debre M, Mahlaoui N, Fischer A, Sousa AE. First use of thymus transplantation therapy for FOXN1 deficiency (nude/SCID): a report of 2 cases. Blood. 2011 Jan 13;117(2):688-96. doi: 10.1182/blood-2010-06-292490. Epub 2010 Oct 26.
Results Reference
result
PubMed Identifier
15100681
Citation
Markert ML, Alexieff MJ, Li J, Sarzotti M, Ozaki DA, Devlin BH, Sempowski GD, Rhein ME, Szabolcs P, Hale LP, Buckley RH, Coyne KE, Rice HE, Mahaffey SM, Skinner MA. Complete DiGeorge syndrome: development of rash, lymphadenopathy, and oligoclonal T cells in 5 cases. J Allergy Clin Immunol. 2004 Apr;113(4):734-41. doi: 10.1016/j.jaci.2004.01.766.
Results Reference
result
PubMed Identifier
22590644
Citation
Albuquerque AS, Marques JG, Silva SL, Ligeiro D, Devlin BH, Dutrieux J, Cheynier R, Pignata C, Victorino RM, Markert ML, Sousa AE. Human FOXN1-deficiency is associated with alphabeta double-negative and FoxP3+ T-cell expansions that are distinctly modulated upon thymic transplantation. PLoS One. 2012;7(5):e37042. doi: 10.1371/journal.pone.0037042. Epub 2012 May 10.
Results Reference
result
PubMed Identifier
23607606
Citation
Chinn IK, Milner JD, Scheinberg P, Douek DC, Markert ML. Thymus transplantation restores the repertoires of forkhead box protein 3 (FoxP3)+ and FoxP3- T cells in complete DiGeorge anomaly. Clin Exp Immunol. 2013 Jul;173(1):140-9. doi: 10.1111/cei.12088.
Results Reference
result
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Thymus Transplantation With Immunosuppression
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