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Safety and Efficacy in LPL-Deficient Subjects of AMT-011, an Adeno-Associated Viral Vector Expressing Human Lipoprotein Lipase [S447X]

Primary Purpose

Familial Lipoprotein Lipase Deficiency

Status
Unknown status
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Alipogene Tiparvovec (AMT-011), Human LPL [S447X]
Mycophenolate mofetil
Alipogene Tiparvovec (AMT-011), Human LPL [S447X]
cyclosporine
Sponsored by
Amsterdam Molecular Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Familial Lipoprotein Lipase Deficiency focused on measuring LPLD, Lipoprotein Lipase Deficiency, Chylomicronaemia, Genetherapy, AAV, Alipogene Tiparvovec, AMT-011, Lipoprotein Lipase

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Eligible Population Study participants must have participated in the preceding observation study (Prep-02: Appendix III) and be diagnosed with lipoprotein lipase deficiency, meeting the following criteria: (I) Their lipoprotein lipase activity levels in post-heparin plasma should be ≤20 % of normal; (II) Confirmed homozygocity or compound heterozygocity for mutations in the LPL gene; (III) Post-heparin plasma LPL mass should be >5% of normal; (IV) Median fasting plasma TG concentrations >10.00mmol/L, as determined on the basis of 5 consecutive time points in the preceding observation study with a history of pancreatitis.
  • General Health The participant must be in good general physical health with, in the opinion of the investigator, no other clinically significant and relevant abnormalities of medical history, and no abnormalities at the physical examination and routine laboratory evaluation performed prior to the trial.
  • Age Age ≥18 years old.
  • Sex Male or female. Females must be of non-child bearing potential or with a negative pregnancy test and not breast feeding. Female subjects must use appropriate contraception (if relevant) and their spouse must use barrier contraception for the duration of the study (12 weeks). Males must practice barrier birth control and their spouse should use appropriate contraception until three consecutive semen samples, taken at least 75 days after administration, are negative for AMT-011 vector DNA.
  • Compliance The participant is willing to fully comply with all study procedures and requirements of the trial such as restrictions to a low-fat diet (see section 8.1).
  • Consent The participant has the mental ability to give voluntary written informed consent to participate in the study.

Exclusion Criteria:

  • Disease
  • Apolipoprotein CII deficiency.
  • Inflammatory muscle disease (e.g. myositis, myopathies or rhabdomolysis).
  • Any current or relevant previous history of serious, severe or unstable physical or psychiatric illness, any medical disorder that may make the participant unlikely to fully complete the study, or any condition that presents undue risk from the study medication or procedures (e.g. malignant neoplasia).
  • Active infectious disease of any nature, including clinically active viral infections.
  • Laboratory Parameters

The following blood screening tests will result in exclusion from participation:

  • Platelet count < 100 x 109 /L.
  • Hemoglobin < 7.0 mmol/L.
  • Liver function disturbances (bilirubin >2.50 x normal, transaminases >3 x ULN).
  • CPK > 3 x ULN.
  • Creatinine > 3 x ULN.

Sites / Locations

  • Ecogene-21 Clinical Trial Center/ Centre de santé et de services sociaux de Chicoutimi

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Dose cohort 3 x 10^11gc/kg

Alipogene Tiparvovec, Human LPL [S447X]

Alipogene Tiparvovec, Human LPL [S447X], 1xE12 gc/kg

Arm Description

intra muscular, 3 x E11 gc per kg body weight, injected in a single series of intramuscular injections

intra muscular, 3 x E11 gc per kg body weight, injected in a single series of intramuscular injections with immunosuppressants

intra muscular, 1 x E12 gc per kg body weight, injected in a single series of intramuscular injections with immunosuppressants

Outcomes

Primary Outcome Measures

Reduction of fasting triglyceride (TG) concentrations
To achieve a reduction in fasting plasma TG such that the difference in median plasma TG observed before administration and up to 12 weeks after administration represents approximately 40% reduction, on top of a low-fat diet.
safety profile of AMT-011
Between 6 and 15 years after administration of AMT-011, patients will be annually contacted by phone to monitor delayed adverse events related to administration of AMT-011.

Secondary Outcome Measures

Reduction of TG concentrations
To achieve sustained efficacy, defined as approximately 40% reduction in fasting plasma TG up to 26 weeks after administration, on top of a low-fat diet.
Reduction of TG concentrations
To achieve a reduction in fasting plasma TG to a level equal to or less than 10.00 mmol/L on top of a low-fat diet at 12 weeks after administration.
Reduction of TG concentrations
To achieve sustained efficacy, defined as a reduction in fasting plasma TG at 26 weeks after administration to a level equal to or less than 10.00 mmol/L on top of a low-fat diet.
Biological activity and expression of the transgene product.
To determine the biological activity and expression of the lipoprotein lipase (LPLS447X) transgene product.
Evaluation immune respons
To evaluate potential immune responses against the lipoprotein lipase (LPLS447X) transgene product and the adeno-associated viral (AAV) vector.
To assess the shedding of the viral vector
To assess shedding of AMT-011

Full Information

First Posted
April 22, 2010
Last Updated
September 29, 2011
Sponsor
Amsterdam Molecular Therapeutics
Collaborators
International Antiviral Therapy Evaluation Center
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1. Study Identification

Unique Protocol Identification Number
NCT01109498
Brief Title
Safety and Efficacy in LPL-Deficient Subjects of AMT-011, an Adeno-Associated Viral Vector Expressing Human Lipoprotein Lipase [S447X]
Official Title
A Study to Determine the Safety and Efficacy in Lipoprotein Lipase-Deficient Subjects After Intramuscular Administration of AMT-011, an Adeno-Associated Viral Vector Expressing Human Lipoprotein LipaseS447X
Study Type
Interventional

2. Study Status

Record Verification Date
April 2010
Overall Recruitment Status
Unknown status
Study Start Date
August 2007 (undefined)
Primary Completion Date
June 2013 (Anticipated)
Study Completion Date
June 2013 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Amsterdam Molecular Therapeutics
Collaborators
International Antiviral Therapy Evaluation Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
LPLD is a rare autosomal recessive disorder, characterized by the presence of marked chylomicronemia and hence hypertriglyceridemia. Clinically the most severe manifestation of chylomicronemia, is acute pancreatitis, which can be lethal. There is no effective therapy available to modulate the course of the illness and prevent complications for these patients. The current clinical management consists of severe reduction of dietary fat that is hard if not almost impossible to comply with. LPLD subjects continue to experience pancreatitis attacks, and are admitted to intensive care units on several occasions. Alipogene tiparvovec corrects or restores lipoprotein lipase (LPL) function long term, and hence reverses some symptoms, halts the disease progression and prevents further complications. Alipogene tiparvovec gene therapy ensures that a catabolically beneficial variant of the human LPL gene, LPL[S447X] is expressed and active in the relevant tissues in humans. Delivery of the gene is realized via intramuscular injection of an adeno-associated viral vector, pseudotyped with AAV1 capsids.
Detailed Description
The CT-AMT-011-01 study is an open-label, dose-escalating study evaluating the safety and efficacy of a single intramuscular administration of AMT-011 (at multiple sites). The study will be performed in the Community Genomic medicineCenter (CGMC) Chicoutimi, Canada, under the supervision of their medical ethical committee and according to the local biosafety procedures. The study participants will be treated under the responsibility of a Principal Investigator specialised in the treatment of lipid disorders. A total number of 14 subjects will be administered. Participants will be screened 3 weeks prior to administration of AMT-011 and will be evaluated for 12 weeks post administration in this study. After the study, subjects will be followed up long term with particular emphasis on the safety and efficacy aspects of LPL gene therapy using AMT-011. Subjects will be evaluated at the clinical site at 19 weeks, 26 weeks, 39 weeks, 1 year, 1.5 years, 2 years, 3 years, 4 years and 5 years after administration of AMT-011. The TG values that are obtained at week 26 will be used for secondary efficacy analysis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Familial Lipoprotein Lipase Deficiency
Keywords
LPLD, Lipoprotein Lipase Deficiency, Chylomicronaemia, Genetherapy, AAV, Alipogene Tiparvovec, AMT-011, Lipoprotein Lipase

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
14 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dose cohort 3 x 10^11gc/kg
Arm Type
Experimental
Arm Description
intra muscular, 3 x E11 gc per kg body weight, injected in a single series of intramuscular injections
Arm Title
Alipogene Tiparvovec, Human LPL [S447X]
Arm Type
Experimental
Arm Description
intra muscular, 3 x E11 gc per kg body weight, injected in a single series of intramuscular injections with immunosuppressants
Arm Title
Alipogene Tiparvovec, Human LPL [S447X], 1xE12 gc/kg
Arm Type
Experimental
Arm Description
intra muscular, 1 x E12 gc per kg body weight, injected in a single series of intramuscular injections with immunosuppressants
Intervention Type
Genetic
Intervention Name(s)
Alipogene Tiparvovec (AMT-011), Human LPL [S447X]
Other Intervention Name(s)
Glybera, AMT-011
Intervention Description
intra muscular, 1 x E12 gc per kg body weight, injected in a single series of intramuscular injections
Intervention Type
Drug
Intervention Name(s)
Mycophenolate mofetil
Other Intervention Name(s)
CellCept
Intervention Description
oral, 2 g/day, day -3 till week 12
Intervention Type
Genetic
Intervention Name(s)
Alipogene Tiparvovec (AMT-011), Human LPL [S447X]
Other Intervention Name(s)
Glybera, AMT 011
Intervention Description
intra muscular, 3 x E11 gc per kg body weight, injected in a single series of intramuscular injections
Intervention Type
Drug
Intervention Name(s)
cyclosporine
Other Intervention Name(s)
Neoral
Intervention Description
oral, 3 mg/kg/day, day -3 till week 12
Primary Outcome Measure Information:
Title
Reduction of fasting triglyceride (TG) concentrations
Description
To achieve a reduction in fasting plasma TG such that the difference in median plasma TG observed before administration and up to 12 weeks after administration represents approximately 40% reduction, on top of a low-fat diet.
Time Frame
12 weeks
Title
safety profile of AMT-011
Description
Between 6 and 15 years after administration of AMT-011, patients will be annually contacted by phone to monitor delayed adverse events related to administration of AMT-011.
Time Frame
15 years
Secondary Outcome Measure Information:
Title
Reduction of TG concentrations
Description
To achieve sustained efficacy, defined as approximately 40% reduction in fasting plasma TG up to 26 weeks after administration, on top of a low-fat diet.
Time Frame
26 weeks
Title
Reduction of TG concentrations
Description
To achieve a reduction in fasting plasma TG to a level equal to or less than 10.00 mmol/L on top of a low-fat diet at 12 weeks after administration.
Time Frame
12 weeks
Title
Reduction of TG concentrations
Description
To achieve sustained efficacy, defined as a reduction in fasting plasma TG at 26 weeks after administration to a level equal to or less than 10.00 mmol/L on top of a low-fat diet.
Time Frame
26 weeks
Title
Biological activity and expression of the transgene product.
Description
To determine the biological activity and expression of the lipoprotein lipase (LPLS447X) transgene product.
Time Frame
1 year
Title
Evaluation immune respons
Description
To evaluate potential immune responses against the lipoprotein lipase (LPLS447X) transgene product and the adeno-associated viral (AAV) vector.
Time Frame
5 years
Title
To assess the shedding of the viral vector
Description
To assess shedding of AMT-011
Time Frame
1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Eligible Population Study participants must have participated in the preceding observation study (Prep-02: Appendix III) and be diagnosed with lipoprotein lipase deficiency, meeting the following criteria: (I) Their lipoprotein lipase activity levels in post-heparin plasma should be ≤20 % of normal; (II) Confirmed homozygocity or compound heterozygocity for mutations in the LPL gene; (III) Post-heparin plasma LPL mass should be >5% of normal; (IV) Median fasting plasma TG concentrations >10.00mmol/L, as determined on the basis of 5 consecutive time points in the preceding observation study with a history of pancreatitis. General Health The participant must be in good general physical health with, in the opinion of the investigator, no other clinically significant and relevant abnormalities of medical history, and no abnormalities at the physical examination and routine laboratory evaluation performed prior to the trial. Age Age ≥18 years old. Sex Male or female. Females must be of non-child bearing potential or with a negative pregnancy test and not breast feeding. Female subjects must use appropriate contraception (if relevant) and their spouse must use barrier contraception for the duration of the study (12 weeks). Males must practice barrier birth control and their spouse should use appropriate contraception until three consecutive semen samples, taken at least 75 days after administration, are negative for AMT-011 vector DNA. Compliance The participant is willing to fully comply with all study procedures and requirements of the trial such as restrictions to a low-fat diet (see section 8.1). Consent The participant has the mental ability to give voluntary written informed consent to participate in the study. Exclusion Criteria: Disease Apolipoprotein CII deficiency. Inflammatory muscle disease (e.g. myositis, myopathies or rhabdomolysis). Any current or relevant previous history of serious, severe or unstable physical or psychiatric illness, any medical disorder that may make the participant unlikely to fully complete the study, or any condition that presents undue risk from the study medication or procedures (e.g. malignant neoplasia). Active infectious disease of any nature, including clinically active viral infections. Laboratory Parameters The following blood screening tests will result in exclusion from participation: Platelet count < 100 x 109 /L. Hemoglobin < 7.0 mmol/L. Liver function disturbances (bilirubin >2.50 x normal, transaminases >3 x ULN). CPK > 3 x ULN. Creatinine > 3 x ULN.
Facility Information:
Facility Name
Ecogene-21 Clinical Trial Center/ Centre de santé et de services sociaux de Chicoutimi
City
Chicoutimi
State/Province
Quebec
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
16259561
Citation
Rip J, Nierman MC, Sierts JA, Petersen W, Van den Oever K, Van Raalte D, Ross CJ, Hayden MR, Bakker AC, Dijkhuizen P, Hermens WT, Twisk J, Stroes E, Kastelein JJ, Kuivenhoven JA, Meulenberg JM. Gene therapy for lipoprotein lipase deficiency: working toward clinical application. Hum Gene Ther. 2005 Nov;16(11):1276-86. doi: 10.1089/hum.2005.16.1276.
Results Reference
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PubMed Identifier
15353045
Citation
Ross CJ, Twisk J, Meulenberg JM, Liu G, van den Oever K, Moraal E, Hermens WT, Rip J, Kastelein JJ, Kuivenhoven JA, Hayden MR. Long-term correction of murine lipoprotein lipase deficiency with AAV1-mediated gene transfer of the naturally occurring LPL(S447X) beneficial mutation. Hum Gene Ther. 2004 Sep;15(9):906-19. doi: 10.1089/hum.2004.15.906.
Results Reference
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PubMed Identifier
16002740
Citation
Ross CJ, Liu G, Kuivenhoven JA, Twisk J, Rip J, van Dop W, Excoffon KJ, Lewis SM, Kastelein JJ, Hayden MR. Complete rescue of lipoprotein lipase-deficient mice by somatic gene transfer of the naturally occurring LPLS447X beneficial mutation. Arterioscler Thromb Vasc Biol. 2005 Oct;25(10):2143-50. doi: 10.1161/01.ATV.0000176971.27302.b0. Epub 2005 Jul 7.
Results Reference
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PubMed Identifier
16716106
Citation
Ross CJ, Twisk J, Bakker AC, Miao F, Verbart D, Rip J, Godbey T, Dijkhuizen P, Hermens WT, Kastelein JJ, Kuivenhoven JA, Meulenberg JM, Hayden MR. Correction of feline lipoprotein lipase deficiency with adeno-associated virus serotype 1-mediated gene transfer of the lipoprotein lipase S447X beneficial mutation. Hum Gene Ther. 2006 May;17(5):487-99. doi: 10.1089/hum.2006.17.487.
Results Reference
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PubMed Identifier
18802015
Citation
Stroes ES, Nierman MC, Meulenberg JJ, Franssen R, Twisk J, Henny CP, Maas MM, Zwinderman AH, Ross C, Aronica E, High KA, Levi MM, Hayden MR, Kastelein JJ, Kuivenhoven JA. Intramuscular administration of AAV1-lipoprotein lipase S447X lowers triglycerides in lipoprotein lipase-deficient patients. Arterioscler Thromb Vasc Biol. 2008 Dec;28(12):2303-4. doi: 10.1161/ATVBAHA.108.175620. Epub 2008 Sep 18. No abstract available.
Results Reference
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PubMed Identifier
20072945
Citation
Burnett JR, Hooper AJ. Alipogene tiparvovec, an adeno-associated virus encoding the Ser(447)X variant of the human lipoprotein lipase gene for the treatment of patients with lipoprotein lipase deficiency. Curr Opin Mol Ther. 2009 Dec;11(6):681-91.
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Citation
Gaudet D, Methot J, Dery S, Brisson D, Essiembre C, Tremblay G, Tremblay K, de Wal J, Twisk J, van den Bulk N, Sier-Ferreira V, van Deventer S. Efficacy and long-term safety of alipogene tiparvovec (AAV1-LPLS447X) gene therapy for lipoprotein lipase deficiency: an open-label trial. Gene Ther. 2013 Apr;20(4):361-9. doi: 10.1038/gt.2012.43. Epub 2012 Jun 21.
Results Reference
derived

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Safety and Efficacy in LPL-Deficient Subjects of AMT-011, an Adeno-Associated Viral Vector Expressing Human Lipoprotein Lipase [S447X]

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