Study of the Safety and Efficacy of Intravenous Alpha-1 Antitrypsin in Type 1 Diabetes Mellitus
Primary Purpose
Type 1 Diabetes Mellitus
Status
Completed
Phase
Phase 1
Locations
Israel
Study Type
Interventional
Intervention
Alpha-1 Antitrypsin 40mg (AAT, Glassia®)
Alpha-1 Antitrypsin 60mg (AAT, Glassia®)
Alpha-1 Antitrypsin 80mg (AAT, Glassia®)
Sponsored by
About this trial
This is an interventional treatment trial for Type 1 Diabetes Mellitus
Eligibility Criteria
Inclusion Criteria:
- Subject (or parent/guardian) willing and able to sign an informed consent
- Age 10-25 (inclusive) years
- Diagnosed with T1DM within the previous 6 months
- Level of C-peptide ≥ 0.2 pmol/mL during MMTT(maximal level)
- Positive for at least one diabetes-related autoantibody(except for insulin autoantibody)
- No significant abnormalities in serum hematology,serum chemistry according to the Investigator's judgment, taking into considerations the potential effects of the diabetic illness.
- No significant abnormalities in urinalysis according to the Principal Investigator's judgment, taking into considerations the potential effects of the diabetic illness.
- No significant abnormalities in ECG per investigator judgment
- Negative for HBsAg and antibodies to HCV, HIV-1
- Non-pregnant, non-lactating female patients, whose screening pregnancy test is negative and who are using contraceptive methods deemed reliable by the investigator.
Exclusion Criteria:
- Subjects who have received an active/ live virus vaccine within 4 weeks of the screening date
- Subjects who have received treatment with corticosteroid medication within 2 months prior to screening or any immunosuppressant or cytostatic agent within 6 months prior to screening
- IgA deficient subjects
- Individuals with a history of severe immediate hypersensitivity reactions, including anaphylaxis, to plasma products
- Planned major surgery within the study period
- Clinically significant intercurrent illnesses, including(but not limited to): cardiac, hepatic, renal,neurological, hematological, neoplastic, immunological, skeletal or other) that in the opinion of the investigator, could interfere with the safety, compliance or other aspects of this study. Patients with well-controlled, chronic diseases could be possibly included after consultation with the treating physician and the sponsor.
- Pregnant or lactating women at entry to study and those who are unwilling to agree to continue to use acceptable methods of contraception throughout the study.
- Presence of psychiatric/ mental disorder or any other medical disorder which might impair the patient's ability to give informed consent or to comply with the requirements of the study protocol.
- Evidence of ongoing viral infection with HCV, HBV and/or HIV-1.
- Evidence of alcohol abuse or history of alcohol abuse or illegal and/or legally prescribed drugs.
- Participation in another interventional clinical trial within 30 days prior to baseline visit.
- Inability to attend scheduled clinic visits and/or comply with the study protocol.
- Any other factor that, in the opinion of the investigator, would prevent the patient form complying with the requirements of the protocol.
- Current use of any medication known to influence glucose tolerance (e.g., beta-blockers, angiotensin-converting enzyme inhibitors, interferons, quinidine anti-malarial drugs, lithium, niacin).
- Current or prior (within the last 30 days prior to screening visit) use of metformin, sulfonylureas, glinides, thiazolidinediones, exenatide, liraglutide, DPP-IV inhibitors or amylin.
Sites / Locations
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes at Schneider Children's Medical Center of Israel
- Assaf Haroffeh Medical Center
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Experimental
Arm Label
Alpha-1 Antitrypsin 40mg (AAT, Glassia®)
Alpha-1 Antitrypsin 60mg (AAT, Glassia®)
Alpha-1 Antitrypsin 80mg (AAT, Glassia®)
Arm Description
Subjects in this arm will receive a dose of 40 mg/kg throughout the study.
Subjects in this arm will receive a dose of 60 mg/kg throughout the study.
Subjects in this arm will receive a dose of 80 mg/kg throughout the study.
Outcomes
Primary Outcome Measures
Safety and Tolerability
Safety and Tolerability: assessed by vital signs(systolic/diastolic blood pressure and heart rate), physical examination, routine safety lab tests, AEs and SAEs.
Secondary Outcome Measures
Efficacy
Pancreatic beta cell function ; External Insulin dose requirements; Glycosylated hemoglobin (HbA1c) levels.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01304537
Brief Title
Study of the Safety and Efficacy of Intravenous Alpha-1 Antitrypsin in Type 1 Diabetes Mellitus
Official Title
Open Label, Proof of Concept, Phase I/II Study of the Safety, Tolerability and Efficacy of Intravenous Alpha-1 Antitrypsin (AAT) [Trade Name Glassia™] in Type 1 Diabetes Mellitus
Study Type
Interventional
2. Study Status
Record Verification Date
February 2013
Overall Recruitment Status
Completed
Study Start Date
June 2011 (undefined)
Primary Completion Date
November 2012 (Actual)
Study Completion Date
November 2012 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kamada, Ltd.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Alpha-1 Antitrypsin (AAT), trade name (Glassia ®), is being explored in this phase I/II trial as a potential disease modifying agent in Type 1 Diabetes Mellitus (T1DM) based on its anti-inflammatory properties. AAT is an acute stress reactant protein that increases during inflammation. In T1DM inflammation serves a major role in disease progression.
Detailed Description
AAT is a protein produced by the human liver and secreted into the blood circulation. AAT, which belongs to a group of serine protease inhibitors (SERPINS) is an acute stress reactant protein that increases during stress conditions, including inflammation. AAT blocks serine proteases that enhance pro-inflammatory mediators (i.e. IL-1 alpha, IL-6, IL-8, TNFalpha) as well as induces production of anti-inflammatory mediators (i.e. IL-10 and IL-1-receptor antagonist).
In Type 1 Diabetes Mellitus (T1DM) inflammation serves a major role in disease progression. The inflammatory signature pattern in these patients appears to have been present years before clinical onset.
Although circulating levels of AAT in T1DM are normal, in majority of cases, the activity of AAT is severely compromised by non-enzymatic glycations, supporting the conclusion that serum protease inhibitory capacity is reduced in T1DM.
It has been shown in different studies, including in vivo and in vitro that AAT has a protective affect on pancreatic islets. This has been demonstrated in both decrease in progression of diabetes in the non-obese diabetic (NOD) mouse as well as during transplantation of islets which presented viability and activity (insulin production) in the presence of AAT. More specifically, islet cells are protected by human AAT from apoptosis, as shown by reduced caspase-3 activity after the addition of human AAT to islet culture media.
Based on the mentioned anti-inflammatory properties of AAT sided to in vivo and in vitro studied indicating that AAT may serve as a disease modifying agent in T1DM, the presented study is suggested.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes Mellitus
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
24 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Alpha-1 Antitrypsin 40mg (AAT, Glassia®)
Arm Type
Experimental
Arm Description
Subjects in this arm will receive a dose of 40 mg/kg throughout the study.
Arm Title
Alpha-1 Antitrypsin 60mg (AAT, Glassia®)
Arm Type
Experimental
Arm Description
Subjects in this arm will receive a dose of 60 mg/kg throughout the study.
Arm Title
Alpha-1 Antitrypsin 80mg (AAT, Glassia®)
Arm Type
Experimental
Arm Description
Subjects in this arm will receive a dose of 80 mg/kg throughout the study.
Intervention Type
Drug
Intervention Name(s)
Alpha-1 Antitrypsin 40mg (AAT, Glassia®)
Intervention Description
Each study group will undergo 3 treatment periods:12 weeks, 8 weeks and 4 weeks.
Intervention Type
Drug
Intervention Name(s)
Alpha-1 Antitrypsin 60mg (AAT, Glassia®)
Intervention Description
Each study group will undergo 3 treatment periods:12 weeks, 8 weeks and 4 weeks.
Intervention Type
Drug
Intervention Name(s)
Alpha-1 Antitrypsin 80mg (AAT, Glassia®)
Intervention Description
Each study group will undergo 3 treatment periods:12 weeks, 8 weeks and 4 weeks.
Primary Outcome Measure Information:
Title
Safety and Tolerability
Description
Safety and Tolerability: assessed by vital signs(systolic/diastolic blood pressure and heart rate), physical examination, routine safety lab tests, AEs and SAEs.
Time Frame
Approximately 1 year
Secondary Outcome Measure Information:
Title
Efficacy
Description
Pancreatic beta cell function ; External Insulin dose requirements; Glycosylated hemoglobin (HbA1c) levels.
Time Frame
Approximately 1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subject (or parent/guardian) willing and able to sign an informed consent
Age 10-25 (inclusive) years
Diagnosed with T1DM within the previous 6 months
Level of C-peptide ≥ 0.2 pmol/mL during MMTT(maximal level)
Positive for at least one diabetes-related autoantibody(except for insulin autoantibody)
No significant abnormalities in serum hematology,serum chemistry according to the Investigator's judgment, taking into considerations the potential effects of the diabetic illness.
No significant abnormalities in urinalysis according to the Principal Investigator's judgment, taking into considerations the potential effects of the diabetic illness.
No significant abnormalities in ECG per investigator judgment
Negative for HBsAg and antibodies to HCV, HIV-1
Non-pregnant, non-lactating female patients, whose screening pregnancy test is negative and who are using contraceptive methods deemed reliable by the investigator.
Exclusion Criteria:
Subjects who have received an active/ live virus vaccine within 4 weeks of the screening date
Subjects who have received treatment with corticosteroid medication within 2 months prior to screening or any immunosuppressant or cytostatic agent within 6 months prior to screening
IgA deficient subjects
Individuals with a history of severe immediate hypersensitivity reactions, including anaphylaxis, to plasma products
Planned major surgery within the study period
Clinically significant intercurrent illnesses, including(but not limited to): cardiac, hepatic, renal,neurological, hematological, neoplastic, immunological, skeletal or other) that in the opinion of the investigator, could interfere with the safety, compliance or other aspects of this study. Patients with well-controlled, chronic diseases could be possibly included after consultation with the treating physician and the sponsor.
Pregnant or lactating women at entry to study and those who are unwilling to agree to continue to use acceptable methods of contraception throughout the study.
Presence of psychiatric/ mental disorder or any other medical disorder which might impair the patient's ability to give informed consent or to comply with the requirements of the study protocol.
Evidence of ongoing viral infection with HCV, HBV and/or HIV-1.
Evidence of alcohol abuse or history of alcohol abuse or illegal and/or legally prescribed drugs.
Participation in another interventional clinical trial within 30 days prior to baseline visit.
Inability to attend scheduled clinic visits and/or comply with the study protocol.
Any other factor that, in the opinion of the investigator, would prevent the patient form complying with the requirements of the protocol.
Current use of any medication known to influence glucose tolerance (e.g., beta-blockers, angiotensin-converting enzyme inhibitors, interferons, quinidine anti-malarial drugs, lithium, niacin).
Current or prior (within the last 30 days prior to screening visit) use of metformin, sulfonylureas, glinides, thiazolidinediones, exenatide, liraglutide, DPP-IV inhibitors or amylin.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mariana Rachmiel, B.Med.Sc
Organizational Affiliation
Assaf Haroffeh Medical Center, Zerifin, Israel
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Yael Lebenthal, MD
Organizational Affiliation
Institute for Endocrinology & Diabetes, Schneider Children's Medical Center, Israel
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes at Schneider Children's Medical Center of Israel
City
Petach Tikva 49202
ZIP/Postal Code
49202
Country
Israel
Facility Name
Assaf Haroffeh Medical Center
City
Zerifin
ZIP/Postal Code
70300
Country
Israel
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
22634621
Citation
Ozeri E, Mizrahi M, Shahaf G, Lewis EC. alpha-1 antitrypsin promotes semimature, IL-10-producing and readily migrating tolerogenic dendritic cells. J Immunol. 2012 Jul 1;189(1):146-53. doi: 10.4049/jimmunol.1101340. Epub 2012 May 25.
Results Reference
derived
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Study of the Safety and Efficacy of Intravenous Alpha-1 Antitrypsin in Type 1 Diabetes Mellitus
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