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Safety Study of AADC Gene Therapy (VY-AADC01) for Parkinson's Disease (AADC)

Primary Purpose

Parkinson's Disease

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
VY-AADC01
Sponsored by
Neurocrine Biosciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson's Disease focused on measuring PD, Parkinson's disease, Aromatic Amino Acid Decarboxylase, AADC, AAV2-AADC, AAV2, Viral Vector, Gene Therapy, Gene Transfer, MRI, PET, VY-AADC01

Eligibility Criteria

40 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed with idiopathic Parkinson's disease
  • Disease duration of at least 5 years or more
  • Adequate duration of levodopa therapy
  • Modified Hoehn and Yahr Staging of at least 2.5 in the OFF state
  • Candidate for surgical intervention because of disabling motor complications.
  • UPDRS Part III (total motor) score ≥ 25 and a maximum of 60 in the OFF state.
  • Unequivocal responsiveness to dopaminergic therapy.
  • Stable Parkinson's symptoms and medication regimen for at least 4 weeks prior to screening examination.
  • Ability to comprehend and sign the informed consent.
  • Normal Laboratory values prior to surgery.
  • Neutralizing AAV2 antibody titer ≤ 1:1200
  • Ability to travel to study visits alone or able to designate a caregiver.
  • Subject agrees to defer any neurological surgery, including deep brain stimulation, until after completing the 12 month study visit (unless recommended by study neurologist).
  • Subject agrees to not participate in any other therapeutic intervention study for 12 months after surgery.
  • Subject agrees to not have any vaccinations within 30 days of surgery.

Exclusion Criteria:

  • Atypical or secondary parkinsonism, including but not limited to symptoms believed to be due to trauma, brain tumor, infection, cerebrovascular disease, other neurological disease, or to drugs, chemicals or toxins.
  • Presence of dementia as defined by a Mattis Dementia Rating Scale-Second Edition (MDRS-2) of less than 130 at screening.
  • Presence or history of psychosis, with the exception of mild, benign hallucinations believed in the judgment of the investigators to be related to Parkinson's medications.
  • Presence of severe depression as measured by Beck Depression Inventory II (BDI-II) > 28 or a history of a major affective disorder within 5 years of screening examination.
  • Current suicidal ideation or suicide attempt within 5 years of screening examination.
  • History of substance abuse within 2 years of screening examination.
  • Brain imaging abnormalities in the striatum or other regions that would substantially increase risk of surgery.
  • Contraindication to MRI and/or gadoteridol.
  • Coagulopathy or inability to temporarily stop any anticoagulation or antiplatelet prior to surgery.
  • Prior brain surgery including deep brain stimulation, infusion therapies or any other brain surgery.
  • Prior gene transfer.
  • History of stroke, poorly controlled or significant cardiovascular disease, diabetes or any other acute or chronic medical condition.
  • History of malignancy other than treated carcinoma in situ within three years of screening evaluation.
  • Clinically apparent or laboratory-detected infection.
  • Prior or current treatment with any investigational agent within 2 months of screening evaluation.
  • Chronic immunosuppressive therapy, including chronic steroids, immunotherapy, cytotoxic therapy and chemotherapy.
  • Pregnant and lactating women.
  • Subject with reproductive capacity who is unwilling to use barrier contraception.
  • Any medical condition that is likely to lead to disability during the course of the study and interfere with confound study assessments
  • Any factors, medical, or social, which would likely cause the subject to be unable to follow the study protocol, including geographical inaccessibility.
  • Ongoing treatments such as, neuroleptic medications, apomorphine, or levodopa infusion therapy (Duodopa®).

Sites / Locations

  • University of California, San Francisco
  • University of Pittsburgh

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

VY-AADC01 Dose 1

VY-AADC01 Dose 2

VY-AADC01 Dose 3

Arm Description

7.5 x 10^11 vector genomes of VY-AADC01; Single dose, neurosurgically infused, bilaterally into the striatum.

1.5 x 10^12 vector genomes of VY-AADC01; Single dose, neurosurgically infused, bilaterally into the striatum.

4.7x 10^12 vector genomes of VY-AADC01; Single dose, neurosurgically infused, bilaterally into the striatum.

Outcomes

Primary Outcome Measures

Safety of AADC Gene Transfer
Safety and Tolerability of AADC Gene Transfer assessed by Adverse Events and Serious Adverse Events.

Secondary Outcome Measures

Parkinson's Symptoms
Effect of AAV2-hAADC on Parkinson's symptoms as recorded in subject diaries, neurological, motor, and non-motor assessments, quality of life surveys and changes to Parkinson's medications.
PET Scan Imaging
Relationship between AAV2 distribution in the brain and change in AADC expression as seen in PET imaging.

Full Information

First Posted
October 25, 2013
Last Updated
February 28, 2020
Sponsor
Neurocrine Biosciences
Collaborators
University of California, San Francisco, Veristat, Inc., Feinstein Institute for Medical Research, Oregon Health and Science University, Voyager Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT01973543
Brief Title
Safety Study of AADC Gene Therapy (VY-AADC01) for Parkinson's Disease
Acronym
AADC
Official Title
An Open-label Safety and Efficacy Study of VY-AADC01 Administered by MRI-Guided Convective Infusion Into the Putamen of Subjects With Parkinson's Disease With Fluctuating Responses to Levodopa
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
October 2013 (Actual)
Primary Completion Date
January 24, 2020 (Actual)
Study Completion Date
January 24, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Neurocrine Biosciences
Collaborators
University of California, San Francisco, Veristat, Inc., Feinstein Institute for Medical Research, Oregon Health and Science University, Voyager Therapeutics

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Safety study of AADC gene transfer (VY-AADC01) in subjects with Parkinson's disease.
Detailed Description
Parkinson's disease is a neurodegenerative disorder involving loss of neurons that release dopamine in the striatum. To compensate for the loss of dopamine, patients are typically prescribed levodopa medication which is converted to dopamine by the enzyme Aromatic L-Amino Acid Decarboxylase (AADC). As Parkinson's disease progresses, levodopa therapy becomes less effective and is associated with motor fluctuations, involuntary movements and other complications. This study will primarily investigate the safety of increasing AADC levels in the striatum via AADC gene delivery. The hAADC gene is packaged into a gene transfer vector derived from a common, non-pathogenic virus (AAV2) to which >90% of humans have been exposed. This investigational drug, termed VY-AADC01, will be injected directly into the striatum during a neurosurgical procedure that is performed with real-time MRI imaging to monitor delivery. Subjects will continue to take Parkinson's disease medications, including levodopa. The safety and potential clinical responses to VY-AADC01 will be assessed by repeated clinical evaluations of Parkinson's disease, cognitive tests, laboratory blood tests and neuroimaging. Clinical evaluations will be performed over a 3 year follow-up period. A test to specifically assess the clinical response to levodopa will be performed once before AADC gene delivery and approximately 6 months after.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson's Disease
Keywords
PD, Parkinson's disease, Aromatic Amino Acid Decarboxylase, AADC, AAV2-AADC, AAV2, Viral Vector, Gene Therapy, Gene Transfer, MRI, PET, VY-AADC01

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
VY-AADC01
Masking
Outcomes Assessor
Allocation
Non-Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
VY-AADC01 Dose 1
Arm Type
Experimental
Arm Description
7.5 x 10^11 vector genomes of VY-AADC01; Single dose, neurosurgically infused, bilaterally into the striatum.
Arm Title
VY-AADC01 Dose 2
Arm Type
Experimental
Arm Description
1.5 x 10^12 vector genomes of VY-AADC01; Single dose, neurosurgically infused, bilaterally into the striatum.
Arm Title
VY-AADC01 Dose 3
Arm Type
Experimental
Arm Description
4.7x 10^12 vector genomes of VY-AADC01; Single dose, neurosurgically infused, bilaterally into the striatum.
Intervention Type
Biological
Intervention Name(s)
VY-AADC01
Other Intervention Name(s)
AAV2-hAADC
Intervention Description
Neurosurgical delivery of VY-AADC01 to the brain.
Primary Outcome Measure Information:
Title
Safety of AADC Gene Transfer
Description
Safety and Tolerability of AADC Gene Transfer assessed by Adverse Events and Serious Adverse Events.
Time Frame
3 Years after Gene Transfer
Secondary Outcome Measure Information:
Title
Parkinson's Symptoms
Description
Effect of AAV2-hAADC on Parkinson's symptoms as recorded in subject diaries, neurological, motor, and non-motor assessments, quality of life surveys and changes to Parkinson's medications.
Time Frame
3 Years after Gene Transfer
Title
PET Scan Imaging
Description
Relationship between AAV2 distribution in the brain and change in AADC expression as seen in PET imaging.
Time Frame
6 Months after Gene Transfer

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed with idiopathic Parkinson's disease Disease duration of at least 5 years or more Adequate duration of levodopa therapy Modified Hoehn and Yahr Staging of at least 2.5 in the OFF state Candidate for surgical intervention because of disabling motor complications. UPDRS Part III (total motor) score ≥ 25 and a maximum of 60 in the OFF state. Unequivocal responsiveness to dopaminergic therapy. Stable Parkinson's symptoms and medication regimen for at least 4 weeks prior to screening examination. Ability to comprehend and sign the informed consent. Normal Laboratory values prior to surgery. Neutralizing AAV2 antibody titer ≤ 1:1200 Ability to travel to study visits alone or able to designate a caregiver. Subject agrees to defer any neurological surgery, including deep brain stimulation, until after completing the 12 month study visit (unless recommended by study neurologist). Subject agrees to not participate in any other therapeutic intervention study for 12 months after surgery. Subject agrees to not have any vaccinations within 30 days of surgery. Exclusion Criteria: Atypical or secondary parkinsonism, including but not limited to symptoms believed to be due to trauma, brain tumor, infection, cerebrovascular disease, other neurological disease, or to drugs, chemicals or toxins. Presence of dementia as defined by a Mattis Dementia Rating Scale-Second Edition (MDRS-2) of less than 130 at screening. Presence or history of psychosis, with the exception of mild, benign hallucinations believed in the judgment of the investigators to be related to Parkinson's medications. Presence of severe depression as measured by Beck Depression Inventory II (BDI-II) > 28 or a history of a major affective disorder within 5 years of screening examination. Current suicidal ideation or suicide attempt within 5 years of screening examination. History of substance abuse within 2 years of screening examination. Brain imaging abnormalities in the striatum or other regions that would substantially increase risk of surgery. Contraindication to MRI and/or gadoteridol. Coagulopathy or inability to temporarily stop any anticoagulation or antiplatelet prior to surgery. Prior brain surgery including deep brain stimulation, infusion therapies or any other brain surgery. Prior gene transfer. History of stroke, poorly controlled or significant cardiovascular disease, diabetes or any other acute or chronic medical condition. History of malignancy other than treated carcinoma in situ within three years of screening evaluation. Clinically apparent or laboratory-detected infection. Prior or current treatment with any investigational agent within 2 months of screening evaluation. Chronic immunosuppressive therapy, including chronic steroids, immunotherapy, cytotoxic therapy and chemotherapy. Pregnant and lactating women. Subject with reproductive capacity who is unwilling to use barrier contraception. Any medical condition that is likely to lead to disability during the course of the study and interfere with confound study assessments Any factors, medical, or social, which would likely cause the subject to be unable to follow the study protocol, including geographical inaccessibility. Ongoing treatments such as, neuroleptic medications, apomorphine, or levodopa infusion therapy (Duodopa®).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steve Hersch, MD
Organizational Affiliation
Voyager Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
University of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
34649873
Citation
Christine CW, Richardson RM, Van Laar AD, Thompson ME, Fine EM, Khwaja OS, Li C, Liang GS, Meier A, Roberts EW, Pfau ML, Rodman JR, Bankiewicz KS, Larson PS. Safety of AADC Gene Therapy for Moderately Advanced Parkinson Disease: Three-Year Outcomes From the PD-1101 Trial. Neurology. 2022 Jan 4;98(1):e40-e50. doi: 10.1212/WNL.0000000000012952. Epub 2021 Oct 14.
Results Reference
derived
PubMed Identifier
30802998
Citation
Christine CW, Bankiewicz KS, Van Laar AD, Richardson RM, Ravina B, Kells AP, Boot B, Martin AJ, Nutt J, Thompson ME, Larson PS. Magnetic resonance imaging-guided phase 1 trial of putaminal AADC gene therapy for Parkinson's disease. Ann Neurol. 2019 May;85(5):704-714. doi: 10.1002/ana.25450. Epub 2019 Mar 26.
Results Reference
derived
Links:
URL
http://www.voyagertherapeutics.com
Description
Voyager website

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Safety Study of AADC Gene Therapy (VY-AADC01) for Parkinson's Disease

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