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A Gene Therapy Study for Homozygous Familial Hypercholesterolemia (HoFH)

Primary Purpose

Homozygous Familial Hypercholesterolemia (HoFH)

Status
Terminated
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AAV directed hLDLR gene therapy
Sponsored by
REGENXBIO Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Homozygous Familial Hypercholesterolemia (HoFH) focused on measuring LDL Receptors, Gene therapy, Metabolic Diseases, Rare diseases, Genetic Diseases, Atherosclerosis, cardiovascular disease

Eligibility Criteria

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

Inclusion Criteria:

  • Male or female ≥ 18 years of age.
  • Untreated and/or treated LDL-C levels and clinical presentation consistent with the diagnosis of homozygous FH
  • Molecularly defined LDLR mutations at both LDLR alleles.
  • A baseline serum AAV8 NAb titer ≤ 1:10.

Exclusion Criteria

  • Unwilling to wash out of the following lipid lowering therapies for the pre-specified time period:

    1. niacin > 250 mg/day: within 6 weeks of baseline
    2. fibrates: within 4 weeks of baseline
    3. lomitapide: within 8 weeks of baseline
    4. mipomersen: within 24 weeks of baseline
  • History of cirrhosis or chronic liver disease based on documented histological evaluation or non-invasive imaging or testing.
  • Abnormal liver function tests (LFTs) at screening (AST or ALT > 2 × upper limit of normal (ULN) and/or Total Bilirubin of > 1.5 × ULN

Sites / Locations

  • Boca Raton location
  • Kansas City Location
  • Portland location
  • Philadelphia Location
  • Nashville location
  • Montreal location
  • Palermo location
  • Rome location
  • Rotterdam location

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Cohort 1

Cohort 2

Cohort 2 Expansion

Arm Description

2.5E12 (genome copies)/kg (kilogram) body weight (E means the exponential constant)

7.5E12 GC/kg body weight

7.5E12 GC/kg body weight DSMB (Data Safety Monitoring Board) approved expansion of Dose 2 cohort, 3 additional subjects enrolled and received prophylactic corticosteroids

Outcomes

Primary Outcome Measures

Number of Participants With IP (Investigational Product) Related Adverse Events
Physical examinations; Clinical laboratory parameters; and adverse event reporting

Secondary Outcome Measures

Percent Change in LDL-C
Percent change in LDL-C compared to baseline
Percent Change in Lipid Parameters Compared to Baseline Values
total cholesterol (TC); non-high density lipoprotein cholesterol (non-HDL-C); HDL-C; fasting triglycerides (TG); overflow density lipoprotein cholesterol (VLDL-C); lipoprotein(a) (Lp(a)); apolipoprotein B (apoB) and apolipoprotein A-I (apo A-I)
Number of Participants With IP Related Adverse Events
Physical examinations; Clinical laboratory parameters; and adverse event reporting
Amount of Vector Shedding, Urine
Amount of virus secreted in urine
Amount of Vector Shedding, Plasma
Amount of virus secreted in plasma

Full Information

First Posted
January 4, 2016
Last Updated
June 21, 2023
Sponsor
REGENXBIO Inc.
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT02651675
Brief Title
A Gene Therapy Study for Homozygous Familial Hypercholesterolemia (HoFH)
Official Title
AAV8-mediated Low Density Lipoprotein Receptor (LDLR) Gene Replacement in Subjects With Homozygous Familial Hypercholesterolemia (HoFH)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Terminated
Why Stopped
Terminated by Sponsor for Business Reasons
Study Start Date
March 2016 (Actual)
Primary Completion Date
November 27, 2020 (Actual)
Study Completion Date
November 27, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
REGENXBIO Inc.
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)

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
This first-in-human study is intended to evaluate the safety and preliminary effectiveness of AAV (Adeno-associated virus)-based liver-directed gene therapy in the treatment of adults with Homozygous Familial Hypercholesterolemia (HoFH).
Detailed Description
Homozygous Familial Hypercholesterolemia (HoFH) is a rare genetic metabolic disorder characterized by absent or severely reduced capacity to catabolize circulating LDL (Low density lipoprotein) particles by the hepatic LDL receptor. As a consequence, HoFH subjects present abnormal total plasma cholesterol (LDL-C) levels, resulting in severe atherosclerosis often leading to early onset of cardiovascular disease. Early initiation of aggressive treatment for these patients is therefore essential. Unfortunately, despite existing therapies, treated LDL-C (Low density lipoprotein cholesterol) levels could remain well above acceptable levels. Thus, the functional replacement of the defective LDLR via AAV-based liver-directed gene therapy may be a viable approach to treat this disease and improve response to current lipid-lowering treatments. This first-in-human study is intended to evaluate the safety of this gene therapy investigational product and assess preliminary evidence of efficacy using plasma LDL-C levels as a surrogate biomarker for human LDLR transgene expression. Subjects may be asked to participate in an optional kinetics study to assess the metabolic mechanism by which LDL-C is reduced.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Homozygous Familial Hypercholesterolemia (HoFH)
Keywords
LDL Receptors, Gene therapy, Metabolic Diseases, Rare diseases, Genetic Diseases, Atherosclerosis, cardiovascular disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
dose escalation
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
2.5E12 (genome copies)/kg (kilogram) body weight (E means the exponential constant)
Arm Title
Cohort 2
Arm Type
Experimental
Arm Description
7.5E12 GC/kg body weight
Arm Title
Cohort 2 Expansion
Arm Type
Experimental
Arm Description
7.5E12 GC/kg body weight DSMB (Data Safety Monitoring Board) approved expansion of Dose 2 cohort, 3 additional subjects enrolled and received prophylactic corticosteroids
Intervention Type
Genetic
Intervention Name(s)
AAV directed hLDLR gene therapy
Intervention Description
AAV directed hLDLR gene therapy is a novel adeno-associated viral (AAV8) vector with human low-density lipoprotein receptor (hLDLR) gene
Primary Outcome Measure Information:
Title
Number of Participants With IP (Investigational Product) Related Adverse Events
Description
Physical examinations; Clinical laboratory parameters; and adverse event reporting
Time Frame
Up to 24 weeks
Secondary Outcome Measure Information:
Title
Percent Change in LDL-C
Description
Percent change in LDL-C compared to baseline
Time Frame
18 weeks, 12 weeks for cohort 1 only, compared to baseline
Title
Percent Change in Lipid Parameters Compared to Baseline Values
Description
total cholesterol (TC); non-high density lipoprotein cholesterol (non-HDL-C); HDL-C; fasting triglycerides (TG); overflow density lipoprotein cholesterol (VLDL-C); lipoprotein(a) (Lp(a)); apolipoprotein B (apoB) and apolipoprotein A-I (apo A-I)
Time Frame
18 weeks, 12 weeks for cohort 1 only, compared to baseline
Title
Number of Participants With IP Related Adverse Events
Description
Physical examinations; Clinical laboratory parameters; and adverse event reporting
Time Frame
up to 104 weeks
Title
Amount of Vector Shedding, Urine
Description
Amount of virus secreted in urine
Time Frame
up to 104 weeks
Title
Amount of Vector Shedding, Plasma
Description
Amount of virus secreted in plasma
Time Frame
up to 104 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female ≥ 18 years of age. Untreated and/or treated LDL-C levels and clinical presentation consistent with the diagnosis of homozygous FH (Familial hypercholesterolemia) Molecularly defined LDLR mutations at both LDLR alleles. A baseline serum AAV8 NAb (Neutralizing antibody) titer ≤ 1:10. Exclusion Criteria Unwilling to wash out of the following lipid lowering therapies for the pre-specified time period: niacin > 250 mg/day: within 6 weeks of baseline fibrates: within 4 weeks of baseline lomitapide: within 8 weeks of baseline mipomersen: within 24 weeks of baseline History of cirrhosis or chronic liver disease based on documented histological evaluation or non-invasive imaging or testing. Abnormal liver function tests (LFTs) at screening (AST (Aspartate aminotransferase) or ALT (Alanine aminotransferase) > 2 × upper limit of normal (ULN) and/or Total Bilirubin of > 1.5 × ULN
Facility Information:
Facility Name
Boca Raton location
City
Boca Raton
State/Province
Florida
ZIP/Postal Code
33434
Country
United States
Facility Name
Kansas City Location
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Facility Name
Portland location
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
Philadelphia Location
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Nashville location
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States
Facility Name
Montreal location
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H1T1C8
Country
Canada
Facility Name
Palermo location
City
Palermo
State/Province
PA
ZIP/Postal Code
90127
Country
Italy
Facility Name
Rome location
City
Roma
State/Province
RM
ZIP/Postal Code
00161
Country
Italy
Facility Name
Rotterdam location
City
Rotterdam
ZIP/Postal Code
3015 CE
Country
Netherlands

12. IPD Sharing Statement

Plan to Share IPD
No

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A Gene Therapy Study for Homozygous Familial Hypercholesterolemia (HoFH)

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