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Interventional Study of Implantation of hESC-derived RPE in Patients With RP Due to Monogenic Mutation

Primary Purpose

Retinitis Pigmentosa

Status
Active
Phase
Phase 1
Locations
France
Study Type
Interventional
Intervention
Human Embryonic Stem Cell Derived Retinal Pigment Epithelium (RPE)
Sponsored by
Centre d'Etude des Cellules Souches
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Retinitis Pigmentosa

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Documented diagnosis of retinitis pigmentosa based on a genetic test confirming the presence of a monogenic mutation that affects a gene involved in the visual signalling process specifically at the level of RPEs, namely RPE65 or LRAT, or MerTK
  • 18 years old ≤ Age ≤ 65 years old

For patient of the first cohort:

  • Visual acuity ≤ 20/200 in the best eye (legally blind)

    - For patient of the second cohort:

  • 20/63 > Visual acuity > 20/200 in the worst eye And
  • Visible photoreceptor outer nuclear layer (ONL) on a spectral domain optical coherence tomography (OCT) scan

For the two cohorts:

  • Negative serum pregnancy test in women of childbearing potential (a woman who is two years post-menopausal confirmed by a physician or surgically sterile is not considered to be of childbearing potential)
  • Female patients of childbearing potential (if sexually active), committed to use two methods of contraception starting from the enrollment, during Mycophenolate Mofetil (MMF) treatment and for 6 weeks after the last dose of MMF
  • Sexually active men (including vasectomized men) committed to use condoms during from the first day of MMF treatment and for at least 90 days after cessation of treatment
  • Signed informed consents by the patient or legal guardian(s). For patients unable to give consent, authorization to participate to the study will be collected close to their legally authorized representative
  • Affiliated to or a beneficiary of a health care system

Exclusion Criteria:

  • - Patient unable or unwilling to comply with the protocol requirements
  • History of allergy or sensitivity to one of the products used during the study
  • Patients with known serious allergies to the fluorescein
  • Patients with a contraindication to general anesthesia
  • Prior treatment with a gene or cell therapy product
  • Patients with chronic hepatitis B or C, i.e. positive hepatitis B surface antigen or hepatitis C RNA viral load positive
  • Patients infected with Human immunodeficiency virus (HIV)
  • Anti-HLA antibodies positive at screening
  • Pregnancy or breastfeeding
  • Presence of any ocular disease or ocular media opacity which in the opinion of the investigator precludes accurate evaluation
  • Participation in another drug or device clinical study within last 6 months prior to baseline
  • Patients known to be affected by pathologies for which the symptoms or associated treatments can alter the visual function and/or affect the retina
  • Systemic corticosteroid therapy or other immunosuppressive / immunomodulating or anti-retroviral drugs within 2 months prior to baseline
  • Patients with a contraindication to immunosuppressive/immunomodulating therapy (MMF) such as severe chronic renal impairment, severe digestive system disease, Lesch-Nyhan disease, Kelley-Seegmiller syndrome…
  • Acute illness or infection within 4 weeks of the anticipated administration of study medication which may interfere with study assessments and immunosuppressive/immunomodulating therapy
  • Any other condition or history that, in the opinion of the Investigator, may compromise the safety or compliance of the patient or would preclude the patient from successful completion of the study

Sites / Locations

  • •Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Implantation of a therapeutical patch

Arm Description

All the patients will receive a single central subretinal implantation in one eye of a monolayer of Human Embryonic Stem Cells-derived Retinal Pigmented Epithelium (hESC-derived RPE). The implanted eye will be the one with the worst visual acuity.

Outcomes

Primary Outcome Measures

Safety assessment
Safety and tolerability measured by the incidence of Adverse Events or Serious Adverse Events throughout the study

Secondary Outcome Measures

Position of therapeutic patch
Position of the therapeutic patch by serial images assessment
Placement of the therapeutic patch
Placement of the therapeutic patch by serial spectral domain Ocular Coherence Tomography (OCT) scan at baseline and by study visit
Change in leakage or perfusion
Change in leakage or perfusion in normal fundal vasculature and presence of abnormal vasculature by fundus fluorescein angiography
Change in thickness of RPE layer
Change in thickness of RPE layer by B-mode orbital ultrasound

Full Information

First Posted
May 22, 2019
Last Updated
January 11, 2023
Sponsor
Centre d'Etude des Cellules Souches
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1. Study Identification

Unique Protocol Identification Number
NCT03963154
Brief Title
Interventional Study of Implantation of hESC-derived RPE in Patients With RP Due to Monogenic Mutation
Official Title
STREAM: A Phase 1/2, Open-label, Safety, Tolerability and Preliminary Efficacy Study of Implantation Into One Eye of hESC-derived RPE in Patients With Retinitis Pigmentosa Due to Monogenic Mutation
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 19, 2019 (Actual)
Primary Completion Date
August 15, 2023 (Anticipated)
Study Completion Date
December 15, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre d'Etude des Cellules Souches

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Phase I/II open-label, safety, tolerability and preliminary efficacy study of implantation into one eye of hESC-derived RPE (Human Embryonic Stem Cell Derived Retinal Pigment Epithelium (RPE)) in patients with retinitis pigmentosa due to monogenic mutation. Study non randomized single group assignment consisting in 2 sequential cohorts of patients: First cohort of 2 patients with very advanced loss of visual acuity (legally blind) Second cohort of 10 patients with less advanced loss of visual acuity:
Detailed Description
Monocentric study (Hospital of 15-20 at Paris) of duration of 106 weeks. At total,12 evaluable patients will be enrolled and assigned in 2 cohorts as described above in brief summary. Expected follow-up for one patient is about 64 weeks including 8 weeks of screening and baseline period and 56 weeks of follow-up after implantation of hESC-derived RPE. After 56 weeks of follow-up, patients will be enrolled in a long term follow-up study during 4 additional years. The primary objective is to assess safety and tolerability of implantation of the Investigational Medecinal Product (ISTEM-01) in patients with retinitis pigmentosa. Secondary objectives are: To evaluate the placement and position of the patch To assess preliminary efficacy based on: Evaluation of visual function Eye fundus Evaluation of photoreceptor survival Assessment of visual function by Diagnosys-Full-field stimulus threshold (D-FST) is the only exploratory objective.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Retinitis Pigmentosa

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Open-label study
Masking
None (Open Label)
Allocation
N/A
Enrollment
7 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Implantation of a therapeutical patch
Arm Type
Experimental
Arm Description
All the patients will receive a single central subretinal implantation in one eye of a monolayer of Human Embryonic Stem Cells-derived Retinal Pigmented Epithelium (hESC-derived RPE). The implanted eye will be the one with the worst visual acuity.
Intervention Type
Biological
Intervention Name(s)
Human Embryonic Stem Cell Derived Retinal Pigment Epithelium (RPE)
Intervention Description
Implantation into one eye of hESC-derived RPE (Human Embryonic Stem Cell Derived Retinal Pigment Epithelium (RPE))
Primary Outcome Measure Information:
Title
Safety assessment
Description
Safety and tolerability measured by the incidence of Adverse Events or Serious Adverse Events throughout the study
Time Frame
From Baseline until Week 56
Secondary Outcome Measure Information:
Title
Position of therapeutic patch
Description
Position of the therapeutic patch by serial images assessment
Time Frame
From baseline until Week 56
Title
Placement of the therapeutic patch
Description
Placement of the therapeutic patch by serial spectral domain Ocular Coherence Tomography (OCT) scan at baseline and by study visit
Time Frame
From Baseline until Week 56
Title
Change in leakage or perfusion
Description
Change in leakage or perfusion in normal fundal vasculature and presence of abnormal vasculature by fundus fluorescein angiography
Time Frame
At baseline and weeks 24, 48, and 56
Title
Change in thickness of RPE layer
Description
Change in thickness of RPE layer by B-mode orbital ultrasound
Time Frame
At weeks 4, 8, 16, 24, 36, 48 and 56

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Documented diagnosis of retinitis pigmentosa based on a genetic test confirming the presence of a monogenic mutation that affects a gene involved in the visual signalling process specifically at the level of RPEs, namely RPE65 or LRAT, or MerTK 18 years old ≤ Age ≤ 65 years old For patient of the first cohort: Visual acuity ≤ 20/200 in the best eye (legally blind) - For patient of the second cohort: 20/63 > Visual acuity > 20/200 in the worst eye And Visible photoreceptor outer nuclear layer (ONL) on a spectral domain optical coherence tomography (OCT) scan For the two cohorts: Negative serum pregnancy test in women of childbearing potential (a woman who is two years post-menopausal confirmed by a physician or surgically sterile is not considered to be of childbearing potential) Female patients of childbearing potential (if sexually active), committed to use two methods of contraception starting from the enrollment, during Mycophenolate Mofetil (MMF) treatment and for 6 weeks after the last dose of MMF Sexually active men (including vasectomized men) committed to use condoms during from the first day of MMF treatment and for at least 90 days after cessation of treatment Signed informed consents by the patient or legal guardian(s). For patients unable to give consent, authorization to participate to the study will be collected close to their legally authorized representative Affiliated to or a beneficiary of a health care system Exclusion Criteria: - Patient unable or unwilling to comply with the protocol requirements History of allergy or sensitivity to one of the products used during the study Patients with known serious allergies to the fluorescein Patients with a contraindication to general anesthesia Prior treatment with a gene or cell therapy product Patients with chronic hepatitis B or C, i.e. positive hepatitis B surface antigen or hepatitis C RNA viral load positive Patients infected with Human immunodeficiency virus (HIV) Anti-HLA antibodies positive at screening Pregnancy or breastfeeding Presence of any ocular disease or ocular media opacity which in the opinion of the investigator precludes accurate evaluation Participation in another drug or device clinical study within last 6 months prior to baseline Patients known to be affected by pathologies for which the symptoms or associated treatments can alter the visual function and/or affect the retina Systemic corticosteroid therapy or other immunosuppressive / immunomodulating or anti-retroviral drugs within 2 months prior to baseline Patients with a contraindication to immunosuppressive/immunomodulating therapy (MMF) such as severe chronic renal impairment, severe digestive system disease, Lesch-Nyhan disease, Kelley-Seegmiller syndrome… Acute illness or infection within 4 weeks of the anticipated administration of study medication which may interfere with study assessments and immunosuppressive/immunomodulating therapy Any other condition or history that, in the opinion of the Investigator, may compromise the safety or compliance of the patient or would preclude the patient from successful completion of the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stéphane BERTIN, MD
Organizational Affiliation
Centre des 15-20
Official's Role
Principal Investigator
Facility Information:
Facility Name
•Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts
City
Paris
ZIP/Postal Code
75012
Country
France

12. IPD Sharing Statement

Plan to Share IPD
No

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Interventional Study of Implantation of hESC-derived RPE in Patients With RP Due to Monogenic Mutation

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