Early Markers of Disease and Response to Therapy
Primary Purpose
Type 1 Diabetes
Status
Unknown status
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Abatacept
Sponsored by
About this trial
This is an interventional basic science trial for Type 1 Diabetes
Eligibility Criteria
Inclusion Criteria:
- ≤ 7 months from type 1 diabetes diagnosis based on ADA criteria
- > 21 days from type 1 diabetes diagnosis or metabolically stable per study physician assessment
- Males and females 6-55 years of age, inclusive, at time of screening visit
- Peak MMTT stimulated C-peptide ≥ 0.2 pmol/ml
- Females of child-bearing age must be willing to use effective birth control for 1 year (which may include abstinence) from screening visit and undergo regular pregnancy testing
- Up to date for clinically recommended immunizations prior to screening
- Willing to forgo live vaccines 3 months prior to the screening visit until three months following last study drug administration
- Willing and able to give informed consent or have parent or legal guardian provide informed consent if the subject is < 18 years of age
- Weight ≥ 20 kg at baseline visit
- HbA1c ≤ 8.5% at baseline visit
- Positive for at least 1 diabetes autoantibody (excluding mIAA in those who have received ≥ 2 weeks of exogenous insulin therapy)
Exclusion Criteria:
- Concurrent or recent (within the past 30 days of screening MMTT (visit -1)) use of non-insulin therapies aimed to control hyperglycemia
- Females who are pregnant or lactating
- Immunodeficiency or clinically significant chronic lymphopenia
- Have an active infection at time of screening or baseline visit
- Recent exposure, or possible or known active SARS-CoV-2 infection as defined by public health guidelines
- Positive QuantiFERON or PPD TB test, history of tuberculosis, or active TB infection
- Active infection with EBV or CMV, defined by real-time PCR
- History of other clinically significant autoimmune disease needing chronic therapy with biologics or steroids with the exception of celiac disease and stable thyroid disease
- Require use of other immunosuppressive agents for any other condition
- Use of medications known to influence glucose tolerance
- Have any complicating medical or psychological issues or abnormal clinical laboratory results that interfere with study conduct or cause increased risk. These include pre-existing cardiac disease, COPD, neurological, or clinically significant blood count abnormalities (such as lymphopenia, leukopenia, or thrombocytopenia).
- Have serologic evidence of current or past HIV, Hepatitis B (positive for Hepatitis B core antibody or surface antigen), or Hepatitis C infection.
- Have a history of malignancies
- Receipt of live vaccine (MMR, intranasal influenza, varicella, rotatvirus) in 3 months before treatment
Sites / Locations
- Benaroya Research InstituteRecruiting
- Medical College of WisconsinRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Abatacept
Arm Description
Abatacept will be given by a subcutaneous (SC) formulation weekly for three months.
Outcomes
Primary Outcome Measures
Change in insulin antibody titers (NIDDK units/mL)
Insulin antibody titers
Change in frequency of B cells within total PBMC (%)
% of B cells
Change in inflammatory Index by serum transcriptional exposure assay (composite score)
Inflammatory Index (359). This is an inflammatory index based on transcription of 359 probe sets (I.I.359) calculated by dividing the average signal intensity of the 103 probe sets generally annotated as 'inflammatory' by the average signal intensity of the 256 probe sets generally annotated as 'regulatory'
Change in B-cell transcriptional module (CD19.mod) (composite score)
CD19 mod is composite score of B cell transcripts.
Change in islet-specific exhausted CD8 T cells (%)
% of CD8+ T cells (CD8+PD-1+KLRG1+CD57-)
Change in EOMES CD8 whole blood gene expression signature (composite score)
Gene transcript score for EOMES module
Change in frequency of TfH within total CD4 T cells (%)
% of TfH cells within CD4+ T cells
Secondary Outcome Measures
Full Information
NCT ID
NCT04118153
First Posted
October 2, 2019
Last Updated
April 26, 2021
Sponsor
Carla Greenbaum, MD
Collaborators
Juvenile Diabetes Research Foundation, Medical College of Wisconsin
1. Study Identification
Unique Protocol Identification Number
NCT04118153
Brief Title
Early Markers of Disease and Response to Therapy
Official Title
Early Markers of Disease and Response to Therapy
Study Type
Interventional
2. Study Status
Record Verification Date
April 2021
Overall Recruitment Status
Unknown status
Study Start Date
March 5, 2021 (Actual)
Primary Completion Date
November 2022 (Anticipated)
Study Completion Date
November 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Carla Greenbaum, MD
Collaborators
Juvenile Diabetes Research Foundation, Medical College of Wisconsin
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
The purpose of this study is to identify early immune markers associated with response to treatment with abatacept in individuals with Type 1 diabetes (T1D). In this open label mechanistic study, participants who were recently diagnosed with T1D (males or females, ages 6-45 and <7months from T1D diagnosis) will be treated with a short-course of abatacept (weekly subcutaneous injections for 3 months). Participants will undergo baseline and repeated mixed meal tolerance testing (MMTT) to assess disease progression and blood samples will be obtained at frequent intervals to measure changes in immune markers.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
7. Study Design
Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Abatacept
Arm Type
Experimental
Arm Description
Abatacept will be given by a subcutaneous (SC) formulation weekly for three months.
Intervention Type
Drug
Intervention Name(s)
Abatacept
Other Intervention Name(s)
ORENCIA
Intervention Description
Abatacept will be administered by subcutaneous injections weekly for 3 months. Dosing is according to body weight at screening visit and will be administered as follows: up to 25 kg receive 50 mg (0.4 mL); 25 to <50 kg receive 87.5 mg (0.7 mL), and > 50 kg receive 125 mg (1.0 mL) per dose.
Primary Outcome Measure Information:
Title
Change in insulin antibody titers (NIDDK units/mL)
Description
Insulin antibody titers
Time Frame
0 to 2 weeks
Title
Change in frequency of B cells within total PBMC (%)
Description
% of B cells
Time Frame
0 to 2 weeks
Title
Change in inflammatory Index by serum transcriptional exposure assay (composite score)
Description
Inflammatory Index (359). This is an inflammatory index based on transcription of 359 probe sets (I.I.359) calculated by dividing the average signal intensity of the 103 probe sets generally annotated as 'inflammatory' by the average signal intensity of the 256 probe sets generally annotated as 'regulatory'
Time Frame
0 to 2 weeks
Title
Change in B-cell transcriptional module (CD19.mod) (composite score)
Description
CD19 mod is composite score of B cell transcripts.
Time Frame
0 to 2 weeks
Title
Change in islet-specific exhausted CD8 T cells (%)
Description
% of CD8+ T cells (CD8+PD-1+KLRG1+CD57-)
Time Frame
0 to 2 weeks
Title
Change in EOMES CD8 whole blood gene expression signature (composite score)
Description
Gene transcript score for EOMES module
Time Frame
0 to 2 weeks
Title
Change in frequency of TfH within total CD4 T cells (%)
Description
% of TfH cells within CD4+ T cells
Time Frame
0 to 2 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
≤ 7 months from type 1 diabetes diagnosis based on ADA criteria
> 21 days from type 1 diabetes diagnosis or metabolically stable per study physician assessment
Males and females 6-55 years of age, inclusive, at time of screening visit
Peak MMTT stimulated C-peptide ≥ 0.2 pmol/ml
Females of child-bearing age must be willing to use effective birth control for 1 year (which may include abstinence) from screening visit and undergo regular pregnancy testing
Up to date for clinically recommended immunizations prior to screening
Willing to forgo live vaccines 3 months prior to the screening visit until three months following last study drug administration
Willing and able to give informed consent or have parent or legal guardian provide informed consent if the subject is < 18 years of age
Weight ≥ 20 kg at baseline visit
HbA1c ≤ 8.5% at baseline visit
Positive for at least 1 diabetes autoantibody (excluding mIAA in those who have received ≥ 2 weeks of exogenous insulin therapy)
Exclusion Criteria:
Concurrent or recent (within the past 30 days of screening MMTT (visit -1)) use of non-insulin therapies aimed to control hyperglycemia
Females who are pregnant or lactating
Immunodeficiency or clinically significant chronic lymphopenia
Have an active infection at time of screening or baseline visit
Recent exposure, or possible or known active SARS-CoV-2 infection as defined by public health guidelines
Positive QuantiFERON or PPD TB test, history of tuberculosis, or active TB infection
Active infection with EBV or CMV, defined by real-time PCR
History of other clinically significant autoimmune disease needing chronic therapy with biologics or steroids with the exception of celiac disease and stable thyroid disease
Require use of other immunosuppressive agents for any other condition
Use of medications known to influence glucose tolerance
Have any complicating medical or psychological issues or abnormal clinical laboratory results that interfere with study conduct or cause increased risk. These include pre-existing cardiac disease, COPD, neurological, or clinically significant blood count abnormalities (such as lymphopenia, leukopenia, or thrombocytopenia).
Have serologic evidence of current or past HIV, Hepatitis B (positive for Hepatitis B core antibody or surface antigen), or Hepatitis C infection.
Have a history of malignancies
Receipt of live vaccine (MMR, intranasal influenza, varicella, rotatvirus) in 3 months before treatment
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Marli McCulloch-Olson
Phone
1-800-888-4187
Email
diabetes@benaroyaresearch.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carla Greenbaum, MD
Organizational Affiliation
Benaroya Research Institute at Virginia Mason
Official's Role
Principal Investigator
Facility Information:
Facility Name
Benaroya Research Institute
City
Seattle
State/Province
Washington
ZIP/Postal Code
98101
Country
United States
Individual Site Status
Recruiting
Facility Name
Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susanne Cabrera, MD
12. IPD Sharing Statement
Plan to Share IPD
No
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