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Gene Therapy With Modified Autologous Hematopoietic Stem Cells for Patients With Mucopolysaccharidosis Type IIIA

Primary Purpose

Mucopolysaccharidosis Type IIIA

Status
Active
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
Autologous CD34+ cells transduced with a lentiviral vector containing the human SGSH gene
Sponsored by
University of Manchester
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mucopolysaccharidosis Type IIIA

Eligibility Criteria

3 Months - 24 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Written informed consent of a legally authorized guardian(s)
  2. Age at baseline ≥3 months and ≤24 months
  3. Normal cognitive function or mild cognitive deterioration (subject has a Development Quotient (DQ) score ≥80) at baseline as determined by the Bayley Scale of Infant Development-third edition (BSID-III), cognitive domain)
  4. Sibling or relative of known MPS IIIA patients with rapidly progressing phenotype, or genotype associated with rapidly progressing phenotype, or presence of somatic features predictive of rapid progression
  5. SGSH activity ≤10% of the Lower Limit of Normal as measured in leukocytes, plus either (1) a normal enzyme activity level of at least one other sulfatase (to rule out multiple sulfatase deficiency) as measured in leukocytes or (2) two documented mutations in the SGSH gene.
  6. Medically stable and able to accommodate the protocol requirements, including travel without placing an undue burden on the patient/patient's family, as determined by the CI.

Exclusion Criteria:

  1. The subject has received stem cell, gene therapy or enzyme replacement therapy (any route of administration)
  2. Subject currently enrolled in other interventional clinical trials.
  3. Contraindications for MRI scans.
  4. The subject has a history of poorly controlled seizures.
  5. Homozygous or compound heterozygous for the S298P mutation or any other mutation known to be associated to slow-progressing phenotype.
  6. The subject is currently receiving psychotropic or other medications which, in the CI's opinion, would be likely to substantially confound test results.
  7. The subject has received any investigational medicinal product (including Genistein) within 30 days prior to the Baseline visit or is scheduled to receive any investigational medicinal product during the course of the study.
  8. Documented Human Immunodeficiency Virus (HIV) infection (positive HIV RNA and/or anti-p24 antibodies).
  9. Malignant neoplasia (except local skin cancer) or a documented history of hereditary cancer syndrome. Subjects with a prior successfully treated malignancy and a sufficient follow-up to exclude recurrence (based on oncologist opinion) can be included after discussion and approval by the Medical Monitor.
  10. Myelodysplasia, cytogenetic alterations characteristic of myelodysplastic syndrome and acute myeloid leukaemia, or other serious haematological disorders.
  11. The subject has a medical condition or extenuating circumstance that, in the opinion of the CI, might compromise the subject's ability to comply with protocol requirements, the subject's well-being or safety, or the interpretability of the subject's clinical data.
  12. Visual or hearing impairment sufficient to preclude cooperation with neurodevelopmental testing.
  13. Severe behavioural disturbances due to reasons other than MPS IIIA and likely to interfere with protocol compliance, as determined by the CI.
  14. Known sensitivity to busulfan.
  15. The receipt of live vaccinations within 30 days prior to study start.

Sites / Locations

  • Manchester University NHS Foundation Trust

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Haematopoietic stem cell gene therapy for MPS IIIA

Arm Description

Open label

Outcomes

Primary Outcome Measures

To evaluate the tolerability of the IMP in MPS IIIA patients: scale
Adverse events will be recorded and graded according to an adapted Pediatric Clinical Toxicity Scale from the National Institute Allergy and Infectious Diseases (NIAID), Autoimmuno-deficiency Syndrome (AIDS) Division
To evaluate the biological efficacy of IMP post-treatment: expression of SGSH in total leukocytes
Measured by the expression of SGSH in total leukocytes within or above normal range at 12 months post-IMP treatment
To assess the safety of the IMP in MPS IIIA patients
Presence of replication competent virus and integration events in the leukocytes

Secondary Outcome Measures

To evaluate overall survival
Overall survival at 36 months post IMP administration compared to natural history data
To evaluate peripheral engraftment of the IMP
Measured as absence of engraftment failure or delayed hematological reconstitution within the first 6 weeks of IMP delivery. Defined as three independent and consecutive days with absolute Neutrophil Count (ANC) >500/mm3 and/or Platelets >20,000/mm3 without transfusions, and/or Hb >8.0 g/dL without transfusions.
Change in adaptive behaviour
Measured using the Vineland Adaptive Behaviour scales against natural history of MPSIIIA
Change in cognitive function
Measurement of cognitive score (standard scores, age equivalent scores and development quotient) using the Bayley Scales of Infant Development, 3rd Edition [BSID-III] or Kaufman Assessment Battery for Children, 2nd Edition [KABC-II] against natural history of MPSIIIA
Change in patient behaviour
Measured using the Sanfilippo Behaviour Rating Scale against natural history of MPSIIIA
Change in patient quality of life
Measured using the Infant Toddler Quality of Life questionnaire against natural history of MPSIIIA
Change in patient's daily living
Measured using the Children sleep Questionnaire against natural history data

Full Information

First Posted
December 5, 2019
Last Updated
October 31, 2022
Sponsor
University of Manchester
Collaborators
Orchard Therapeutics, CTI Clinical Trial and Consulting Services, University College, London, Great Ormond Street Hospital for Children NHS Foundation Trust, Manchester University NHS Foundation Trust
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1. Study Identification

Unique Protocol Identification Number
NCT04201405
Brief Title
Gene Therapy With Modified Autologous Hematopoietic Stem Cells for Patients With Mucopolysaccharidosis Type IIIA
Official Title
A Phase I-II, Study of Autologous CD34+ Haematopoietic Stem Cells Transduced ex Vivo With CD11b Lentiviral Vector Encoding for Human SGSH in Patients With Mucopolysaccharidosis Type IIIA (MPS IIIa, Sanfilippo Syndrome Type A)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
January 7, 2020 (Actual)
Primary Completion Date
October 30, 2024 (Anticipated)
Study Completion Date
October 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Manchester
Collaborators
Orchard Therapeutics, CTI Clinical Trial and Consulting Services, University College, London, Great Ormond Street Hospital for Children NHS Foundation Trust, Manchester University NHS Foundation Trust

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
Patients with MPS IIIA have a clinical disorder marked by severe and progressive brain disease and neurological symptoms due to the accumulation of undigested glycosaminoglycans in all cells of the body. This study will be the first in human clinical trial to explore the safety, tolerability and clinical efficacy of ex vivo gene therapy (autologous CD34+ cells transduced with a lentiviral vector containing the human SGSH gene) in MPSIIIA patients. Following treatment with the gene therapy patients will be followed up for a minimum of 3 years.
Detailed Description
MPS IIIA is caused by a deficiency of the heparan-N-sulfatase (SGSH) enzyme, leading to the accumulation of the glycosaminoglycan heparan sulphate in the lysosomes. Untreated patients of MPS IIIA experience rapid and progressive neurologic deterioration. To date, there is no effective disease-modifying treatment for patients suffering from MPS IIIA. This study aims to recruit 3 to 5 patients with MPS IIIA who satisfy the inclusion and exclusion criteria and provide full consent, between 3 months and 24 months of age. The investigational medicinal product (IMP) will be a cell-based gene therapy that uses genetically modified autologous CD34+ haematopoietic stem cells transduced with a lentiviral vector containing the human SGSH gene. Patients will be followed up for a minimum of 3 years after gene therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mucopolysaccharidosis Type IIIA

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Haematopoietic stem cell gene therapy for MPS IIIA
Arm Type
Experimental
Arm Description
Open label
Intervention Type
Drug
Intervention Name(s)
Autologous CD34+ cells transduced with a lentiviral vector containing the human SGSH gene
Intervention Description
Autologous CD34+ haematopoietic stem cells from MPS IIIA patients will be genetically modified ex vivo using CD11b.SGSH Lentiviral vector (LV), a self-inactivating LV expressing the SGSH gene codon optimized for human use and regulated by a human CD11b myeloid-specific promoter. Cells will be cryopreserved prior to patient administration.
Primary Outcome Measure Information:
Title
To evaluate the tolerability of the IMP in MPS IIIA patients: scale
Description
Adverse events will be recorded and graded according to an adapted Pediatric Clinical Toxicity Scale from the National Institute Allergy and Infectious Diseases (NIAID), Autoimmuno-deficiency Syndrome (AIDS) Division
Time Frame
up to 3 years
Title
To evaluate the biological efficacy of IMP post-treatment: expression of SGSH in total leukocytes
Description
Measured by the expression of SGSH in total leukocytes within or above normal range at 12 months post-IMP treatment
Time Frame
12 months post gene therapy
Title
To assess the safety of the IMP in MPS IIIA patients
Description
Presence of replication competent virus and integration events in the leukocytes
Time Frame
up to 3 years
Secondary Outcome Measure Information:
Title
To evaluate overall survival
Description
Overall survival at 36 months post IMP administration compared to natural history data
Time Frame
up to 3 years
Title
To evaluate peripheral engraftment of the IMP
Description
Measured as absence of engraftment failure or delayed hematological reconstitution within the first 6 weeks of IMP delivery. Defined as three independent and consecutive days with absolute Neutrophil Count (ANC) >500/mm3 and/or Platelets >20,000/mm3 without transfusions, and/or Hb >8.0 g/dL without transfusions.
Time Frame
within 42 days of treatments
Title
Change in adaptive behaviour
Description
Measured using the Vineland Adaptive Behaviour scales against natural history of MPSIIIA
Time Frame
up to 3 years (multiple visits)
Title
Change in cognitive function
Description
Measurement of cognitive score (standard scores, age equivalent scores and development quotient) using the Bayley Scales of Infant Development, 3rd Edition [BSID-III] or Kaufman Assessment Battery for Children, 2nd Edition [KABC-II] against natural history of MPSIIIA
Time Frame
up to 3 years (multiple visits)
Title
Change in patient behaviour
Description
Measured using the Sanfilippo Behaviour Rating Scale against natural history of MPSIIIA
Time Frame
up to 3 years
Title
Change in patient quality of life
Description
Measured using the Infant Toddler Quality of Life questionnaire against natural history of MPSIIIA
Time Frame
Up to 3 years
Title
Change in patient's daily living
Description
Measured using the Children sleep Questionnaire against natural history data
Time Frame
Up to 3 years
Other Pre-specified Outcome Measures:
Title
To evaluate the effect of the IMP on heparan sulphate concentration in cerebrospinal fluid (CSF), plasma and urine
Description
Measure change in ng/ml glycosaminoglycans in CSF from baseline following IMP administration
Time Frame
6 months and 12 months post-IMP treatments and multiple other visits over time
Title
To evaluate the effect of the IMP on SGSH activity in CSF, plasma and peripheral blood mononuclear cells.
Description
Change in SGSH activity measured from baseline
Time Frame
6 months and 12 months post-IMP treatments and multiple other visits over time
Title
To evaluate clinical efficacy of the IMP on brain imaging biomarkers
Description
Measure change in brain volume (total brain, grey and white matter, ventricle volume) by MRI and compare to baseline and natural history data to help assess brain development
Time Frame
up to 3 years
Title
To explore the presence of anti-SGSH antibodies following treatment with the IMP
Description
Measure whether an immune response is generated against the SGSH enzyme
Time Frame
up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Months
Maximum Age & Unit of Time
24 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent of a legally authorized guardian(s) Age at baseline ≥3 months and ≤24 months Normal cognitive function or mild cognitive deterioration (subject has a Development Quotient (DQ) score ≥80) at baseline as determined by the Bayley Scale of Infant Development-third edition (BSID-III), cognitive domain) Sibling or relative of known MPS IIIA patients with rapidly progressing phenotype, or genotype associated with rapidly progressing phenotype, or presence of somatic features predictive of rapid progression SGSH activity ≤10% of the Lower Limit of Normal as measured in leukocytes, plus either (1) a normal enzyme activity level of at least one other sulfatase (to rule out multiple sulfatase deficiency) as measured in leukocytes or (2) two documented mutations in the SGSH gene. Medically stable and able to accommodate the protocol requirements, including travel without placing an undue burden on the patient/patient's family, as determined by the CI. Exclusion Criteria: The subject has received stem cell, gene therapy or enzyme replacement therapy (any route of administration) Subject currently enrolled in other interventional clinical trials. Contraindications for MRI scans. The subject has a history of poorly controlled seizures. Homozygous or compound heterozygous for the S298P mutation or any other mutation known to be associated to slow-progressing phenotype. The subject is currently receiving psychotropic or other medications which, in the CI's opinion, would be likely to substantially confound test results. The subject has received any investigational medicinal product (including Genistein) within 30 days prior to the Baseline visit or is scheduled to receive any investigational medicinal product during the course of the study. Documented Human Immunodeficiency Virus (HIV) infection (positive HIV RNA and/or anti-p24 antibodies). Malignant neoplasia (except local skin cancer) or a documented history of hereditary cancer syndrome. Subjects with a prior successfully treated malignancy and a sufficient follow-up to exclude recurrence (based on oncologist opinion) can be included after discussion and approval by the Medical Monitor. Myelodysplasia, cytogenetic alterations characteristic of myelodysplastic syndrome and acute myeloid leukaemia, or other serious haematological disorders. The subject has a medical condition or extenuating circumstance that, in the opinion of the CI, might compromise the subject's ability to comply with protocol requirements, the subject's well-being or safety, or the interpretability of the subject's clinical data. Visual or hearing impairment sufficient to preclude cooperation with neurodevelopmental testing. Severe behavioural disturbances due to reasons other than MPS IIIA and likely to interfere with protocol compliance, as determined by the CI. Known sensitivity to busulfan. The receipt of live vaccinations within 30 days prior to study start.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brian Bigger
Organizational Affiliation
The University of Manchester
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Robert Wynn
Organizational Affiliation
MFT
Official's Role
Principal Investigator
Facility Information:
Facility Name
Manchester University NHS Foundation Trust
City
Manchester
ZIP/Postal Code
M13 9WL
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
No, there is not a plan to make IPD available.
Citations:
PubMed Identifier
31044143
Citation
Ellison SM, Liao A, Wood S, Taylor J, Youshani AS, Rowlston S, Parker H, Armant M, Biffi A, Chan L, Farzaneh F, Wynn R, Jones SA, Heal P, Gaspar HB, Bigger BW. Pre-clinical Safety and Efficacy of Lentiviral Vector-Mediated Ex Vivo Stem Cell Gene Therapy for the Treatment of Mucopolysaccharidosis IIIA. Mol Ther Methods Clin Dev. 2019 Apr 6;13:399-413. doi: 10.1016/j.omtm.2019.04.001. eCollection 2019 Jun 14.
Results Reference
background
PubMed Identifier
30136572
Citation
Holley RJ, Wood SR, Bigger BW. Delivering Hematopoietic Stem Cell Gene Therapy Treatments for Neurological Lysosomal Diseases. ACS Chem Neurosci. 2019 Jan 16;10(1):18-20. doi: 10.1021/acschemneuro.8b00408. Epub 2018 Aug 23.
Results Reference
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PubMed Identifier
28651568
Citation
Ghosh A, Shapiro E, Rust S, Delaney K, Parker S, Shaywitz AJ, Morte A, Bubb G, Cleary M, Bo T, Lavery C, Bigger BW, Jones SA. Recommendations on clinical trial design for treatment of Mucopolysaccharidosis Type III. Orphanet J Rare Dis. 2017 Jun 26;12(1):117. doi: 10.1186/s13023-017-0675-4.
Results Reference
background
PubMed Identifier
23748415
Citation
Sergijenko A, Langford-Smith A, Liao AY, Pickford CE, McDermott J, Nowinski G, Langford-Smith KJ, Merry CL, Jones SA, Wraith JE, Wynn RF, Wilkinson FL, Bigger BW. Myeloid/Microglial driven autologous hematopoietic stem cell gene therapy corrects a neuronopathic lysosomal disease. Mol Ther. 2013 Oct;21(10):1938-49. doi: 10.1038/mt.2013.141. Epub 2013 Jun 7.
Results Reference
background
PubMed Identifier
22547151
Citation
Langford-Smith A, Wilkinson FL, Langford-Smith KJ, Holley RJ, Sergijenko A, Howe SJ, Bennett WR, Jones SA, Wraith J, Merry CL, Wynn RF, Bigger BW. Hematopoietic stem cell and gene therapy corrects primary neuropathology and behavior in mucopolysaccharidosis IIIA mice. Mol Ther. 2012 Aug;20(8):1610-21. doi: 10.1038/mt.2012.82. Epub 2012 May 1.
Results Reference
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Gene Therapy With Modified Autologous Hematopoietic Stem Cells for Patients With Mucopolysaccharidosis Type IIIA

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