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Safety and Efficacy Study Using Gene Therapy for Critical Limb Ischemia (NL003-CLI-III-2)

Primary Purpose

Arterial Occlusive Disease, Ischemia, Ulcers

Status
Recruiting
Phase
Phase 3
Locations
China
Study Type
Interventional
Intervention
NL003
Normal Saline
Sponsored by
Beijing Northland Biotech. Co., Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Arterial Occlusive Disease focused on measuring HGF, Gene, Critical Limb Ischemia

Eligibility Criteria

20 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 1. At the age of 20 and 80 (at the time of signing the informed consent), both male and female.

    2. According to DSA or CTA, patients diagnosed with lower limb arterial ischemic disease based on the medical history and clinical manifestations and with Rutherford grade 5 (with ulcer) must meet the substandardProspective.(if both limbs of the subject suffer from lower limb arterial ischemic disease, it is up to the investigator to select one limb for the study.)Resting ankle systolic pressure (dorsal foot artery or posterior tibial artery) ≤70mmHg or ABI≤0.5 or TcPO2 < 30mmHg;In the first 3 months after randomized inclusion, DSA or CTA confirmed severe stenosis (≥70%) or occlusion of superficial femoral artery or popliteal artery or inferior knee artery.

    3. Patients with chronic lower limb arterial ischemia complicated with ulceration also met the following requirements: when signing the informed consent, the ischemic ulcer of the artery lasted at least 2 weeks;When signing the informed consent, the area of a single ulcer is no more than 10cm2;If there are multiple ulcers in the affected limb selected at the time of signing the informed consent, the total number of ulcers shall not exceed 3.Basic ulcer care (according to standard ulcer care procedure) should be maintained during the test to avoid aggravation of infection.The ulcer did not expose bone or joint capsule.If there is gangrene, only partial toe gangrene.

    4. Agreed to use the basic treatment drugs as required during the test, and kept a complete record of the subjects' diaries on time. The compliance of the basic treatment drugs and the subjects' diaries during the screening period was ≥70%.

    5. Agree to use appropriate contraceptive measures during the experiment;Female subjects of reproductive age, blood pregnancy test negative.

    6. Signed informed consent.

Exclusion Criteria:

  • 1. Patients with acute lower limb ischemia or acute exacerbation of chronic lower limb ischemia.

    2. Vascular reconstruction (bypass or intravascular therapy) or sympathetic resection or amputation was performed within 4 weeks prior to the signing of the informed consent.

    3. Due to the surgical operation, the patient was still in the postoperative risk period, and the researcher judged that it was not suitable for the participant.

    4. Main-iliac artery stenosis ≥70%.

    5. Severe limb infection (cellulitis, osteomyelitis, etc.), distal fascia or bone exposure were observed.

    6. Cardiac function NYHA class belongs to Ⅳ grading standards (see appendix 1).

    7. Cerebral infarction, cerebral hemorrhage, myocardial infarction or unstable angina pectoris occurred within 3 months before signing the informed consent.

    8. Refractory hypertension (systolic blood pressure ≥180mmHg or diastolic blood pressure ≥110mmHg when taking three or more antihypertensive drugs).

    9. Proliferative retinopathy and retinopathy examination is not available.

    10. Inability to accurately describe symptoms and emotions.

    11. Severe liver disease with uncompensated cirrhosis, jaundice, ascites or hemorrhagic varices.

    12. Current recipients of immunosuppressants or chemoradiotherapy.

    13. Anti-hiv antibody positive, anti-hepatitis c antibody positive and hepatitis b surface antigen positive (if the subject is HBsAg positive and HBV DNA in peripheral blood is combined, the researcher believes that the subject's chronic hepatitis b is stable and will not increase the risk of the subject, the subject can be selected).

    14. Results of laboratory examination during screening period: hemoglobin < 80g/L, white blood cell count < 3.0×109/L, platelet < 75×109/L, upper limit of normal AST or ALT >, upper limit of normal serum creatinine > was 3 times, or other laboratory examination indicators showed abnormalities that researchers thought might affect the evaluation of test results.

    15. Poor blood glucose control after treatment (glycosylated hemoglobin > 10%).

    16. Previously diagnosed with malignant tumor, or any of the following test results determined by the investigator to be at risk of tumor: fecal occult blood test;Chest X-ray examination or chest CT examination;Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and ca19-9;Male subjects, prostate specific antigen test (PSA, free PSA);Female subjects: cervical smear (Pap), mammography/b-ultrasound, ca-125;The investigators determined that additional tests were necessary to eliminate the tumor risk.

    17. In the opinion of the investigators, patients with comorbidities that affect safety and efficacy evaluation, or those with a predicted survival of less than 12 months.

    18. Frequent drinkers within the 12 months prior to the signing of the informed consent, i.e., those who drank more than 14 units of alcohol per week (1 unit =360 mL beer or 45 mL alcohol of 40% spirits or 150 mL wine) or substance abusers.

    19. Participate in other clinical trials within 3 months before signing the informed consent.

Sites / Locations

  • Beijing HospitaiRecruiting
  • Peking Union Medical College HospitalRecruiting
  • The Ninth People's Hospital of ChongqingRecruiting
  • Zhangzhou Municipal Hospital of Fujian ProvinceRecruiting
  • The Second Xiangya Hospital of Central South University
  • The Third Xiangya Hospital of Central South UniversityRecruiting
  • Xuzhou Mining Group General HospitalRecruiting
  • Chifeng Municipal HospitalRecruiting
  • The Affiliated Hospital of Qingdao UniversityRecruiting
  • Shanghai seventh people's hospitalRecruiting
  • Shanxi Provincial People's HospitalRecruiting
  • First Affiliated Hospital of Xi 'an Jiaotong UniversityRecruiting
  • Second Affiliated Hospital of Xi 'an Jiaotong UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

investigational produc

Placebo

Arm Description

Patients in this treatment group will receive 8mg NL003 respective in D0、14、28

Patients in this group will receive normal saline respective in D0、14、18

Outcomes

Primary Outcome Measures

Percentage of ulcer complete healing
1.At D180 visit, subjects intended to observe the healing of all arterial ischemic ulcers in the limb;2.Ulcer healing criteria: skin epidermal cell regeneration without secretion.

Secondary Outcome Measures

The time when the ulcer finally heals completely
The time between the first use of the study drug and the final full healing of the ulcer.
Percentage of cases with ulcer area reduced by ≥50% from baseline
The ulcer area at the last visit was 50% less than the baseline case percentage.
Percentage of new ulcer or gangrene cases
The percentage of new ulcer or gangrene cases after use of the study drug.
Rate of complete disappearance of pain
Rate of complete disappearance of pain.
Percentage of cases with a 50% reduction in pain score from baseline
A 50% reduction in pain score from baseline at the last visit.
Changes in pain score from baseline
The severity of critical Limb ischemia was assessed by Rutherford grading at screening, D14, D28, D60, D90, and D180, respectively.
Changes in quality of life scores from baseline
The quality of life score questionnaire was conducted to evaluate the subjective perception of Critical Limb Ischemia, including the subjects' perception of quality of life, health, or other aspects of life.
Changes in Rutherford grading from baseline
The severity of critical Limb ischemia was assessed by Rutherford grading at screening, D14, D28, D60, D90, and D180, respectively.
Changes to the ABI from the baseline
Ankle-brachial index (ABI) refers to the ratio of systolic blood pressure of the anterior tibial artery (dorsal foot artery) or posterior tibial artery to the systolic blood pressure of the brachial artery.Participants were tested for ankle-brachial index (ABI).
The percentage of patients who undergo revascularization (open surgery or interventional therapy) has a high amputation rate of mortality
The percentage of patients who undergo revascularization (open surgery or interventional therapy) has a high amputation rate of mortality.

Full Information

First Posted
January 18, 2020
Last Updated
March 29, 2022
Sponsor
Beijing Northland Biotech. Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT04274049
Brief Title
Safety and Efficacy Study Using Gene Therapy for Critical Limb Ischemia (NL003-CLI-III-2)
Official Title
A Phase III, Double-Blind, Randomized, Placebo-Controlled, Multicenter Study to Assess the Safety and Efficacy of NL003 in Subject With Critical Limb Ischemia(Rutherford 5)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
August 18, 2019 (Actual)
Primary Completion Date
October 31, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Beijing Northland Biotech. Co., Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
The purpose of this study is to evaluate whether intramuscular injections of NL003 into the calf is safe and effective in the treatment of critical limb ischemia
Detailed Description
Management of CLI process consumes a significant amount of healthcare resources,and the new therapeutic approaches are required. Hepatocyte growth factor (HGF) has been shown to be a potent angiogenic growth factor stimulating the growth of endothelial cells and migration of vascular smooth muscle cells. Because of its pluripotent capabilities, increasing the availability of HGF in ischemic tissues to achieve therapeutic angiogenesis has been a growing area of research. This study will use NL003, which is a DNA plasmid that contains novel genomic cDNA hybrid human HGF coding sequence (HGF-X7) expressing two isoforms of HGF, HGF 728 and HGF 723. As there are currently no approved drugs that can reverse CLI and as most patients have exhausted surgical and endovascular intervention options, inducing angiogenesis in the affected limb with NL003 may result in an increase in tissue perfusion, which, in turn improve wound healing, reduce pain and improve limb salvage rates.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Arterial Occlusive Disease, Ischemia, Ulcers, Peripheral Vascular Disease
Keywords
HGF, Gene, Critical Limb Ischemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
240 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
investigational produc
Arm Type
Experimental
Arm Description
Patients in this treatment group will receive 8mg NL003 respective in D0、14、28
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients in this group will receive normal saline respective in D0、14、18
Intervention Type
Genetic
Intervention Name(s)
NL003
Other Intervention Name(s)
HGF plasmid, pCK-HGF-X7
Intervention Description
Day 0: 8mg of NL003 (32 injections of 0.5ml of NL003) Day 14: 8mg of NL003 (32 injections of 0.5ml of NL003) Day 28: 8mg of NL003 (32 injections of 0.5ml of NL003)
Intervention Type
Other
Intervention Name(s)
Normal Saline
Other Intervention Name(s)
Placebo
Intervention Description
Day 0: 16ml of Normal Saline (32 injections ) Day 14: 16ml of Normal Saline (32 injections ) Day 28: 16ml of Normal Saline (32 injections )
Primary Outcome Measure Information:
Title
Percentage of ulcer complete healing
Description
1.At D180 visit, subjects intended to observe the healing of all arterial ischemic ulcers in the limb;2.Ulcer healing criteria: skin epidermal cell regeneration without secretion.
Time Frame
Day180
Secondary Outcome Measure Information:
Title
The time when the ulcer finally heals completely
Description
The time between the first use of the study drug and the final full healing of the ulcer.
Time Frame
Day14,Day28,Day60,Day90,Day120,Day180
Title
Percentage of cases with ulcer area reduced by ≥50% from baseline
Description
The ulcer area at the last visit was 50% less than the baseline case percentage.
Time Frame
Day180
Title
Percentage of new ulcer or gangrene cases
Description
The percentage of new ulcer or gangrene cases after use of the study drug.
Time Frame
Day14,Day28,Day60,Day90,Day120,Day180
Title
Rate of complete disappearance of pain
Description
Rate of complete disappearance of pain.
Time Frame
Day180
Title
Percentage of cases with a 50% reduction in pain score from baseline
Description
A 50% reduction in pain score from baseline at the last visit.
Time Frame
Day180
Title
Changes in pain score from baseline
Description
The severity of critical Limb ischemia was assessed by Rutherford grading at screening, D14, D28, D60, D90, and D180, respectively.
Time Frame
Day14,Day28,Day60,Day90,Day120,Day180
Title
Changes in quality of life scores from baseline
Description
The quality of life score questionnaire was conducted to evaluate the subjective perception of Critical Limb Ischemia, including the subjects' perception of quality of life, health, or other aspects of life.
Time Frame
Day14,Day28,Day60,Day90,Day120,Day180
Title
Changes in Rutherford grading from baseline
Description
The severity of critical Limb ischemia was assessed by Rutherford grading at screening, D14, D28, D60, D90, and D180, respectively.
Time Frame
Day14,Day28,Day60,Day90,Day120,Day180
Title
Changes to the ABI from the baseline
Description
Ankle-brachial index (ABI) refers to the ratio of systolic blood pressure of the anterior tibial artery (dorsal foot artery) or posterior tibial artery to the systolic blood pressure of the brachial artery.Participants were tested for ankle-brachial index (ABI).
Time Frame
Day60,Day90,Day120,Day180
Title
The percentage of patients who undergo revascularization (open surgery or interventional therapy) has a high amputation rate of mortality
Description
The percentage of patients who undergo revascularization (open surgery or interventional therapy) has a high amputation rate of mortality.
Time Frame
Day180

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. At the age of 20 and 80 (at the time of signing the informed consent), both male and female. 2. According to DSA or CTA, patients diagnosed with lower limb arterial ischemic disease based on the medical history and clinical manifestations and with Rutherford grade 5 (with ulcer) must meet the substandardProspective.(if both limbs of the subject suffer from lower limb arterial ischemic disease, it is up to the investigator to select one limb for the study.)Resting ankle systolic pressure (dorsal foot artery or posterior tibial artery) ≤70mmHg or ABI≤0.5 or TcPO2 < 30mmHg;In the first 3 months after randomized inclusion, DSA or CTA confirmed severe stenosis (≥70%) or occlusion of superficial femoral artery or popliteal artery or inferior knee artery. 3. Patients with chronic lower limb arterial ischemia complicated with ulceration also met the following requirements: when signing the informed consent, the ischemic ulcer of the artery lasted at least 2 weeks;When signing the informed consent, the area of a single ulcer is no more than 10cm2;If there are multiple ulcers in the affected limb selected at the time of signing the informed consent, the total number of ulcers shall not exceed 3.Basic ulcer care (according to standard ulcer care procedure) should be maintained during the test to avoid aggravation of infection.The ulcer did not expose bone or joint capsule.If there is gangrene, only partial toe gangrene. 4. Agreed to use the basic treatment drugs as required during the test, and kept a complete record of the subjects' diaries on time. The compliance of the basic treatment drugs and the subjects' diaries during the screening period was ≥70%. 5. Agree to use appropriate contraceptive measures during the experiment;Female subjects of reproductive age, blood pregnancy test negative. 6. Signed informed consent. Exclusion Criteria: 1. Patients with acute lower limb ischemia or acute exacerbation of chronic lower limb ischemia. 2. Vascular reconstruction (bypass or intravascular therapy) or sympathetic resection or amputation was performed within 4 weeks prior to the signing of the informed consent. 3. Due to the surgical operation, the patient was still in the postoperative risk period, and the researcher judged that it was not suitable for the participant. 4. Main-iliac artery stenosis ≥70%. 5. Severe limb infection (cellulitis, osteomyelitis, etc.), distal fascia or bone exposure were observed. 6. Cardiac function NYHA class belongs to Ⅳ grading standards (see appendix 1). 7. Cerebral infarction, cerebral hemorrhage, myocardial infarction or unstable angina pectoris occurred within 3 months before signing the informed consent. 8. Refractory hypertension (systolic blood pressure ≥180mmHg or diastolic blood pressure ≥110mmHg when taking three or more antihypertensive drugs). 9. Proliferative retinopathy and retinopathy examination is not available. 10. Inability to accurately describe symptoms and emotions. 11. Severe liver disease with uncompensated cirrhosis, jaundice, ascites or hemorrhagic varices. 12. Current recipients of immunosuppressants or chemoradiotherapy. 13. Anti-hiv antibody positive, anti-hepatitis c antibody positive and hepatitis b surface antigen positive (if the subject is HBsAg positive and HBV DNA in peripheral blood is combined, the researcher believes that the subject's chronic hepatitis b is stable and will not increase the risk of the subject, the subject can be selected). 14. Results of laboratory examination during screening period: hemoglobin < 80g/L, white blood cell count < 3.0×109/L, platelet < 75×109/L, upper limit of normal AST or ALT >, upper limit of normal serum creatinine > was 3 times, or other laboratory examination indicators showed abnormalities that researchers thought might affect the evaluation of test results. 15. Poor blood glucose control after treatment (glycosylated hemoglobin > 10%). 16. Previously diagnosed with malignant tumor, or any of the following test results determined by the investigator to be at risk of tumor: fecal occult blood test;Chest X-ray examination or chest CT examination;Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and ca19-9;Male subjects, prostate specific antigen test (PSA, free PSA);Female subjects: cervical smear (Pap), mammography/b-ultrasound, ca-125;The investigators determined that additional tests were necessary to eliminate the tumor risk. 17. In the opinion of the investigators, patients with comorbidities that affect safety and efficacy evaluation, or those with a predicted survival of less than 12 months. 18. Frequent drinkers within the 12 months prior to the signing of the informed consent, i.e., those who drank more than 14 units of alcohol per week (1 unit =360 mL beer or 45 mL alcohol of 40% spirits or 150 mL wine) or substance abusers. 19. Participate in other clinical trials within 3 months before signing the informed consent.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
yue liu
Phone
+86-10-82890893
Email
liuyue@northland-bio.com
First Name & Middle Initial & Last Name or Official Title & Degree
yinjian sun
Phone
+86-10-82890893
Email
sunyinjian@northland-bio.com
Facility Information:
Facility Name
Beijing Hospitai
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100005
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yongjun LI
Facility Name
Peking Union Medical College Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100032
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
changwei liu
Facility Name
The Ninth People's Hospital of Chongqing
City
Chongqing
State/Province
Chongqing
ZIP/Postal Code
400700
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shigang Duan
Facility Name
Zhangzhou Municipal Hospital of Fujian Province
City
Zhangzhou
State/Province
Fujian
ZIP/Postal Code
363000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mingzhi Cai
Facility Name
The Second Xiangya Hospital of Central South University
City
Changsha
State/Province
Hunan
ZIP/Postal Code
410000
Country
China
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chang Shu
Facility Name
The Third Xiangya Hospital of Central South University
City
Changsha
State/Province
Hunan
ZIP/Postal Code
410000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kai Yao
Facility Name
Xuzhou Mining Group General Hospital
City
Xuzhou
State/Province
Jiangsu
ZIP/Postal Code
221006
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jian Wang
Facility Name
Chifeng Municipal Hospital
City
Chifeng
State/Province
Neimenggu
ZIP/Postal Code
024000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Liu Yang
Facility Name
The Affiliated Hospital of Qingdao University
City
Qingdao
State/Province
Shandong
ZIP/Postal Code
266003
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Haofu Wang
Facility Name
Shanghai seventh people's hospital
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200120
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Bin Zhao
Facility Name
Shanxi Provincial People's Hospital
City
Taiyuan
State/Province
Shanxi
ZIP/Postal Code
030012
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Qiang Guan
Facility Name
First Affiliated Hospital of Xi 'an Jiaotong University
City
XiAn
State/Province
Shanxi
ZIP/Postal Code
710061
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shaoying Lu
Facility Name
Second Affiliated Hospital of Xi 'an Jiaotong University
City
XiAn
State/Province
Shanxi
ZIP/Postal Code
710061
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xi Chen

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Safety and Efficacy Study Using Gene Therapy for Critical Limb Ischemia (NL003-CLI-III-2)

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