Study to Evaluate Safety and Activity of TRL1068 in Chronic Rhinosinusitis
Primary Purpose
Chronic Rhinosinusitis With Nasal Polyps
Status
Not yet recruiting
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
TRL1068
Sponsored by
About this trial
This is an interventional treatment trial for Chronic Rhinosinusitis With Nasal Polyps focused on measuring biofilm, antibiotic-resistant infections
Eligibility Criteria
Inclusion Criteria:
- Age 18 to 85 years, inclusive
Diagnosis of chronic rhinosinusitis with:
- Acute exacerbation of CRSwNP with increased sinonasal discharge OR
- Acute exacerbation post-functional endoscopic sinus surgery (FESS) with increased sinonasal discharge AND
- Sinonasal culture positive for SA or PA without concomitant fungal infection in culture or PCR
- Symptoms and culture results justify initiation of topical and/or systemic antibiotic treatment
- Willing and able to provide written informed consent
- Willing to perform and comply with all study procedures including attending clinic visits as scheduled
- Men and women of child bearing potential (WOCBP) must be willing to practice a highly effective method of contraception that may include, but is not limited to, abstinence, sex only with persons of the same sex, monogamous relationship with vasectomized partner, vasectomy, hysterectomy, bilateral tubal ligation, licensed hormonal methods, intrauterine device (IUD), or use of spermicide combined with a barrier method (e.g., condom, diaphragm) for 28 days before receiving the investigational product (IP) and through Day 50.
Exclusion Criteria:
- Active malignancy, or history of malignancy or chemotherapy within the past 2 years other than history of localized or surgical removal of focal skin cancer, or cervical cancer in situ treated successfully in the past by local treatment (including but not limited to cryotherapy or laser therapy) or by hysterectomy
- Any chronic or acute bacterial infection other than acute exacerbation of CRS
- Concomitant intrasinal culture or 16S PCR indicative of concomitant fungal infection
- Allergic fungal rhinosinusitis, characterized by elevated antifungal IgE and eosinophilic mucus
- Receiving or recently received another investigational drug (within 30 days of Day 1, or 5 half-lives of the investigational drug, whichever is longer)
- Received a COVID-19 vaccine or booster within 14 days of planned Day 1 or planned COVID-19 vaccination within 14 days after Day 1
- Positive serum test for pregnancy, pregnant, or nursing women
- History of drug or alcohol abuse that, in the opinion of the Investigator, would interfere with the subject's ability to comply with the study requirements
- Any other comorbidity or condition that, in the opinion of the Investigator would make the subject unsuitable for the study or unable to comply with the study requirements
Sites / Locations
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
TRL1068
Arm Description
all subjects will receive a single intravenous dose of 15 mg/kg of TRL1068 on Day 1
Outcomes
Primary Outcome Measures
Incidence of abnormal physical exam findings
Clinically-significant abnormal physical exam findings will be reviewed
Incidence of abnormal serum chemistries and hematology
Clinically-significant abnormal laboratory results will be reviewed
Incidence of abnormal vital signs (temperature)
Clinically-significant abnormal temperatures will be reviewed
Incidence of abnormal vital signs (blood pressure)
Clinically-significant abnormal blood pressures will be reviewed
Incidence of abnormal vital signs (heart rate)
Clinically-significant abnormal heart rates will be reviewed
Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
reported AEs and SAEs will be reviewed
Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmax)
Individual subject TRL1068 Cmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmin)
Individual subject TRL1068 Cmin in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in serum (Tmax)
Individual subject TRL1068 Tmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCLAST)
Individual subject TRL1068 AUCLAST in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCINF)
Individual subject TRL1068 AUCINF in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmax)
Individual subject TRL1068 Cmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmin)
Individual subject TRL1068 Cmin intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Tmax)
Individual subject TRL1068 Tmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCLAST)
Individual subject TRL1068 AUCLAST intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCINF)
Individual subject TRL1068 AUCINF intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of bacterial pathogen infection)
Cultures will be tested for bacterial pathogen presence by bacterial culture and/or PCR assessment. Time to resolution of bacterial pathogen infection is defined as the number of days from start of current acute exacerbation to the day when testing by bacterial culture and/or PCR assessment are reported as negative. Descriptive statistics will be performed including mean, median and confidence interval.
Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of signs and symptoms of acute exacerbation)
Patients will be evaluated for signs and symptoms of acute exacerbation using SNOT-22 scoring. Time to resolution of signs and symptoms of acute exacerbation is defined as the day when the SNOT-22 score is back to pre-acute exacerbation score.
Assess the immunogenicity of TRL1068 as measured by anti-drug antibodies (ADAs)
Anti-drug antibodies (ADA), i.e. anti-TRL1068 antibodies in serum will determined by electrochemiluminescence assay
Secondary Outcome Measures
Assess the incidence of improvement of baseline symptoms of chronic rhinosinusitis (CRS) after intravenous TRL1068
signs and symptoms will be measured using the SNOT-22
Assess time to improvement of baseline symptoms of CRS as compared with previous duration of acute exacerbations
signs and symptoms will be measured using the SNOT-22 and compared with historical data
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05355207
Brief Title
Study to Evaluate Safety and Activity of TRL1068 in Chronic Rhinosinusitis
Official Title
Phase 1 Study to Evaluate the Safety, Pharmacokinetics, and Pharmacodynamics of TRL1068 in Subjects With Acute Exacerbation of Chronic Rhinosinusitis
Study Type
Interventional
2. Study Status
Record Verification Date
April 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
January 2024 (Anticipated)
Primary Completion Date
January 2025 (Anticipated)
Study Completion Date
January 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Trellis Bioscience LLC
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
TRL1068 is expected to eliminate the pathogen-protecting biofilm in Chronic Rhinosinusitis, thus making these bacteria substantially more susceptible to established antibiotic treatment regimens. This initial study is to assess overall safety and pharmacokinetics (PK) of TRL1068. The goal of the development program is to demonstrate effectiveness of TRL1068 in difficult to treat bacterial infections such as in CRS.
Detailed Description
Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and decreased quality of life. Defects in the epithelial cell barrier, increased exposure to pathogenic and colonized bacteria, and dysregulation of the host immune system are all thought to play prominent roles in disease pathogenesis. Colonization with S. aureus or P. aureus are associated with recalcitrant disease and biofilm formation, making eradication difficult.
Distribution of topical solutions in the unoperated sinuses has been observed to be less than 2% of the total irrigation volume, with almost no penetration in the frontal and sphenoid sinuses. For those patients with mucosal edema from infection and chronic inflammation, distribution is probably significantly less when applied topically. Intravenously administered TRL1068 is expected to achieve effective anti-biofilm levels throughout the sinonasal space for several weeks. TRL1068 is a monoclonal human antibody that rapidly eliminates biofilm at very low concentrations, thus making the targeted bacterial pathogens substantially more sensitive to standard of care antibiotic treatment regimen and greatly accelerating clinical improvement and potential for bacterial eradication.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Rhinosinusitis With Nasal Polyps
Keywords
biofilm, antibiotic-resistant infections
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
single group, all subjects will receive 15 mg/kg of TRL1068 on Day 1
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
TRL1068
Arm Type
Experimental
Arm Description
all subjects will receive a single intravenous dose of 15 mg/kg of TRL1068 on Day 1
Intervention Type
Drug
Intervention Name(s)
TRL1068
Intervention Description
A human IgG1κ (G1m1,17 (z,a); Km3 allotype) monoclonal antibody
Primary Outcome Measure Information:
Title
Incidence of abnormal physical exam findings
Description
Clinically-significant abnormal physical exam findings will be reviewed
Time Frame
6 weeks
Title
Incidence of abnormal serum chemistries and hematology
Description
Clinically-significant abnormal laboratory results will be reviewed
Time Frame
6 weeks
Title
Incidence of abnormal vital signs (temperature)
Description
Clinically-significant abnormal temperatures will be reviewed
Time Frame
6 weeks
Title
Incidence of abnormal vital signs (blood pressure)
Description
Clinically-significant abnormal blood pressures will be reviewed
Time Frame
6 weeks
Title
Incidence of abnormal vital signs (heart rate)
Description
Clinically-significant abnormal heart rates will be reviewed
Time Frame
6 weeks
Title
Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Description
reported AEs and SAEs will be reviewed
Time Frame
7 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmax)
Description
Individual subject TRL1068 Cmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmin)
Description
Individual subject TRL1068 Cmin in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in serum (Tmax)
Description
Individual subject TRL1068 Tmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCLAST)
Description
Individual subject TRL1068 AUCLAST in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCINF)
Description
Individual subject TRL1068 AUCINF in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmax)
Description
Individual subject TRL1068 Cmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmin)
Description
Individual subject TRL1068 Cmin intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Tmax)
Description
Individual subject TRL1068 Tmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCLAST)
Description
Individual subject TRL1068 AUCLAST intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCINF)
Description
Individual subject TRL1068 AUCINF intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
Time Frame
6 weeks
Title
Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of bacterial pathogen infection)
Description
Cultures will be tested for bacterial pathogen presence by bacterial culture and/or PCR assessment. Time to resolution of bacterial pathogen infection is defined as the number of days from start of current acute exacerbation to the day when testing by bacterial culture and/or PCR assessment are reported as negative. Descriptive statistics will be performed including mean, median and confidence interval.
Time Frame
6 weeks
Title
Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of signs and symptoms of acute exacerbation)
Description
Patients will be evaluated for signs and symptoms of acute exacerbation using SNOT-22 scoring. Time to resolution of signs and symptoms of acute exacerbation is defined as the day when the SNOT-22 score is back to pre-acute exacerbation score.
Time Frame
6 weeks
Title
Assess the immunogenicity of TRL1068 as measured by anti-drug antibodies (ADAs)
Description
Anti-drug antibodies (ADA), i.e. anti-TRL1068 antibodies in serum will determined by electrochemiluminescence assay
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Assess the incidence of improvement of baseline symptoms of chronic rhinosinusitis (CRS) after intravenous TRL1068
Description
signs and symptoms will be measured using the SNOT-22
Time Frame
7 weeks
Title
Assess time to improvement of baseline symptoms of CRS as compared with previous duration of acute exacerbations
Description
signs and symptoms will be measured using the SNOT-22 and compared with historical data
Time Frame
7 weeks
Other Pre-specified Outcome Measures:
Title
Assess the effects of treatment on the intrasinal microbiome
Description
intrasinal culture and PCR results will be reviewed
Time Frame
6 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age 18 to 85 years, inclusive
Diagnosis of chronic rhinosinusitis with:
Acute exacerbation of CRSwNP with increased sinonasal discharge OR
Acute exacerbation post-functional endoscopic sinus surgery (FESS) with increased sinonasal discharge AND
Sinonasal culture positive for SA or PA without concomitant fungal infection in culture or PCR
Symptoms and culture results justify initiation of topical and/or systemic antibiotic treatment
Willing and able to provide written informed consent
Willing to perform and comply with all study procedures including attending clinic visits as scheduled
Men and women of child bearing potential (WOCBP) must be willing to practice a highly effective method of contraception that may include, but is not limited to, abstinence, sex only with persons of the same sex, monogamous relationship with vasectomized partner, vasectomy, hysterectomy, bilateral tubal ligation, licensed hormonal methods, intrauterine device (IUD), or use of spermicide combined with a barrier method (e.g., condom, diaphragm) for 28 days before receiving the investigational product (IP) and through Day 50.
Exclusion Criteria:
Active malignancy, or history of malignancy or chemotherapy within the past 2 years other than history of localized or surgical removal of focal skin cancer, or cervical cancer in situ treated successfully in the past by local treatment (including but not limited to cryotherapy or laser therapy) or by hysterectomy
Any chronic or acute bacterial infection other than acute exacerbation of CRS
Concomitant intrasinal culture or 16S PCR indicative of concomitant fungal infection
Allergic fungal rhinosinusitis, characterized by elevated antifungal IgE and eosinophilic mucus
Receiving or recently received another investigational drug (within 30 days of Day 1, or 5 half-lives of the investigational drug, whichever is longer)
Received a COVID-19 vaccine or booster within 14 days of planned Day 1 or planned COVID-19 vaccination within 14 days after Day 1
Positive serum test for pregnancy, pregnant, or nursing women
History of drug or alcohol abuse that, in the opinion of the Investigator, would interfere with the subject's ability to comply with the study requirements
Any other comorbidity or condition that, in the opinion of the Investigator would make the subject unsuitable for the study or unable to comply with the study requirements
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Anton (Tony) Leighton, MD
Phone
650-838-1400
Email
Clinicalstudies@trellisbio.com
First Name & Middle Initial & Last Name or Official Title & Degree
Adriane Kisch-Hancock
Phone
650-838-1400
Email
akisch-hancock@trellisbio.com
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
We plan to make the Clinical Protocol and SAP available on Protocols.io (https://www.protocols.io/) before trial recruitment is complete.
IPD Sharing Time Frame
Before trial recruitment is complete on Protocols.io (https://www.protocols.io/)
IPD Sharing Access Criteria
available
Citations:
PubMed Identifier
26833157
Citation
Estelles A, Woischnig AK, Liu K, Stephenson R, Lomongsod E, Nguyen D, Zhang J, Heidecker M, Yang Y, Simon RJ, Tenorio E, Ellsworth S, Leighton A, Ryser S, Gremmelmaier NK, Kauvar LM. A High-Affinity Native Human Antibody Disrupts Biofilm from Staphylococcus aureus Bacteria and Potentiates Antibiotic Efficacy in a Mouse Implant Infection Model. Antimicrob Agents Chemother. 2016 Mar 25;60(4):2292-301. doi: 10.1128/AAC.02588-15. Print 2016 Apr.
Results Reference
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PubMed Identifier
28717038
Citation
Xiong YQ, Estelles A, Li L, Abdelhady W, Gonzales R, Bayer AS, Tenorio E, Leighton A, Ryser S, Kauvar LM. A Human Biofilm-Disrupting Monoclonal Antibody Potentiates Antibiotic Efficacy in Rodent Models of both Staphylococcus aureus and Acinetobacter baumannii Infections. Antimicrob Agents Chemother. 2017 Sep 22;61(10):e00904-17. doi: 10.1128/AAC.00904-17. Print 2017 Oct.
Results Reference
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Study to Evaluate Safety and Activity of TRL1068 in Chronic Rhinosinusitis
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