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Biomarker Validation Following Sargramostim Treatment in Parkinson's Disease

Primary Purpose

Parkinson's Disease and Parkinsonism

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Sargramostim
Sponsored by
University of Nebraska
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Parkinson's Disease and Parkinsonism focused on measuring Leukine, sargramostim, biomarker

Eligibility Criteria

35 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Onset of bradykinesia and 1 or both of the following: rest tremor and/or rigidity Asymmetric onset of clinical signs Progressive motor symptoms Age at onset 35-85 years Duration of PD symptoms of at least 3 years Female subjects must be either: Not pregnant, not breastfeeding, and not planning on becoming pregnant during the study; Not of childbearing potential, defined as one who has been postmenopausal for at least 1 year and with follicle stimulating hormone (FSH) levels in the laboratory defined postmenopausal range, or has been surgically sterilized, or has had a hysterectomy at least 3 months prior to the start of this trial; or If of childbearing potential, must agree to use an effective method of avoiding pregnancy to the end of the trial and must have a negative serum beta-human chorionic gonadotropin (β-HCG) test. Effective methods of avoiding pregnancy are contraceptive methods used consistently and correctly (including implantable contraceptives, injectable contraceptives, oral contraceptives, transdermal contraceptives, intrauterine devices, diaphragm with spermicide, male or female condoms with spermicide, or cervical cap), abstinence, or a sterile sexual partner. Must be stage 4 or less according to the Hoehn and Yahr scale Exclusion Criteria: Atypical features indicative of a Parkinson-Plus disorder (Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), Corticobasal Degeneration (CBD)) including cerebellar signs, supranuclear gaze palsy, apraxia and other cortical signs, or prominent autonomic failure Neuroleptic treatment at time of onset of parkinsonism Active treatment with a neuroleptic at time of study entry History of repeated strokes with stepwise progression of parkinsonism History of repeated head injury History of definite encephalitis More than one blood relative diagnosed with PD Prominent gait imbalance early in the course (< 5 years) Mini-mental state examination score <26 Hematological malignancy or coagulopathy Abnormal blood analyses: hematocrit <30; WBC>11.5; clinically significant laboratory data (e.g. alanine aminotransferase [ALT] or aspartate aminotransferase [AST] 3x the upper limit of normal [ULN]), or any abnormal laboratory value that could interfere with the assessment of safety in the judgment of the investigator; significant abnormalities on the clinical examination, vital signs, and clinical chemistry or hematology results (excluding findings of Parkinson's disease), that may interfere with the study or present a safety risk for the subject as judged by the clinical investigator charged in the care of study participants Serious medical illness or co-morbidity that may interfere with participation in the study Brain surgery for parkinsonism (DBS, cell implantation, gene therapy) History of an autoimmune disorder or systemic inflammatory disorder deemed significant by physician Immunostimulatory or immunosuppressive treatment (including amphet-amines or systemic corticosteroids) within 90 days Exclusively unilateral parkinsonism for longer than 3 years Known hypersensitivity to GM-CSF, yeast-derived products Current lithium treatment Individuals with current diagnoses of alcohol or substance abuse/dependence Anyone who is not appropriate for participation in this research protocol as deemed by the principal or co-investigator Anyone who has previously been treated with GM-CSF as an immunomodulatory therapy Anyone with poor venous access Anyone who has any illnesses or events that would cause a neurological abnormality, apart from Parkinson's disease. Subjects with allergies or sensitivities to yeast products. Subjects that have received a flu shot within the past 3 weeks.

Sites / Locations

  • University of Nebraska Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Leukine Treatment

Arm Description

48 week regimen of Leukine administered as a weight-based dose at 3 µg/kg/day for 5 days (week), followed by a 2-day holiday (weekend)

Outcomes

Primary Outcome Measures

Change in incidence of adverse events over time
The safety of Leukine administration in PD will be examined by documenting abnormal results from CBC with differential, total T cell count, or comprehensive metabolic panel analyses; abnormal physical and or neurological exam findings; abnormal levels of antibodies to GM-CSF; clinically increasing Unified Parkinson's disease Rating Scale (UPDRS) part I, II, III, and IV scores as determined by the examining physician; and other adverse events. Adverse event logs will be reported every 4 weeks.

Secondary Outcome Measures

Change in Treatment Biomarkers over time
During the baseline visit and at 24 weeks and 48 weeks post-Leukine initiation, subjects will undergo leukapheresis to collect large amounts of monocytes and lymphocytes for biomarker evaluations. Cells will be harvested and subjected to proteomic and transcriptomic tests to assess therapeutic response and treatment-induced biomarkers. Biomarkers assessed will be proteins levels along with corresponding gene levels determined as fold change from baseline.

Full Information

First Posted
December 15, 2022
Last Updated
September 28, 2023
Sponsor
University of Nebraska
Collaborators
Partner Therapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05677633
Brief Title
Biomarker Validation Following Sargramostim Treatment in Parkinson's Disease
Official Title
A Phase 1, Open-label Study to Validate Treatment-induced Biomarkers Following Sargramostim Treatment in Parkinson's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 19, 2023 (Actual)
Primary Completion Date
February 2024 (Anticipated)
Study Completion Date
May 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Nebraska
Collaborators
Partner Therapeutics, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Investigators will evaluate the safety of a 48 week regimen of Leukine administered as a weight-based dose at 3 ug/kg/ day for 5 days followed by a 2-day holiday. This 48 week long study will extend the prior biomarker evaluations observed in a previous study. Clinical signs and symptoms will be measured by personal well-being, physical, and neurological examinations (UPDRS Parts I, II, III, and IV assessments) and blood tests (CBC with differential, total T cell count, and a comprehensive metabolic sera panel). Leukapheresis will be performed to collect large numbers of immune cells for biomarker testing and immune phenotyping. Additionally, the investigators will determine whether immune deficits of PD are consistent during baseline data collection, and the potential Leukine-induced motor control and mobility improvements will be determined by UPDRS part I, II, III, and IV scores off treatment and on treatment.
Detailed Description
Primary Objectives: There are two main study goals. First, the investigators will determine the safety of a 48 week regimen of Leukine administered as a weight-based dose at 3 µg/kg/day for 5 days, followed by a 2-day holiday. This 48 weeks (n=10) pilot study will continue to assess the safety of Leukine for treatment of Parkinson's disease (PD). Clinical signs and symptoms will be measured by personal well-being, physical, and neurological examinations (UPDRS Parts I, II, III, and IV assessments) and blood tests (CBC with differential, total T cell count, and a comprehensive metabolic sera panel). Due to fragility of the patient population and prior recorded adverse events the proposed dose reductions are justified. Second, in future preparations for an intended broader number of patient enrollments, the investigators wish to functionally examine any or all "putative" relevant biomarker assessments. Secondary Objectives: The investigators will examine over a time of 48 weeks, effects of treatment on defined adaptive immune deficits in PD as measured by analysis of peripheral blood mononuclear cells collected before and during Leukine therapy. The investigators will assess the individual T cell parameters that include links between T cell function and subset analyses and clinical neurological signs and symptoms. These immune parameters will be serially examined as they may contribute to the immune deficits in PD. Thus, timed analyses of changes in T cell phenotypes and/or function will be completed. In addition, the investigators will assess the functional stability of the immune deficits in PD. To this end, the investigators will examine T cell subsets in PD patients in this study against prior results. The investigators will determine whether the immune deficits of PD are consistent during baseline data collection. The investigators will evaluate the potential Leukine-induced motor control and mobility improvements by assessing UPDRS part I, II, III, and IV scores of treatment and on treatment. Additionally, over the course of this 48 week treatment study, investigators will also be assessing various biomarkers within plasma, peripheral blood, and the total lymphocyte and monocyte populations isolated from leukapheresis before Leukine therapy and after 24 and 48 weeks of treatment. Identified biomarkers will be correlated to disease severity and progression as assessed by UPDRS. Serum will also be collected to determine the generation of anti-drug neutralizing antibodies that may develop due to the dosing scheme.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Parkinson's Disease and Parkinsonism
Keywords
Leukine, sargramostim, biomarker

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Leukine Treatment
Arm Type
Experimental
Arm Description
48 week regimen of Leukine administered as a weight-based dose at 3 µg/kg/day for 5 days (week), followed by a 2-day holiday (weekend)
Intervention Type
Drug
Intervention Name(s)
Sargramostim
Other Intervention Name(s)
Leukine
Intervention Description
Recombinant human GM-CSF produced by recombinant DNA technology using a yeast (S. cerevisiae) expression system
Primary Outcome Measure Information:
Title
Change in incidence of adverse events over time
Description
The safety of Leukine administration in PD will be examined by documenting abnormal results from CBC with differential, total T cell count, or comprehensive metabolic panel analyses; abnormal physical and or neurological exam findings; abnormal levels of antibodies to GM-CSF; clinically increasing Unified Parkinson's disease Rating Scale (UPDRS) part I, II, III, and IV scores as determined by the examining physician; and other adverse events. Adverse event logs will be reported every 4 weeks.
Time Frame
every 6 months during the course of treatment, up to 48 weeks until drug cessation
Secondary Outcome Measure Information:
Title
Change in Treatment Biomarkers over time
Description
During the baseline visit and at 24 weeks and 48 weeks post-Leukine initiation, subjects will undergo leukapheresis to collect large amounts of monocytes and lymphocytes for biomarker evaluations. Cells will be harvested and subjected to proteomic and transcriptomic tests to assess therapeutic response and treatment-induced biomarkers. Biomarkers assessed will be proteins levels along with corresponding gene levels determined as fold change from baseline.
Time Frame
every 6 months during the course of treatment, up to 48 weeks until drug cessation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Onset of bradykinesia and 1 or both of the following: rest tremor and/or rigidity Asymmetric onset of clinical signs Progressive motor symptoms Age at onset 35-85 years Duration of PD symptoms of at least 3 years Female subjects must be either: Not pregnant, not breastfeeding, and not planning on becoming pregnant during the study; Not of childbearing potential, defined as one who has been postmenopausal for at least 1 year and with follicle stimulating hormone (FSH) levels in the laboratory defined postmenopausal range, or has been surgically sterilized, or has had a hysterectomy at least 3 months prior to the start of this trial; or If of childbearing potential, must agree to use an effective method of avoiding pregnancy to the end of the trial and must have a negative serum beta-human chorionic gonadotropin (β-HCG) test. Effective methods of avoiding pregnancy are contraceptive methods used consistently and correctly (including implantable contraceptives, injectable contraceptives, oral contraceptives, transdermal contraceptives, intrauterine devices, diaphragm with spermicide, male or female condoms with spermicide, or cervical cap), abstinence, or a sterile sexual partner. Must be stage 4 or less according to the Hoehn and Yahr scale Exclusion Criteria: Atypical features indicative of a Parkinson-Plus disorder (Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), Corticobasal Degeneration (CBD)) including cerebellar signs, supranuclear gaze palsy, apraxia and other cortical signs, or prominent autonomic failure Neuroleptic treatment at time of onset of parkinsonism Active treatment with a neuroleptic at time of study entry History of repeated strokes with stepwise progression of parkinsonism History of repeated head injury History of definite encephalitis More than one blood relative diagnosed with PD Prominent gait imbalance early in the course (< 5 years) Mini-mental state examination score <26 Hematological malignancy or coagulopathy Abnormal blood analyses: hematocrit <30; WBC>11.5; clinically significant laboratory data (e.g. alanine aminotransferase [ALT] or aspartate aminotransferase [AST] 3x the upper limit of normal [ULN]), or any abnormal laboratory value that could interfere with the assessment of safety in the judgment of the investigator; significant abnormalities on the clinical examination, vital signs, and clinical chemistry or hematology results (excluding findings of Parkinson's disease), that may interfere with the study or present a safety risk for the subject as judged by the clinical investigator charged in the care of study participants Serious medical illness or co-morbidity that may interfere with participation in the study Brain surgery for parkinsonism (DBS, cell implantation, gene therapy) History of an autoimmune disorder or systemic inflammatory disorder deemed significant by physician Immunostimulatory or immunosuppressive treatment (including amphet-amines or systemic corticosteroids) within 90 days Exclusively unilateral parkinsonism for longer than 3 years Known hypersensitivity to GM-CSF, yeast-derived products Current lithium treatment Individuals with current diagnoses of alcohol or substance abuse/dependence Anyone who is not appropriate for participation in this research protocol as deemed by the principal or co-investigator Anyone who has previously been treated with GM-CSF as an immunomodulatory therapy Anyone with poor venous access Anyone who has any illnesses or events that would cause a neurological abnormality, apart from Parkinson's disease. Subjects with allergies or sensitivities to yeast products. Subjects that have received a flu shot within the past 3 weeks.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Katherine E Olson, PhD
Phone
402-559-2547
Email
katherine.olson@unmc.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Lee Mosley, PhD
Phone
402-559-2510
Email
rlmosley@unmc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Howard E Gendelman, MD
Organizational Affiliation
University of Nebraska
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Nebraska Medical Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Katherine E Olson
Phone
402-559-2547
Email
katherine.olson@unmc.edu

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
No plan to share IPD with other researchers.
Citations:
PubMed Identifier
34000620
Citation
Olson KE, Namminga KL, Lu Y, Schwab AD, Thurston MJ, Abdelmoaty MM, Kumar V, Wojtkiewicz M, Obaro H, Santamaria P, Mosley RL, Gendelman HE. Safety, tolerability, and immune-biomarker profiling for year-long sargramostim treatment of Parkinson's disease. EBioMedicine. 2021 May;67:103380. doi: 10.1016/j.ebiom.2021.103380. Epub 2021 May 14.
Results Reference
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PubMed Identifier
35802825
Citation
Abdelmoaty MM, Machhi J, Yeapuri P, Shahjin F, Kumar V, Olson KE, Mosley RL, Gendelman HE. Monocyte biomarkers define sargramostim treatment outcomes for Parkinson's disease. Clin Transl Med. 2022 Jul;12(7):e958. doi: 10.1002/ctm2.958.
Results Reference
background
PubMed Identifier
28649610
Citation
Gendelman HE, Zhang Y, Santamaria P, Olson KE, Schutt CR, Bhatti D, Shetty BLD, Lu Y, Estes KA, Standaert DG, Heinrichs-Graham E, Larson L, Meza JL, Follett M, Forsberg E, Siuzdak G, Wilson TW, Peterson C, Mosley RL. Evaluation of the safety and immunomodulatory effects of sargramostim in a randomized, double-blind phase 1 clinical Parkinson's disease trial. NPJ Parkinsons Dis. 2017 Mar 23;3:10. doi: 10.1038/s41531-017-0013-5. eCollection 2017.
Results Reference
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Biomarker Validation Following Sargramostim Treatment in Parkinson's Disease

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