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Gene Transfer Clinical Trial for Infantile and Late Infantile Krabbe Disease Treated in the Past With HSCT (REKLAIM)

Primary Purpose

Krabbe Disease

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
FBX-101
Sponsored by
Forge Biologics, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Krabbe Disease focused on measuring Leukodystrophy, Globoid Cell, Hereditary Central Nervous System Demyelinating Diseases, Brain Diseases, Metabolic, Inborn, Brain Diseases, Metabolic, Brain Diseases, Central Nervous System Diseases, Nervous System Diseases, Sphingolipidoses, Lysosomal Storage Diseases, Nervous System, Leukoencephalopathies, Demyelinating Diseases, Metabolism, Inborn Errors, Genetic Diseases, Inborn, Lipidoses, Lipid Metabolism, Inborn Errors, Lysosomal Storage Diseases, Metabolic Diseases, Lipid Metabolism Disorders

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Group 1: Subjects transplanted for infantile onset Krabbe disease (IKD onset <12 months) with initial diagnosis based on: Galactocerebrosidase (GALC) activity levels in leukocytes compatible with the diagnosis of infantile Krabbe disease; AND AT LEAST ONE OF THE FOLLOWING: Elevated psychosine levels predictive of infantile onset by dried blood spot (DBS); OR Imaging or neurophysiological findings consistent with Krabbe disease (CSF, MRI, NCV, ABR); OR Two GALC mutations predictive to result in infantile onset phenotype. Group 2: Subjects transplanted for late infantile onset Krabbe (LIKD onset 12-47 months) with signs or symptoms of Krabbe disease, and with initial diagnosis based on: Galactocerebrosidase (GALC) activity levels in leukocytes compatible with the diagnosis of late infantile Krabbe disease; AND AT LEAST ONE OF THE FOLLOWING: Elevated psychosine levels predictive of late infantile onset by DBS; OR Imaging or neurophysiological findings consistent with Krabbe disease (CSF, MRI, NCV, ABR); OR Two GALC mutations predictive to result in late infantile onset phenotype; OR Neurological/developmental exam findings consistent with late infantile Krabbe disease Participants must have received HSCT at least 90 days prior to dosing date Chimerism should reflect at least 30% of myeloid cells from the donor by month 3 post-transplant or 10% by one-year post-transplant that result in GALC leukocyte levels > or equal to 0.2 nmol/h/mg. Participant's parents or legal guardian consent to participate in the study and provide informed consent according to IRB/IEC guidelines prior to any study procedures being performed Parent(s) and/or legal guardian able to comply with the clinical protocol Exclusion Criteria: Immunoassay with total anti-AAVrh10 antibody titers of >1:100 History of prior treatment with a gene therapy product Inability to actively move upper extremities against gravity Grade 2 or higher abnormalities in LFTs, bilirubin, creatinine, white count, hemoglobin, platelets, PT/INR and PTT according to latest version of CTCAE Presence of any neurocognitive deficit, motor deficit, or brain damage not attributable to Krabbe disease Signs of active infections or disease from cytomegalovirus, adenovirus, EBV, hepatitis B or C, and HIV or other viruses excluding rhinovirus from RVP and asymptomatic norovirus presence in stool Active bacterial or fungal infection documented in the preceding 7 days Presence of any contraindication for MRI or lumbar puncture (LP) Use of any investigational product prior to study enrollment or current enrollment in another study that involves clinical interventions Immunizations with live viruses in the 30 days prior to immune suppression Ejection fraction of <50% by echocardiogram or other appropriate study without evidence of pulmonary hypertension Active acute Graft Versus Host Disease (GvHD) Grade II or higher according to modified Glucksberg criteria (Przepiorka et al., 1995) or active, moderate, or severe, chronic GvHD according to revised NIH criteria (Jagasia et al., 2015) Any other medical condition, serious intercurrent illness, other genetic condition or extenuating circumstance that, in the opinion of the PI, would preclude participation in the study

Sites / Locations

  • Children's Hospital of Orange County (CHOC)Recruiting
  • University of Michigan Hospitals - Michigan Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Cohort 1 - Low Dose FBX-101 (aka AAVrh.10-GALC)

Cohort 2 - High Dose FBX-101 (aka AAVrh.10-GALC)

Arm Description

Group 1: N=3 patients with Infantile Krabbe disease with previous HSCT will receive a single infusion at the low dose Group 2: N=3 patients with Late Infantile Krabbe disease with previous HSCT will receive a single infusion at the low dose

Group 1: N=3 patients with Infantile Krabbe disease with previous HSCT will receive a single infusion at the high dose Group 2: N=3 patients with Late Infantile Krabbe disease with previous HSCT will receive a single infusion at the high dose

Outcomes

Primary Outcome Measures

Safety as assessed by incidence and severity of adverse events and serious adverse events that are attributed to FBX-101

Secondary Outcome Measures

Efficacy as assessed by improvement of gross motor function as measured longitudinally by Gross Motor Function Measure 88 (GMFM-88) compared to untreated patients or those receiving HSCT only

Full Information

First Posted
February 13, 2023
Last Updated
August 24, 2023
Sponsor
Forge Biologics, Inc
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1. Study Identification

Unique Protocol Identification Number
NCT05739643
Brief Title
Gene Transfer Clinical Trial for Infantile and Late Infantile Krabbe Disease Treated in the Past With HSCT
Acronym
REKLAIM
Official Title
A Phase 1b Clinical Study of Intravenous AAVrh10 Vector Expressing GALC in Krabbe Subjects Who Previously Received Hematopoietic Stem Cell Transplantation (REKLAIM)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 3, 2023 (Actual)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Forge Biologics, Inc

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
This is a non-blinded, non-randomized dose escalation study of intravenous FBX-101 in which subjects who have previously received hematopoietic stem cell transplant will receive a single infusion of an adeno-associated virus gene therapy product. Data from untreated and previously transplanted patients with infantile and late infantile Krabbe disease will be used as a comparator group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Krabbe Disease
Keywords
Leukodystrophy, Globoid Cell, Hereditary Central Nervous System Demyelinating Diseases, Brain Diseases, Metabolic, Inborn, Brain Diseases, Metabolic, Brain Diseases, Central Nervous System Diseases, Nervous System Diseases, Sphingolipidoses, Lysosomal Storage Diseases, Nervous System, Leukoencephalopathies, Demyelinating Diseases, Metabolism, Inborn Errors, Genetic Diseases, Inborn, Lipidoses, Lipid Metabolism, Inborn Errors, Lysosomal Storage Diseases, Metabolic Diseases, Lipid Metabolism Disorders

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Dose escalation study from a low dose to a high dose following safety review
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1 - Low Dose FBX-101 (aka AAVrh.10-GALC)
Arm Type
Experimental
Arm Description
Group 1: N=3 patients with Infantile Krabbe disease with previous HSCT will receive a single infusion at the low dose Group 2: N=3 patients with Late Infantile Krabbe disease with previous HSCT will receive a single infusion at the low dose
Arm Title
Cohort 2 - High Dose FBX-101 (aka AAVrh.10-GALC)
Arm Type
Experimental
Arm Description
Group 1: N=3 patients with Infantile Krabbe disease with previous HSCT will receive a single infusion at the high dose Group 2: N=3 patients with Late Infantile Krabbe disease with previous HSCT will receive a single infusion at the high dose
Intervention Type
Biological
Intervention Name(s)
FBX-101
Other Intervention Name(s)
AAVrh.10-hGALC
Intervention Description
A replication-deficient adeno-associated virus gene transfer vector expressing the human galactocerebrosidase (GALC) cDNA will be delivered one-time through a venous catheter inserted into a peripheral limb vein.
Primary Outcome Measure Information:
Title
Safety as assessed by incidence and severity of adverse events and serious adverse events that are attributed to FBX-101
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Efficacy as assessed by improvement of gross motor function as measured longitudinally by Gross Motor Function Measure 88 (GMFM-88) compared to untreated patients or those receiving HSCT only
Time Frame
12 months and 24 months

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Group 1: Subjects transplanted for infantile onset Krabbe disease (IKD onset <12 months) with initial diagnosis based on: Galactocerebrosidase (GALC) activity levels in leukocytes compatible with the diagnosis of infantile Krabbe disease; AND AT LEAST ONE OF THE FOLLOWING: Elevated psychosine levels predictive of infantile onset by dried blood spot (DBS); OR Imaging or neurophysiological findings consistent with Krabbe disease (CSF, MRI, NCV, ABR); OR Two GALC mutations predictive to result in infantile onset phenotype. Group 2: Subjects transplanted for late infantile onset Krabbe (LIKD onset 12-47 months) with signs or symptoms of Krabbe disease, and with initial diagnosis based on: Galactocerebrosidase (GALC) activity levels in leukocytes compatible with the diagnosis of late infantile Krabbe disease; AND AT LEAST ONE OF THE FOLLOWING: Elevated psychosine levels predictive of late infantile onset by DBS; OR Imaging or neurophysiological findings consistent with Krabbe disease (CSF, MRI, NCV, ABR); OR Two GALC mutations predictive to result in late infantile onset phenotype; OR Neurological/developmental exam findings consistent with late infantile Krabbe disease Participants must have received HSCT at least 90 days prior to dosing date Chimerism should reflect at least 30% of myeloid cells from the donor by month 3 post-transplant or 10% by one-year post-transplant that result in GALC leukocyte levels > or equal to 0.2 nmol/h/mg. Participant's parents or legal guardian consent to participate in the study and provide informed consent according to IRB/IEC guidelines prior to any study procedures being performed Parent(s) and/or legal guardian able to comply with the clinical protocol Exclusion Criteria: Immunoassay with total anti-AAVrh10 antibody titers of >1:100 History of prior treatment with a gene therapy product Inability to actively move upper extremities against gravity Grade 2 or higher abnormalities in LFTs, bilirubin, creatinine, white count, hemoglobin, platelets, PT/INR and PTT according to latest version of CTCAE Presence of any neurocognitive deficit, motor deficit, or brain damage not attributable to Krabbe disease Signs of active infections or disease from cytomegalovirus, adenovirus, EBV, hepatitis B or C, and HIV or other viruses excluding rhinovirus from RVP and asymptomatic norovirus presence in stool Active bacterial or fungal infection documented in the preceding 7 days Presence of any contraindication for MRI or lumbar puncture (LP) Use of any investigational product prior to study enrollment or current enrollment in another study that involves clinical interventions Immunizations with live viruses in the 30 days prior to immune suppression Ejection fraction of <50% by echocardiogram or other appropriate study without evidence of pulmonary hypertension Active acute Graft Versus Host Disease (GvHD) Grade II or higher according to modified Glucksberg criteria (Przepiorka et al., 1995) or active, moderate, or severe, chronic GvHD according to revised NIH criteria (Jagasia et al., 2015) Any other medical condition, serious intercurrent illness, other genetic condition or extenuating circumstance that, in the opinion of the PI, would preclude participation in the study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Michelle Salvo
Phone
380-239-2013
Email
advocacy@forgebiologics.com
Facility Information:
Facility Name
Children's Hospital of Orange County (CHOC)
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nina Movsesyan, PhD
Phone
714-509-3008
Email
nmovsesyan@choc.org
First Name & Middle Initial & Last Name & Degree
Raymond Wang, MD
Email
rawang@choc.org
First Name & Middle Initial & Last Name & Degree
Raymond Wang, MD
Facility Name
University of Michigan Hospitals - Michigan Medicine
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States
Individual Site Status
Active, not recruiting

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30089515
Citation
Bascou N, DeRenzo A, Poe MD, Escolar ML. A prospective natural history study of Krabbe disease in a patient cohort with onset between 6 months and 3 years of life. Orphanet J Rare Dis. 2018 Aug 9;13(1):126. doi: 10.1186/s13023-018-0872-9.
Results Reference
background
PubMed Identifier
30777126
Citation
Beltran-Quintero ML, Bascou NA, Poe MD, Wenger DA, Saavedra-Matiz CA, Nichols MJ, Escolar ML. Early progression of Krabbe disease in patients with symptom onset between 0 and 5 months. Orphanet J Rare Dis. 2019 Feb 18;14(1):46. doi: 10.1186/s13023-019-1018-4.
Results Reference
background
PubMed Identifier
15901860
Citation
Escolar ML, Poe MD, Provenzale JM, Richards KC, Allison J, Wood S, Wenger DA, Pietryga D, Wall D, Champagne M, Morse R, Krivit W, Kurtzberg J. Transplantation of umbilical-cord blood in babies with infantile Krabbe's disease. N Engl J Med. 2005 May 19;352(20):2069-81. doi: 10.1056/NEJMoa042604.
Results Reference
background
PubMed Identifier
27638597
Citation
Escolar ML, West T, Dallavecchia A, Poe MD, LaPoint K. Clinical management of Krabbe disease. J Neurosci Res. 2016 Nov;94(11):1118-25. doi: 10.1002/jnr.23891.
Results Reference
background
PubMed Identifier
32363154
Citation
Rafi MA, Luzi P, Wenger DA. Conditions for combining gene therapy with bone marrow transplantation in murine Krabbe disease. Bioimpacts. 2020;10(2):105-115. doi: 10.34172/bi.2020.13. Epub 2020 Mar 24.
Results Reference
background
PubMed Identifier
33150395
Citation
Yoon IC, Bascou NA, Poe MD, Szabolcs P, Escolar ML. Long-term neurodevelopmental outcomes of hematopoietic stem cell transplantation for late-infantile Krabbe disease. Blood. 2021 Apr 1;137(13):1719-1730. doi: 10.1182/blood.2020005477.
Results Reference
background
PubMed Identifier
28855403
Citation
Wright MD, Poe MD, DeRenzo A, Haldal S, Escolar ML. Developmental outcomes of cord blood transplantation for Krabbe disease: A 15-year study. Neurology. 2017 Sep 26;89(13):1365-1372. doi: 10.1212/WNL.0000000000004418. Epub 2017 Aug 30.
Results Reference
background
PubMed Identifier
25844309
Citation
Gupta A, Poe MD, Styner MA, Panigrahy A, Escolar ML. Regional differences in fiber tractography predict neurodevelopmental outcomes in neonates with infantile Krabbe disease. Neuroimage Clin. 2014 Sep 26;7:792-8. doi: 10.1016/j.nicl.2014.09.014. eCollection 2015.
Results Reference
background
PubMed Identifier
19386732
Citation
Escolar ML, Poe MD, Smith JK, Gilmore JH, Kurtzberg J, Lin W, Styner M. Diffusion tensor imaging detects abnormalities in the corticospinal tracts of neonates with infantile Krabbe disease. AJNR Am J Neuroradiol. 2009 May;30(5):1017-21. doi: 10.3174/ajnr.A1476. Epub 2009 Apr 22.
Results Reference
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Gene Transfer Clinical Trial for Infantile and Late Infantile Krabbe Disease Treated in the Past With HSCT

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