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Central Nervous System Uptake of Anti-CD8+ T Cell Minibodies in Multiple Sclerosis and Progressive Multifocal Leukoencephalopathy

Primary Purpose

Multiple Sclerosis, Progressive Multifocal Leukoencephalopathy

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
89 Zr-Df-crefmirlimab
Sponsored by
National Institute of Neurological Disorders and Stroke (NINDS)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring 89 Zr-Df-crefmirlimab, PET Imaging

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: In order to be eligible to participate in this study, an individual must meet all of the following criteria: Multiple Sclerosis Inclusion Criteria Enrolled in the NINDS Natural History Study for MS (protocol 89-N-0045) Able to understand, and willing to sign, a written, informed consent document. Willing to comply with all study procedures and available for the duration of the study. Male or female, aged >=18. Diagnosis of MS according to the 2017 revision of the McDonald diagnostic criteria48 (in the presence or absence of a clinical relapse). For females of reproductive potential: agrees to use highly effective contraception for at least one month prior to screening and during study participation. PML Inclusion Criteria Enrolled in the NINDS Natural History Study for PML (protocol 13-N-0017) Able to understand and willing to sign a written, informed consent document Willing to comply with all study procedures and available for the duration of the study. Male or female, aged >=18. Diagnosis of definite PML according to 2013 AAN Consensus Criteria49 or PML-IRIS based on clinical, radiological and laboratory evidence. For females of reproductive potential: agrees to use highly effective contraception for at least one month prior to screening and during study participation. EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from participation in this study: Pregnant or lactating. Contraindications for MRI gadolinium contrast administration or 3T MRI. History of, or current diagnosis with, concomitant medical or clinical conditions that would adversely affect participation in this study. Weighs > 350 lb (158 kg; weight limit for the scanner table) or is unable to fit within the MRI or PET imaging gantry. Severe claustrophobia unresponsive to oral anxiolytics.

Sites / Locations

  • National Institutes of Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Multiple Sclerosis

Progressive Multifocal Leukoencephalopathy

Arm Description

MS cohort- Three study visits. (1) Baseline; (2) Day 0: MRI brain/spinal cord (with gadolinium) followed by an intravenous injection of anti-CD8 minibody (aka"PET/CT tracer"); (3) Day 1: PET/CT scan

PML cohort- Up to five study visits. (1) Baseline; (2) Day 0: MRI brain (with gadolinium) followed by an intravenous injection of anti-CD8 minibody (aka "PET/CT tracer"); (3) Day 1: PET/CT scan; (4) Study visit 4 (optional; time-period between study visit 3 and 4 is variable): MRI brain (with gadolinium) followed by an intravenous injection of anti-CD8 minibody (aka "PET/CT tracer") following clinical, radiological and/or laboratory-defined immune reconstitution (spontaneous or facilitated); (5) Study visit 5: PET/ CT scan

Outcomes

Primary Outcome Measures

Infiltration of CD8+ T cells in the CNS of adults with MS and PML via PET-CT scans using a minibody with high affinity for CD8+ T cells.
To detect and localize infiltration of CD8+ T cells in the CNS of adults with MS and PML via PET-CT scans using a minibody with high affinity for CD8+ T cells.

Secondary Outcome Measures

Safety of 89Zr-Dfcrefmirlimab in the participants with CNS disease.
To assess the safety of 89Zr-Dfcrefmirlimab in participants with CNS disease.
For the PML cohort with longitudinal evaluation, effects of immune reconstitution, either spontaneous or facilitated, on 89Zr-Dfcrefmirlimab uptake.
Comparison of SUV before and after immune reconstitution, either spontaneous or facilitated (for participants with optional follow-up imaging).

Full Information

First Posted
May 8, 2023
Last Updated
October 21, 2023
Sponsor
National Institute of Neurological Disorders and Stroke (NINDS)
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1. Study Identification

Unique Protocol Identification Number
NCT05849467
Brief Title
Central Nervous System Uptake of Anti-CD8+ T Cell Minibodies in Multiple Sclerosis and Progressive Multifocal Leukoencephalopathy
Official Title
Central Nervous System Uptake of Anti-CD8+ T Cell Minibodies in Multiple Sclerosis and Progressive Multifocal Leukoencephalopathy: A Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
October 17, 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 19, 2023 (Actual)
Primary Completion Date
June 30, 2024 (Anticipated)
Study Completion Date
June 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Neurological Disorders and Stroke (NINDS)

4. Oversight

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

5. Study Description

Brief Summary
Background: Multiple sclerosis (MS) and progressive multifocal leukoencephalopathy (PML) are disorders that affect the central nervous system (CNS). The CNS includes the brain, spinal cord, and optic nerves. Both diseases can cause muscle weakness and impair vision, speech, and coordination. Researchers are working to better understand how MS and PML affect the CNS. Objective: To test whether an experimental radioactive tracer (minibody) can help positron emission tomography (PET) scans detect certain immune cells in the CNS of people with MS and PML. Eligibility: People aged 18 years and older with MS or PML. Design: Participants will come to the clinic for at least 3 visits over 4 to 6 weeks. Participants will undergo testing. They will have a physical and neurological exam. They will have blood tests and tests of their heart function. They will have a magnetic resonance imaging (MRI) scan of the brain. They may have a spinal tap: Their lower back will be numbed, and a needle will be inserted between the bones of the spine to withdraw fluid from around the spinal cord. Minibody is given through a tube with a needle placed in a vein in the arm. This takes 5 to 10 minutes. Participants will have heart function tests before and after receiving the minibody. Participants will return the next day for the PET scan. They will lie on a table that moves through a doughnut-shaped machine. This scan will take about 1 hour. Participants with PML may opt to repeat the minibody infusion and the PET scan within 6 months.
Detailed Description
Study Description: This study will obtain pilot data for noninvasive positron emission tomography (PET) imaging of CD8+ T lymphocytes in two inflammatory central nervous system (CNS) demyelinating diseases, multiple sclerosis (MS) and progressive multifocal leukoencephalopathy (PML), by characterizing CNS uptake of anti-CD8+ T cell antibody fragment (aka minibody ) (89Zr-Dfcrefmirlimab), an investigational, intravenous PET tracer. Objectives: Primary Objective: To detect and localize infiltration of CD8+ T cells in the CNS of adults with MS and PML via PET-CT (computed tomography) scans using a minibody with high affinity for CD8+ T cells. Secondary Objectives: (1) To characterize safety and tolerability of 89Zr-Df-crefmirlimab in the participant population. (2) For the PML cohort with longitudinal evaluation, to determine the effects of immune reconstitution, either spontaneous or facilitated, on 89Zr-Dfcrefmirlimab uptake. Endpoints: Primary Endpoints: Standardized uptake values (SUV) in different tissue types (lesions, white matter, gray matter, meninges, choroid plexus, as determined from coregistered MRI) in each cohort (MS or PML) by region-of-interest (ROI) analysis. Secondary Endpoints: (1) Frequency and nature of adverse events; (2) For the PML cohort with longitudinal evaluation, changes in SUV over time.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis, Progressive Multifocal Leukoencephalopathy
Keywords
89 Zr-Df-crefmirlimab, PET Imaging

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Multiple Sclerosis
Arm Type
Experimental
Arm Description
MS cohort- Three study visits. (1) Baseline; (2) Day 0: MRI brain/spinal cord (with gadolinium) followed by an intravenous injection of anti-CD8 minibody (aka"PET/CT tracer"); (3) Day 1: PET/CT scan
Arm Title
Progressive Multifocal Leukoencephalopathy
Arm Type
Experimental
Arm Description
PML cohort- Up to five study visits. (1) Baseline; (2) Day 0: MRI brain (with gadolinium) followed by an intravenous injection of anti-CD8 minibody (aka "PET/CT tracer"); (3) Day 1: PET/CT scan; (4) Study visit 4 (optional; time-period between study visit 3 and 4 is variable): MRI brain (with gadolinium) followed by an intravenous injection of anti-CD8 minibody (aka "PET/CT tracer") following clinical, radiological and/or laboratory-defined immune reconstitution (spontaneous or facilitated); (5) Study visit 5: PET/ CT scan
Intervention Type
Drug
Intervention Name(s)
89 Zr-Df-crefmirlimab
Intervention Description
an 80 kDa minibody (Mb) with high affinity to CD8 glycoprotein (binding EC50 = 0.4 nM) that is conjugated with deferoxamine (Df) and radiolabeled with the positron emitting radionuclide, Zr-89 (T1/2 78.4 hours).
Primary Outcome Measure Information:
Title
Infiltration of CD8+ T cells in the CNS of adults with MS and PML via PET-CT scans using a minibody with high affinity for CD8+ T cells.
Description
To detect and localize infiltration of CD8+ T cells in the CNS of adults with MS and PML via PET-CT scans using a minibody with high affinity for CD8+ T cells.
Time Frame
Day 1 Study Visit
Secondary Outcome Measure Information:
Title
Safety of 89Zr-Dfcrefmirlimab in the participants with CNS disease.
Description
To assess the safety of 89Zr-Dfcrefmirlimab in participants with CNS disease.
Time Frame
At each study visit
Title
For the PML cohort with longitudinal evaluation, effects of immune reconstitution, either spontaneous or facilitated, on 89Zr-Dfcrefmirlimab uptake.
Description
Comparison of SUV before and after immune reconstitution, either spontaneous or facilitated (for participants with optional follow-up imaging).
Time Frame
up to 6 months after first PET/CT scan

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: In order to be eligible to participate in this study, an individual must meet all of the following criteria: Multiple Sclerosis Inclusion Criteria Enrolled in the NINDS Natural History Study for MS (protocol 89-N-0045) Able to understand, and willing to sign, a written, informed consent document. Willing to comply with all study procedures and available for the duration of the study. Male or female, aged >=18. Diagnosis of MS according to the 2017 revision of the McDonald diagnostic criteria48 (in the presence or absence of a clinical relapse). For females of reproductive potential: agrees to use highly effective contraception for at least one month prior to screening and during study participation. PML Inclusion Criteria Enrolled in the NINDS Natural History Study for PML (protocol 13-N-0017) Able to understand and willing to sign a written, informed consent document Willing to comply with all study procedures and available for the duration of the study. Male or female, aged >=18. Diagnosis of definite PML according to 2013 AAN Consensus Criteria49 or PML-IRIS based on clinical, radiological and laboratory evidence. For females of reproductive potential: agrees to use highly effective contraception for at least one month prior to screening and during study participation. EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from participation in this study: Pregnant or lactating. Contraindications for MRI gadolinium contrast administration or 3T MRI. History of, or current diagnosis with, concomitant medical or clinical conditions that would adversely affect participation in this study. Weighs > 350 lb (158 kg; weight limit for the scanner table) or is unable to fit within the MRI or PET imaging gantry. Severe claustrophobia unresponsive to oral anxiolytics.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Maria I Gaitan, M.D.
Phone
(301) 496-1801
Email
maria.gaitan@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Daniel S Reich, M.D.
Phone
(301) 496-1801
Email
reichds@ninds.nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel S Reich, M.D.
Organizational Affiliation
National Institute of Neurological Disorders and Stroke (NINDS)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
NIH Clinical Center Office of Patient Recruitment (OPR)
Phone
800-411-1222
Ext
TTY dial 711
Email
ccopr@nih.gov

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_001519-N.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Central Nervous System Uptake of Anti-CD8+ T Cell Minibodies in Multiple Sclerosis and Progressive Multifocal Leukoencephalopathy

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