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The Safety and Tolerability Study With ER2001 Intravenous Injection in Adults With Early Manifest Huntington's Disease

Primary Purpose

Huntington Disease

Status
Recruiting
Phase
Early Phase 1
Locations
China
Study Type
Interventional
Intervention
ER2001 injection
Sponsored by
ExoRNA Bioscience
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Huntington Disease

Eligibility Criteria

25 Years - 55 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patient has documented ability to understand the written study informed consent forms (ICFs) at the time of screening and has provided signed written informed consent prior to any study procedures. 25 Years to 55 Years. Gender is not limited. Early manifest HD as defined by a UHDRS total functional capacity (TFC) score of 9 to 13 and a diagnostic classification level (DCL) of 4. HTT gene expansion testing with the presence of ≥40 CAG repeats. Ability to undergo and tolerate MRI scans. Ability to undergo and tolerate lumbar puncture. All HD medications given for motor, behavioral, and cognitive symptoms have been stable for 3 months prior to Screening. Other concomitant medications have been stable for 1 month prior to Screening. organ function measured prior to administration of study treatment. Postmenopausal or evidence of non-childbearing status for women of childbearing potential. Male patients must use a condom during treatment and for 6 months after the last dose of ER2001 when having sexual intercourse with a pregnant woman or with a woman of childbearing potential. Female partners of male patients should also use a highly effective form of contraception if they are of childbearing potential. Exclusion Criteria: History of attempted suicide or suicidal ideation with plan (i.e., active suicidal ideation) that required hospital visit and/or change in level of care within 12 months prior to screening. Current active psychosis, confusional state, or violent behavior. Bleeding tendency or history of coagulation disorder; As long as the investigator confirms that there is no evidence of bleeding tendency or coagulation dysfunction at present. ECG with corrected QT interval (QTc) > 480 ms and/or indication of uncontrolled cardiac conditions, as judged by the investigator (e.g. unstable ischemia, uncontrolled ventricular arrhythmia, recent (within 3 months) myocardial infarction,congestive heart failure, electrolyte disturbances, etc.) Patients with HIV, Treponema pallidum, Hepatitis B, or Hepatitis C infection. Need to take antiretroviral drugs, including antiretroviral drugs as preventive treatment. Current or recurrent disease, infection, or other significant concurrent medical condition or medications that could confound clinical and laboratory evaluations or could affect a subject's safety or their ability to undergo the neurosurgical procedure or comply with the procedures and study visit schedule. Clinical diagnosis of chronic migraines. Presence of an implanted deep brain stimulation device, ventriculoperitoneal or other CSF shunt, or other implanted catheter. Preexisting structural brain lesions (such as tumor, arteriovenous malformation) as assessed by a centrally read MRI scan during the screening period. Any history of gene therapy, RNA or DNA investigational agents, such as antisense oligonucleotides (ASO), cell transplantation or any other experimental brain surgery. Treatment with investigational therapy within 4 weeks prior to screening or 5 drug elimination half-lives of investigational therapy, whichever is longer. Unable or unsafe to perform lumbar puncture on the patient. In the Investigator's judgment, that Parkinson's disease, multiple system atrophy and other dystonia diseases may be combined. Patients who are hypersensitive to any ingredients in the formulation of ER2001. Malignancy within 5 years of screening, except for basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated. Concurrent or planned concurrent participation in any interventional clinical study, including explicit pharmacological and non-pharmacological interventions. Observational studies are acceptable. Any serious medical condition or clinically significant laboratory, vital signs, or abnormalities at screening that, in the Investigator's judgment, precludes the patient's safe participation in and completion of the study.

Sites / Locations

  • First Affiliated Hospital of Guangzhou Medical UniversityRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ER2001 Injection

Arm Description

The minimum initial dose is 0.04mg/kg, then escalate to 0.08mg/kg, 0.16mg/kg and 0.32mg/kg. The planned duration of the treatment is 14 weeks, and ER2001 will be administrated intravenously at the first day of weeks 1, 3, 4, 5, 6, 7, 8, and 14.

Outcomes

Primary Outcome Measures

Incidence and Severity of adverse events (AEs) and serious adverse events (SAEs)
To evaluate the safety and tolerability of ER2001 injection.

Secondary Outcome Measures

Peak Plasma Concentration (Cmax)
To assess the Pharmacokinetics (PK) of ER2001 injection.
Terminal half-life (t1/2)
To assess the Pharmacokinetics (PK) of ER2001 injection.
Area under the plasma concentration versus time curve from time 0 to the last quantifiable concentration (AUC0-t)
To assess the Pharmacokinetics (PK) of ER2001 injection.
Maximum concentration (Cmax) in cerebrospinal fluid (CSF)
To assess the Pharmacokinetics (PK) of ER2001 injection.

Full Information

First Posted
May 25, 2023
Last Updated
August 29, 2023
Sponsor
ExoRNA Bioscience
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1. Study Identification

Unique Protocol Identification Number
NCT06024265
Brief Title
The Safety and Tolerability Study With ER2001 Intravenous Injection in Adults With Early Manifest Huntington's Disease
Official Title
An Open-Label, Dose Escalation Early Phase 1 Study of ER2001 Intravenous Injection in Adults With Early Manifest Huntington's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 4, 2023 (Actual)
Primary Completion Date
October 4, 2024 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ExoRNA Bioscience

4. Oversight

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

5. Study Description

Brief Summary
This is an open label, dose escalation clinic trial of ER2001 intravenous injection to evaluate safety, tolerability and pharmacokinetics of ascending single and multiple doses of intravenously administered ER2001 in patients with early manifest Huntington's Disease. Furthermore, pharmacodynamics in particular target engagement, and early clinical signs of efficacy will be assessed. This study will evaluate increasing doses of ER2001 in sequential cohorts. ER2001 was escalated over 4 dose levels . The planned duration of this treatment is 14 weeks.
Detailed Description
Participants will receive totally 8 intravenous injections of ER2001 on the first day of the study, after 2 weeks they will receive 6 injections at weekly intervals, followed by 1 injections at 6 weeks interval. The treatment period of 14 weeks will be followed by an observation phase of 84 days . A modified 3 plus 3 dose-escalation design will be employed with escalating rules set according to the incidence of dose-limiting toxicity (DLT). The first cohort of 1-6 participants will receive a low dose. After safety analysis the next cohort of 3-6 will received a higher dose. Planned doses for increase in subsequent cohorts are 0.04, 0.08, 0.16, and 0.32 mg/kg. Decision to proceed to the next higher dose cohort will be based upon a safety review of the included participants. Treatment will continue until intolerable toxicity or as per patient preference.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Huntington Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Model Description
As designed, the single group will be divided into four cohorts. The first cohort of 1-6 participants will receive an initial dose, followed by a safety review of the included participants. If the safety is confirmed and decision made to proceed to the next higher dose, the next cohort of 3-6 participants will receive a higher dose. The planned increasing doses are 0.04, 0.08, 0.16, and 0.32 mg/kg, respectively in subsequent.
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ER2001 Injection
Arm Type
Experimental
Arm Description
The minimum initial dose is 0.04mg/kg, then escalate to 0.08mg/kg, 0.16mg/kg and 0.32mg/kg. The planned duration of the treatment is 14 weeks, and ER2001 will be administrated intravenously at the first day of weeks 1, 3, 4, 5, 6, 7, 8, and 14.
Intervention Type
Drug
Intervention Name(s)
ER2001 injection
Other Intervention Name(s)
ER2001 intravenous injection solution
Intervention Description
The minimum initial dose is 0.04mg/kg, then escalate to 0.08mg/kg, 0.16mg/kg and 0.32mg/kg. The planned duration of the treatment is 14 weeks, and ER2001 will be administrated intravenously at the first day of weeks 1, 3, 4, 5, 6, 7, 8, and 14.
Primary Outcome Measure Information:
Title
Incidence and Severity of adverse events (AEs) and serious adverse events (SAEs)
Description
To evaluate the safety and tolerability of ER2001 injection.
Time Frame
Approximately 6.5 months
Secondary Outcome Measure Information:
Title
Peak Plasma Concentration (Cmax)
Description
To assess the Pharmacokinetics (PK) of ER2001 injection.
Time Frame
Approximately 3.5 months
Title
Terminal half-life (t1/2)
Description
To assess the Pharmacokinetics (PK) of ER2001 injection.
Time Frame
Approximately 3.5 months
Title
Area under the plasma concentration versus time curve from time 0 to the last quantifiable concentration (AUC0-t)
Description
To assess the Pharmacokinetics (PK) of ER2001 injection.
Time Frame
Approximately 3.5 months
Title
Maximum concentration (Cmax) in cerebrospinal fluid (CSF)
Description
To assess the Pharmacokinetics (PK) of ER2001 injection.
Time Frame
Approximately 3.5 months
Other Pre-specified Outcome Measures:
Title
Immunogenicity
Description
To collect the incidence of Anti-Drug Antibodies (ADAs).
Time Frame
approximately- 6.5 months
Title
Change from baseline in the concentration of mutant huntingtin (mHTT) protein in cerebrospinal fluid (CSF)
Description
To assess the dose-response relationship of ER2001 injection on mHTT protein change from baseline in cerebrospinal fluid (CSF).
Time Frame
approximately- 6.5 months
Title
Change from baseline in Unified Huntington's Disease Rating Scale (UHDRS) Total Functional Capacity (TFC) score
Description
UHDRS is a research tool developed by Huntington Disease (HD) Study Group to provide a uniform assessment of the clinical features and course of HD. The UHDRS TFC comprises 5 functional domains associated with disability (occupation, finances, domestic chores, activities of daily living, and care level), with scores on each item ranging from 0 to either 2 or 3. The TFC total score is the sum of the 5 TFC items and can range from 0 to 13, with greater scores indicating higher functioning. Negative change from baseline indicates worsening.
Time Frame
approximately- 6.5 months
Title
Change from baseline in Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score (TMS) score
Description
UHDRS is a research tool developed by Huntington Disease (HD) Study Group to provide a uniform assessment of the clinical features and course of HD. The UHDRS TMS assesses all the motor features of HD and includes maximal chorea, maximal dystonia, ocular pursuit, saccade initiation and velocity, dysarthria, tongue protrusion, finger tapping, hand pronation and supination, luria, rigidity, bradykinesia, gait, tandem walking, and retropulsion pull test. Each of these was rated on a scale of 0 (normal motor function) to 4 (severely impaired motor function). TMS score is a sum of individual scores ranging from 0 (normal motor function) to 124 (severely impaired motor function). Lower TMS scores indicate better motor function.
Time Frame
approximately- 6.5 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient has documented ability to understand the written study informed consent forms (ICFs) at the time of screening and has provided signed written informed consent prior to any study procedures. 25 Years to 55 Years. Gender is not limited. Early manifest HD as defined by a UHDRS total functional capacity (TFC) score of 9 to 13 and a diagnostic classification level (DCL) of 4. HTT gene expansion testing with the presence of ≥40 CAG repeats. Ability to undergo and tolerate MRI scans. Ability to undergo and tolerate lumbar puncture. All HD medications given for motor, behavioral, and cognitive symptoms have been stable for 3 months prior to Screening. Other concomitant medications have been stable for 1 month prior to Screening. organ function measured prior to administration of study treatment. Postmenopausal or evidence of non-childbearing status for women of childbearing potential. Male patients must use a condom during treatment and for 6 months after the last dose of ER2001 when having sexual intercourse with a pregnant woman or with a woman of childbearing potential. Female partners of male patients should also use a highly effective form of contraception if they are of childbearing potential. Exclusion Criteria: History of attempted suicide or suicidal ideation with plan (i.e., active suicidal ideation) that required hospital visit and/or change in level of care within 12 months prior to screening. Current active psychosis, confusional state, or violent behavior. Bleeding tendency or history of coagulation disorder; As long as the investigator confirms that there is no evidence of bleeding tendency or coagulation dysfunction at present. ECG with corrected QT interval (QTc) > 480 ms and/or indication of uncontrolled cardiac conditions, as judged by the investigator (e.g. unstable ischemia, uncontrolled ventricular arrhythmia, recent (within 3 months) myocardial infarction,congestive heart failure, electrolyte disturbances, etc.) Patients with HIV, Treponema pallidum, Hepatitis B, or Hepatitis C infection. Need to take antiretroviral drugs, including antiretroviral drugs as preventive treatment. Current or recurrent disease, infection, or other significant concurrent medical condition or medications that could confound clinical and laboratory evaluations or could affect a subject's safety or their ability to undergo the neurosurgical procedure or comply with the procedures and study visit schedule. Clinical diagnosis of chronic migraines. Presence of an implanted deep brain stimulation device, ventriculoperitoneal or other CSF shunt, or other implanted catheter. Preexisting structural brain lesions (such as tumor, arteriovenous malformation) as assessed by a centrally read MRI scan during the screening period. Any history of gene therapy, RNA or DNA investigational agents, such as antisense oligonucleotides (ASO), cell transplantation or any other experimental brain surgery. Treatment with investigational therapy within 4 weeks prior to screening or 5 drug elimination half-lives of investigational therapy, whichever is longer. Unable or unsafe to perform lumbar puncture on the patient. In the Investigator's judgment, that Parkinson's disease, multiple system atrophy and other dystonia diseases may be combined. Patients who are hypersensitive to any ingredients in the formulation of ER2001. Malignancy within 5 years of screening, except for basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated. Concurrent or planned concurrent participation in any interventional clinical study, including explicit pharmacological and non-pharmacological interventions. Observational studies are acceptable. Any serious medical condition or clinically significant laboratory, vital signs, or abnormalities at screening that, in the Investigator's judgment, precludes the patient's safe participation in and completion of the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Li Lin, Ph.D
Phone
+86-13816957902
Email
li.lin@exornabio.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Xia Meng, Ph.D
Organizational Affiliation
ExoRNA Bioscience
Official's Role
Study Chair
Facility Information:
Facility Name
First Affiliated Hospital of Guangzhou Medical University
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510080
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
xiang chen, Ph.D
Phone
+86-15602398386
Email
wuliancx@163.com
First Name & Middle Initial & Last Name & Degree
pingyi xu, Ph.D

12. IPD Sharing Statement

Citations:
PubMed Identifier
34918046
Citation
Zhang L, Wu T, Shan Y, Li G, Ni X, Chen X, Hu X, Lin L, Li Y, Guan Y, Gao J, Chen D, Zhang Y, Pei Z, Chen X. Therapeutic reversal of Huntington's disease by in vivo self-assembled siRNAs. Brain. 2021 Dec 16;144(11):3421-3435. doi: 10.1093/brain/awab354.
Results Reference
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The Safety and Tolerability Study With ER2001 Intravenous Injection in Adults With Early Manifest Huntington's Disease

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