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Autologous Ex-vivo Gene Modified HSCT in MPSII

Primary Purpose

Mucopolysaccharidosis II

Status
Recruiting
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
Autologous CD34+ HSCs transduced ex vivo with CD11B LV encoding human IDS tagged with ApoEII
Sponsored by
University of Manchester
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mucopolysaccharidosis II

Eligibility Criteria

3 Months - 12 Months (Child)MaleDoes not accept healthy volunteers

Inclusion Criteria: Written informed consent from a legally authorized guardian. Male, age at consent ≥3 months and ≤12 months. Normal cognitive function or mild cognitive dysfunction (patient has a Development Quotient (DQ) score ≥70 at screening as determined by the Bayley Scale of Infant Development-third edition (BSID-III), cognitive domain), or assessed as normal or only mildly impaired by experienced neuropsychologist. Close male relative with known severe (progressive neuronopathic) phenotype of MPSII, or genotype associated with progressive neuronopathic phenotype. This is to be confirmed by the independent expert reviewers. IDS activity ≤10% of the Lower Limit of Normal as measured in leucocytes or plasma, plus either (1) a normal enzyme activity level of at least one other sulfatase (to rule out multiple sulfatase deficiency) as measured in leucocytes, or (2) a documented mutation in the IDS gene. Medically stable and able to accommodate the protocol requirements, including travel without placing an undue burden on the patient/patient's family, as determined by the CI. Patients and their parents/legal guardians must be willing and able to comply with study restrictions and to commit to attend clinic for the required duration during the study and follow-up period as specified in the protocol. Exclusion Criteria: The patient has previously received stem cell or gene therapy The patient has received modified intravenous ERT or intra-thecal ERT in a trial setting. Patient currently enrolled in another interventional clinical trial The patient has a history of poorly controlled seizures Hemizygous for mutation known to be associated with non-neuropathic phenotype The patient is currently receiving psychotropic or other medications which, in the CI's opinion, would be likely to substantially confound test results The patient has received any investigational medicinal product (including Genistein) within 30 days prior to the Baseline visit or is scheduled to receive any investigational medicinal product during the course of the study Documented Human Immunodeficiency Virus (HIV) infection (positive HIV RNA and/or anti-p24 antibodies) Malignant neoplasia (except local skin cancer) or a documented history of hereditary cancer syndrome. Patients with a prior successfully treated malignancy and a sufficient follow-up to exclude recurrence (based on oncologist opinion) can be included after discussion and approval by the Medical Monitor Myelodysplasia, cytogenetic alterations characteristic of myelodysplastic syndrome and acute myeloid leukaemia, or other serious haematological disorders The patient has a medical condition or extenuating circumstance that, in the opinion of the CI, might compromise the patient's ability to comply with protocol requirements, the patient's well-being or safety, or the interpretability of the patient's clinical data Visual or hearing impairment sufficient to preclude adequate neurodevelopmental testing Severe behavioural disturbances due to reasons other than MPS II and likely to interfere with protocol compliance, as determined by the CI Known sensitivity to Busulfan The receipt of live vaccinations within 30 days prior to treatment start Known sensitivity to DMSO

Sites / Locations

  • Manchester University Foundation TrustRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Autologous CD34+ HSCs transduced ex vivo with CD11B LV encoding human IDS tagged with ApoEII

Arm Description

Outcomes

Primary Outcome Measures

To evaluate the tolerability of the IMP in MPS II patients
Adverse events will be recorded and graded according to an adapted Paediatric Clinical Toxicity Scale from the National Institute Allergy and Infectious Diseases (NIAID), Autoimmuno-deficiency Syndrome (AIDS) Division
To assess the safety of the IMP in MPS II patients
Presence of replication competent virus and integration events in the leukocytes

Secondary Outcome Measures

Heparan sulphate in cerebrospinal fluid (CSF)
Heparan sulphate in plasma
Heparan sulphate in urine
Glycosaminoglycan (GAG) ratio in urine by dimethylmethylene blue [DMB]
IDS enzyme activity in plasma within or above normal range measured using an IDS enzyme activity assay
IDS enzyme activity in total leucocytes within or above normal range measured using an IDS enzyme activity assay
IDS enzyme activity in CSF within or above normal range measured using an IDS enzyme activity assay
VCN in total leucocyte and the bone marrow
Proportion of cells containing the inserted IDS.ApoEII gene in total bone marrow colony forming units (CFUs)
IDS enzyme activity in the bone marrow within or above normal range
Cognitive scores (standard scores, age-equivalent scores and development quotient) measured using the Bayley Scales of Infant Development, 3rd Edition (BSID-III) or Kaufman Assessment Battery for Children, 2nd Edition (KABC-II)
Adaptive behaviour (age-equivalent scores) measured using the Vineland Adaptive Behaviour Scales, 3rd Edition (VABS-III)

Full Information

First Posted
December 7, 2022
Last Updated
October 11, 2023
Sponsor
University of Manchester
Collaborators
AVROBIO, CTI Clinical Trial and Consulting Services, Great Ormond Street Hospital for Children NHS Foundation Trust, Manchester University NHS Foundation Trust
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1. Study Identification

Unique Protocol Identification Number
NCT05665166
Brief Title
Autologous Ex-vivo Gene Modified HSCT in MPSII
Official Title
A Phase I/II, Study of Autologous CD34+ Haematopoietic Stem Cells Transduced ex Vivo With CD11B Lentiviral Vector Encoding Human IDS Tagged With ApoEII in Patients With Neuronopathic Mucopolysaccharidosis Type II (nMPS II, Hunters Syndrome)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 1, 2023 (Actual)
Primary Completion Date
August 2026 (Anticipated)
Study Completion Date
December 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Manchester
Collaborators
AVROBIO, CTI Clinical Trial and Consulting Services, Great Ormond Street Hospital for Children NHS Foundation Trust, Manchester University NHS Foundation Trust

4. Oversight

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

5. Study Description

Brief Summary
Patients with MPS II have a clinical disorder marked by progressive brain disease, neurological and somatic symptoms due to the accumulation of undigested glycosaminoglycans in all cells of the body. This study will be the first in human clinical trial to explore the safety, tolerability and clinical efficacy of ex vivo gene therapy (autologous CD34+ cells transduced with a lentiviral vector containing the human IDS gene) in MPSII patients. Following treatment with the gene therapy patients will be followed up for a minimum of 2 years.
Detailed Description
Mucopolysaccharidosis type II (MPSII, Hunter Syndrome) is a rare paediatric X-linked lysosomal storage disease caused by a deficiency in iduronate-2-sulphatase (IDS), due to a mutation on the IDS gene. IDS is essential for the breakdown of glycosaminoglycans (GAGs), in particular, heparan sulphate (HS) and dermatan sulphate (DS). Currently, enzyme replacement therapy (ERT) is the only clinically approved treatment available for MPSII. However, ERT is a supportive therapy and is intended to alleviate symptoms and improve patient quality of life, rather than addressing the pathogenic mechanisms of the disease. To date, there is no effective disease-modifying treatment. This study aims to recruit 5 patients with MPS II who satisfy the inclusion and exclusion criteria and provide full consent, between 3 months and 12 months of age at screening. The investigational medicinal product (IMP) will be a cell-based gene therapy that uses genetically modified autologous CD34+ haematopoietic stem cells transduced with a lentiviral vector containing the human IDS gene tagged with ApoEII. Patients will be followed up for a minimum of 2 years after gene therapy.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Phase I-II prospective, single-centre, non-randomised, open label, safety and proof of concept study
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Autologous CD34+ HSCs transduced ex vivo with CD11B LV encoding human IDS tagged with ApoEII
Arm Type
Experimental
Intervention Type
Genetic
Intervention Name(s)
Autologous CD34+ HSCs transduced ex vivo with CD11B LV encoding human IDS tagged with ApoEII
Intervention Description
Autologous CD34+ haematopoietic stem cells from MPS II patients will be genetically modified ex vivo using CD11b.IDS-ApoEII Lentiviral Vector (LV), a self-inactivating (SIN) LV expressing the human codon-optimized IDS gene tagged with ApoEII and regulated by a human CD11b myeloid-specific promoter. These transduced CD34+ HSCs will then be cryopreserved until the time of infusion back to the patients
Primary Outcome Measure Information:
Title
To evaluate the tolerability of the IMP in MPS II patients
Description
Adverse events will be recorded and graded according to an adapted Paediatric Clinical Toxicity Scale from the National Institute Allergy and Infectious Diseases (NIAID), Autoimmuno-deficiency Syndrome (AIDS) Division
Time Frame
Up to 24 months post IMP
Title
To assess the safety of the IMP in MPS II patients
Description
Presence of replication competent virus and integration events in the leukocytes
Time Frame
Up to 24 months post IMP
Secondary Outcome Measure Information:
Title
Heparan sulphate in cerebrospinal fluid (CSF)
Time Frame
baseline, 3, 6, 12, and 24 months post-IMP
Title
Heparan sulphate in plasma
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Heparan sulphate in urine
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Glycosaminoglycan (GAG) ratio in urine by dimethylmethylene blue [DMB]
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
IDS enzyme activity in plasma within or above normal range measured using an IDS enzyme activity assay
Time Frame
Baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
IDS enzyme activity in total leucocytes within or above normal range measured using an IDS enzyme activity assay
Time Frame
Baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
IDS enzyme activity in CSF within or above normal range measured using an IDS enzyme activity assay
Time Frame
Baseline, 3, 6, 12, and 24 months post-IMP
Title
VCN in total leucocyte and the bone marrow
Time Frame
baseline and 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Proportion of cells containing the inserted IDS.ApoEII gene in total bone marrow colony forming units (CFUs)
Time Frame
baseline, 1, 6, 12 and 24 month's post-IMP
Title
IDS enzyme activity in the bone marrow within or above normal range
Time Frame
12 months and at multiple other visits over time
Title
Cognitive scores (standard scores, age-equivalent scores and development quotient) measured using the Bayley Scales of Infant Development, 3rd Edition (BSID-III) or Kaufman Assessment Battery for Children, 2nd Edition (KABC-II)
Time Frame
baseline, 6, 12, 18 and 24 months post- IMP treatment
Title
Adaptive behaviour (age-equivalent scores) measured using the Vineland Adaptive Behaviour Scales, 3rd Edition (VABS-III)
Time Frame
baseline, 6, 12, 18 and 24 months post-IMP treatment
Other Pre-specified Outcome Measures:
Title
Dermatan sulphate in cerebrospinal fluid (CSF)
Time Frame
Baseline, 3, 6, 12, and 24 months post-IMP
Title
Dermatan sulphate in plasma
Time Frame
Baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Dermatan sulphate in urine
Time Frame
Baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
IDS enzyme activity in subpopulations (i.e., CD3+, CD15+, CD19+ cells) measured using IDS enzyme activity assay
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
VCN in blood subpopulations (CD3+, CD15+, CD19+ cells) measured using RT-qPCR
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Obstructive sleep apnoea assessed by polysomnography (using the apnoea-hypopnoea index [AHI])
Time Frame
baseline, 6, 12 and 24 months post-IMP
Title
Presence and persistence of anti-IDS antibodies in blood and CSF
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Hearing measured using tympanometry and distortion product optoacoustic emission testing
Time Frame
baseline, 12 and 24 months post-IMP
Title
Height measured by standard calibrated stadiometer from the age they can stand independently, prior to this measuring length
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post- IMP
Title
Presence of exploratory biomarkers
Time Frame
baseline, 1, 3, 6, 9, 12, 18 and 24 months post-IMP
Title
Cognitive score (GSV) measured using the Bayley Scales of Infant Development, 3rd Edition (BSID-III) or Kaufman Assessment Battery for Children, 2nd Edition (KABC-II)
Time Frame
baseline and 6, 12, 18 and 24 months post-IMP
Title
Adaptive behaviour (GSV) measured using the Vineland Adaptive Behaviour Scales, 3rd Edition (VABS-III)
Time Frame
baseline and 6, 12, 18 and 24 months post-IMP
Title
Rate of fidelity analysis of neurocognitive assessments looking at the quality of interactions
Time Frame
baseline, 6, 12, 18 and 24 months post-IMP treatment
Title
Parental reported observations of child's development by using collated comments in qualitative descriptive analyses
Time Frame
baseline, 6, 12, 18 and 24 months post-IMP treatment

10. Eligibility

Sex
Male
Gender Based
Yes
Minimum Age & Unit of Time
3 Months
Maximum Age & Unit of Time
12 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent from a legally authorized guardian. Male, age at consent ≥3 months and ≤12 months. Normal cognitive function or mild cognitive dysfunction (patient has a Development Quotient (DQ) score ≥70 at screening as determined by the Bayley Scale of Infant Development-third edition (BSID-III), cognitive domain), or assessed as normal or only mildly impaired by experienced neuropsychologist. Close male relative with known severe (progressive neuronopathic) phenotype of MPSII, or genotype associated with progressive neuronopathic phenotype. This is to be confirmed by the independent expert reviewers. IDS activity ≤10% of the Lower Limit of Normal as measured in leucocytes or plasma, plus either (1) a normal enzyme activity level of at least one other sulfatase (to rule out multiple sulfatase deficiency) as measured in leucocytes, or (2) a documented mutation in the IDS gene. Medically stable and able to accommodate the protocol requirements, including travel without placing an undue burden on the patient/patient's family, as determined by the CI. Patients and their parents/legal guardians must be willing and able to comply with study restrictions and to commit to attend clinic for the required duration during the study and follow-up period as specified in the protocol. Exclusion Criteria: The patient has previously received stem cell or gene therapy The patient has received modified intravenous ERT or intra-thecal ERT in a trial setting. Patient currently enrolled in another interventional clinical trial The patient has a history of poorly controlled seizures Hemizygous for mutation known to be associated with non-neuropathic phenotype The patient is currently receiving psychotropic or other medications which, in the CI's opinion, would be likely to substantially confound test results The patient has received any investigational medicinal product (including Genistein) within 30 days prior to the Baseline visit or is scheduled to receive any investigational medicinal product during the course of the study Documented Human Immunodeficiency Virus (HIV) infection (positive HIV RNA and/or anti-p24 antibodies) Malignant neoplasia (except local skin cancer) or a documented history of hereditary cancer syndrome. Patients with a prior successfully treated malignancy and a sufficient follow-up to exclude recurrence (based on oncologist opinion) can be included after discussion and approval by the Medical Monitor Myelodysplasia, cytogenetic alterations characteristic of myelodysplastic syndrome and acute myeloid leukaemia, or other serious haematological disorders The patient has a medical condition or extenuating circumstance that, in the opinion of the CI, might compromise the patient's ability to comply with protocol requirements, the patient's well-being or safety, or the interpretability of the patient's clinical data Visual or hearing impairment sufficient to preclude adequate neurodevelopmental testing Severe behavioural disturbances due to reasons other than MPS II and likely to interfere with protocol compliance, as determined by the CI Known sensitivity to Busulfan The receipt of live vaccinations within 30 days prior to treatment start Known sensitivity to DMSO
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Robert Wynn, Prof
Phone
0161 2755112
Email
robert.wynn@mft.nhs.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Laura Booth
Phone
0161 2755112
Email
mpsiitrial@manchester.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Wynn
Organizational Affiliation
Manchester Foundation Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
Manchester University Foundation Trust
City
Manchester
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Robert Wynn

12. IPD Sharing Statement

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Autologous Ex-vivo Gene Modified HSCT in MPSII

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