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CNS10-NPC for the Treatment of RP

Primary Purpose

Retinitis Pigmentosa

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CNS10-NPC implantation
Sponsored by
Cedars-Sinai Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Retinitis Pigmentosa focused on measuring RP, Retinopathy, Pigmentary Retinopathy, Retinal Degeneration

Eligibility Criteria

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

Inclusion Criteria:

  1. To participate in this study, the subject must be 18 years of age or older and must understand and sign the protocol's informed consent.
  2. Participant with diagnosis of retinitis pigmentosa.

    • Clinical signs of retinitis pigmentosa.
    • A history of nyctalopia
    • Retinal pigmentary changes
    • Arteriolar attenuation
    • Waxy disc pallor
    • Electrophysiologic evidence of rod dysfunction on full field electroretinography
    • Visual field constriction.

      3a. Participants in Group 1 (n=6) will have visual acuity equal to or worse than 20/200. Participants in Group 2 (n=10) will have visual acuity equal to or worse than 20/80.

      3b. Group 1 participants will have central visual field of 40 degrees diameter or less. Group 2, participants will have a measurable visual field defect.

4. Participant will be medically able to undergo ophthalmic surgery.

Exclusion Criteria:

  1. Presence of significant ocular abnormalities that would preclude the planned surgery or interfere with the interpretation of study endpoints (e.g. glaucoma, corneal or significant lens opacities, pre-existing uveitis, intraocular infection, macular edema, choroidal neovascularization). Any ocular diseases that the investigator feels would interfere with accurate ocular measurements. This would exclude potential subjects with significant cataract, corneal scars or significant corneal irregularities such as keratoconus, previous penetrating keratoplasty or glaucoma with central visual field.
  2. Any pre-existing factor or history of eye disease that may predispose to an increased risk of surgical complications in the study eye (e.g. trauma, previous surgery other than uncomplicated cataract surgery, uveitis, congenital developmental or structural abnormalities).
  3. Concomitant systemic diseases including those in which the disease itself, or the treatment for the disease, can alter ocular function or immune status (e.g. malignancies, uncontrolled diabetes).
  4. Any ocular surgery or laser in either eye within 12 weeks of screening.
  5. Any contraindication to pupil dilatation in either eye.
  6. Treatment with intravitreal, subtenon or periocular steroid within 4 months of enrollment.
  7. Any known allergy to any component of the delivery vehicle or diagnostic agents used during the study (e.g., dilation drops), or medications planned for use during the peri-operative period including corticosteroids, tacrolimus and mycophenolate.
  8. Imminently life-threatening illness.
  9. Abuse of alcohol or any illegal substance(s) within 12 months of the procedure.
  10. Laboratory test abnormalities or abnormalities in electrocardiogram or chest X-ray, which in the opinion of the Principal Investigator are clinically significant and would make the patient unable to tolerate study procedures.
  11. Intercurrent illness or infection 28 days prior to enrolment.
  12. Contraindications to use of anesthesia.
  13. Females of child-bearing potential (i.e. those who are not surgically sterile and not at least 12-months post-menopausal) who are not willing to comply with the study's contraception requirement (women who are unwilling to use an effective form of contraception such as the contraceptive pill or intrauterine device).
  14. Women who are pregnant.
  15. Females who are nursing or who intend to nurse during the first 6 months post-treatment.
  16. Men or women who do not agree to use barrier or medical contraception for at least 6 months post-operatively.
  17. History of any investigational agent administration within 28 days prior to administration.
  18. Participation in a prior gene transfer therapy study or cell-based therapy.
  19. Enrollment in any other clinical study, for any condition, including those relating to RP throughout the duration of the study.
  20. Current or anticipated long-term treatment with systemic corticosteroids (for a period longer than 7 days).
  21. Current treatment with immunosuppressant therapies or any contraindications to use of the immunosuppressants in this protocol.
  22. A history of malignancy within a five-year period or a positive cancer screening test within a one-year period of the screening visit.
  23. Any physical or mental disability that will impair the ability of the patient to travel to and from the study center or provide informed consent/assent or effective safety assessments as specified by the protocol. Any mental or psychiatric disorders that prevent the patient from having full authority to do so (i.e. the subject cannot have power of attorney signed over to another individual).
  24. Inability or unwillingness to comply with the study protocol.
  25. Medical history of HIV, or hepatitis A, B or C.
  26. Subjects who have taken any prescription or investigational oral retinoid medication (e.g., Accutaneยฎ Soriataneยฎ), or any medicines that may affect the macula (e.g. tamoxifen, mellaril, thorazine, plaquenil, niacin) within 6 months of enrollment.
  27. Allergy to Beta-Lactam antibiotics.
  28. The presence of cystoid macular edema.
  29. Glucose-6-phosphate dehydrogenase (G6PD) Deficiency

Sites / Locations

  • Retina-Vitreous Associates Medical GroupRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Group 1A

Group 1B

Group 2

Arm Description

Visual acuity of 20/200 or worse Single, unilateral, subretinal injection of 300,000 CNS10-NPC (n=3)

Visual acuity of 20/200 or worse Single, unilateral, subretinal injection of 1,000,000 CNS10-NPC (n=3)

Visual acuity between 20/80 and 20/200 Single, unilateral, subretinal injection of 1,000,000 CNS10-NPC (n=10)

Outcomes

Primary Outcome Measures

Safety as evaluated by incidence of Adverse Events (AE) and Serious Adverse Events (SAE) and their relationship to the intervention
Safety, as evaluated by changes in the complete blood count
Safety, as evaluated by changes in the comprehensive metabolic panel
Safety, as evaluated by changes in Donor Specific Antibodies
Safety, as evaluated by changes in the urinalysis
Safety, as evaluated by changes in Visual Acuity
ETRDS, or FrACT in cases of very low vision.
Safety, as evaluated by changes in visual field
Goldman perimetry will be used for central visual fields and microperimetry will be used for peripheral visual fields
Safety, as evaluated by changes in Spectral Domain Optical Coherence Tomography (SD-OCT)
Ellipsoid zone measurement through SD-OCT will be performed

Secondary Outcome Measures

Slit lamp examination
Intraocular pressure measurement
Funduscopic examination
Fundus photography (color, red free, or infrared)
Fundus Autofluorescence (FAF)
Best Corrected Visual Acuity
Visual Function Questionnaire-25 (VFQ-25)
The Visual Function Questionnaire-25 is graded in a scale from 0-100 where a higher number represents better function
Spectral domain optical coherence tomography (SD-OCT)
Retinal Thickness
Electroretinography (ERG)
Goldmann visual field area (microperimetry)
Change in rate of vision field loss

Full Information

First Posted
February 18, 2020
Last Updated
February 10, 2023
Sponsor
Cedars-Sinai Medical Center
Collaborators
California Institute for Regenerative Medicine (CIRM)
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1. Study Identification

Unique Protocol Identification Number
NCT04284293
Brief Title
CNS10-NPC for the Treatment of RP
Official Title
Clinical Study to Assess Safety and Efficacy of Subretinal Injection of Human Neural Progenitor Cells for Treatment of Retinitis Pigmentosa
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 22, 2021 (Actual)
Primary Completion Date
November 2024 (Anticipated)
Study Completion Date
November 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Cedars-Sinai Medical Center
Collaborators
California Institute for Regenerative Medicine (CIRM)

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
The investigator is examining the safety of transplanting cells into the subretinal space of patients with Retinitis Pigmentosa (RP). The cells are called neural progenitor cells, which are a type of stem cell that can become several different types of cells in the nervous system. These cells have been derived to specifically become astrocytes, which is a type of neuronal cell. The cells are called "CNS10-NPC." The investigational treatment has been tested in animals, but it has not yet been tested in people. In this study, the investigators want to learn if CNS10-NPC cells are safe to transplant into the subretinal space of people.
Detailed Description
This study will be the first to use a human progenitor cell line to treat retinitis pigmentosa in people. This is a Phase 1/2a, single-center, open label, safety study of two escalating doses of human neural progenitor cells (CNS10-NPC) delivered unilaterally to the subretinal space of subjects with RP. Subjects meeting all Eligibility Criteria and providing Informed Consent will be enrolled in one of two sequential dosing groups. Subjects will be treated sequentially with a minimum of one month interval between surgeries for the first three subjects in each dosing cohort. The remaining subjects in the cohort will be treated with a minimum interval of at least one week between surgeries. Primary objective. To assess the safety and tolerability of two escalating doses of clinical grade human fetal cortical-derived neural progenitor cells (CNS10-NPC) administered in the subretinal space of one eye (unilaterally) in patients with retinitis pigmentosa (RP). Secondary objectives. Within constraints of a small first in-human study focused on safety: Determine if CNS10-NPC can engraft and survive long-term in the retina of transiently immunosuppressed subjects, Obtain evidence that subretinal injection of CNS10-NPC can favorably impact the progression of vision loss in subjects with moderate RP.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Retinitis Pigmentosa
Keywords
RP, Retinopathy, Pigmentary Retinopathy, Retinal Degeneration

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
16 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group 1A
Arm Type
Experimental
Arm Description
Visual acuity of 20/200 or worse Single, unilateral, subretinal injection of 300,000 CNS10-NPC (n=3)
Arm Title
Group 1B
Arm Type
Experimental
Arm Description
Visual acuity of 20/200 or worse Single, unilateral, subretinal injection of 1,000,000 CNS10-NPC (n=3)
Arm Title
Group 2
Arm Type
Experimental
Arm Description
Visual acuity between 20/80 and 20/200 Single, unilateral, subretinal injection of 1,000,000 CNS10-NPC (n=10)
Intervention Type
Biological
Intervention Name(s)
CNS10-NPC implantation
Other Intervention Name(s)
Neural Progenitor Cell (NPC), Stem Cell
Intervention Description
All patients will receive a single, unilateral, subretinal injection of CNS10-NPC
Primary Outcome Measure Information:
Title
Safety as evaluated by incidence of Adverse Events (AE) and Serious Adverse Events (SAE) and their relationship to the intervention
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in the complete blood count
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in the comprehensive metabolic panel
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in Donor Specific Antibodies
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in the urinalysis
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in Visual Acuity
Description
ETRDS, or FrACT in cases of very low vision.
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in visual field
Description
Goldman perimetry will be used for central visual fields and microperimetry will be used for peripheral visual fields
Time Frame
Subjects will be followed postoperatively for 12 months
Title
Safety, as evaluated by changes in Spectral Domain Optical Coherence Tomography (SD-OCT)
Description
Ellipsoid zone measurement through SD-OCT will be performed
Time Frame
Subjects will be followed postoperatively for 12 months
Secondary Outcome Measure Information:
Title
Slit lamp examination
Time Frame
Performed 7 times over 15 months
Title
Intraocular pressure measurement
Time Frame
Performed 7 times over 15 months
Title
Funduscopic examination
Time Frame
Performed 7 times over 15 months
Title
Fundus photography (color, red free, or infrared)
Time Frame
Performed 4 times over 15 months
Title
Fundus Autofluorescence (FAF)
Time Frame
Performed 4 times over 15 months
Title
Best Corrected Visual Acuity
Time Frame
Performed 7 times over 15 months
Title
Visual Function Questionnaire-25 (VFQ-25)
Description
The Visual Function Questionnaire-25 is graded in a scale from 0-100 where a higher number represents better function
Time Frame
Performed 5 times over 15 months
Title
Spectral domain optical coherence tomography (SD-OCT)
Description
Retinal Thickness
Time Frame
Performed 5 times over 15 months
Title
Electroretinography (ERG)
Time Frame
Performed 5 times over 15 months
Title
Goldmann visual field area (microperimetry)
Time Frame
Performed 5 times over 15 months
Title
Change in rate of vision field loss
Time Frame
Through study completion, ~15 months.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: To participate in this study, the subject must be 18 years of age or older and must understand and sign the protocol's informed consent. Participant with diagnosis of retinitis pigmentosa. Clinical signs of retinitis pigmentosa. A history of nyctalopia Retinal pigmentary changes Arteriolar attenuation Waxy disc pallor Electrophysiologic evidence of rod dysfunction on full field electroretinography Visual field constriction. 3a. Participants in Group 1 (n=6) will have visual acuity equal to or worse than 20/200. Participants in Group 2 (n=10) will have visual acuity equal to or worse than 20/80. 3b. Group 1 participants will have central visual field of 40 degrees diameter or less. Group 2, participants will have a measurable visual field defect. 4. Participant will be medically able to undergo ophthalmic surgery. Exclusion Criteria: Presence of significant ocular abnormalities that would preclude the planned surgery or interfere with the interpretation of study endpoints (e.g. glaucoma, corneal or significant lens opacities, pre-existing uveitis, intraocular infection, macular edema, choroidal neovascularization). Any ocular diseases that the investigator feels would interfere with accurate ocular measurements. This would exclude potential subjects with significant cataract, corneal scars or significant corneal irregularities such as keratoconus, previous penetrating keratoplasty or glaucoma with central visual field. Any pre-existing factor or history of eye disease that may predispose to an increased risk of surgical complications in the study eye (e.g. trauma, previous surgery other than uncomplicated cataract surgery, uveitis, congenital developmental or structural abnormalities). Concomitant systemic diseases including those in which the disease itself, or the treatment for the disease, can alter ocular function or immune status (e.g. malignancies, uncontrolled diabetes). Any ocular surgery or laser in either eye within 12 weeks of screening. Any contraindication to pupil dilatation in either eye. Treatment with intravitreal, subtenon or periocular steroid within 4 months of enrollment. Any known allergy to any component of the delivery vehicle or diagnostic agents used during the study (e.g., dilation drops), or medications planned for use during the peri-operative period including corticosteroids, tacrolimus and mycophenolate. Imminently life-threatening illness. Abuse of alcohol or any illegal substance(s) within 12 months of the procedure. Laboratory test abnormalities or abnormalities in electrocardiogram or chest X-ray, which in the opinion of the Principal Investigator are clinically significant and would make the patient unable to tolerate study procedures. Intercurrent illness or infection 28 days prior to enrolment. Contraindications to use of anesthesia. Females of child-bearing potential (i.e. those who are not surgically sterile and not at least 12-months post-menopausal) who are not willing to comply with the study's contraception requirement (women who are unwilling to use an effective form of contraception such as the contraceptive pill or intrauterine device). Women who are pregnant. Females who are nursing or who intend to nurse during the first 6 months post-treatment. Men or women who do not agree to use barrier or medical contraception for at least 6 months post-operatively. History of any investigational agent administration within 28 days prior to administration. Participation in a prior gene transfer therapy study or cell-based therapy. Enrollment in any other clinical study, for any condition, including those relating to RP throughout the duration of the study. Current or anticipated long-term treatment with systemic corticosteroids (for a period longer than 7 days). Current treatment with immunosuppressant therapies or any contraindications to use of the immunosuppressants in this protocol. A history of malignancy within a five-year period or a positive cancer screening test within a one-year period of the screening visit. Any physical or mental disability that will impair the ability of the patient to travel to and from the study center or provide informed consent/assent or effective safety assessments as specified by the protocol. Any mental or psychiatric disorders that prevent the patient from having full authority to do so (i.e. the subject cannot have power of attorney signed over to another individual). Inability or unwillingness to comply with the study protocol. Medical history of HIV, or hepatitis A, B or C. Subjects who have taken any prescription or investigational oral retinoid medication (e.g., Accutaneยฎ Soriataneยฎ), or any medicines that may affect the macula (e.g. tamoxifen, mellaril, thorazine, plaquenil, niacin) within 6 months of enrollment. Allergy to Beta-Lactam antibiotics. The presence of cystoid macular edema. Glucose-6-phosphate dehydrogenase (G6PD) Deficiency
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Pablo Avalos, MD
Phone
310-248-8584
Email
Pablo.Avalos@cshs.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Liao, MD, PhD
Organizational Affiliation
Retina-Vitreous Associates Medical Group
Official's Role
Principal Investigator
Facility Information:
Facility Name
Retina-Vitreous Associates Medical Group
City
Beverly Hills
State/Province
California
ZIP/Postal Code
90211
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Janet Kurokouchi
Phone
310-289-2478
Ext
3
Email
jkurokouchi@laretina.com
First Name & Middle Initial & Last Name & Degree
David Liao, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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CNS10-NPC for the Treatment of RP

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