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Early Markers of Disease and Response to Therapy

Primary Purpose

Type 1 Diabetes

Status
Unknown status
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Abatacept
Sponsored by
Carla Greenbaum, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Type 1 Diabetes

Eligibility Criteria

6 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. ≤ 7 months from type 1 diabetes diagnosis based on ADA criteria
  2. > 21 days from type 1 diabetes diagnosis or metabolically stable per study physician assessment
  3. Males and females 6-55 years of age, inclusive, at time of screening visit
  4. Peak MMTT stimulated C-peptide ≥ 0.2 pmol/ml
  5. Females of child-bearing age must be willing to use effective birth control for 1 year (which may include abstinence) from screening visit and undergo regular pregnancy testing
  6. Up to date for clinically recommended immunizations prior to screening
  7. Willing to forgo live vaccines 3 months prior to the screening visit until three months following last study drug administration
  8. Willing and able to give informed consent or have parent or legal guardian provide informed consent if the subject is < 18 years of age
  9. Weight ≥ 20 kg at baseline visit
  10. HbA1c ≤ 8.5% at baseline visit
  11. Positive for at least 1 diabetes autoantibody (excluding mIAA in those who have received ≥ 2 weeks of exogenous insulin therapy)

Exclusion Criteria:

  1. Concurrent or recent (within the past 30 days of screening MMTT (visit -1)) use of non-insulin therapies aimed to control hyperglycemia
  2. Females who are pregnant or lactating
  3. Immunodeficiency or clinically significant chronic lymphopenia
  4. Have an active infection at time of screening or baseline visit
  5. Recent exposure, or possible or known active SARS-CoV-2 infection as defined by public health guidelines
  6. Positive QuantiFERON or PPD TB test, history of tuberculosis, or active TB infection
  7. Active infection with EBV or CMV, defined by real-time PCR
  8. History of other clinically significant autoimmune disease needing chronic therapy with biologics or steroids with the exception of celiac disease and stable thyroid disease
  9. Require use of other immunosuppressive agents for any other condition
  10. Use of medications known to influence glucose tolerance
  11. Have any complicating medical or psychological issues or abnormal clinical laboratory results that interfere with study conduct or cause increased risk. These include pre-existing cardiac disease, COPD, neurological, or clinically significant blood count abnormalities (such as lymphopenia, leukopenia, or thrombocytopenia).
  12. Have serologic evidence of current or past HIV, Hepatitis B (positive for Hepatitis B core antibody or surface antigen), or Hepatitis C infection.
  13. Have a history of malignancies
  14. Receipt of live vaccine (MMR, intranasal influenza, varicella, rotatvirus) in 3 months before treatment

Sites / Locations

  • Benaroya Research InstituteRecruiting
  • Medical College of WisconsinRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Abatacept

Arm Description

Abatacept will be given by a subcutaneous (SC) formulation weekly for three months.

Outcomes

Primary Outcome Measures

Change in insulin antibody titers (NIDDK units/mL)
Insulin antibody titers
Change in frequency of B cells within total PBMC (%)
% of B cells
Change in inflammatory Index by serum transcriptional exposure assay (composite score)
Inflammatory Index (359). This is an inflammatory index based on transcription of 359 probe sets (I.I.359) calculated by dividing the average signal intensity of the 103 probe sets generally annotated as 'inflammatory' by the average signal intensity of the 256 probe sets generally annotated as 'regulatory'
Change in B-cell transcriptional module (CD19.mod) (composite score)
CD19 mod is composite score of B cell transcripts.
Change in islet-specific exhausted CD8 T cells (%)
% of CD8+ T cells (CD8+PD-1+KLRG1+CD57-)
Change in EOMES CD8 whole blood gene expression signature (composite score)
Gene transcript score for EOMES module
Change in frequency of TfH within total CD4 T cells (%)
% of TfH cells within CD4+ T cells

Secondary Outcome Measures

Full Information

First Posted
October 2, 2019
Last Updated
April 26, 2021
Sponsor
Carla Greenbaum, MD
Collaborators
Juvenile Diabetes Research Foundation, Medical College of Wisconsin
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1. Study Identification

Unique Protocol Identification Number
NCT04118153
Brief Title
Early Markers of Disease and Response to Therapy
Official Title
Early Markers of Disease and Response to Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Unknown status
Study Start Date
March 5, 2021 (Actual)
Primary Completion Date
November 2022 (Anticipated)
Study Completion Date
November 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Carla Greenbaum, MD
Collaborators
Juvenile Diabetes Research Foundation, Medical College of Wisconsin

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 purpose of this study is to identify early immune markers associated with response to treatment with abatacept in individuals with Type 1 diabetes (T1D). In this open label mechanistic study, participants who were recently diagnosed with T1D (males or females, ages 6-45 and <7months from T1D diagnosis) will be treated with a short-course of abatacept (weekly subcutaneous injections for 3 months). Participants will undergo baseline and repeated mixed meal tolerance testing (MMTT) to assess disease progression and blood samples will be obtained at frequent intervals to measure changes in immune markers.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes

7. Study Design

Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Abatacept
Arm Type
Experimental
Arm Description
Abatacept will be given by a subcutaneous (SC) formulation weekly for three months.
Intervention Type
Drug
Intervention Name(s)
Abatacept
Other Intervention Name(s)
ORENCIA
Intervention Description
Abatacept will be administered by subcutaneous injections weekly for 3 months. Dosing is according to body weight at screening visit and will be administered as follows: up to 25 kg receive 50 mg (0.4 mL); 25 to <50 kg receive 87.5 mg (0.7 mL), and > 50 kg receive 125 mg (1.0 mL) per dose.
Primary Outcome Measure Information:
Title
Change in insulin antibody titers (NIDDK units/mL)
Description
Insulin antibody titers
Time Frame
0 to 2 weeks
Title
Change in frequency of B cells within total PBMC (%)
Description
% of B cells
Time Frame
0 to 2 weeks
Title
Change in inflammatory Index by serum transcriptional exposure assay (composite score)
Description
Inflammatory Index (359). This is an inflammatory index based on transcription of 359 probe sets (I.I.359) calculated by dividing the average signal intensity of the 103 probe sets generally annotated as 'inflammatory' by the average signal intensity of the 256 probe sets generally annotated as 'regulatory'
Time Frame
0 to 2 weeks
Title
Change in B-cell transcriptional module (CD19.mod) (composite score)
Description
CD19 mod is composite score of B cell transcripts.
Time Frame
0 to 2 weeks
Title
Change in islet-specific exhausted CD8 T cells (%)
Description
% of CD8+ T cells (CD8+PD-1+KLRG1+CD57-)
Time Frame
0 to 2 weeks
Title
Change in EOMES CD8 whole blood gene expression signature (composite score)
Description
Gene transcript score for EOMES module
Time Frame
0 to 2 weeks
Title
Change in frequency of TfH within total CD4 T cells (%)
Description
% of TfH cells within CD4+ T cells
Time Frame
0 to 2 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: ≤ 7 months from type 1 diabetes diagnosis based on ADA criteria > 21 days from type 1 diabetes diagnosis or metabolically stable per study physician assessment Males and females 6-55 years of age, inclusive, at time of screening visit Peak MMTT stimulated C-peptide ≥ 0.2 pmol/ml Females of child-bearing age must be willing to use effective birth control for 1 year (which may include abstinence) from screening visit and undergo regular pregnancy testing Up to date for clinically recommended immunizations prior to screening Willing to forgo live vaccines 3 months prior to the screening visit until three months following last study drug administration Willing and able to give informed consent or have parent or legal guardian provide informed consent if the subject is < 18 years of age Weight ≥ 20 kg at baseline visit HbA1c ≤ 8.5% at baseline visit Positive for at least 1 diabetes autoantibody (excluding mIAA in those who have received ≥ 2 weeks of exogenous insulin therapy) Exclusion Criteria: Concurrent or recent (within the past 30 days of screening MMTT (visit -1)) use of non-insulin therapies aimed to control hyperglycemia Females who are pregnant or lactating Immunodeficiency or clinically significant chronic lymphopenia Have an active infection at time of screening or baseline visit Recent exposure, or possible or known active SARS-CoV-2 infection as defined by public health guidelines Positive QuantiFERON or PPD TB test, history of tuberculosis, or active TB infection Active infection with EBV or CMV, defined by real-time PCR History of other clinically significant autoimmune disease needing chronic therapy with biologics or steroids with the exception of celiac disease and stable thyroid disease Require use of other immunosuppressive agents for any other condition Use of medications known to influence glucose tolerance Have any complicating medical or psychological issues or abnormal clinical laboratory results that interfere with study conduct or cause increased risk. These include pre-existing cardiac disease, COPD, neurological, or clinically significant blood count abnormalities (such as lymphopenia, leukopenia, or thrombocytopenia). Have serologic evidence of current or past HIV, Hepatitis B (positive for Hepatitis B core antibody or surface antigen), or Hepatitis C infection. Have a history of malignancies Receipt of live vaccine (MMR, intranasal influenza, varicella, rotatvirus) in 3 months before treatment
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Marli McCulloch-Olson
Phone
1-800-888-4187
Email
diabetes@benaroyaresearch.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carla Greenbaum, MD
Organizational Affiliation
Benaroya Research Institute at Virginia Mason
Official's Role
Principal Investigator
Facility Information:
Facility Name
Benaroya Research Institute
City
Seattle
State/Province
Washington
ZIP/Postal Code
98101
Country
United States
Individual Site Status
Recruiting
Facility Name
Medical College of Wisconsin
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53226
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susanne Cabrera, MD

12. IPD Sharing Statement

Plan to Share IPD
No

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Early Markers of Disease and Response to Therapy

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