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Efficacy and Safety of Human Lipoprotein Lipase (LPL)[S447X] Expressed by an Adeno-Associated Viral Vector in LPL-deficient Subjects

Primary Purpose

Familial Lipoprotein Lipase Deficiency

Status
Completed
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Alipogene Tiparvovec (AMT-011), Human LPL [S447X]
mycophenolate mofetil
cyclosporine
methylprednisolone
Sponsored by
Amsterdam Molecular Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Familial Lipoprotein Lipase Deficiency focused on measuring LPLD, Lipoprotein Lipase Deficiency, Chylomicronemia, Gene therapy, AAV, Lipoprotein Lipase, Alipogene tiparvovec, AMT-011

Eligibility Criteria

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

Inclusion Criteria:

  • Being diagnosed with LPLD defined as:

    • Confirmed homozygosity or compound heterozygosity for the mutations in the LPL gene, resulting in LPL deficiency
    • Having a post heparin plasma LPL activity of ≤ 20% of normal or a well defined mutation for which it is documented that the LPL mass and activity are within the limits described above
    • Having a history of pancreatitis
    • Having fluctuating TG concentrations with median fasting plasma TG concentrations > 10.00 mmol/L
  • Being in good general physical health with, in the opinion of the investigator:

    • No other clinically significant and relevant abnormalities in the medical history which could interfere with the participation to the study
    • No clinically significant abnormalities at the physical examination which could interfere with the participation to the study
    • No clinically significant abnormalities at the routine laboratory evaluation performed prior to the trial
  • Women of non-child bearing potential or with a negative pregnancy test.
  • Non breast feeding women
  • Women using appropriate contraceptive (if relevant) and their partner using barrier contraception 2 weeks before starting immunosuppressive therapy
  • Men practicing barrier birth control and their partner using appropriate contraception.
  • Willing to fully comply with all study procedures and requirements of the trial such as restrictions to a low-fat diet.

Exclusion Criteria:

  • Having a chronic inflammatory muscle disease.
  • Any current or relevant previous history of serious, severe or unstable physical or psychiatric illness, any medical disorder that may make the subject unlikely to fully complete the study, or any condition that presents undue risk from the study medication or procedures based on the investigator's opinion(eg. malignant neoplasia)
  • Active infectious disease of any nature, including clinically active viral infections
  • Having one of the following outcomes from the blood screening tests after appropriate correction due to the presence of chylomicronemia:

    • Platelet count < 100 x 109 /L
    • Hemoglobin < 6.2 mmol/L
    • Liver function disturbances (bilirubin ≥1.5 x normal, ALT > 2 x ULN (upper limit of normal)
    • CPK > 2 x ULN
    • Cockcroft-Gault estimated creatinine clearance < 50cc/min
    • PT and PTT outside normal range or not determinable unless judged as acceptable for the subjects by the investigator
    • Having a positive test for HIV, Hepatitis B, Hepatitis C or being positive for tuberculosis
  • Obesity defined as body mass index (BMI) > 30 kg/m2
  • Having a recent history of alcohol or drug abuse e.g. barbiturates, cannabinoids and amphetamines, and the subject is positive in a urine screen for drugs of abuse
  • Using anti-coagulants
  • Participation in another clinical trial or receipt of any other investigational drug within 30 days of screening or planning to participate in another clinical trial during the course of the study, except observational studies
  • Subjects which cannot be treated with immunosuppressive medication or steroids
  • Known to be allergic to any constituent of the therapy (including the immune suppressors) or a having a condition that prohibits the use of therapy
  • Received previous treatment with AMT-010, Alipogene tiparvovec or other gene therapy investigational product
  • Requiring a post heparin plasma LPL activity test for diagnostic confirmation and having a history of heparin induced thrombocytopenia or other heparin related complications

Sites / Locations

  • ECOGENE-21 Clinical Trial Center / Centre de santé et de services sociaux de Chicoutimi
  • Centre des Maladies Lipidiques de Québec

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment arm

Arm Description

Gene Therapy

Outcomes

Primary Outcome Measures

Reduction of triglyceride (TG) concentrations

Secondary Outcome Measures

Reduction of chylomicrons and/or chylomicron-TG ratio
To determine the biological activity and expression of the lipoprotein lipase [LPLS447X] transgene product
To assess the safety profile
To assess shedding of viral vector

Full Information

First Posted
April 30, 2009
Last Updated
September 28, 2011
Sponsor
Amsterdam Molecular Therapeutics
Collaborators
The Clinical Trial Company
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1. Study Identification

Unique Protocol Identification Number
NCT00891306
Brief Title
Efficacy and Safety of Human Lipoprotein Lipase (LPL)[S447X] Expressed by an Adeno-Associated Viral Vector in LPL-deficient Subjects
Official Title
An Open-label Study to Assess the Efficacy and Safety of Alipogene Tiparvovec (AMT-011), Human LPL [S447X], Expressed by an Adeno-Associated Viral Vector After Intramuscular Administration in LPL-deficient Adult Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
September 2011
Overall Recruitment Status
Completed
Study Start Date
February 2009 (undefined)
Primary Completion Date
August 2010 (Actual)
Study Completion Date
April 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Amsterdam Molecular Therapeutics
Collaborators
The Clinical Trial Company

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This trial is designed to expand the currently available data on the safety and efficacy of alipogene tiparvovec treatment in lipoprotein lipase deficiency (LPLD) and to further the understanding of possible mechanisms of action of the therapy.
Detailed Description
LPLD is a rare autosomal recessive disorder, characterized by the presence of marked chylomicronemia and hence hypertriglyceridemia. Clinically the most severe manifestation of chylomicronemia, is acute pancreatitis, which can be lethal. There is no effective therapy available to modulate the course of the illness and prevent complications for these patients. The current clinical management consists of severe reduction of dietary fat that is hard if not almost impossible to comply with. LPLD subjects continue to experience pancreatitis attacks, and are admitted to intensive care units on several occasions. Alipogene tiparvovec corrects or restores lipoprotein lipase (LPL) function long term, and hence reverses some symptoms, halts the disease progression and prevents further complications. Alipogene tiparvovec gene therapy ensures that a catabolically beneficial variant of the human LPL gene, LPL[S447X] is expressed and active in the relevant tissues in humans. Delivery of the gene is realized via intramuscular injection of an adeno-associated viral vector, pseudotyped with AAV1 capsids.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Familial Lipoprotein Lipase Deficiency
Keywords
LPLD, Lipoprotein Lipase Deficiency, Chylomicronemia, Gene therapy, AAV, Lipoprotein Lipase, Alipogene tiparvovec, AMT-011

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
5 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment arm
Arm Type
Experimental
Arm Description
Gene Therapy
Intervention Type
Genetic
Intervention Name(s)
Alipogene Tiparvovec (AMT-011), Human LPL [S447X]
Other Intervention Name(s)
Glybera, AMT-011
Intervention Description
intra muscular, 1 x E12 gc per kg body weight, injected in a single series of intramuscular injections
Intervention Type
Drug
Intervention Name(s)
mycophenolate mofetil
Other Intervention Name(s)
CellCept
Intervention Description
oral, 2 g/day, day -3 till week 12
Intervention Type
Drug
Intervention Name(s)
cyclosporine
Other Intervention Name(s)
Neoral
Intervention Description
oral, 3 mg/kg/day, day -3 till week 12
Intervention Type
Drug
Intervention Name(s)
methylprednisolone
Other Intervention Name(s)
Solumedrol®
Intervention Description
single intravenous bolus of methylprednisolone (1 mg/kg bodyweight)
Primary Outcome Measure Information:
Title
Reduction of triglyceride (TG) concentrations
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Reduction of chylomicrons and/or chylomicron-TG ratio
Time Frame
12 weeks
Title
To determine the biological activity and expression of the lipoprotein lipase [LPLS447X] transgene product
Time Frame
14 weeks
Title
To assess the safety profile
Time Frame
14 weeks
Title
To assess shedding of viral vector
Time Frame
14 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Being diagnosed with LPLD defined as: Confirmed homozygosity or compound heterozygosity for the mutations in the LPL gene, resulting in LPL deficiency Having a post heparin plasma LPL activity of ≤ 20% of normal or a well defined mutation for which it is documented that the LPL mass and activity are within the limits described above Having a history of pancreatitis Having fluctuating TG concentrations with median fasting plasma TG concentrations > 10.00 mmol/L Being in good general physical health with, in the opinion of the investigator: No other clinically significant and relevant abnormalities in the medical history which could interfere with the participation to the study No clinically significant abnormalities at the physical examination which could interfere with the participation to the study No clinically significant abnormalities at the routine laboratory evaluation performed prior to the trial Women of non-child bearing potential or with a negative pregnancy test. Non breast feeding women Women using appropriate contraceptive (if relevant) and their partner using barrier contraception 2 weeks before starting immunosuppressive therapy Men practicing barrier birth control and their partner using appropriate contraception. Willing to fully comply with all study procedures and requirements of the trial such as restrictions to a low-fat diet. Exclusion Criteria: Having a chronic inflammatory muscle disease. Any current or relevant previous history of serious, severe or unstable physical or psychiatric illness, any medical disorder that may make the subject unlikely to fully complete the study, or any condition that presents undue risk from the study medication or procedures based on the investigator's opinion(eg. malignant neoplasia) Active infectious disease of any nature, including clinically active viral infections Having one of the following outcomes from the blood screening tests after appropriate correction due to the presence of chylomicronemia: Platelet count < 100 x 109 /L Hemoglobin < 6.2 mmol/L Liver function disturbances (bilirubin ≥1.5 x normal, ALT > 2 x ULN (upper limit of normal) CPK > 2 x ULN Cockcroft-Gault estimated creatinine clearance < 50cc/min PT and PTT outside normal range or not determinable unless judged as acceptable for the subjects by the investigator Having a positive test for HIV, Hepatitis B, Hepatitis C or being positive for tuberculosis Obesity defined as body mass index (BMI) > 30 kg/m2 Having a recent history of alcohol or drug abuse e.g. barbiturates, cannabinoids and amphetamines, and the subject is positive in a urine screen for drugs of abuse Using anti-coagulants Participation in another clinical trial or receipt of any other investigational drug within 30 days of screening or planning to participate in another clinical trial during the course of the study, except observational studies Subjects which cannot be treated with immunosuppressive medication or steroids Known to be allergic to any constituent of the therapy (including the immune suppressors) or a having a condition that prohibits the use of therapy Received previous treatment with AMT-010, Alipogene tiparvovec or other gene therapy investigational product Requiring a post heparin plasma LPL activity test for diagnostic confirmation and having a history of heparin induced thrombocytopenia or other heparin related complications
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel Gaudet, MD, Ph.D.
Organizational Affiliation
ECOGENE-21 Clinical Trial Center / Centre de santé et de services sociaux de Chicoutimi, Chicoutimi Hospital, Quebec, Canada
Official's Role
Principal Investigator
Facility Information:
Facility Name
ECOGENE-21 Clinical Trial Center / Centre de santé et de services sociaux de Chicoutimi
City
Chicoutimi
State/Province
Quebec
ZIP/Postal Code
G7H 5H6
Country
Canada
Facility Name
Centre des Maladies Lipidiques de Québec
City
Quebec
ZIP/Postal Code
G1V 4M6
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
16259561
Citation
Rip J, Nierman MC, Sierts JA, Petersen W, Van den Oever K, Van Raalte D, Ross CJ, Hayden MR, Bakker AC, Dijkhuizen P, Hermens WT, Twisk J, Stroes E, Kastelein JJ, Kuivenhoven JA, Meulenberg JM. Gene therapy for lipoprotein lipase deficiency: working toward clinical application. Hum Gene Ther. 2005 Nov;16(11):1276-86. doi: 10.1089/hum.2005.16.1276.
Results Reference
background
PubMed Identifier
15353045
Citation
Ross CJ, Twisk J, Meulenberg JM, Liu G, van den Oever K, Moraal E, Hermens WT, Rip J, Kastelein JJ, Kuivenhoven JA, Hayden MR. Long-term correction of murine lipoprotein lipase deficiency with AAV1-mediated gene transfer of the naturally occurring LPL(S447X) beneficial mutation. Hum Gene Ther. 2004 Sep;15(9):906-19. doi: 10.1089/hum.2004.15.906.
Results Reference
background
PubMed Identifier
16002740
Citation
Ross CJ, Liu G, Kuivenhoven JA, Twisk J, Rip J, van Dop W, Excoffon KJ, Lewis SM, Kastelein JJ, Hayden MR. Complete rescue of lipoprotein lipase-deficient mice by somatic gene transfer of the naturally occurring LPLS447X beneficial mutation. Arterioscler Thromb Vasc Biol. 2005 Oct;25(10):2143-50. doi: 10.1161/01.ATV.0000176971.27302.b0. Epub 2005 Jul 7.
Results Reference
background
PubMed Identifier
16716106
Citation
Ross CJ, Twisk J, Bakker AC, Miao F, Verbart D, Rip J, Godbey T, Dijkhuizen P, Hermens WT, Kastelein JJ, Kuivenhoven JA, Meulenberg JM, Hayden MR. Correction of feline lipoprotein lipase deficiency with adeno-associated virus serotype 1-mediated gene transfer of the lipoprotein lipase S447X beneficial mutation. Hum Gene Ther. 2006 May;17(5):487-99. doi: 10.1089/hum.2006.17.487.
Results Reference
background
PubMed Identifier
18802015
Citation
Stroes ES, Nierman MC, Meulenberg JJ, Franssen R, Twisk J, Henny CP, Maas MM, Zwinderman AH, Ross C, Aronica E, High KA, Levi MM, Hayden MR, Kastelein JJ, Kuivenhoven JA. Intramuscular administration of AAV1-lipoprotein lipase S447X lowers triglycerides in lipoprotein lipase-deficient patients. Arterioscler Thromb Vasc Biol. 2008 Dec;28(12):2303-4. doi: 10.1161/ATVBAHA.108.175620. Epub 2008 Sep 18. No abstract available.
Results Reference
background
PubMed Identifier
22438229
Citation
Carpentier AC, Frisch F, Labbe SM, Gagnon R, de Wal J, Greentree S, Petry H, Twisk J, Brisson D, Gaudet D. Effect of alipogene tiparvovec (AAV1-LPL(S447X)) on postprandial chylomicron metabolism in lipoprotein lipase-deficient patients. J Clin Endocrinol Metab. 2012 May;97(5):1635-44. doi: 10.1210/jc.2011-3002. Epub 2012 Mar 21.
Results Reference
derived
Links:
URL
http://www.amtbiopharma.com/
Description
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Efficacy and Safety of Human Lipoprotein Lipase (LPL)[S447X] Expressed by an Adeno-Associated Viral Vector in LPL-deficient Subjects

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