Gene Therapy for Children With CLN3 Batten Disease
Primary Purpose
CLN3, Batten Disease
Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Low dose AT-GTX-502
High dose AT-GTX-502
Sponsored by
About this trial
This is an interventional treatment trial for CLN3 focused on measuring CLN3, Neuronal ceroid lipofuscinosis, NCL, Gene Transfer
Eligibility Criteria
Inclusion Criteria
- Diagnosis of CLN3 Batten disease determined by genotype available at screening by a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA)-certified laboratory (or a non-US laboratory with an equivalent national accreditation/certification)
- Aged ≥ 3 to < 11 years
- UBDRS physical impairment score of ≤ 7
- Able to walk independently at least 50 feet
Exclusion Criteria
- Presence of another inherited neurologic or metabolic disease, eg, other forms of Batten disease (also known as neuronal ceroid lipofuscinosis; NCL) or seizures unrelated to CLN3 Batten disease (subjects with febrile seizures may be eligible at the discretion of the investigator)
- Presence of another neurological illness that may have caused cognitive decline (eg, trauma, meningitis, hemorrhage) before screening
- Active viral infection (includes HIV or serology positive for hepatitis B or C)
- Subjects with 2 consecutive aminotransaminase liver tests > 3 times the upper limit of normal or > 1.5 times the upper limit of normal if taking valproic acid at Visit 1 (screening/baseline)
- Subjects with anti-AAV9 antibody titers > 1:400 as determined by ELISA (enzyme-linked immunosorbent assay) binding immunoassay
- Abnormal laboratory values considered clinically significant
- Presence of immunologic disease
- Has received stem cell or bone marrow transplantation
- Has received any form of organ transplant
- History of or current chemotherapy, radiotherapy, or other immunosuppression therapy within the past 30 days (corticosteroid treatment may be permitted at the discretion of the investigator)
- Current use of cannabinoids and any by-products
- Contraindications for intrathecal administration of the product or lumbar puncture (for collection of CSF), such as bleeding disorders or other medical conditions (eg, spina bifida, meningitis, or clotting abnormalities)
- Contraindications for MRI scans (eg, cardiac pacemaker, metal fragment or chip in the eye, aneurysm clip in the brain)
- Poorly controlled seizures - intractable epilepsy
- Episode of generalized motor status epilepticus within 4 weeks before the Gene Transfer visit
- History of corneal or intraocular surgery
- Severe infection (eg, upper respiratory tract infection, pneumonia, pyelonephritis, or meningitis) within 4 weeks before the Gene Transfer visit (Enrollment may be postponed.)
- Has received any investigational medication within 30 days before the infusion of study drug
- Has a medical condition or extenuating circumstance that, in the opinion of the investigator, might compromise the subject's ability to comply with the protocol required testing or procedures or compromise the subject's wellbeing, safety, or clinical interpretability
- Pregnancy at screening or Day 0. Any female subject judged by the investigator to be of childbearing potential will be tested for pregnancy.
- Family does not want to disclose subject's study participation with primary care physician and other medical providers
Sites / Locations
- Nationwide Children's Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
Cohort 1: AT-GTX-502 Low-Dose
Cohort 2: AT-GTX-502 High-Dose
Arm Description
No more than 5 mL of 6 x 1013 vg AT-GTX-502 administered via intrathecal injection
No more than 10 mL of 1.2 x 1014 vg of AT-GTX-502 administered via intrathecal injection
Outcomes
Primary Outcome Measures
Safety evaluation based on the development of dose-limiting toxicity (DLT).
The DLT is defined as any unanticipated AE that is considered related to AT-GTX-502 and is Common Terminology Criteria for Adverse Events Grade 3 or higher.
Efficacy: Change in rating as determined using the Unified Batten Disease Rating Scale (UBDRS) rating scale.
The UBDRS is a clinical ratings instrument used specifically to assess motor, seizure, behavioral and functional capabilities. The "Physical Assessment" is a 20 item subscale that measures vision, speech, motor strength, gait, abnormal involuntary movements and balance. Each item has a score range of 0 to 4. The minimum score is 0 and the maximum score is 112. The items are summed up to obtain a total score.The higher the score, the more severe the disability and worse the outcome.
Secondary Outcome Measures
QOL: Change in Quality of Life (QOL) as determined using the Pediatric Quality of Life (PedsQL™) scale.
The PedsQL is used to assess physical, emotional, social, and school functioning of pediatric subjects in ranging from 2 years to 18 years of age.
Seizures: Change is seizure subscore as determined using Seizure subscale of the UBDRS scale.
The UBDRS seizure subscale is used to assess seizure history, type, frequency, duration, and frequency of seizure-related injury.
Global impression: Change in disease severity using the UBDRS clinical global impression (CGI) subscale.
The clinical global impression subscale includes assessment of motor, seizure, behavioral and cognitive function in NCL subjects.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03770572
Brief Title
Gene Therapy for Children With CLN3 Batten Disease
Official Title
Phase I/IIa Gene Transfer Clinical Trial for Juvenile Neuronal Ceroid Lipofuscinosis, Delivering the CLN3 Gene by Self-Complementary AAV9
Study Type
Interventional
2. Study Status
Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
November 13, 2018 (Actual)
Primary Completion Date
September 30, 2024 (Anticipated)
Study Completion Date
September 30, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Amicus Therapeutics
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This is a phase 1/2, open-label, single dose, dose-escalation clinical trial to evaluate the safety and efficacy of AT-GTX-502 (previous NCH Code: scAAV9.P546.CLN3) delivered intrathecally into the lumbar spinal cord region of subjects with CLN3 Batten disease.
Detailed Description
This is a phase 1/2, open-label, single-dose, dose-escalation study of AT-GTX-502 administered intrathecally into the lumbar spinal cord region of pediatric patients with CLN3 Batten disease.
This study consists of a one-time injection of AT-GTX-502 with follow-up visits on Day 7, 14, 21, and 30, followed by every 3 months through 1 year post-dose, and then every 6 months through the fifth year. There are two Cohorts with a low dose and a high dose.
The primary outcome for this clinical study is to evaluate safety. The co-primary objective is to determine the efficacy of AT-GTX-502 as measured by United Batten Disease Rating Scale (UBDRS) physical subscale.
The secondary outcome measures include Pediatric Quality of Life (PedsQL) inventory, seizure subscale of the UBDRS and global impression subscale of the UBDRS.
The exploratory outcome measures include visual impairment assessment, cognitive evaluations, Brain magnetic resonance imaging (MRI), electroencephalogram (EEG), electrocardiogram (ECG) and echocardiogram (ECHO).
For more information about this study, please contact Amicus Therapeutics Patient Advocacy at clinicaltrials@amicusrx.com or +1 609-662-2000.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
CLN3, Batten Disease
Keywords
CLN3, Neuronal ceroid lipofuscinosis, NCL, Gene Transfer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Single Treatment Group (AAV9-CLN3) - 2 Cohort Assignment (Low-dose, High-dose)
Dose escalation in this study will begin with low-dose, determined to be the minimal efficacious dose as determined in non-clinical studies. Dose escalation to a high-dose (2x the minimally effective dose (MED) as evaluated in Cohort 1) will proceed as part of Cohort 2 of the study upon demonstration of safety of the low-dose in Cohort 1 of the study.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
7 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Cohort 1: AT-GTX-502 Low-Dose
Arm Type
Experimental
Arm Description
No more than 5 mL of 6 x 1013 vg AT-GTX-502 administered via intrathecal injection
Arm Title
Cohort 2: AT-GTX-502 High-Dose
Arm Type
Experimental
Arm Description
No more than 10 mL of 1.2 x 1014 vg of AT-GTX-502 administered via intrathecal injection
Intervention Type
Genetic
Intervention Name(s)
Low dose AT-GTX-502
Intervention Description
Subjects with diagnosis of CLN3 Batten disease will receive a single dose of AT-GTX-502 at low dose
Intervention Type
Genetic
Intervention Name(s)
High dose AT-GTX-502
Intervention Description
Subjects with diagnosis of CLN3 Batten disease will receive a single dose of AT-GTX-502 at high dose
Primary Outcome Measure Information:
Title
Safety evaluation based on the development of dose-limiting toxicity (DLT).
Description
The DLT is defined as any unanticipated AE that is considered related to AT-GTX-502 and is Common Terminology Criteria for Adverse Events Grade 3 or higher.
Time Frame
36 Months
Title
Efficacy: Change in rating as determined using the Unified Batten Disease Rating Scale (UBDRS) rating scale.
Description
The UBDRS is a clinical ratings instrument used specifically to assess motor, seizure, behavioral and functional capabilities. The "Physical Assessment" is a 20 item subscale that measures vision, speech, motor strength, gait, abnormal involuntary movements and balance. Each item has a score range of 0 to 4. The minimum score is 0 and the maximum score is 112. The items are summed up to obtain a total score.The higher the score, the more severe the disability and worse the outcome.
Time Frame
36 months
Secondary Outcome Measure Information:
Title
QOL: Change in Quality of Life (QOL) as determined using the Pediatric Quality of Life (PedsQL™) scale.
Description
The PedsQL is used to assess physical, emotional, social, and school functioning of pediatric subjects in ranging from 2 years to 18 years of age.
Time Frame
36 months
Title
Seizures: Change is seizure subscore as determined using Seizure subscale of the UBDRS scale.
Description
The UBDRS seizure subscale is used to assess seizure history, type, frequency, duration, and frequency of seizure-related injury.
Time Frame
36 months
Title
Global impression: Change in disease severity using the UBDRS clinical global impression (CGI) subscale.
Description
The clinical global impression subscale includes assessment of motor, seizure, behavioral and cognitive function in NCL subjects.
Time Frame
36 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
10 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria
Diagnosis of CLN3 Batten disease determined by genotype available at screening by a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA)-certified laboratory (or a non-US laboratory with an equivalent national accreditation/certification)
Aged ≥ 3 to < 11 years
UBDRS physical impairment score of ≤ 7
Able to walk independently at least 50 feet
Exclusion Criteria
Presence of another inherited neurologic or metabolic disease, eg, other forms of Batten disease (also known as neuronal ceroid lipofuscinosis; NCL) or seizures unrelated to CLN3 Batten disease (subjects with febrile seizures may be eligible at the discretion of the investigator)
Presence of another neurological illness that may have caused cognitive decline (eg, trauma, meningitis, hemorrhage) before screening
Active viral infection (includes HIV or serology positive for hepatitis B or C)
Subjects with 2 consecutive aminotransaminase liver tests > 3 times the upper limit of normal or > 1.5 times the upper limit of normal if taking valproic acid at Visit 1 (screening/baseline)
Subjects with anti-AAV9 antibody titers > 1:400 as determined by ELISA (enzyme-linked immunosorbent assay) binding immunoassay
Abnormal laboratory values considered clinically significant
Presence of immunologic disease
Has received stem cell or bone marrow transplantation
Has received any form of organ transplant
History of or current chemotherapy, radiotherapy, or other immunosuppression therapy within the past 30 days (corticosteroid treatment may be permitted at the discretion of the investigator)
Current use of cannabinoids and any by-products
Contraindications for intrathecal administration of the product or lumbar puncture (for collection of CSF), such as bleeding disorders or other medical conditions (eg, spina bifida, meningitis, or clotting abnormalities)
Contraindications for MRI scans (eg, cardiac pacemaker, metal fragment or chip in the eye, aneurysm clip in the brain)
Poorly controlled seizures - intractable epilepsy
Episode of generalized motor status epilepticus within 4 weeks before the Gene Transfer visit
History of corneal or intraocular surgery
Severe infection (eg, upper respiratory tract infection, pneumonia, pyelonephritis, or meningitis) within 4 weeks before the Gene Transfer visit (Enrollment may be postponed.)
Has received any investigational medication within 30 days before the infusion of study drug
Has a medical condition or extenuating circumstance that, in the opinion of the investigator, might compromise the subject's ability to comply with the protocol required testing or procedures or compromise the subject's wellbeing, safety, or clinical interpretability
Pregnancy at screening or Day 0. Any female subject judged by the investigator to be of childbearing potential will be tested for pregnancy.
Family does not want to disclose subject's study participation with primary care physician and other medical providers
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Research
Organizational Affiliation
Amicus Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
Nationwide Children's Hospital
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43201
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
23602993
Citation
Schulz A, Kohlschutter A, Mink J, Simonati A, Williams R. NCL diseases - clinical perspectives. Biochim Biophys Acta. 2013 Nov;1832(11):1801-6. doi: 10.1016/j.bbadis.2013.04.008. Epub 2013 Apr 17.
Results Reference
background
PubMed Identifier
15657902
Citation
Phillips SN, Benedict JW, Weimer JM, Pearce DA. CLN3, the protein associated with batten disease: structure, function and localization. J Neurosci Res. 2005 Mar 1;79(5):573-83. doi: 10.1002/jnr.20367.
Results Reference
background
PubMed Identifier
9311735
Citation
Munroe PB, Mitchison HM, O'Rawe AM, Anderson JW, Boustany RM, Lerner TJ, Taschner PE, de Vos N, Breuning MH, Gardiner RM, Mole SE. Spectrum of mutations in the Batten disease gene, CLN3. Am J Hum Genet. 1997 Aug;61(2):310-6. doi: 10.1086/514846.
Results Reference
background
PubMed Identifier
24547931
Citation
Drack AV, Mullins RF, Pfeifer WL, Augustine EF, Stasheff SF, Hong SD. Immunosuppressive Treatment for Retinal Degeneration in Juvenile Neuronal Ceroid Lipofuscinosis (Juvenile Batten Disease). Ophthalmic Genet. 2015;36(4):359-64. doi: 10.3109/13816810.2014.886271. Epub 2014 Feb 19.
Results Reference
background
PubMed Identifier
22013180
Citation
Kwon JM, Adams H, Rothberg PG, Augustine EF, Marshall FJ, Deblieck EA, Vierhile A, Beck CA, Newhouse NJ, Cialone J, Levy E, Ramirez-Montealegre D, Dure LS, Rose KR, Mink JW. Quantifying physical decline in juvenile neuronal ceroid lipofuscinosis (Batten disease). Neurology. 2011 Nov 15;77(20):1801-7. doi: 10.1212/WNL.0b013e318237f649. Epub 2011 Oct 19.
Results Reference
background
PubMed Identifier
24014508
Citation
Adams HR, Mink JW; University of Rochester Batten Center Study Group. Neurobehavioral features and natural history of juvenile neuronal ceroid lipofuscinosis (Batten disease). J Child Neurol. 2013 Sep;28(9):1128-36. doi: 10.1177/0883073813494813.
Results Reference
background
PubMed Identifier
21464428
Citation
Ostergaard JR, Rasmussen TB, Molgaard H. Cardiac involvement in juvenile neuronal ceroid lipofuscinosis (Batten disease). Neurology. 2011 Apr 5;76(14):1245-51. doi: 10.1212/WNL.0b013e31821435bd.
Results Reference
background
PubMed Identifier
12374761
Citation
Cotman SL, Vrbanac V, Lebel LA, Lee RL, Johnson KA, Donahue LR, Teed AM, Antonellis K, Bronson RT, Lerner TJ, MacDonald ME. Cln3(Deltaex7/8) knock-in mice with the common JNCL mutation exhibit progressive neurologic disease that begins before birth. Hum Mol Genet. 2002 Oct 15;11(22):2709-21. doi: 10.1093/hmg/11.22.2709.
Results Reference
background
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Gene Therapy for Children With CLN3 Batten Disease
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