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Open-label, Pivotal Clinical Trial to Confirm Efficacy and Safety of Autologous Grafts Containing Stem Cells Genetically Modified for Epidermis Restoration in Patients With Junctional Epidermolysis Bullosa (HOLOGENE 5)

Primary Purpose

Junctional Epidermolysis Bullosa Non-Herlitz Type

Status
Recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Transplantation
Sponsored by
Holostem Terapie Avanzate s.r.l.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Junctional Epidermolysis Bullosa Non-Herlitz Type

Eligibility Criteria

6 Months - 65 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Signed and dated informed consent prior to any study-related procedures.
  2. Male and female patients between 6 months and 65 years old;
  3. Diagnosis of generalized intermediate LAMB3-dependent JEB, confirmed by NGS or Sanger sequencing and/or immunofluorescence;
  4. Detectable residual expression of laminin 332 (and its beta-3 chain) by immunofluorescence and/or Western Blot analysis;
  5. Presence of blisters and/or ≥ 6 cm2 erosions (persistent or recurrent for more than 3 months); the area of the erosion can be considered as the sum of smaller areas in the same body part (i.e. leg, thigh, arm, …)
  6. A cooperative attitude to follow the study procedures (caregivers in case of children);
  7. Patients' compliance with the study schedule and procedures, including complete immobilization of the transplanted areas for at least two weeks and hospitalization up to 1 month after transplantation.

Exclusion Criteria:

  1. Known or suspected intolerance to anaesthesia;
  2. Bad general condition (ECOG index >1);
  3. Presence of any skin cancers in the area(s) qualified for treatment;
  4. Clinical and/or laboratory signs of acute systemic infections at the time of screening. Patient can be re-screened after appropriate treatment;
  5. Female subjects: Pregnant (as evident by a positive urine hCG or serum-hCG test) or lactating women and all women physiologically capable of becoming pregnant (i.e. women of childbearing potential [WOCBP]) UNLESS they are willing to use highly effective birth control methods;
  6. Allergy, sensitivity or intolerance to study medication excipients or other material required by study protocol (as per Investigator's brochure)
  7. Contraindications to the local or systemic antibiotics and/or corticosteroids foreseen by the protocol;
  8. Contraindications to undergo extensive surgical procedures;
  9. Presence of i) systemic diseases, ii) clinically significant or unstable concurrent disease, iii) other concomitant medical conditions, iv) other clinical contraindications to stem cell transplantation, which based on Investigator's judgment, in consultation with the Sponsor Medical Expert may affect the participation in the study or the grafting procedure;
  10. Patients (or parents in case of paediatric subject) unlikely to comply with the study protocol or unable to understand the nature and scope of the study or the possible benefits or unwanted effects of the study procedures and treatments.
  11. Previous treatments or clinical trials envisaging the use of cells (including bone marrow transplantation, BMT) and/or both in vivo or ex vivo gene therapy products.

Sites / Locations

  • Hopital Necker-Enfants Malades
  • Struttura Complessa di Dermatologia Azienda Ospedaliero Universitaria Policlinico di ModenaRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment

Arm Description

After confirmation of eligibility criteria and ICF signature, subject undergoes to skin biopsy for collection of autologous epidermal cells to be used to produce IMP under GMP process. Approximately 2 months later, IMP is transplanted on selected area.

Outcomes

Primary Outcome Measures

Re-epithelialization
Re-epithelialization in absence of blisters in at least 50% of the transplanted area measured by the Investigator
Protein residual expression
Protein residual expression resulting in 'Yes' or 'Partial' measured by Immunofluorescence
Expression of transgenic mRNA
Expression of transgenic mRNA resulting in 'Yes' or 'Partial' measured by In situ hybridization
Hemidesmosomes presence
Presence of hemidesmosomes measured by electron microscopy
Skin stability
Negativity or positivity at the stripping test
Patient Reported Outcome
Chnage in Patient Reported Outcome score measured by 5-points Likert scale, where: 1=Definitely Worsened, 2=Slightly Worsened, 3=Unchanged, 4=Slightly Improved, 5=Definitely Improved

Secondary Outcome Measures

Re-epithelialization by Independent Assessor
% of re-epithelialization assessed by the Independent Assessor
Quality of Life improvement
Change in EBDASI (Epidermolysis Bullosa Disease Activity and Scarring Index) skin section score, where Best score=0 and Worse score=120 for Activity and Best score=0 and Worse score=84 for Damage
Treatment-emergent adverse events
Number and % of treatment-emergent adverse events
Serious adverse events
Number and % of serious adverse events
Adverse events of special interest
Number and % of adverse events of special interest
Adverse drug reactions
Number and % of adverse drug reactions

Full Information

First Posted
September 1, 2021
Last Updated
August 8, 2022
Sponsor
Holostem Terapie Avanzate s.r.l.
Collaborators
IRCCS San Raffaele, University of Modena and Reggio Emilia
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1. Study Identification

Unique Protocol Identification Number
NCT05111600
Brief Title
Open-label, Pivotal Clinical Trial to Confirm Efficacy and Safety of Autologous Grafts Containing Stem Cells Genetically Modified for Epidermis Restoration in Patients With Junctional Epidermolysis Bullosa
Acronym
HOLOGENE 5
Official Title
Multicentre, Open-label, Uncontrolled, Pivotal Clinical Trial to Confirm the Efficacy and Safety of Autologous Fibrin-cultured Epidermal Grafts Containing Epidermal Stem Cells Genetically Modified for Restoration of Epidermis in Patients With Junctional Epidermolysis Bullosa
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
July 15, 2022 (Actual)
Primary Completion Date
June 2024 (Anticipated)
Study Completion Date
June 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Holostem Terapie Avanzate s.r.l.
Collaborators
IRCCS San Raffaele, University of Modena and Reggio Emilia

4. Oversight

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

5. Study Description

Brief Summary
Prospective, multicenter and multinational, open-label, uncontrolled clinical study to assess the safety and efficacy of autologous cultured epidermal grafts containing epidermal stem cells genetically modified transduced with a LAMB3-gamma retroviral vector. The purpose of this study is to demonstrate the safety and efficacy after one or more treatments with genetically corrected cultured epidermal autograft (Hologene 5) for restoration of the epidermis in patients with generalized intermediate LAMB3-dependent Junctional Epidermolysis Bullosa.
Detailed Description
This trial aims to prove the efficacy and safety of RV-LAMB3-transduced epidermal stem cells and lead to a permanent therapy for the skin lesions affecting JEB patients. Patients are screened according to the Study Inclusion and Exclusion criteria and if found eligible, participants are candidate for the treatment. After confirmation of eligibility, patients will undergo to biopsy for the collection of the autologous epidermal cells used to produce the tissue for the treatment. If all criteria are met, the transplantation of the new cultured transgenic epidermis will be planned according to the procedures and the need of the patient. The study treatment consists of a surgical intervention for new restored stem cells implantation. The surgery is carried out in 2 stages, the first aims at taking biopsy to isolate epidermal cells including stem cells. The biopsy is processed in a laboratory of a regenerative medicine manufacturing site where the tissue is corrected, expanded and prepared as final sheets to be implanted. Afterward, the patient undergoes to the second intervention when the grafts containing genetically corrected cultured keratinocytes (Hologene-5) are implanted into the selected area under local or general anaesthesia. The treated area is then immobilized for some days after this surgery. Antibiotics and anti-inflammatory drugs may be administered (if necessary) to prevent infections and to minimise swelling. The follow-up after implantation is 12 months. The treatment can be repeated. The end of the trial is defined as the last visit of the last patient after the last treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Junctional Epidermolysis Bullosa Non-Herlitz Type

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
6 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
After confirmation of eligibility criteria and ICF signature, subject undergoes to skin biopsy for collection of autologous epidermal cells to be used to produce IMP under GMP process. Approximately 2 months later, IMP is transplanted on selected area.
Intervention Type
Drug
Intervention Name(s)
Transplantation
Other Intervention Name(s)
Engraftment
Intervention Description
Implantation of autologous cultured grafts containing genetically modified stem cells for restoration of functional skin on pre-selected areas
Primary Outcome Measure Information:
Title
Re-epithelialization
Description
Re-epithelialization in absence of blisters in at least 50% of the transplanted area measured by the Investigator
Time Frame
12 months
Title
Protein residual expression
Description
Protein residual expression resulting in 'Yes' or 'Partial' measured by Immunofluorescence
Time Frame
12 months
Title
Expression of transgenic mRNA
Description
Expression of transgenic mRNA resulting in 'Yes' or 'Partial' measured by In situ hybridization
Time Frame
12 months
Title
Hemidesmosomes presence
Description
Presence of hemidesmosomes measured by electron microscopy
Time Frame
12 months
Title
Skin stability
Description
Negativity or positivity at the stripping test
Time Frame
12 months
Title
Patient Reported Outcome
Description
Chnage in Patient Reported Outcome score measured by 5-points Likert scale, where: 1=Definitely Worsened, 2=Slightly Worsened, 3=Unchanged, 4=Slightly Improved, 5=Definitely Improved
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Re-epithelialization by Independent Assessor
Description
% of re-epithelialization assessed by the Independent Assessor
Time Frame
12 months
Title
Quality of Life improvement
Description
Change in EBDASI (Epidermolysis Bullosa Disease Activity and Scarring Index) skin section score, where Best score=0 and Worse score=120 for Activity and Best score=0 and Worse score=84 for Damage
Time Frame
12 months
Title
Treatment-emergent adverse events
Description
Number and % of treatment-emergent adverse events
Time Frame
12 months
Title
Serious adverse events
Description
Number and % of serious adverse events
Time Frame
12 months
Title
Adverse events of special interest
Description
Number and % of adverse events of special interest
Time Frame
12 months
Title
Adverse drug reactions
Description
Number and % of adverse drug reactions
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Months
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed and dated informed consent prior to any study-related procedures. Male and female patients between 6 months and 65 years old; Diagnosis of generalized intermediate LAMB3-dependent JEB, confirmed by NGS or Sanger sequencing and/or immunofluorescence; Detectable residual expression of laminin 332 (and its beta-3 chain) by immunofluorescence and/or Western Blot analysis; Presence of blisters and/or ≥ 6 cm2 erosions (persistent or recurrent for more than 3 months); the area of the erosion can be considered as the sum of smaller areas in the same body part (i.e. leg, thigh, arm, …) A cooperative attitude to follow the study procedures (caregivers in case of children); Patients' compliance with the study schedule and procedures, including complete immobilization of the transplanted areas for at least two weeks and hospitalization up to 1 month after transplantation. Exclusion Criteria: Known or suspected intolerance to anaesthesia; Bad general condition (ECOG index >1); Presence of any skin cancers in the area(s) qualified for treatment; Clinical and/or laboratory signs of acute systemic infections at the time of screening. Patient can be re-screened after appropriate treatment; Female subjects: Pregnant (as evident by a positive urine hCG or serum-hCG test) or lactating women and all women physiologically capable of becoming pregnant (i.e. women of childbearing potential [WOCBP]) UNLESS they are willing to use highly effective birth control methods; Allergy, sensitivity or intolerance to study medication excipients or other material required by study protocol (as per Investigator's brochure) Contraindications to the local or systemic antibiotics and/or corticosteroids foreseen by the protocol; Contraindications to undergo extensive surgical procedures; Presence of i) systemic diseases, ii) clinically significant or unstable concurrent disease, iii) other concomitant medical conditions, iv) other clinical contraindications to stem cell transplantation, which based on Investigator's judgment, in consultation with the Sponsor Medical Expert may affect the participation in the study or the grafting procedure; Patients (or parents in case of paediatric subject) unlikely to comply with the study protocol or unable to understand the nature and scope of the study or the possible benefits or unwanted effects of the study procedures and treatments. Previous treatments or clinical trials envisaging the use of cells (including bone marrow transplantation, BMT) and/or both in vivo or ex vivo gene therapy products.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Clinical Trials Info Holostem Terapie Avanzate Srl
Phone
+39 059 2058070
Email
ClinicalTrials-info@holostem.com
First Name & Middle Initial & Last Name or Official Title & Degree
Michele De Luca, MD
Email
m.deluca@holostem.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cristina Magnoni, MD, Surgeon
Organizational Affiliation
Struttura Complessa di Dermatologia Azienda Ospedaliero Universitaria Policlinico di Modena
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hopital Necker-Enfants Malades
City
Paris
Country
France
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Christine Bodemer, MD
First Name & Middle Initial & Last Name & Degree
Christine Bodemer, MD
Facility Name
Struttura Complessa di Dermatologia Azienda Ospedaliero Universitaria Policlinico di Modena
City
Modena
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Cristina Magnoni, MD
First Name & Middle Initial & Last Name & Degree
Cristina Magnoni, MD

12. IPD Sharing Statement

Links:
URL
http://links.email.frontiersin.org/ls/click?upn=Dpg5ochww630xh6EMvshS4k2vZe-2Fd8MH-2FVpzt1-2FUQD91C-2FNL5bIclwWnNjv5HD9izZCaOx2V3EtqIs0Ckedw-2F1A-2BcH3PXDfrM3tKsGvB5mOBFA4D4IQsXZBBoywIR8CqP788TC4QjwkjLexp8GkbdobTlDoKSXKIZ4hzFDGy-2BSoPWinVxRUD26SZk4zWlZmIujIlA-2FcuhGtrzCic2TjA6R9WgboLuof6h4bANVfct1-2BR0PaKBaVQpkvKuBSjOwJY97llGsKrkBbQeTFucCWc6XjFbhLpgcO4VwoW0SZPxFOMb0wxr9TxMiyhhXdL-2Fj3ryc_c_Uho53-2BBXHz3IQwFuqmgP8k0vc6XETh9Rxa541lPSMSnGAcDSIwNa63R8LWkU68mnnscH3GsPwiS7GYOTbVFnuLvR-2F6xG6nfgMBA6u57DAAcghHjoQgF1ekrer-2BMmuEgMoSQJ-2Br7xcgVDOTCTOisKEFWCQ14VP684FGXCk8kzV87l0diRwtDJAzg4RRyX46iK-2F7fkoeyDaTJnM3mYt5-2BqgmH9nN2J575hO0RVIJvYWZCkku-2Fsh7f63TYQ3gN2rLlX
Description
Hologene 5: A Phase II/III Clinical Trial of Combined Cell and Gene Therapy of Junctional Epidermolysis Bullosa

Learn more about this trial

Open-label, Pivotal Clinical Trial to Confirm Efficacy and Safety of Autologous Grafts Containing Stem Cells Genetically Modified for Epidermis Restoration in Patients With Junctional Epidermolysis Bullosa

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