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Regulatory T Cells for Amyotrophic Lateral Sclerosis (REGALS)

Primary Purpose

Amyotrophic Lateral Sclerosis

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CK0803
Excipient
Sponsored by
Cellenkos, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Amyotrophic Lateral Sclerosis focused on measuring ALS, Cellenkos, T Regulatory Cells, Randomized Placebo Control Trial, Umbilical cord blood, Amyotrophic Lateral Sclerosis

Eligibility Criteria

18 Years - 95 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Ability of the subject or his/her legally authorized representative to provide informed consent. Adult ALS subjects (≥18 years of age) Diagnosis of ALS, according to the Revised El Escorial Criteria for ALS Subjects with disease onset ≤ 5 years Upright (sitting position) Slow Vital Capacity (SVC) as adjusted for sex, age and height ≥ 50% predicted Subjects must have documented ALSFRSR score of 36-45 at baseline. Subjects taking concomitant Riluzole or Edaravone or Albrioza at study entry must be on a stable dose for ≥ 30 days prior to the first dose of study treatment (Day 1). Screening values of coagulation parameters including platelet count, international normalized ratio (INR), prothrombin time (PT), and activated partial thromboplastin time (APTT) should be within normal ranges. Agree to practice highly effective contraception during the study and continue contraception for 90 days after their last dose of study treatment. Exclusion Criteria: Uncontrolled infection, not responding to appropriate antimicrobial agents after seven days of therapy. The Protocol medical monitor is the final arbiter of eligibility. Antiplatelet or anticoagulant therapy within the 14 days prior to Day 1 or anticipated use during the study, including but not limited to daily aspirin including low dose aspirin (defined as ≤ 150 mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, rivaroxaban and apixaban Clinically significant low platelet count (defined as < 100,000/mm3), coagulation tests, or laboratory abnormalities that would render a subject unsuitable for inclusion Unwillingness to comply with study procedures, including follow-up, as specified by this protocol, or unwillingness to cooperate fully with the Investigator Have any other conditions, which, in the opinion of the Investigator would make the subject unsuitable for inclusion, or could interfere with the subject participating in or completing the study Concurrent participation in any other interventional clinical study Treatment with another investigational drug, biological agent, or device, including, but not limited to sodium phenylbutyrate, within 1 month of Screening, or 5 half-lives of investigational agent, whichever is longer Treatment of cancer in the last 5 years (except in situ carcinoma of the cervix or basal cell carcinoma) Female subjects who are pregnant or currently breastfeeding Other unspecified reasons that, in the opinion of the Investigator or Sponsor, make the subject unsuitable for enrollment.

Sites / Locations

  • Columbia University Irving Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

CK0803

Placebo

Arm Description

CK0803 (cryopreserved, allogeneic, cord blood derived T regulatory cells that express neurotropic homing markers) will be administered intravenously Dose: 100 million Treg cells (fixed dose) Dose regimen: Induction: one infusion every 7 days (+/-3) x 4 doses Consolidation: one infusion every 28 days (+/-3) x 5 doses

Excipient

Outcomes

Primary Outcome Measures

Treatment Limiting Toxicity (TLT)
TLT of CK0803 as assessed by the incidence and severity of AE and SAEs using NCI-CTCAE Version 5.0 criteria. TLT is a primary endpoint for bothe phase 1 safety run-in and phase 1b RCT part
Combined assessment of function and survival (CAFS)
CAFS ranks patients' clinical outcomes based on survival time and change in the ALS Functional Rating Scale-Revised (ALSFRS-R) score where score = 0 is worst and score = 48 is best. Each patient's outcome is compared to every other patient's outcome, assigned a score, and the summed scores are ranked. The mean rank score for each treatment group can then be calculated. A higher mean CAFS score indicates a better group outcome.

Secondary Outcome Measures

Incidence of all cause AEs and SAEs
Treatment limiting toxicities of CK0803 as assessed by the incidence and severity of AE and SAEs using NCI-CTCAE Version 5.0 criteria.
ALS Functional Rating Scale-Revised (ALSFRS-R) Score
Longitudinal processes of ALSFRS-R score measured at baseline and different time points. ALSFRS-R score 0=worst; 48=best
Amyotrophic Lateral Sclerosis Specific Quality of Life - Revised (ALSSQOL-R)
Each item of the ALSSQOL-R is rated by the individual using a 0 to 10 point Likert scale, with 0 being the least desirable situation, and 10 being the most desirable.
Slow Vital Capacity (SVC)
SVC is the volume of air expired, on a low complete expiration after a maximal inspiration without forced or rapid effort.
Handheld dynamometer (HHD)
HHD allows for objective measurement of muscle strength
Nfl CSF
Neurofilament light chain level in the CSF
Nfl Serum
Neurofilament light chain level in the Serum
Ventilation assistance-free survival (VAFS)
VAFS is defined as the time to the earliest occurrence of 1 of the following events: i) Death, or ii) Permanent ventilation (> 22 hours of mechanical ventilation [invasive or non-invasive] per day for > 21 consecutive days in the absence of an acute potentially reversible event)
Overall Survival (OS)
OS defined as the length of time from the start of treatment that patients are still alive.

Full Information

First Posted
January 3, 2023
Last Updated
June 20, 2023
Sponsor
Cellenkos, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05695521
Brief Title
Regulatory T Cells for Amyotrophic Lateral Sclerosis
Acronym
REGALS
Official Title
Phase 1 Safety Run-in Study and Phase 1b Randomized, Double Blinded, Placebo Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 3, 2023 (Actual)
Primary Completion Date
May 2026 (Anticipated)
Study Completion Date
December 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cellenkos, Inc.

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
Phase 1 Safety Run-in Study of 6 patients followed by Phase 1b Randomized, Double Blind, Placebo Control Trial of CK0803, neurotropic, allogeneic, umbilical cord blood derived T regulatory (Treg) cells in additional 60 patients with Amyotrophic Lateral Sclerosis.
Detailed Description
CK0803, neurotrophic allogenic T regulatory Cells (Treg), utilizes Cellenkos' proprietary CRANE technology to generate disease specific products. The primary objective of the upcoming phase 1 study is to establish safety and tolerability of multiple doses of CK0803 in ALS patients. The goal of the phase 1b study is to extend safety and establish efficacy of CK0803 in ALS using the combined assessment of function and survival (CAFS) that ranks patients' clinical outcomes based on survival time and change in the ALS Functional Rating Scale-Revised (ALSFRS-R) score.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Amyotrophic Lateral Sclerosis
Keywords
ALS, Cellenkos, T Regulatory Cells, Randomized Placebo Control Trial, Umbilical cord blood, Amyotrophic Lateral Sclerosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Model Description
This is a randomized two-arm, multi-center phase Ib trial of CK0803 (cryopreserved, allogeneic, cord blood derived T regulatory cells that express neurotropic homing markers) versus placebo for treatment of adults with amyotrophic lateral sclerosis (ALS) having onset within 5 years of trial entry. This trial will consist of a 6-patient safety run-in followed by a randomized comparative trial with up to two stages (stages 1 and 2), each stage of size 30 patients, with a safety rule applied after stage 1 that may terminate the trial early, for a maximum total sample size of 6+30+30 = 66 patients.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double Blinded, Placebo Control
Allocation
Randomized
Enrollment
66 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
CK0803
Arm Type
Experimental
Arm Description
CK0803 (cryopreserved, allogeneic, cord blood derived T regulatory cells that express neurotropic homing markers) will be administered intravenously Dose: 100 million Treg cells (fixed dose) Dose regimen: Induction: one infusion every 7 days (+/-3) x 4 doses Consolidation: one infusion every 28 days (+/-3) x 5 doses
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Excipient
Intervention Type
Biological
Intervention Name(s)
CK0803
Intervention Description
CK0803 (cryopreserved, allogeneic, cord blood derived T regulatory cells that express neurotropic homing markers) will be administered intravenously
Intervention Type
Other
Intervention Name(s)
Excipient
Intervention Description
Excipient
Primary Outcome Measure Information:
Title
Treatment Limiting Toxicity (TLT)
Description
TLT of CK0803 as assessed by the incidence and severity of AE and SAEs using NCI-CTCAE Version 5.0 criteria. TLT is a primary endpoint for bothe phase 1 safety run-in and phase 1b RCT part
Time Frame
28 days
Title
Combined assessment of function and survival (CAFS)
Description
CAFS ranks patients' clinical outcomes based on survival time and change in the ALS Functional Rating Scale-Revised (ALSFRS-R) score where score = 0 is worst and score = 48 is best. Each patient's outcome is compared to every other patient's outcome, assigned a score, and the summed scores are ranked. The mean rank score for each treatment group can then be calculated. A higher mean CAFS score indicates a better group outcome.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Incidence of all cause AEs and SAEs
Description
Treatment limiting toxicities of CK0803 as assessed by the incidence and severity of AE and SAEs using NCI-CTCAE Version 5.0 criteria.
Time Frame
baseline and at weeks 1, 2, 3, 4, 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at end of treatment (EOT)
Title
ALS Functional Rating Scale-Revised (ALSFRS-R) Score
Description
Longitudinal processes of ALSFRS-R score measured at baseline and different time points. ALSFRS-R score 0=worst; 48=best
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT
Title
Amyotrophic Lateral Sclerosis Specific Quality of Life - Revised (ALSSQOL-R)
Description
Each item of the ALSSQOL-R is rated by the individual using a 0 to 10 point Likert scale, with 0 being the least desirable situation, and 10 being the most desirable.
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT
Title
Slow Vital Capacity (SVC)
Description
SVC is the volume of air expired, on a low complete expiration after a maximal inspiration without forced or rapid effort.
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT
Title
Handheld dynamometer (HHD)
Description
HHD allows for objective measurement of muscle strength
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT
Title
Nfl CSF
Description
Neurofilament light chain level in the CSF
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT
Title
Nfl Serum
Description
Neurofilament light chain level in the Serum
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT12 months
Title
Ventilation assistance-free survival (VAFS)
Description
VAFS is defined as the time to the earliest occurrence of 1 of the following events: i) Death, or ii) Permanent ventilation (> 22 hours of mechanical ventilation [invasive or non-invasive] per day for > 21 consecutive days in the absence of an acute potentially reversible event)
Time Frame
Each measured at baseline and at weeks 5, 8, 12 and/or 13, 16, 20, 24 and/or 25, 36 and 48 from first infusion and/or at EOT
Title
Overall Survival (OS)
Description
OS defined as the length of time from the start of treatment that patients are still alive.
Time Frame
24 weeks and 48 weeks from first infusion and/or at EOT

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
95 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability of the subject or his/her legally authorized representative to provide informed consent. Adult ALS subjects (≥18 years of age) Diagnosis of ALS, according to the Revised El Escorial Criteria for ALS Subjects with disease onset ≤ 5 years Upright (sitting position) Slow Vital Capacity (SVC) as adjusted for sex, age and height ≥ 50% predicted Subjects must have documented ALSFRSR score of 36-45 at baseline. Subjects taking concomitant Riluzole or Edaravone or Albrioza at study entry must be on a stable dose for ≥ 30 days prior to the first dose of study treatment (Day 1). Screening values of coagulation parameters including platelet count, international normalized ratio (INR), prothrombin time (PT), and activated partial thromboplastin time (APTT) should be within normal ranges. Agree to practice highly effective contraception during the study and continue contraception for 90 days after their last dose of study treatment. Exclusion Criteria: Uncontrolled infection, not responding to appropriate antimicrobial agents after seven days of therapy. The Protocol medical monitor is the final arbiter of eligibility. Antiplatelet or anticoagulant therapy within the 14 days prior to Day 1 or anticipated use during the study, including but not limited to daily aspirin including low dose aspirin (defined as ≤ 150 mg/day), clopidogrel, dipyridamole, warfarin, dabigatran, rivaroxaban and apixaban Clinically significant low platelet count (defined as < 100,000/mm3), coagulation tests, or laboratory abnormalities that would render a subject unsuitable for inclusion Unwillingness to comply with study procedures, including follow-up, as specified by this protocol, or unwillingness to cooperate fully with the Investigator Have any other conditions, which, in the opinion of the Investigator would make the subject unsuitable for inclusion, or could interfere with the subject participating in or completing the study Concurrent participation in any other interventional clinical study Treatment with another investigational drug, biological agent, or device, including, but not limited to sodium phenylbutyrate, within 1 month of Screening, or 5 half-lives of investigational agent, whichever is longer Treatment of cancer in the last 5 years (except in situ carcinoma of the cervix or basal cell carcinoma) Female subjects who are pregnant or currently breastfeeding Other unspecified reasons that, in the opinion of the Investigator or Sponsor, make the subject unsuitable for enrollment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jess Singleton
Phone
212-305-6788
Email
alsresearch@columbia.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Neil Shneider, MD, PhD
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Columbia University Irving Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10033
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Neil Shneider, MD, PhD
First Name & Middle Initial & Last Name & Degree
Neil Shneider, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
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Regulatory T Cells for Amyotrophic Lateral Sclerosis

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