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Safety Study of a Dual Anti-HIV Gene Transfer Construct to Treat HIV-1 Infection

Primary Purpose

Human Immunodeficiency Virus

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Busulfan
Cal-1 modified HSPC
Cal-1 modified CD4+ T lymphocytes
Sponsored by
Calimmune, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Human Immunodeficiency Virus focused on measuring HIV-1

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Prior to any study-related procedures, signed informed consent indicating that they understand the purpose, risks and procedures required for the study and are willing to participate in the study
  • Individuals aged 18 to 65 years of age (inclusive) at time of consent
  • Documented HIV-1 infection ≥ 6 months prior to Screening 1
  • Previous treatment with antiretroviral agents that had a demonstrated suppressive effect (defined as plasma HIV RNA ≤ 50 copies/ml)
  • A documented viable ART regimen option, as determined by the Investigator, taking into account prior ART experience and HIV geno/phenotyping analyses
  • Not taking antiretroviral therapy for ≥ 6 weeks prior to Screening 1, for one or more of the following reasons:

    i) Concerns over short-term or long-term toxicities associated with antiretroviral agents, or ii) Treatment fatigue from the daily regimen of life-long therapy

  • Plasma HIV-1 viral RNA ≥ 5,000 copies/mL and ≤ 100,000 copies/ml at Screening 1 and Screening 2
  • CD4+ T lymphocyte count ≥ 500 cells/µl at Screening 1 and Screening 2

Exclusion Criteria:

  • Abnormal hematology at Screening 1: Absolute neutrophil count (ANC) < 1.5 x 109/L, Platelet count < 100 x 109/L, Hemoglobin < 10 g/dL
  • Abnormal biochemistry at Screening 1: Alanine aminotransferase (ALT) > 2.5 x Upper Limit of Normal (ULN), Total bilirubin > 1.5 x ULN, Serum creatinine > 1.5 x ULN
  • Detection of any CXCR4-tropic HIV-1 at Screening 1
  • Evidence of co-infection with hepatitis B virus, hepatitis C virus, West Nile Virus, or HTLV-1 as detected at Screening 2
  • Evidence of active TB infection determined by positive QuantiFERON®-TB Gold/IGRA test result and clinical confirmation at Screening 2
  • ART or other antiretroviral therapy within 6 weeks of Screening 1 or any time during the pre-infusion period
  • Documented history of CD4+ T lymphocyte count < 250 cells/µl
  • Any previous or current AIDS-defining illnesses (CDC Category C), including AIDS-related dementia, with the exception of Kaposi's sarcoma confined to the skin
  • History of malignancy or systemic chemotherapy within the last 5 years (i.e., subjects with prior malignancy must be disease-free for 5 years), except curatively-treated basal cell carcinoma, cutaneous squamous cell carcinoma, or cervical or anal intra-epithelial neoplasia
  • History of steroid-dependent asthma in the past 5 years
  • History of seizure
  • Any clinical history of hematologic diseases including leukemia, myelodysplasia, myeloproliferative disease, thromboembolic disease, sickle cell disorder, thrombocytopenia or leukopenia
  • Class II-IV heart failure, according to the New York Heart Association classification
  • Inadequate venous access for apheresis, as assessed at Screening 1
  • Current or planned systemic immunosuppressive or immunomodulatory medication
  • Taking warfarin, aspirin or any medication that is likely to affect platelet function or other aspects of blood coagulation, and unable to safely cease this medication for a period of 1 week prior, during, and 1 week after administration of G-CSF (a total period of 19 days)
  • Participation in any study involving any investigational drug or medical device within 30 days prior to Screening 1
  • Receipt of a vaccine for HIV-1 or any gene transfer product at any time
  • Prior treatment with recombinant G-CSF or busulfan or other stem-cell mobilizing or modulating agent within the previous 12 months
  • Known hypersensitivity to busulfan, G-CSF (Neupogen™) or E. coli-derived proteins
  • Subjects who will not accept transfusions of blood products
  • Pregnant or breast-feeding at any time between Screening 1 and Baseline (infusion)
  • History of alcohol or drug abuse within the 12 months prior to Screening 1
  • Inability to understand and provide informed consent

Sites / Locations

  • UCLA CARE Center
  • Quest Clinical Research

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

No busulfan pre-conditioning

1 x 4mg/kg busulfan preconditioning

2 x 4mg/kg busulfan pre-conditioning

Arm Description

Cal-1 modified HSPC and Cal-1 modified CD4+ T lymphocytes without busulfan preconditioning

Cal-1 modified HSPC and Cal-1 modified CD4+ T lymphocytes, with single 4mg/kg busulfan dose administered as pre-conditioning for transplant

Cal-1 modified HSPC and Cal-1 modified CD4+ T lymphocytes, with two 4mg/kg busulfan doses administered as pre-conditioning for transplant

Outcomes

Primary Outcome Measures

Number of Participants With Severe and Life-threatening Adverse Events (AEs)
Number of Participants With Severe or Life-threatening AEs Related to CSL202
Number of Participants With the Presence of Replication-competent Retrovirus
Number of Participants With Predominant Integration Site Analysis
Vector Integration Site Analysis performed only when Cal-1 Marking is >= 1%.
Mean Cell Dose for CD4+ Cells (Ttn)
Mean Cell Dose for CD34+ Cells (HSPCtn)
Percent Transduction Efficiency of CD4+ Cells (Ttn) and CD34+ Cells (HSPCtn) of Final Cell Product
Total Area Under the Curve (AUC) for Busulfan
Cohort 3: Total AUC = first dose AUC value + second dose AUC value

Secondary Outcome Measures

Percent Cal-1 Marking in Peripheral Blood
Cal-1 Marking in Gut-associated Lymphoid Tissue (GALT) (10-15 cm)
Samples were collected via endoscopic biopsy from the sigmoid colon: 10-15 cm from the anal margin
Cal-1 Marking in GALT (25-35 cm)
Samples were collected via endoscopic biopsy from the sigmoid colon: 25-35 cm from the anal margin
Cal-1 Marking in Bone Marrow
Cal-1 C46 Expression in Peripheral Blood
C46 relative expression will be analyzed by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) and normalized to the expression of β2-microglobulin (β2M) mRNA
Cal-1 sh5 Expression in Peripheral Blood
sh5 relative expression will be analyzed by RT-qPCR and normalized to the expression of RNU38B microRNA
HIV Viral Load at Baseline Screening and Week 48 or at Anti-retroviral Therapy (ART) Re-commencement
CD4+ Count at Baseline Screening and Week 48 or at ART Re-commencement
Number of Participants With HIV-1 Tropism Shift
Shift from R5 to X4 or dual/mixed tropism

Full Information

First Posted
November 19, 2012
Last Updated
July 22, 2020
Sponsor
Calimmune, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01734850
Brief Title
Safety Study of a Dual Anti-HIV Gene Transfer Construct to Treat HIV-1 Infection
Official Title
An Adaptive Phase I/II Study of the Safety of CD4+ T Lymphocytes and CD34+ Hematopoietic Stem/Progenitor Cells Transduced With LVsh5/C46, a Dual Anti-HIV Gene Transfer Construct, With and Without Conditioning With Busulfan in HIV-1 Infected Adults Previously Exposed to ART
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
April 2013 (Actual)
Primary Completion Date
September 2017 (Actual)
Study Completion Date
November 2017 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an early phase research study looking at whether an experimental gene transfer, LVsh5/C46 (also known as Cal-1), is safe and if it can protect the immune system from the effects of HIV without the use of antiretroviral drugs. Cal-1 is an experimental gene transfer agent designed to inhibit HIV infection through 2 active parts: Removing a protein named CCR5 from bone marrow and white blood cells Producing a protein named C46 on bone marrow and white blood cells
Detailed Description
It is estimated that 33 million individuals are currently infected with HIV. HIV/AIDS is a disease that impairs immune function, primarily by decreasing CD4+ T lymphocytes. The progression can be contained by daily dosing with antiretroviral therapy (ART) but there are side effects that can be treatment limiting, and the development of HIV drug resistance can force the physician to modify the ART regimen. There are no effective vaccines currently available for HIV. LVsh5/C46 (also known as Cal-1) is a dual therapeutic, self-inactivating lentiviral vector that encodes for both a short hairpin RNA against the HIV-1 co-receptor CCR5 (sh5) and a HIV-1 fusion inhibitor, C46 and inhibits two processes required for HIV-1 infection: Binding of the virus to the cellular CCR5 co-receptor and Fusion of the virus with the host cell The rationale is that Cal-1 introduced into hematopoietic progenitor/stem cells (HSPC) and mature CD4+ T lymphocytes will protect these cells and their progeny cells from HIV-1 infection and its pathogenic sequelae. This may provide a continuous means of controlling HIV-1 after a single or infrequent dose(s), thereby decreasing or delaying (partially or completely) the need for antiretroviral drug therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Human Immunodeficiency Virus
Keywords
HIV-1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
No busulfan pre-conditioning
Arm Type
Experimental
Arm Description
Cal-1 modified HSPC and Cal-1 modified CD4+ T lymphocytes without busulfan preconditioning
Arm Title
1 x 4mg/kg busulfan preconditioning
Arm Type
Experimental
Arm Description
Cal-1 modified HSPC and Cal-1 modified CD4+ T lymphocytes, with single 4mg/kg busulfan dose administered as pre-conditioning for transplant
Arm Title
2 x 4mg/kg busulfan pre-conditioning
Arm Type
Experimental
Arm Description
Cal-1 modified HSPC and Cal-1 modified CD4+ T lymphocytes, with two 4mg/kg busulfan doses administered as pre-conditioning for transplant
Intervention Type
Drug
Intervention Name(s)
Busulfan
Other Intervention Name(s)
Busulfex
Intervention Description
Intravenous busulfan
Intervention Type
Biological
Intervention Name(s)
Cal-1 modified HSPC
Other Intervention Name(s)
LVsh5/C46 modified HSPC
Intervention Description
Hematopoietic progenitor/stem cells (HSPC) modified with LVsh5/C46 (Cal-1)
Intervention Type
Biological
Intervention Name(s)
Cal-1 modified CD4+ T lymphocytes
Other Intervention Name(s)
LVsh5/C46 modified CD4+ T lymphocytes
Intervention Description
CD4+ T lymphocytes modified with LVsh5/C46 (Cal-1)
Primary Outcome Measure Information:
Title
Number of Participants With Severe and Life-threatening Adverse Events (AEs)
Time Frame
Up to 48 weeks
Title
Number of Participants With Severe or Life-threatening AEs Related to CSL202
Time Frame
Up to 48 weeks
Title
Number of Participants With the Presence of Replication-competent Retrovirus
Time Frame
Up to 48 weeks
Title
Number of Participants With Predominant Integration Site Analysis
Description
Vector Integration Site Analysis performed only when Cal-1 Marking is >= 1%.
Time Frame
Up to 48 weeks
Title
Mean Cell Dose for CD4+ Cells (Ttn)
Time Frame
Up to 48 weeks
Title
Mean Cell Dose for CD34+ Cells (HSPCtn)
Time Frame
Up to 48 weeks
Title
Percent Transduction Efficiency of CD4+ Cells (Ttn) and CD34+ Cells (HSPCtn) of Final Cell Product
Time Frame
Up to 48 weeks
Title
Total Area Under the Curve (AUC) for Busulfan
Description
Cohort 3: Total AUC = first dose AUC value + second dose AUC value
Time Frame
Up to 48 weeks
Secondary Outcome Measure Information:
Title
Percent Cal-1 Marking in Peripheral Blood
Time Frame
Up to 48 weeks
Title
Cal-1 Marking in Gut-associated Lymphoid Tissue (GALT) (10-15 cm)
Description
Samples were collected via endoscopic biopsy from the sigmoid colon: 10-15 cm from the anal margin
Time Frame
Up to 48 weeks
Title
Cal-1 Marking in GALT (25-35 cm)
Description
Samples were collected via endoscopic biopsy from the sigmoid colon: 25-35 cm from the anal margin
Time Frame
Up to 48 weeks
Title
Cal-1 Marking in Bone Marrow
Time Frame
Up to 48 weeks
Title
Cal-1 C46 Expression in Peripheral Blood
Description
C46 relative expression will be analyzed by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) and normalized to the expression of β2-microglobulin (β2M) mRNA
Time Frame
Up to 48 weeks
Title
Cal-1 sh5 Expression in Peripheral Blood
Description
sh5 relative expression will be analyzed by RT-qPCR and normalized to the expression of RNU38B microRNA
Time Frame
Up to 48 weeks
Title
HIV Viral Load at Baseline Screening and Week 48 or at Anti-retroviral Therapy (ART) Re-commencement
Time Frame
Up to 48 weeks
Title
CD4+ Count at Baseline Screening and Week 48 or at ART Re-commencement
Time Frame
Up to 48 weeks
Title
Number of Participants With HIV-1 Tropism Shift
Description
Shift from R5 to X4 or dual/mixed tropism
Time Frame
Up to 48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Prior to any study-related procedures, signed informed consent indicating that they understand the purpose, risks and procedures required for the study and are willing to participate in the study Individuals aged 18 to 65 years of age (inclusive) at time of consent Documented HIV-1 infection ≥ 6 months prior to Screening 1 Previous treatment with antiretroviral agents that had a demonstrated suppressive effect (defined as plasma HIV RNA ≤ 50 copies/ml) A documented viable ART regimen option, as determined by the Investigator, taking into account prior ART experience and HIV geno/phenotyping analyses Not taking antiretroviral therapy for ≥ 6 weeks prior to Screening 1, for one or more of the following reasons: i) Concerns over short-term or long-term toxicities associated with antiretroviral agents, or ii) Treatment fatigue from the daily regimen of life-long therapy Plasma HIV-1 viral RNA ≥ 5,000 copies/mL and ≤ 100,000 copies/ml at Screening 1 and Screening 2 CD4+ T lymphocyte count ≥ 500 cells/µl at Screening 1 and Screening 2 Exclusion Criteria: Abnormal hematology at Screening 1: Absolute neutrophil count (ANC) < 1.5 x 109/L, Platelet count < 100 x 109/L, Hemoglobin < 10 g/dL Abnormal biochemistry at Screening 1: Alanine aminotransferase (ALT) > 2.5 x Upper Limit of Normal (ULN), Total bilirubin > 1.5 x ULN, Serum creatinine > 1.5 x ULN Detection of any CXCR4-tropic HIV-1 at Screening 1 Evidence of co-infection with hepatitis B virus, hepatitis C virus, West Nile Virus, or HTLV-1 as detected at Screening 2 Evidence of active TB infection determined by positive QuantiFERON®-TB Gold/IGRA test result and clinical confirmation at Screening 2 ART or other antiretroviral therapy within 6 weeks of Screening 1 or any time during the pre-infusion period Documented history of CD4+ T lymphocyte count < 250 cells/µl Any previous or current AIDS-defining illnesses (CDC Category C), including AIDS-related dementia, with the exception of Kaposi's sarcoma confined to the skin History of malignancy or systemic chemotherapy within the last 5 years (i.e., subjects with prior malignancy must be disease-free for 5 years), except curatively-treated basal cell carcinoma, cutaneous squamous cell carcinoma, or cervical or anal intra-epithelial neoplasia History of steroid-dependent asthma in the past 5 years History of seizure Any clinical history of hematologic diseases including leukemia, myelodysplasia, myeloproliferative disease, thromboembolic disease, sickle cell disorder, thrombocytopenia or leukopenia Class II-IV heart failure, according to the New York Heart Association classification Inadequate venous access for apheresis, as assessed at Screening 1 Current or planned systemic immunosuppressive or immunomodulatory medication Taking warfarin, aspirin or any medication that is likely to affect platelet function or other aspects of blood coagulation, and unable to safely cease this medication for a period of 1 week prior, during, and 1 week after administration of G-CSF (a total period of 19 days) Participation in any study involving any investigational drug or medical device within 30 days prior to Screening 1 Receipt of a vaccine for HIV-1 or any gene transfer product at any time Prior treatment with recombinant G-CSF or busulfan or other stem-cell mobilizing or modulating agent within the previous 12 months Known hypersensitivity to busulfan, G-CSF (Neupogen™) or E. coli-derived proteins Subjects who will not accept transfusions of blood products Pregnant or breast-feeding at any time between Screening 1 and Baseline (infusion) History of alcohol or drug abuse within the 12 months prior to Screening 1 Inability to understand and provide informed consent
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ronald Mitsuyasu, M.D.
Organizational Affiliation
University of California, Los Angeles
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCLA CARE Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90035
Country
United States
Facility Name
Quest Clinical Research
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States

12. IPD Sharing Statement

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Safety Study of a Dual Anti-HIV Gene Transfer Construct to Treat HIV-1 Infection

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