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Study to Evaluate Safety and Activity of TRL1068 in Chronic Rhinosinusitis

Primary Purpose

Chronic Rhinosinusitis With Nasal Polyps

Status
Not yet recruiting
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
TRL1068
Sponsored by
Trellis Bioscience LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Rhinosinusitis With Nasal Polyps focused on measuring biofilm, antibiotic-resistant infections

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age 18 to 85 years, inclusive
  2. Diagnosis of chronic rhinosinusitis with:

    1. Acute exacerbation of CRSwNP with increased sinonasal discharge OR
    2. Acute exacerbation post-functional endoscopic sinus surgery (FESS) with increased sinonasal discharge AND
    3. Sinonasal culture positive for SA or PA without concomitant fungal infection in culture or PCR
  3. Symptoms and culture results justify initiation of topical and/or systemic antibiotic treatment
  4. Willing and able to provide written informed consent
  5. Willing to perform and comply with all study procedures including attending clinic visits as scheduled
  6. Men and women of child bearing potential (WOCBP) must be willing to practice a highly effective method of contraception that may include, but is not limited to, abstinence, sex only with persons of the same sex, monogamous relationship with vasectomized partner, vasectomy, hysterectomy, bilateral tubal ligation, licensed hormonal methods, intrauterine device (IUD), or use of spermicide combined with a barrier method (e.g., condom, diaphragm) for 28 days before receiving the investigational product (IP) and through Day 50.

Exclusion Criteria:

  1. Active malignancy, or history of malignancy or chemotherapy within the past 2 years other than history of localized or surgical removal of focal skin cancer, or cervical cancer in situ treated successfully in the past by local treatment (including but not limited to cryotherapy or laser therapy) or by hysterectomy
  2. Any chronic or acute bacterial infection other than acute exacerbation of CRS
  3. Concomitant intrasinal culture or 16S PCR indicative of concomitant fungal infection
  4. Allergic fungal rhinosinusitis, characterized by elevated antifungal IgE and eosinophilic mucus
  5. Receiving or recently received another investigational drug (within 30 days of Day 1, or 5 half-lives of the investigational drug, whichever is longer)
  6. Received a COVID-19 vaccine or booster within 14 days of planned Day 1 or planned COVID-19 vaccination within 14 days after Day 1
  7. Positive serum test for pregnancy, pregnant, or nursing women
  8. History of drug or alcohol abuse that, in the opinion of the Investigator, would interfere with the subject's ability to comply with the study requirements
  9. Any other comorbidity or condition that, in the opinion of the Investigator would make the subject unsuitable for the study or unable to comply with the study requirements

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    TRL1068

    Arm Description

    all subjects will receive a single intravenous dose of 15 mg/kg of TRL1068 on Day 1

    Outcomes

    Primary Outcome Measures

    Incidence of abnormal physical exam findings
    Clinically-significant abnormal physical exam findings will be reviewed
    Incidence of abnormal serum chemistries and hematology
    Clinically-significant abnormal laboratory results will be reviewed
    Incidence of abnormal vital signs (temperature)
    Clinically-significant abnormal temperatures will be reviewed
    Incidence of abnormal vital signs (blood pressure)
    Clinically-significant abnormal blood pressures will be reviewed
    Incidence of abnormal vital signs (heart rate)
    Clinically-significant abnormal heart rates will be reviewed
    Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
    reported AEs and SAEs will be reviewed
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmax)
    Individual subject TRL1068 Cmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmin)
    Individual subject TRL1068 Cmin in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (Tmax)
    Individual subject TRL1068 Tmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCLAST)
    Individual subject TRL1068 AUCLAST in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCINF)
    Individual subject TRL1068 AUCINF in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmax)
    Individual subject TRL1068 Cmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmin)
    Individual subject TRL1068 Cmin intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Tmax)
    Individual subject TRL1068 Tmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCLAST)
    Individual subject TRL1068 AUCLAST intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCINF)
    Individual subject TRL1068 AUCINF intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of bacterial pathogen infection)
    Cultures will be tested for bacterial pathogen presence by bacterial culture and/or PCR assessment. Time to resolution of bacterial pathogen infection is defined as the number of days from start of current acute exacerbation to the day when testing by bacterial culture and/or PCR assessment are reported as negative. Descriptive statistics will be performed including mean, median and confidence interval.
    Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of signs and symptoms of acute exacerbation)
    Patients will be evaluated for signs and symptoms of acute exacerbation using SNOT-22 scoring. Time to resolution of signs and symptoms of acute exacerbation is defined as the day when the SNOT-22 score is back to pre-acute exacerbation score.
    Assess the immunogenicity of TRL1068 as measured by anti-drug antibodies (ADAs)
    Anti-drug antibodies (ADA), i.e. anti-TRL1068 antibodies in serum will determined by electrochemiluminescence assay

    Secondary Outcome Measures

    Assess the incidence of improvement of baseline symptoms of chronic rhinosinusitis (CRS) after intravenous TRL1068
    signs and symptoms will be measured using the SNOT-22
    Assess time to improvement of baseline symptoms of CRS as compared with previous duration of acute exacerbations
    signs and symptoms will be measured using the SNOT-22 and compared with historical data

    Full Information

    First Posted
    April 18, 2022
    Last Updated
    April 10, 2023
    Sponsor
    Trellis Bioscience LLC
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05355207
    Brief Title
    Study to Evaluate Safety and Activity of TRL1068 in Chronic Rhinosinusitis
    Official Title
    Phase 1 Study to Evaluate the Safety, Pharmacokinetics, and Pharmacodynamics of TRL1068 in Subjects With Acute Exacerbation of Chronic Rhinosinusitis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    January 2024 (Anticipated)
    Primary Completion Date
    January 2025 (Anticipated)
    Study Completion Date
    January 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Trellis Bioscience LLC

    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
    TRL1068 is expected to eliminate the pathogen-protecting biofilm in Chronic Rhinosinusitis, thus making these bacteria substantially more susceptible to established antibiotic treatment regimens. This initial study is to assess overall safety and pharmacokinetics (PK) of TRL1068. The goal of the development program is to demonstrate effectiveness of TRL1068 in difficult to treat bacterial infections such as in CRS.
    Detailed Description
    Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and decreased quality of life. Defects in the epithelial cell barrier, increased exposure to pathogenic and colonized bacteria, and dysregulation of the host immune system are all thought to play prominent roles in disease pathogenesis. Colonization with S. aureus or P. aureus are associated with recalcitrant disease and biofilm formation, making eradication difficult. Distribution of topical solutions in the unoperated sinuses has been observed to be less than 2% of the total irrigation volume, with almost no penetration in the frontal and sphenoid sinuses. For those patients with mucosal edema from infection and chronic inflammation, distribution is probably significantly less when applied topically. Intravenously administered TRL1068 is expected to achieve effective anti-biofilm levels throughout the sinonasal space for several weeks. TRL1068 is a monoclonal human antibody that rapidly eliminates biofilm at very low concentrations, thus making the targeted bacterial pathogens substantially more sensitive to standard of care antibiotic treatment regimen and greatly accelerating clinical improvement and potential for bacterial eradication.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Chronic Rhinosinusitis With Nasal Polyps
    Keywords
    biofilm, antibiotic-resistant infections

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1
    Interventional Study Model
    Single Group Assignment
    Model Description
    single group, all subjects will receive 15 mg/kg of TRL1068 on Day 1
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    12 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    TRL1068
    Arm Type
    Experimental
    Arm Description
    all subjects will receive a single intravenous dose of 15 mg/kg of TRL1068 on Day 1
    Intervention Type
    Drug
    Intervention Name(s)
    TRL1068
    Intervention Description
    A human IgG1κ (G1m1,17 (z,a); Km3 allotype) monoclonal antibody
    Primary Outcome Measure Information:
    Title
    Incidence of abnormal physical exam findings
    Description
    Clinically-significant abnormal physical exam findings will be reviewed
    Time Frame
    6 weeks
    Title
    Incidence of abnormal serum chemistries and hematology
    Description
    Clinically-significant abnormal laboratory results will be reviewed
    Time Frame
    6 weeks
    Title
    Incidence of abnormal vital signs (temperature)
    Description
    Clinically-significant abnormal temperatures will be reviewed
    Time Frame
    6 weeks
    Title
    Incidence of abnormal vital signs (blood pressure)
    Description
    Clinically-significant abnormal blood pressures will be reviewed
    Time Frame
    6 weeks
    Title
    Incidence of abnormal vital signs (heart rate)
    Description
    Clinically-significant abnormal heart rates will be reviewed
    Time Frame
    6 weeks
    Title
    Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
    Description
    reported AEs and SAEs will be reviewed
    Time Frame
    7 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmax)
    Description
    Individual subject TRL1068 Cmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (Cmin)
    Description
    Individual subject TRL1068 Cmin in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (Tmax)
    Description
    Individual subject TRL1068 Tmax in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCLAST)
    Description
    Individual subject TRL1068 AUCLAST in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in serum (AUCINF)
    Description
    Individual subject TRL1068 AUCINF in serum will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmax)
    Description
    Individual subject TRL1068 Cmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Cmin)
    Description
    Individual subject TRL1068 Cmin intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (Tmax)
    Description
    Individual subject TRL1068 Tmax intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCLAST)
    Description
    Individual subject TRL1068 AUCLAST intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacokinetics (PK) of TRL1068 in intrasinal concentrations (AUCINF)
    Description
    Individual subject TRL1068 AUCINF intrasinal will be determined by ELISA and derived PK parameters will be summarized using descriptive statistics.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of bacterial pathogen infection)
    Description
    Cultures will be tested for bacterial pathogen presence by bacterial culture and/or PCR assessment. Time to resolution of bacterial pathogen infection is defined as the number of days from start of current acute exacerbation to the day when testing by bacterial culture and/or PCR assessment are reported as negative. Descriptive statistics will be performed including mean, median and confidence interval.
    Time Frame
    6 weeks
    Title
    Characterize the pharmacodynamics (PD) of TRL1068 (time to resolution of signs and symptoms of acute exacerbation)
    Description
    Patients will be evaluated for signs and symptoms of acute exacerbation using SNOT-22 scoring. Time to resolution of signs and symptoms of acute exacerbation is defined as the day when the SNOT-22 score is back to pre-acute exacerbation score.
    Time Frame
    6 weeks
    Title
    Assess the immunogenicity of TRL1068 as measured by anti-drug antibodies (ADAs)
    Description
    Anti-drug antibodies (ADA), i.e. anti-TRL1068 antibodies in serum will determined by electrochemiluminescence assay
    Time Frame
    6 weeks
    Secondary Outcome Measure Information:
    Title
    Assess the incidence of improvement of baseline symptoms of chronic rhinosinusitis (CRS) after intravenous TRL1068
    Description
    signs and symptoms will be measured using the SNOT-22
    Time Frame
    7 weeks
    Title
    Assess time to improvement of baseline symptoms of CRS as compared with previous duration of acute exacerbations
    Description
    signs and symptoms will be measured using the SNOT-22 and compared with historical data
    Time Frame
    7 weeks
    Other Pre-specified Outcome Measures:
    Title
    Assess the effects of treatment on the intrasinal microbiome
    Description
    intrasinal culture and PCR results will be reviewed
    Time Frame
    6 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    85 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Age 18 to 85 years, inclusive Diagnosis of chronic rhinosinusitis with: Acute exacerbation of CRSwNP with increased sinonasal discharge OR Acute exacerbation post-functional endoscopic sinus surgery (FESS) with increased sinonasal discharge AND Sinonasal culture positive for SA or PA without concomitant fungal infection in culture or PCR Symptoms and culture results justify initiation of topical and/or systemic antibiotic treatment Willing and able to provide written informed consent Willing to perform and comply with all study procedures including attending clinic visits as scheduled Men and women of child bearing potential (WOCBP) must be willing to practice a highly effective method of contraception that may include, but is not limited to, abstinence, sex only with persons of the same sex, monogamous relationship with vasectomized partner, vasectomy, hysterectomy, bilateral tubal ligation, licensed hormonal methods, intrauterine device (IUD), or use of spermicide combined with a barrier method (e.g., condom, diaphragm) for 28 days before receiving the investigational product (IP) and through Day 50. Exclusion Criteria: Active malignancy, or history of malignancy or chemotherapy within the past 2 years other than history of localized or surgical removal of focal skin cancer, or cervical cancer in situ treated successfully in the past by local treatment (including but not limited to cryotherapy or laser therapy) or by hysterectomy Any chronic or acute bacterial infection other than acute exacerbation of CRS Concomitant intrasinal culture or 16S PCR indicative of concomitant fungal infection Allergic fungal rhinosinusitis, characterized by elevated antifungal IgE and eosinophilic mucus Receiving or recently received another investigational drug (within 30 days of Day 1, or 5 half-lives of the investigational drug, whichever is longer) Received a COVID-19 vaccine or booster within 14 days of planned Day 1 or planned COVID-19 vaccination within 14 days after Day 1 Positive serum test for pregnancy, pregnant, or nursing women History of drug or alcohol abuse that, in the opinion of the Investigator, would interfere with the subject's ability to comply with the study requirements Any other comorbidity or condition that, in the opinion of the Investigator would make the subject unsuitable for the study or unable to comply with the study requirements
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Anton (Tony) Leighton, MD
    Phone
    650-838-1400
    Email
    Clinicalstudies@trellisbio.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Adriane Kisch-Hancock
    Phone
    650-838-1400
    Email
    akisch-hancock@trellisbio.com

    12. IPD Sharing Statement

    Plan to Share IPD
    Yes
    IPD Sharing Plan Description
    We plan to make the Clinical Protocol and SAP available on Protocols.io (https://www.protocols.io/) before trial recruitment is complete.
    IPD Sharing Time Frame
    Before trial recruitment is complete on Protocols.io (https://www.protocols.io/)
    IPD Sharing Access Criteria
    available
    Citations:
    PubMed Identifier
    26833157
    Citation
    Estelles A, Woischnig AK, Liu K, Stephenson R, Lomongsod E, Nguyen D, Zhang J, Heidecker M, Yang Y, Simon RJ, Tenorio E, Ellsworth S, Leighton A, Ryser S, Gremmelmaier NK, Kauvar LM. A High-Affinity Native Human Antibody Disrupts Biofilm from Staphylococcus aureus Bacteria and Potentiates Antibiotic Efficacy in a Mouse Implant Infection Model. Antimicrob Agents Chemother. 2016 Mar 25;60(4):2292-301. doi: 10.1128/AAC.02588-15. Print 2016 Apr.
    Results Reference
    background
    PubMed Identifier
    28717038
    Citation
    Xiong YQ, Estelles A, Li L, Abdelhady W, Gonzales R, Bayer AS, Tenorio E, Leighton A, Ryser S, Kauvar LM. A Human Biofilm-Disrupting Monoclonal Antibody Potentiates Antibiotic Efficacy in Rodent Models of both Staphylococcus aureus and Acinetobacter baumannii Infections. Antimicrob Agents Chemother. 2017 Sep 22;61(10):e00904-17. doi: 10.1128/AAC.00904-17. Print 2017 Oct.
    Results Reference
    background

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    Study to Evaluate Safety and Activity of TRL1068 in Chronic Rhinosinusitis

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