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The ONE Study ATDC Trial (ONEatDC)

Primary Purpose

Renal Failure, End Stage

Status
Completed
Phase
Phase 1
Locations
France
Study Type
Interventional
Intervention
ATDC_Nantes
Sponsored by
Nantes University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Renal Failure, End Stage

Eligibility Criteria

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

RECIPIENT

Inclusion Criteria:

  1. Chronic renal insufficiency necessitating kidney transplantation and approved to receive a primary kidney allograft from a living donor
  2. Aged at least 18 years
  3. Able to commence the immunosuppressive regimen at the protocol-specified time point
  4. Willing and able to participate in The ONE Study IM and HEC subprojects
  5. Eligible for leucapheresis prior to organ transplantation
  6. Signed and dated written informed consent

Exclusion Criteria:

  1. Patient has previously received any tissue or organ transplant other than the planned kidney graft
  2. Known contraindication to the protocol-specified treatments / medications (like known allergies to heparin)
  3. Genetically identical to the prospective organ donor at the HLA loci (A.B.DR 0 mismatch)
  4. PRA grade > 0 within 6 months prior to enrolment
  5. Previous treatment with any desensitisation procedure (with or without IVIg)
  6. Concomitant malignancy or history of malignancy within 5 years prior to planned study entry (excluding successfully-treated non-metastatic basal/squamous cell carcinoma of the skin)
  7. ABO incompatibility
  8. Presence of DSA (donor specific antibodies) detected by luminex prior transplantation
  9. Evidence of significant local or systemic infection
  10. HIV-positive, EBV-negative or suffering chronic viral hepatitis, syphilis serology- positive
  11. Significant liver disease, defined as persistently elevated AST and/or ALT levels > 2 x ULN (Upper Limit of Normal range)
  12. Malignant or pre-malignant haematological conditions
  13. Any uncontrolled medical condition or concurrent disease that could interfere with the study objectives
  14. Any condition which, in the judgement of the Investigator, would place the subject at undue risk
  15. Ongoing treatment with systemic immunosuppressive drugs at inclusion (despite corticoids lower than 10 mg)
  16. Participation in another clinical trial during the study or within 28 days prior to planned study entry
  17. Exposure to an investigational product during the study or within 28 days prior to planned study entry
  18. Female patients of child-bearing potential with a positive pregnancy test at enrolment and F01
  19. Female patients who are breast-feeding
  20. All female patients of child-bearing potential* UNLESS:

    1. The patient is willing to maintain a highly effective method of birth control** for the duration of the study
    2. The career, lifestyle, or sexual orientation of the patient ensures that there is no risk of pregnancy for the duration of the study (at the discretion of the Investigator)
  21. Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up visit schedule
  22. Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the Investigator, may invalidate communication with the Investigator and/or designated study personnel
  23. Patients unable to freely give their informed consent (e.g. individuals under legal guardianship).

    Criteria specific to the infusion of the ATDC_Nantes:

  24. Any pro-coagulant disposition, as evidenced by a past history of thromboembolic disease or abnormal laboratory coagulation parameters which, in the judgement of the Investigator, would place the subject at undue risk
  25. Any condition resulting in a substantial reduction in the volume of the pulmonary vasculature or an increase in the pulmonary vascular resistance. Any disease or disease process leading to substantially elevated pulmonary arterial pressure (as evidenced by electrocardiography, echocardiography, radiology or cardiac catheterisation) or right heart hypertrophy or dysfunction
  26. Known atrial or ventricular septal defects posing a risk of paradoxical embolism of infused cells or cell aggregates
  27. Known hypersensitivity to any component of the cell product or components used in the manufacture of the cell product.

DONOR

Inclusion Criteria:

  1. Eligible for live kidney donation
  2. Willing and able to provide a blood sample for The ONE Study IM Subproject
  3. Willing to provide personal and medical/biological data for the trial analysis
  4. Signed and dated written informed consent

Exclusion Criteria:

  1. Genetically identical to the prospective organ recipient at the HLA loci (A.B.DR 0 mismatch)
  2. Exposure to any investigational agents at the time of kidney donation, or within 28 days prior to kidney donation
  3. Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the Investigator, may invalidate communication with the Investigator and/or designated study personnel
  4. Subjects unable to freely give their informed consent (e.g. individuals under legal guardianship).
  5. ABO incompatibility

Sites / Locations

  • Nantes University hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ATDC Treatment

Arm Description

ATDC treatment (1 x 106 cells/kg BW slow peripheral venous) occurs the day before transplantation. Recipients also receive prednisolone, Mycophenolate Mofetil and tacrolimus, as detailed below : Prednidolone : D 0: 500 mg IV D 1: 125 mg IV D 2 to 14: 20.0 mg/d Wk 3 to 4: 15.0 mg/d Wk 5 to 8: 10.0 mg/d Wk 9 to 12: 5.0 mg/d Wk 13 to 14: 2.5 mg/d Wk 15 to End:Cessation MMF (or biologic equiv.): D -7 to -2: 500 mg/d (250mg 2x/d) D -1 to 14: 2000 mg/d Wk 3 to 36: 1000 mg/d Wk 37 to 40: 750 mg/d Wk 41 to 44: 500 mg/d Wk 45 to 48: 250 mg/d Wk 49 to End:Cessation Note : MMF tapering will only happen if the 36-week protocol biopsy shows no signs of subclinical rejection and there is evidence of declining renal function or if the clinician has any other concern about MMF dose reduction. Tacrolimus : ≤ 48 h pre-Tx to D 14: 3-12 ng/ml Wk 3 to 12: 3-10 ng/ml Wk 13 to 36: 3-8 ng/ml Wk 37 to End: 3-6 ng/ml

Outcomes

Primary Outcome Measures

Incidence of biopsy-confirmed acute rejection (BCAR)

Secondary Outcome Measures

Time to first acute rejection episode
Severity of acute rejection episodes
based on response to treatment and histological scoring
Total immunosuppressive burden
assessed at last study visit
Incidence of patients treated for subclinical acute rejection on the basis of histopathological findings
Prevention of chronic graft dysfunction (chronic rejection or IF/TA)
assessed by clinical (impairment of GFR) and histopathological (Banff staging) measures.
Incidence of post-transplant dialysis, inclusion on the transplant waiting list or re-transplantation following graft loss through rejection (acute or chronic).
Avoidance of drug-related complications by immunosuppressant reduction
Incidence of embolic pulmonary complications and other embolic events
Incidence of immunological reactions resulting in anaphylactoid reactions, immediate cardiovascular compromise or other acute organ failure
Biochemical disturbances caused by cell infusion
Over-suppression of the immune system assessed by the incidence of major and/or opportunistic infections, especially CMV, EBV and polyoma virus
Over-suppression of the immune system assessed by the incidence of neoplasia.
Immunological condition of study patients w
an extensive immune monitoring program has been established in the ONE Study

Full Information

First Posted
September 25, 2014
Last Updated
December 28, 2018
Sponsor
Nantes University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02252055
Brief Title
The ONE Study ATDC Trial
Acronym
ONEatDC
Official Title
A Phase I/II Monocentric Trial of Cellular Immunotherapy Based on Autologous Tolerogenic Dendritic Cells (ATDCs) Administration in Patients With Renal Insufficiency Receiving as First Transplantation a Kidney Transplant From a Living-donor.
Study Type
Interventional

2. Study Status

Record Verification Date
December 2018
Overall Recruitment Status
Completed
Study Start Date
March 19, 2015 (Actual)
Primary Completion Date
November 14, 2018 (Actual)
Study Completion Date
November 14, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nantes University Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To collect evidence of the safety of administering autologous tolerogenic dendritic cells (ATDC) preparations to living-donor renal transplant recipients in the context of an international European Union funded consortium aimed at evaluationg cellular immunotherapy in solid organ transplantation (The ONE Study). It is anticipated that immune regulation induced by ATDC therapy can evntually be used to reduce the need for conventional immunosuppression in transplant recipients.
Detailed Description
Decades of immunosuppressive drug development have produced an array of powerful pharmacological agents, but the various drawbacks associated with these treatments leaves considerable room for improvement. By harnessing the power of suppressive mechanisms in the human immune system, regulatory cell therapy may be able to support peripheral tolerance and induce a level of donor-specific unresponsiveness that allows for a reduction in the use of conventional immunosuppression in organ transplant recipients. Several alternative regulatory cell types have been identified as potential adjunct immunotherapies for solid organ transplantation and are now approaching a stage of development that would allow clinical testing in an early-stage trial. The ONE Study aims to answer the question as whether ATDC treatment, or immunoregulatory cell-based therapy in general, has any place in the clinical management of solid organ transplant recipients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Renal Failure, End Stage

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ATDC Treatment
Arm Type
Experimental
Arm Description
ATDC treatment (1 x 106 cells/kg BW slow peripheral venous) occurs the day before transplantation. Recipients also receive prednisolone, Mycophenolate Mofetil and tacrolimus, as detailed below : Prednidolone : D 0: 500 mg IV D 1: 125 mg IV D 2 to 14: 20.0 mg/d Wk 3 to 4: 15.0 mg/d Wk 5 to 8: 10.0 mg/d Wk 9 to 12: 5.0 mg/d Wk 13 to 14: 2.5 mg/d Wk 15 to End:Cessation MMF (or biologic equiv.): D -7 to -2: 500 mg/d (250mg 2x/d) D -1 to 14: 2000 mg/d Wk 3 to 36: 1000 mg/d Wk 37 to 40: 750 mg/d Wk 41 to 44: 500 mg/d Wk 45 to 48: 250 mg/d Wk 49 to End:Cessation Note : MMF tapering will only happen if the 36-week protocol biopsy shows no signs of subclinical rejection and there is evidence of declining renal function or if the clinician has any other concern about MMF dose reduction. Tacrolimus : ≤ 48 h pre-Tx to D 14: 3-12 ng/ml Wk 3 to 12: 3-10 ng/ml Wk 13 to 36: 3-8 ng/ml Wk 37 to End: 3-6 ng/ml
Intervention Type
Biological
Intervention Name(s)
ATDC_Nantes
Intervention Description
ATDC treatment (1 x 106 cells/kg BW slow peripheral venous) occurs the day before transplantation into recipients also recipients of a living donor renal transplantation. Recipients also receive prednisolone, Mycophenolate Mofetil and tacrolimus background immunosuppression ( as described in detail in the arm description)
Primary Outcome Measure Information:
Title
Incidence of biopsy-confirmed acute rejection (BCAR)
Time Frame
60 weeks
Secondary Outcome Measure Information:
Title
Time to first acute rejection episode
Time Frame
60 weeks
Title
Severity of acute rejection episodes
Description
based on response to treatment and histological scoring
Time Frame
60 weeks
Title
Total immunosuppressive burden
Description
assessed at last study visit
Time Frame
60 weeks
Title
Incidence of patients treated for subclinical acute rejection on the basis of histopathological findings
Time Frame
60 weeks
Title
Prevention of chronic graft dysfunction (chronic rejection or IF/TA)
Description
assessed by clinical (impairment of GFR) and histopathological (Banff staging) measures.
Time Frame
60 weeks
Title
Incidence of post-transplant dialysis, inclusion on the transplant waiting list or re-transplantation following graft loss through rejection (acute or chronic).
Time Frame
60 weeks
Title
Avoidance of drug-related complications by immunosuppressant reduction
Time Frame
60 weeks
Title
Incidence of embolic pulmonary complications and other embolic events
Time Frame
60 weeks
Title
Incidence of immunological reactions resulting in anaphylactoid reactions, immediate cardiovascular compromise or other acute organ failure
Time Frame
1 week
Title
Biochemical disturbances caused by cell infusion
Time Frame
1 week
Title
Over-suppression of the immune system assessed by the incidence of major and/or opportunistic infections, especially CMV, EBV and polyoma virus
Time Frame
1 week
Title
Over-suppression of the immune system assessed by the incidence of neoplasia.
Time Frame
1 week
Title
Immunological condition of study patients w
Description
an extensive immune monitoring program has been established in the ONE Study
Time Frame
60 weeks
Other Pre-specified Outcome Measures:
Title
Incidence of malignancies arising directly from ATDC_Nantes
Time Frame
60 weeks
Title
ii) incidence of autoimmune disorders
Time Frame
60 weeks
Title
Incidence of inflammatory pathologies
Time Frame
60 weeks
Title
Incidence of anaemia, cytopaenia or biochemical disturbances unrelated to the function of the transplanted kidney.
Time Frame
60 weeks
Title
A Health-Economic Subproject will evaluate the health-related quality-of-life of trial patients using patient-reported outcome measures.
Description
This subproject will also calculate the cost-effectiveness of ATDC_Nantes to review the financial implications of cellular immunotherapy as a practical and routine clinical prescription.
Time Frame
60weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
RECIPIENT Inclusion Criteria: Chronic renal insufficiency necessitating kidney transplantation and approved to receive a primary kidney allograft from a living donor Aged at least 18 years Able to commence the immunosuppressive regimen at the protocol-specified time point Willing and able to participate in The ONE Study IM and HEC subprojects Eligible for leucapheresis prior to organ transplantation Signed and dated written informed consent Exclusion Criteria: Patient has previously received any tissue or organ transplant other than the planned kidney graft Known contraindication to the protocol-specified treatments / medications (like known allergies to heparin) Genetically identical to the prospective organ donor at the HLA loci (A.B.DR 0 mismatch) PRA grade > 0 within 6 months prior to enrolment Previous treatment with any desensitisation procedure (with or without IVIg) Concomitant malignancy or history of malignancy within 5 years prior to planned study entry (excluding successfully-treated non-metastatic basal/squamous cell carcinoma of the skin) ABO incompatibility Presence of DSA (donor specific antibodies) detected by luminex prior transplantation Evidence of significant local or systemic infection HIV-positive, EBV-negative or suffering chronic viral hepatitis, syphilis serology- positive Significant liver disease, defined as persistently elevated AST and/or ALT levels > 2 x ULN (Upper Limit of Normal range) Malignant or pre-malignant haematological conditions Any uncontrolled medical condition or concurrent disease that could interfere with the study objectives Any condition which, in the judgement of the Investigator, would place the subject at undue risk Ongoing treatment with systemic immunosuppressive drugs at inclusion (despite corticoids lower than 10 mg) Participation in another clinical trial during the study or within 28 days prior to planned study entry Exposure to an investigational product during the study or within 28 days prior to planned study entry Female patients of child-bearing potential with a positive pregnancy test at enrolment and F01 Female patients who are breast-feeding All female patients of child-bearing potential* UNLESS: The patient is willing to maintain a highly effective method of birth control** for the duration of the study The career, lifestyle, or sexual orientation of the patient ensures that there is no risk of pregnancy for the duration of the study (at the discretion of the Investigator) Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up visit schedule Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the Investigator, may invalidate communication with the Investigator and/or designated study personnel Patients unable to freely give their informed consent (e.g. individuals under legal guardianship). Criteria specific to the infusion of the ATDC_Nantes: Any pro-coagulant disposition, as evidenced by a past history of thromboembolic disease or abnormal laboratory coagulation parameters which, in the judgement of the Investigator, would place the subject at undue risk Any condition resulting in a substantial reduction in the volume of the pulmonary vasculature or an increase in the pulmonary vascular resistance. Any disease or disease process leading to substantially elevated pulmonary arterial pressure (as evidenced by electrocardiography, echocardiography, radiology or cardiac catheterisation) or right heart hypertrophy or dysfunction Known atrial or ventricular septal defects posing a risk of paradoxical embolism of infused cells or cell aggregates Known hypersensitivity to any component of the cell product or components used in the manufacture of the cell product. DONOR Inclusion Criteria: Eligible for live kidney donation Willing and able to provide a blood sample for The ONE Study IM Subproject Willing to provide personal and medical/biological data for the trial analysis Signed and dated written informed consent Exclusion Criteria: Genetically identical to the prospective organ recipient at the HLA loci (A.B.DR 0 mismatch) Exposure to any investigational agents at the time of kidney donation, or within 28 days prior to kidney donation Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the Investigator, may invalidate communication with the Investigator and/or designated study personnel Subjects unable to freely give their informed consent (e.g. individuals under legal guardianship). ABO incompatibility
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Edward K Geissler, PhD
Organizational Affiliation
University Hospital Regensburg
Official's Role
Study Director
Facility Information:
Facility Name
Nantes University hospital
City
Nantes
ZIP/Postal Code
44093
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
23369457
Citation
Geissler EK. The ONE Study compares cell therapy products in organ transplantation: introduction to a review series on suppressive monocyte-derived cells. Transplant Res. 2012 Sep 28;1(1):11. doi: 10.1186/2047-1440-1-11. No abstract available.
Results Reference
background
PubMed Identifier
32446407
Citation
Sawitzki B, Harden PN, Reinke P, Moreau A, Hutchinson JA, Game DS, Tang Q, Guinan EC, Battaglia M, Burlingham WJ, Roberts ISD, Streitz M, Josien R, Boger CA, Scotta C, Markmann JF, Hester JL, Juerchott K, Braudeau C, James B, Contreras-Ruiz L, van der Net JB, Bergler T, Caldara R, Petchey W, Edinger M, Dupas N, Kapinsky M, Mutzbauer I, Otto NM, Ollinger R, Hernandez-Fuentes MP, Issa F, Ahrens N, Meyenberg C, Karitzky S, Kunzendorf U, Knechtle SJ, Grinyo J, Morris PJ, Brent L, Bushell A, Turka LA, Bluestone JA, Lechler RI, Schlitt HJ, Cuturi MC, Schlickeiser S, Friend PJ, Miloud T, Scheffold A, Secchi A, Crisalli K, Kang SM, Hilton R, Banas B, Blancho G, Volk HD, Lombardi G, Wood KJ, Geissler EK. Regulatory cell therapy in kidney transplantation (The ONE Study): a harmonised design and analysis of seven non-randomised, single-arm, phase 1/2A trials. Lancet. 2020 May 23;395(10237):1627-1639. doi: 10.1016/S0140-6736(20)30167-7. Erratum In: Lancet. 2020 Jun 27;395(10242):1972.
Results Reference
derived
Links:
URL
http://www.onestudy.org
Description
Related Info

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