Huntington's Disease Clinical Trial
Official title:
A Phase I/II, Randomized, Double-Blind, Sham Control Study to Explore Safety, Tolerability, and Efficacy Signals of Multiple Doses of Striatally-Administered rAAV5-miHTT Total Huntingtin Gene (HTT) Lowering Therapy (AMT-130) in Early Manifest Huntington's Disease
This is the first study of AMT-130 in patients with early manifest HD and is designed to establish safety and proof-of-concept (PoC). CT-AMT-130-01 is a Phase I/II, randomized, multicenter, multiple dose, double-blind, imitation surgery, first-in-human (FIH) study. Cohort 3 participants will receive either high or low dose (1:1 randomization). Participants enrolled in Cohort 3 will also receive an immunosuppression regimen consisting of dexamethasone, sirolimus, and rituximab.
Status | Recruiting |
Enrollment | 36 |
Est. completion date | June 2029 |
Est. primary completion date | April 2029 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 25 Years to 65 Years |
Eligibility | Inclusion Criteria: 1. Able and willing to provide written informed consent prior to the study and study-related procedure 2. Participants 25 to 65 years of age of both sexes 3a. Cohort 1 & 2: Early manifest HD as defined by a UHDRS total functional capacity (TFC) score of 9 to 13 and EITHER a diagnostic confidence level (DCL) of 4 OR a DCL of 3 if the subject either meets the definition of multidimensional manifest HD (UHDRS question 80) or has cognitive symptoms 3b. Cohort 3: Early manifest HD as defined by a UHDRS TFC score of = 11 and EITHER a DCL of 4 or a DCL of 3 with either a positive "Yes" response to UHDRS Question 80 (multidimensional manifest diagnosis on motor, cognitive, behavioral, functional) or DSM5 criteria for cognitive disorder (Movement Disorder Society Task Force criteria). 4. HTT gene expansion testing with the presence of =40 CAG repeats 5. Striatal MRI volume requirements per hemisphere: Putamen =2.5 cm3 (per side); Caudate =2.0 cm3 (per side) 6. All HD concomitant medications (addressing motor, behavioral, and cognitive symptoms) must be stable for 3 months prior to Screening with no change in clinical symptoms requiring change in medication prior to anticipated administration procedure 7. Able and willing to comply with all procedures and the study visit schedule as outlined in the protocol 8. All female participants of childbearing potential (FOCP) must have a negative serum pregnancy test at Screening, (and Visit 1A, as appropriate), a negative pregnancy urine dipstick at Baseline, and not be breastfeeding. All FOCPs and sexually mature males must be compliant with a highly effective birth control method. Exclusion Criteria: 1. Evidence of suicide risk 2. Receipt of an experimental agent within 60 days or five half-lives prior to Screening or anytime over the duration of this study. 3. Participation in an investigational trial or investigational paradigm (such as exercise/physical activity, cognitive therapy, brain stimulation) within 60 days prior to Screening or anytime over the duration of this study. 4. Presence of an implanted deep brain stimulation device, ventriculoperitoneal or other CSF shunt, or other implanted catheter 5. Any history of gene therapy, RNA or DNA targeted HD specific investigational agents, such as antisense oligonucleotides (ASOs), cell transplantation or any other experimental brain surgery. 6. Any contraindication to 3.0 Tesla MRI as per local guidelines 7. Brain and spinal pathology that may interfere with the surgical delivery of AMT-130 or represents a significant neurologic comorbid disorder 8. Any contraindication to lumbar puncture as per local guidelines 9. Malignancy within 5 years of Screening, except for basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated 10. Hospitalization for any major medical or surgical procedure involving general anesthesia within 12 weeks of Screening or planned during the study 11. Current or recurrent disease, (including pre-existing cardiovascular or pulmonary conditions) infection, or other significant concurrent medical condition or medications that could confound clinical and laboratory evaluations or could affect a participant's safety or their ability to undergo the neurosurgical procedure or comply with the procedures and study visit schedule 12. Known or suspected intolerance or hypersensitivity to the investigational product(s), closely-related compounds, or any of the stated ingredients 13. Any known allergy to gadoteridol (ProHance) 14. Screening laboratory values (as measured by the central laboratory): a. Alanine aminotransferase (ALT) >2 × upper limit of normal (ULN) b. Aspartate aminotransferase (AST) >2 × ULN c. Total bilirubin >2 × ULN d. Alkaline phosphatase (ALP) >2 × ULN e. Creatinine >1.5 × ULN f. Platelet count <100,000/mm3g.Prothrombin time (PT) >1.2 × ULN h. Partial thromboplastin time (PTT) >1.2 × ULN 15. Known immunocompromised status including participants who have undergone organ transplantation; or who test positive at Screening for human immunodeficiency virus (HIV); or who are at risk of pathogen reactivation if immunosuppressed, including participants who test positive at Screening for hepatitis C virus antibody (anti-HCV), hepatitis C virus ribonucleic acid (HCV RNA), or hepatitis B surface antigen (HBsAg); or who have history of active tuberculosis or a positive tuberculosis blood test during Screening. For participants with an indeterminate tuberculosis blood test result or positive tuberculosis test result, repeat testing is recommended. 16. Known allergy, sensitivity, or other contraindication to medications in the immunosuppression regimen in this protocol. 17. Any participant with an active infection (e.g., coronavirus disease 2019 [COVID-19]) at Screening or at the time of treatment that requires medical intervention. Participants may rescreen, or if screened eligible and an open surgical slot is available, may receive treatment after recovery. |
Country | Name | City | State |
---|---|---|---|
United States | University of Michigan Department of Neurology | Ann Arbor | Michigan |
United States | Johns Hopkins University | Baltimore | Maryland |
United States | University of Alabama at Birmingham | Birmingham | Alabama |
United States | Beth Israel Deaconess Medical Center | Boston | Massachusetts |
United States | Rush University Medical Center | Chicago | Illinois |
United States | Ohio State University | Columbus | Ohio |
United States | CenExel Rocky Mountain Clinical Research | Englewood | Colorado |
United States | University of Florida College of Medicine | Gainesville | Florida |
United States | The University of Texas | Houston | Texas |
United States | Vanderbilt University Medical Center | Nashville | Tennessee |
United States | Virginia Commonwealth University VCU School of Medicine, Department of Neurology | Richmond | Virginia |
United States | University of California, San Francisco | San Francisco | California |
United States | University of Washington Medical Center | Seattle | Washington |
United States | University of Arizona (Surgical Site Only) | Tucson | Arizona |
Lead Sponsor | Collaborator |
---|---|
UniQure Biopharma B.V. |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | CSF Mutant Protein (fM) | Will be used as an exploratory biomarker to measure disease progression and responsiveness to AMT-130 treatment. | Collected for duration of study through month 60 | |
Other | CSF/Serum Neurofilament Light Chain (pg/mL) | Will be used as an exploratory biomarker to measure disease progression and responsiveness to AMT-130 treatment. | Collected for duration of study through month 60 | |
Other | Unified Huntington Disease Rating Scale (UHDRS) | The UHDRS will assess changes from baseline in summary scores of domains of motor function, cognitive function, behavioral function, and functional abilities. | Collected for duration of study through month 60 | |
Other | Quantitative Motor (Q-Motor) Testing | Q-Motor testing will measure disease progression and responsiveness to AMT-130 treatment. | Collected for duration of study through month 60 | |
Other | Magnetic Resonance Imaging (MRI) | MRI assessments will include whole brain volume, striatal region volumes, white matter volume, gray matter volume, ventricular volume, cortical thickness, and diffusion MRI measures. | Collected for duration of study through month 60 | |
Other | Neuro-QoL Measures | The Neuro-QoL is a brief, reliable, valid, standardized set of patient reported, Health Related Quality of Life (HRQoL) measures for people living with neurological conditions. | Collected for duration of study through month 60 | |
Other | HDQLIFE Measures | The HDQLIFE is a measurement system that was designed to provide a brief, reliable and valid assessment of HRQoL in HD and consists of NeuroQoL measures that have been validated in the HD population and several new HD specific measures. | Collected for duration of study through month 60 | |
Primary | Number and type of Adverse Events (AE) | Safety will be assessed by adverse events (AEs) related to clinical safety laboratory tests, vital signs, electrocardiograms (ECGs), neurological and physical examinations, rAAV5 vector shedding, immunogenicity response, suicidality risk [Columbia-Suicide Severity Rating Scale [C-SSRS)], changes in global cognitive functioning [Montreal Cognitive Assessment Scale (MoCA)] and MRI measures of edema, inflammation, volume loss and structural changes. | 12 months (Cohorts 1 & 2) and 12 months (Cohort 3) | |
Secondary | Duration of persistence of AMT-130 in the brain | Change over time in levels of AMT-130-derived Vector DNA Expression in the Cerebrospinal Fluid (CSF) | Collected for duration of study through month 60 |
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