Safety & Tolerability Study of Chimeric Antigen Receptor T-Reg Cell Therapy in Living Donor Renal Transplant Recipients

End Stage Renal Disease Clinical Trial

— STEADFAST  

Official title:

Multicentre Open-Label Single Ascending Dose Dose-Ranging Phase I/IIa Study to Evaluate Safety and Tolerability of an Autologous Antigen-Specific Chimeric Antigen Receptor TRegulatory Cell Therapy in Living Donor Renal Transplant Recipients

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04817774
• Other study ID #: TX200 KT02
• Secondary ID: 2019-001730-34
• Status: Active, not recruiting
• Phase: Phase 1/Phase 2
• Start date: March 17, 2021
• Est. completion date: March 4, 2026

Study information

• Verified date: April 2024
• Source: Sangamo Therapeutics
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate the safety and tolerability of TX200-TR101 and its effects on the donated kidney in living donor kidney transplant recipients. TX200-TR101 is a product made from a kidney transplant recipient's own immune cells, which are genetically modified and designed to help the transplant recipient's body accept their donated kidney and prevent their immune system from rejecting it.

Description:

This is a multicentre, first-in-human, open-label, single ascending dose, dose-ranging study of autologous, chimeric antigen receptor T regulatory cells (CAR-Treg) in HLA-A2 mismatched living donor kidney transplant recipients, with a control cohort of mismatched kidney transplant recipients of similar immunological risk.The aim is for the CAR-Tregs to recognise the HLA-A2 molecule present on the donated kidney and subsequently induce and maintain immunological tolerance to the organ.

The study requires three different types of participants - transplant recipients who will receive the study treatment TX200-TR101; control participants, who are transplant recipients who will not receive the study treatment; and transplant donors, who will donate their kidney to the transplant recipients.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 22
• Est. completion date: March 4, 2026
• Est. primary completion date: November 13, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 70 Years

Eligibility

Inclusion Criteria:

• Written informed consent.

• Male or female aged 18 - 70 years.

• Diagnosis of End Stage Renal Disease and waiting for a new kidney from an identified live donor.

• Subjects who will be single organ recipients (kidney).

• Able and willing to use contraception.

Exclusion Criteria:

• HLA identical to the donor.

• Subjects with prior organ transplant.

• Known hypersensitivity to study medication ingredients, protocol defined immunosuppressive medications, or a significant allergic reaction to any drug.

• Positive serology for human immunodeficiency virus (HIV) or syphilis, active or occult hepatitis B virus (HBV), active hepatitis C virus (HCV) infection, or other clinically active local or systemic infection.

• Subjects who are Epstein-Barr Virus (EBV) seronegative.

• Positive flow cytometric crossmatch using donor lymphocytes and recipient serum.

• Subjects with panel-reactive antibody (PRA) >20% within 6 months prior to enrolment.

• Subjects with current or recent donor-specific antibodies.

• Use of any experimental medicinal product within 3 months.

• Current use of systemic immunosuppressive agents

• Significant unstable or poorly controlled acute or chronic diseases (except ESRD), limited life expectancy, clinically relevant central nervous system pathology, history of drug/alcohol abuse or psychiatric disorder or other condition that is not compatible with adequate study follow-up, history of malignancy in the past 5 years and any other reason that, in the opinion of the Site Investigator or Medical Monitor, would render the subject unsuitable for participation in the study.

• Subjects with abnormal laboratory values in the following parameters:

• Haemoglobin

• Platelets

• White blood cells

• Aspartate transaminase (AST) and or alanine transaminase (ALT)

• Total bilirubin

Related Conditions & MeSH terms

• End Stage Renal Disease
• Kidney Failure, Chronic
• Kidney Transplant Rejection

Intervention

Biological:
• TX200-TR101
TX200-TR101 is an autologous gene therapy medicinal product composed of Treg cells (CD4+/CD45RA+/CD25+/CD127low/neg) that have been ex vivo expanded and transduced with a lentiviral vector encoding for a CAR to recognize HLA-A*02. Treatment will be given via an IV infusion at a pre-defined timepoint several weeks after transplant. Four, single ascending dose cohorts of TX200-TR101 are planned and an additional expansion cohort.

Locations

Country	Name	City	State
Belgium	University Hospitals Leuven	Leuven
Netherlands	University Medical Center Groningen	Groningen
Netherlands	Leiden University Medical Centre	Leiden
Netherlands	Erasmus MC, University Medical Center	Rotterdam
United Kingdom	Oxford University Hospitals NHS Foundation Trust,	Oxford

Sponsors (1)

Lead Sponsor	Collaborator
Sangamo Therapeutics

Countries where clinical trial is conducted

Belgium,  Netherlands,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety and Tolerability	Safety and tolerability of TX200-TR101 infusion evaluated by incidence and grade of treatment-emergent adverse events (TEAEs), including serious adverse events (SAEs) according to CTCAE V5.0.	28 days post infusion
Secondary	Acute graft related outcomes	Incidence of biopsy confirmed acute rejection according to the Banff classification criteria	Day of infusion through to Week 84
Secondary	Long-term safety	Number of transplant recipient subjects with TEAEs, including SAEs, as assessed by CTCAE v5.0	Day of infusion through to Week 84
Secondary	Immunosuppression	Ability to reduce immunosuppression as measured by the proportion of subjects receiving tacrolimus monotherapy at Week 84	Day of infusion through to Week 84
Secondary	Graft localization	Graft localization of TX200-TR101 cells as measured by the presence of CD4+ CAR+ cells in the renal transplant biopsy	Day of infusion through to Week 84
Secondary	Chronic graft related outcomes	Chronic graft dysfunction as measured by estimated glomerular filtration rate	Day of infusion through to Week 84
Secondary	Chronic graft related outcomes	Incidence of chronic graft rejection according to the Banff criteria for chronic rejection	Day of infusion through to Week 84