Gene Therapy for X-CGD

X-linked Chronic Granulomatous Disease Clinical Trial

Official title:

A Phase I/II Gene Therapy Trial for X-CGD With a SIN Gammaretroviral Vector

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT01906541
• Other study ID #: X-CGD
• Status: Recruiting
• Phase: Phase 1/Phase 2
• First received: July 15, 2013
• Last updated: August 1, 2013
• Start date: July 2013
• Est. completion date: December 2019

Study information

• Verified date: August 2013
• Source: Johann Wolfgang Goethe University Hospitals
• Contact: Hubert Serve, Prof., MD
• Phone: 0049/69/6301
• Email: serve[@]em.uni-frankfurt.de
• Is FDA regulated: No
• Health authority: Germany: Paul-Ehrlich-Institut
• Study type: Interventional

Clinical Trial Summary

X-linked chronic granulomatous disease (X-CGD) is a rare inherited immune defect, which is caused by the inability of phagocytic cells to produce reactive oxygen species due to a defect in the gp91phox subunit of the NADPH oxidase complex. X-CGD patients suffer from recurrent and life-threatening infections and severe hyperinflammatory complications.

The only curative treatment for X-CGD is allogenic hematopoietic stem cell transplantation, but this procedure implies severe risks and many patients lack an appropriate donor. Therefore alternative curative approaches are urgently needed. In this study, patients will be treated with gene-corrected autologous CD34+ cells, using a SIN gammaretroviral vector for ex-vivo gene-therapy.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 5
• Est. completion date: December 2019
• Est. primary completion date: December 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Verified diagnosis of the X-linked form of chronic granulomatous disease, with loss of gp91phox expression (Western Blot). Evidence of less than 5% of normal oxidase production in circulating neutrophil granulocytes as measured by dihydrorhodamine- (DHR-) and nitro blue tetrazolium- (NBT-) assay

• History of severe chronic infections with life-threatening course or severe steroid- sensitive or steroid insensitive granulomatous disease, with necessity of inpatient treatment, without sustained improvement even under maximum conservative treatment measures

• No Human Leukocyte Antigen (HLA) identical (10/10 match) sibling- or unrelated donor, or contraindications for allogenic stem cell transplantation in presence of a suitable donor. The lack of an HLA-identical (10/10 match) sibling- or unrelated donor has to be confirmed by an unsuccessful search in national and international donor registers for at leat 3 months

• Normal organ-function: glomerular filtration rate (GFR) = 60ml/min., Bilirubin = 1.5-fold upper reference-level, normal parameters for liver enzymes and clotting (TPZ 75-100%, partial thromboplastin time (PTT) 30-38sec, Fibrinogen 200-400mg/dl), Leukocytes > 3 x 10^9/l, Granulocytes > 1.5 x 10^9/l, Thrombocytes >100 x 10^9/l

• Contraception from start of G-CSF application until 1 year after retransfusion of the gene-corrected cells

• No interferon-gamma injection within two weeks prior to hematopoietic stem cell mobilization

• Karnofsky-Index > 70%

• Signed informed consent

Exclusion Criteria:

• Patients with non-controlled acute infections

• Severe cardiac or pulmonary malfunctions: ejection fraction < 60%, valvular heart disease > II°, arrhythmia requiring therapy, forced expiratory volume at one second/vital capacity (FEV1/VC) < 75% , diffusion capacity of lung for carbon monoxide (DLCO) <60%

• Bilirubin > 1.5-fold upper reference-level

• HIV-, Hepatitis B- or C - infection

• Contraindications for G-CSF administration, as autoimmune vasculitis.

• Contraindications for stem cell apheresis, as low hemoglobin < 8g/dl, cardiovascular instability or severe coagulopathy

• Pregnancy or breast-feeding

• Drug- or alcohol-abuse

• Lack of search for an unrelated donor

• Patients with a HLA 9/10 mismatched unrelated donor (MMUD) will be excluded, if a thorough risk-benefit analysis favors allogenic hematopoietic stem cell transplantation (HSCT)

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Granuloma
• Granulomatous Disease, Chronic
• X-linked Chronic Granulomatous Disease

Intervention

Genetic:
• ex-vivo gene-therapy
transplantation autologous CD34+ cells, transduced with a SIN gammaretroviral vector

Locations

Country	Name	City	State
Germany	University Hospital Frankfurt	Frankfurt am Main

Sponsors (1)

Lead Sponsor	Collaborator
Hubert Serve, Prof., MD

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Transduction rate of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral CD34+ cells from CGD patients with a SIN gamma retroviral vector		1 week	No
Primary	Engraftment rate of the transduced CD34+ cells in the patients		5 years	No
Primary	Long-term expression of the transgene (rate of gp91phox positive cells) in circulating cells in the peripheral blood		5 years	No
Primary	Functional reconstitution of the NADPH oxidase in circulating cells of the peripheral blood (% DHR positive cells)		5 years	No
Primary	Frequency and severity of unexpected toxic adverse events during and after infusion of the genetically modified CD34+ cells		5 years	Yes
Secondary	Frequency of infections as indicator for the clinical benefit for the patients		5 years	No
Secondary	Proliferation rate of CD34+ cells in ex-vivo culture under serum-free conditions		up to 3 weeks	No
Secondary	Differentiation rate of CD34+ cells (as measured by flow cytometry) in ex-vivo culture under serum-free conditions		up to 3 weeks	No
Secondary	Transduction rate of CD34+ cells in ex-vivo culture under serum-free conditions		up to 12 weeks	No