First-in-human Safety Study of Hypoimmune Pancreatic Islet Transplantation in Adult Subjects With Type 1 Diabetes

Type1diabetes Clinical Trial

Official title:

First-in-human Safety Study of Hypoimmune Pancreatic Islet Transplantation in Adult Subjects With Type 1 Diabetes

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06239636
• Other study ID #: UP421-ET1D
• Secondary ID: 2023-507988-19-0
• Status: Not yet recruiting
• Phase: Early Phase 1
• Start date: February 2024
• Est. completion date: June 2025

Study information

• Verified date: January 2024
• Source: Uppsala University Hospital
• Contact: Per-Ola Carlsson, MD, PhD
• Phone: +46 18 4710000
• Email: per-ola.carlsson[@]mcb.uu.se
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The current study tests the hypothesis whether genetically modified Langerhans islet cells containing insulin-producing cells from a deceased organ donor can 1. be transplanted safely and 2. help to regain insulin production in individuals with type 1 diabetes without need in simultaneous treatment with immunosuppressive medicines. The study is an open, one-armed study where adult subjects with longstanding type 1 diabetes will receive transplantation of Langerhans islet cells (25 000 000-80 000 000) into forearm muscle. Both subjects receive active treatment. Safety is monitored with frquent follow-up visits over a year, including medical examinations, blood tests and MRI scans. Insluin producing cell function is monitored with blood samples and continuous glucose measurement. Main objective is to to investigate the safety of an intramuscular transplantation of genetically modified allogeneic human islets (study product UP421) in adult subjects diagnosed with type 1 diabetes. Secondary objectives are to study changes in beta-cell function, metabolic control and immunological response to pancreatic islets during the first year following treatment.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 2
• Est. completion date: June 2025
• Est. primary completion date: May 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 30 Years to 45 Years

Eligibility

Inclusion Criteria:

1. Signed informed consent for participation in the study

2. Diagnosis of type 1 diabetes mellitus (T1D); i) for = 5 years and ii) diagnosed before the age of 18 years and iii) at least one or more HbA1c documented in the subject's medical journal or Swedish National Diabetes Registry during the last five-year period must be =70 mmol/mol.

3. The subject must be involved in intensive diabetes management defined as self-monitoring of subcutaneous glucose level by continuous glucose monitoring or by intermittent scanning glucose monitoring no less than a mean of three times per day averaged over each week and by the administration of three or more insulin injections per day or insulin pump therapy. This management must be under the direction of an M.D specialized in endocrinology and diabetology with support of a diabetes nurse at a specialist clinic for Endocrinology and Diabetology or Internal Medicine during the 12 months prior to study enrolment.

4. C-peptide negative (C-peptide < 0.01 nmol/l) in response to a mixed meal tolerance test (MMTT)

5. Positive for antibodies to either GAD or IA2 at screening

6. 30-45 years of age at time of enrollment

7. HbA1c =70 mmol/mol

8. Exogenous insulin needs < 1 IU/kg

9. Body weight <80 kg

10. Female subjects of child-bearing potential must agree to using adequate contraception until one year after the administration of UP421, as outlined in https://www.hma.eu/fileadmin/dateien/Human_Medicines/01-About_HMA/Working_Groups/CTFG/2014_ 09_HMA_CTFG_Contraception.pdf A woman is considered of childbearing potential if she is not surgically sterile or isles than 1 year since last menstrual period.

Adequate contraception is as follows:

1. combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal or transdermal)

2. progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable or implantable)

3. intrauterine device (IUD)

4. intrauterine hormone-releasing system (IUS)

5. bilateral tubal occlusion f) vasectomised partner g) sexual abstinence Male subjects must not intend to procreate until one year after the administration of UP241. Males must be willing to use effective measures of contraception (condoms) during the whole trial period. Exclusion Criteria: Any previous organ transplantation;

2. Any systemic immunosuppressive medication for any other disease;

3. Any history of malignancy;

4. Use of any investigational agent(s) within 4 weeks of enrollment;

5. Use of any anti-diabetic medication, other than insulin, within 4 weeks of enrollment;

6. Active infections including Tuberculosis, HIV, HBV and HCV;

7. Liver function test value for AST, ALT, GGT or ALP exceeding the respective reference interval for the clinical assay at Uppsala university hospital;

8. Serological evidence of infection with HTLVI or HTLVII;

9. Pregnancy, nursing, intention for pregnancy;

10. Chronic kidney disease grade 3 or worse (GFR<60 ml/min as estimated by creatine measurement) ;

11. Medical history of cardiac disease, or symptoms at screening consistent with cardiac disease;

12. HLA immunization;

13. MIC A/B immunization;

14. Known autoimmune disease other than type I diabetes (e.g. Hashimoto disease);

15. Administration of live attenuated vaccines <6 months before transplant;

16. Islet antibodies where GADA >2000 IE/ml or IA2A >4000 IE/ml, or positive for ZnT8 auto-antibodies;

17. Untreated proliferative diabetic retinopathy;

18. Major ongoing psychiatric illness which the Principal Investigator judges increases the risk of noncompliance or does not allow safe participation in the study;

19. Ongoing substance abuse, drug or alcohol; or recent history of treatment noncompliance;

20. Known hypersensitivity to ciprofloxacin, gentamicin, or amphotericin (since these are used in the manufacturing process of UP421);

21. Any other condition that in the opinion of the Principal Investigator does not allow safe participation in the study.

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 1
• Type1diabetes

Intervention

Biological:
• UP421
Intramuscular transplantation with the ATMP UP421 composed of genetically modified human pancreatic islet cells

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
Per-Ola Carlsson	Sana Biotechnology

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety as assessed by number of treatment related adverse events accoridng to CTCAE v 5.0	Number of treatment related adverse events as assessed by CTCAE v5.0	12 months
Secondary	Immune evasion of implanted cells, as evaluated in systemic peripheral blood.	Assessed at 0 (before tx), 2, 4, 8, 12, 18, 26 and 52 weeks post-transplantation	12 months
Secondary	Presence of peak C-peptide >0.01 nmol/l in response to a mixed meal tolerance test	Assessed at 4, 8, 12, 18, 26 and 52 weeks post-transplantation	12 months
Secondary	Presence of non-fasting C-peptide concentrations >0.01 nmol/l.	Assessed at 1, 2, 3, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26 and 52 weeks post-transplantation	12 months
Secondary	Presence of peak C-peptide >0.20 nmol/l in response to a mixed meal tolerance test	Assessed at 4, 8, 12, 26 and 52 weeks post-transplantation	12 months
Secondary	Survival of implanted cells as assessed by Magnetic resonance imaging	Assessed within 48 h after transplantation and 2, 4, 6, 8, 12, 26 and 52 weeks post-transplantation	12 months
Secondary	C-peptide AUC in response to a mixed meal tolerance test	Assessed at 4, 8, 12, 18, 26 and 52 weeks post-transplantation	12 months
Secondary	Delta changes in insulin requirement/kg BW	Assessed at 1, 2, 3, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26 and 52 weeks transplantation when compared to before transplantation	12 months
Secondary	Delta changes in HbA1c	Assessed at 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 26 and 52 weeks post-transplantation when compared to before transplantation	12 months
Secondary	Delta changes in glucose variability derived from a continuous glucose monitoring system	Assessed at 4, 8, 12, 18, 26 and 52 weeks post-transplantation when compared to before transplantation	12 months
Secondary	Score in diabetes treatment satisfaction questionnaire	Assesssed at 4, 8, 12, 18, 26 and 52 weeks post-transplantation when compared to before transplantation	12 months