- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00849888
Serum-Free Thymus Transplantation in DiGeorge Anomaly (SerumFree)
March 21, 2022 updated by: Enzyvant Therapeutics GmBH
Phase I Serum-Free Cultured Thymus Transplantation in DiGeorge Anomaly, IND9836
The study purpose is to determine if thymus tissue cultured in a serum-free (SF) solution is a safe and effective treatment for atypical and typical complete DiGeorge anomaly.
[Funding Source - FDA OOPD]
Study Overview
Status
Terminated
Conditions
Detailed Description
Complete DiGeorge anomaly is a congenital disorder characterized by athymia.
Without successful treatment, patients remain immunodeficient and usually die by age 2 years.
In "typical" complete DiGeorge subjects who have no T cells, thymus transplantation without immunosuppression has resulted in diverse T cell development and good T cell function.
In "atypical" complete DiGeorge subjects who have no thymus, a rash, and some T cells that presumably developed extrathymically, thymus transplantation with immunosuppression has resulted in diverse T cell development and good T cell function.
Thus far, thymus transplantation studies have used thymus cultured in fetal bovine serum (FBS medium).
This protocol's purpose is to determine whether transplanted thymus cultured in serum free medium can safely support thymopoiesis and T cell reconstitution as does FBS medium cultured thymus tissue in DiGeorge anomaly subjects.
This protocol includes 2 arms: atypical DiGeorge subjects who will receive immunosuppression and thymus transplantation; and, typical complete DiGeorge subjects who will receive thymus transplantation without immunosuppression.
Serum free medium use would reduce concerns of animal product exposure including potential exposure to bovine spongiform encephalopathy(BSE).
Study Type
Interventional
Enrollment (Actual)
2
Phase
- Phase 1
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
No older than 2 years (CHILD)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Thymus Recipients Inclusion:
Complete DiGeorge anomaly diagnosis
Must have one of following:
- congenital heart disease
- hypocalcemia requiring replacement
- 22q11 or 10p13 hemizygous
- CHARGE
Atypical Arm:
- Must have, or have had, rash. If rash present, skin biopsy must show T cells. If rash resolved, must have >50/cumm T cells; & <50/cumm naive T cells or <5% total
- PHA response must be <40000 counts per minute(cpm) on immunosuppression; or, <75000cpm off immunosuppression. PHA test must be done 2x
- CD45RA+CD62L+ CD3+ T cells must be <50/mm3; or, <5% of total CD3. Test must be done 2x
Typical Arm:
- PHA response <20 fold or <5,000cpm
- Circulating CD3+CD45RA+CD62L+T cells <50/mm3 or <5% total T cells
- 2 tests of T cells & PHA response must show similar results
Biological Mother Inclusion:
-Must be recipient's biological mother
Thymus Recipient Exclusion:
- Heart surgery <4 weeks pre-transplant or within 3 months post-transplant
- Rejection by surgeon or anesthesiologist as surgical candidates
- Lack of sufficient muscle tissue to accept transplant
- Medical condition does not allow to undergo a biopsy
- HIV
- CMV(>500 copies/ml blood by PCR on 2 tests)
- Ventilator dependence
- GVHD
- Maternal T cells >20% of total T cells
- Prior immune reconstitution attempts (e.g., BMT, prior thymus transplant)
- Hypoparathyroidism meeting criteria for combined thymus/parathyroid transplant & parents desiring it
- RSV or parainfluenza virus
- Enterovirus or Adenovirus in stool
Biological Mother Exclusion:
-Unwillingness to sign consent or provide blood/buccal samples
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Atypical Complete DiGeorge
Thymus Transplantation with Immunosuppression
|
Cyclosporine pre-transplant (trough 180-220ng/ml) until naive T cells develop.
Subjects >4,000/cumm T cells, pre-transplant methylprednisolone or prednisolone 1-2mg/kg/day.
All subjects pre-transplant days -5,-4,-3: 3 doses 2mg/kg rabbit anti-thymocyte globulin.
Thymus tissue (unrelated donor), donor, & donor's mother screened for safety.
Transplant under general anesthesia into quadriceps.
First 2 subjects, FBS cultured thymus is transplanted in 1 leg & serum free (SF) in other.
After first 2 subjects >10% naïve T cells, 3rd receives only SF thymus.
After 3rd subject >10%naive T cells, 4th subject transplanted.
Thymus dose 4-18 grams/m2 body surface area.
Thymus biopsy 8-12 weeks post-transplant.
Skin biopsy at time of transplant & thymus biopsy.
Followed by immune evaluations.
Other Names:
|
EXPERIMENTAL: Typical Complete DiGeorge
Thymus Transplantation without Immunosuppression
|
Thymus tissue (unrelated donor), donor, & donor's mother screened for safety.
Transplant under general anesthesia into quadriceps.
First 2 subjects: FBS cultured thymus transplanted in 1 leg & serum free cultured thymus in other leg.
After first 2 subjects have thymopoiesis in serum-free biopsy, >10% naïve T cells, 3rd subject receives only serum free cultured thymus.
After 3rd subject >10% naive T cells, 4th subject receives transplant of only serum free cultured thymus.
Dose 4-18grams/m2 body surface area.
At time of transplant, skin biopsy.
Allograft biopsy & skin biopsy done 8 to 12 weeks post-transplant.
(Graft biopsy not done if subject medically unstable.)
Post-transplant, subjects followed by immune evaluations, using blood samples, for two years.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Survival
Time Frame: One year post-thymus transplantation.
|
Survival at one year post thymus transplantation.
|
One year post-thymus transplantation.
|
Incidence of graft-versus-host-disease (GVHD).
Time Frame: One year post-thymus-transplantation.
|
Development of graft versus host disease in first year after transplantation associated with T cells from the thymus donor.
|
One year post-thymus-transplantation.
|
Thymopoiesis or graft rejection on biopsy.
Time Frame: Two months post-thymus transplantation.
|
Graft rejection analysis by biopsy at 2 months post-thymus transplantation.
|
Two months post-thymus transplantation.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of autoimmune disease.
Time Frame: By two years post-thymus transplantation.
|
Incidence of autoimmune disease by year 2 after transplantation Cytopenias as assessed by complete blood counts and differential.
Thyroid disease as assessed by thyroid function tests
|
By two years post-thymus transplantation.
|
Immune outcomes: T cell development; evaluate T cell numbers, diversity, and function.
Time Frame: One year post-thymus transplantation.
|
Number of naïve CD4 T cells at one year after transplantation Number of total CD4 T cells at one year after transplantation Proliferative response to PHA at one year after transplantation TCRBV diversity by spectratyping measured by DKL score at one year after transplantation
|
One year post-thymus transplantation.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: M. Louise Markert, M.D., Ph.D, Duke University Medical Center, Pediatrics, Allergy & Immunology
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Markert ML, Devlin BH, Alexieff MJ, Li J, McCarthy EA, Gupton SE, Chinn IK, Hale LP, Kepler TB, He M, Sarzotti M, Skinner MA, Rice HE, Hoehner JC. Review of 54 patients with complete DiGeorge anomaly enrolled in protocols for thymus transplantation: outcome of 44 consecutive transplants. Blood. 2007 May 15;109(10):4539-47. doi: 10.1182/blood-2006-10-048652. Epub 2007 Feb 6.
- Markert ML, Alexieff MJ, Li J, Sarzotti M, Ozaki DA, Devlin BH, Sedlak DA, Sempowski GD, Hale LP, Rice HE, Mahaffey SM, Skinner MA. Postnatal thymus transplantation with immunosuppression as treatment for DiGeorge syndrome. Blood. 2004 Oct 15;104(8):2574-81. doi: 10.1182/blood-2003-08-2984. Epub 2004 Apr 20.
- Markert ML, Sarzotti M, Ozaki DA, Sempowski GD, Rhein ME, Hale LP, Le Deist F, Alexieff MJ, Li J, Hauser ER, Haynes BF, Rice HE, Skinner MA, Mahaffey SM, Jaggers J, Stein LD, Mill MR. Thymus transplantation in complete DiGeorge syndrome: immunologic and safety evaluations in 12 patients. Blood. 2003 Aug 1;102(3):1121-30. doi: 10.1182/blood-2002-08-2545. Epub 2003 Apr 17.
- Selim MA, Markert ML, Burchette JL, Herman CM, Turner JW. The cutaneous manifestations of atypical complete DiGeorge syndrome: a histopathologic and immunohistochemical study. J Cutan Pathol. 2008 Apr;35(4):380-5. doi: 10.1111/j.1600-0560.2007.00816.x.
- Chinn IK, Devlin BH, Li YJ, Markert ML. Long-term tolerance to allogeneic thymus transplants in complete DiGeorge anomaly. Clin Immunol. 2008 Mar;126(3):277-81. doi: 10.1016/j.clim.2007.11.009. Epub 2007 Dec 26.
- Markert ML, Li J, Devlin BH, Hoehner JC, Rice HE, Skinner MA, Li YJ, Hale LP. Use of allograft biopsies to assess thymopoiesis after thymus transplantation. J Immunol. 2008 May 1;180(9):6354-64. doi: 10.4049/jimmunol.180.9.6354.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
April 1, 2008
Primary Completion (ACTUAL)
February 1, 2011
Study Completion (ACTUAL)
February 1, 2011
Study Registration Dates
First Submitted
February 22, 2009
First Submitted That Met QC Criteria
February 23, 2009
First Posted (ESTIMATE)
February 24, 2009
Study Record Updates
Last Update Posted (ACTUAL)
April 1, 2022
Last Update Submitted That Met QC Criteria
March 21, 2022
Last Verified
March 1, 2022
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Lymphatic Diseases
- Endocrine System Diseases
- Genetic Diseases, Inborn
- Musculoskeletal Diseases
- Parathyroid Diseases
- Heart Defects, Congenital
- Cardiovascular Abnormalities
- Craniofacial Abnormalities
- Musculoskeletal Abnormalities
- Abnormalities, Multiple
- Chromosome Disorders
- 22q11 Deletion Syndrome
- Lymphatic Abnormalities
- Hypoparathyroidism
- Congenital Abnormalities
- DiGeorge Syndrome
Other Study ID Numbers
- Pro00006109
- R01AI047040 (NIH)
- R01AI054843 (NIH)
- R56 Bridge R01AI4704011A1 (OTHER_GRANT: [NIH American Recovery and Reinvestment Act (ARRA) of 2009])
- 2R01AI047040-11A2 (NIH)
- 5K12HD043494-09 (NIH)
- 1R01FD003528-01 (FDA)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on DiGeorge Anomaly
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsCompletedDiGeorge Anomaly | Complete DiGeorge Anomaly | Complete DiGeorge Syndrome | Complete Atypical DiGeorge Anomaly | Complete Atypical DiGeorge SyndromeUnited States
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsApproved for marketingDiGeorge Syndrome | DiGeorge Anomaly | Complete DiGeorge Anomaly | Complete DiGeorge SyndromeUnited States
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsCompletedDiGeorge Syndrome | DiGeorge Anomaly | Complete DiGeorge Anomaly | Complete DiGeorge SyndromeUnited States
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsCompletedDiGeorge Syndrome | DiGeorge Anomaly | Complete DiGeorge Anomaly | Complete DiGeorge SyndromeUnited States
-
Sumitomo Pharma Switzerland GmbHRecruitingComplete DiGeorge Anomaly | Complete DiGeorge Syndrome | Congenital AthymiaUnited States
-
University of California, San DiegoWithdrawnMajor Fetal AnomalyUnited States
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsCompletedDiGeorge Syndrome | Complete Typical DiGeorge AnomalyUnited States
-
University Hospital, GhentRecruitingMullerian Anomaly of Uterus, Nec | Mullerian Anomaly of Vagina | Mullerian Anomaly of CervixBelgium
-
University Hospital, GhentRecruitingMullerian Anomaly of Uterus, Nec | Mullerian Anomaly of Vagina | Mullerian Anomaly of CervixBelgium
-
Sohag UniversityNot yet recruiting
Clinical Trials on Serum Free Thymus Transplantation with Immunosuppression
-
University of MinnesotaGenentech, Inc.CompletedPost-Transplant Infections | Thymoglobulin | Transplant Recipient (Kidney) | Steroid-Free Maintenance ImmunosuppressionUnited States
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsCompletedDiGeorge Syndrome | DiGeorge Anomaly | Complete DiGeorge Anomaly | Complete DiGeorge SyndromeUnited States
-
Fundación Pública Andaluza para la gestión de la...Unknown
-
Enzyvant Therapeutics GmBHNational Institute of Allergy and Infectious Diseases (NIAID); Eunice Kennedy... and other collaboratorsCompletedDiGeorge Anomaly | Complete DiGeorge Anomaly | Complete DiGeorge Syndrome | Complete Atypical DiGeorge Anomaly | Complete Atypical DiGeorge SyndromeUnited States
-
Duke UniversityNational Cancer Institute (NCI)Withdrawn
-
University of Maryland, BaltimoreUniversity of Maryland Greenebaum Cancer CenterCompletedLymphoma | Myelodysplastic Syndromes | Leukemia | Anemia | Multiple Myeloma and Plasma Cell Neoplasm | Graft Versus Host DiseaseUnited States
-
M.D. Anderson Cancer CenterCelgene CorporationTerminatedChronic Lymphocytic LeukemiaUnited States
-
New York Medical CollegeCompletedLymphoma | Leukemia | Sickle Cell Disease | Histiocytosis | Immunodeficiencies | Inborn Errors of Metabolism | Bone Marrow Failure | Beta ThalassemiaUnited States
-
Eastern Cooperative Oncology GroupNational Cancer Institute (NCI)WithdrawnAdult Acute Myeloid Leukemia | Adult Acute Erythroid Leukemia | Adult Acute Monoblastic and Acute Monocytic Leukemia
-
Case Comprehensive Cancer CenterNational Cancer Institute (NCI)CompletedMyelodysplastic Syndromes | Leukemia | Myelodysplastic/Myeloproliferative DiseasesUnited States