Sub-retinal Transplantation of hESC Derived RPE(MA09-hRPE)Cells in Patients With Stargardt's Macular Dystrophy

A Phase I/II, Open-Label, Multi-Center, Prospective Study to Determine the Safety and Tolerability of Sub-retinal Transplantation of Human Embryonic Stem Cell Derived Retinal Pigmented Epithelial (MA09-hRPE) Cells in Patients With Stargardt's Macular Dystrophy (SMD)

This is a safety and tolerability trial to evaluate the effect of subretinal injection of human embryonic stem cell derived retinal pigment epithelium cells in patients with Stargardt's Macular Dystrophy (SMD).

Study Overview

• Status: Completed
• Conditions: Stargardt's Macular Dystrophy
• Intervention / Treatment: Biological: MA09-hRPE

Detailed Description

This study is a Phase I/II, open-label, non randomized, sequential, multi-center clinical trial. There will be 5 cohorts, the 4 low vision cohorts will contain 3 patients, the better vision cohort will contain 4 patients. The enrolled cohorts will be as follows:

Three SMD patients- 50,000 MA09-hRPE cells transplanted

Three SMD patients- 100,000 MA09-hRPE cells transplanted

Four Better Vison SMD patients- 100,000 MA09-hRPE cells transplanted

Three SMD patients- 150,000 MA09-hRPE cells transplanted

Three SMD patients- 200,000 MA09-hRPE cells transplanted

Patients will be enrolled sequentially, and within each cohort of 3 patients, each patient's clinical course over the first 6 weeks following cell transplantation will be reviewed by an independent (DSMB) before enrollment is opened for the next 2 patients. A full safety assessment of all 3 patients in each cohort will be made by the DSMB when the 3rd patient in each cohort completes 4 weeks of follow-up, and before the first patient in the next cohort receives a cell transplant. The exception is the better vision group where all patients may be enrolled once DSMB approval has been received.

Each cohort will be enrolled sequentially in turn, with the exception of the better vision cohort which may be enrolled in parallel with the other cohorts.

The day of the cell implantation will be Day 0, and patients will remain in the study until the last visit at 12 months.

• Study Type: Interventional
• Enrollment (Actual): 13
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90095
      • Jules Stein Eye Institute, UCLA School of Medicine
  • Florida
    • Miami, Florida, United States, 33136
      • Bascom Palmer Eye Institute
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19107
      • Wills Eye Institute-Mid Atlantic Retina

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adult male or female over 18 years of age.
• Clinical diagnosis of advanced SMD.
• If known, the patient's genotype will be recorded in the medical history, if unknown, patient will allow for the submission of a sample for genotyping.Clinical findings consistent with SMD.
• The visual acuity of the eye to receive the transplant will be no better than 20/400. The visual acuity of the eye in the better vision cohort to receive the transplant will be no better than 20/100.
• The visual acuity of the eye that is not to receive the transplant will be no better than 20/400 for the worse vision patients and no worse than 20/100 for the better vision patients.
• Peripheral visual field constriction documented on standard kinetic visual field testing.
• Electrophysiological findings consistent with SMD.
• Medically suitable to undergo vitrectomy and subretinal injection.
• Medically suitable for general anesthesia or waking sedation, if needed.
• Medically suitable for transplantation of an embryonic stem cell line:
• Normal serum chemistry (sequential multi-channel analyzer 20 [SMA- 20]) and hematology (complete blood count [CBC], prothrombin time [PT], and activated partial thromboplastin time [aPTT]) screening tests.
• Negative urine screen for drugs of abuse.
• Negative human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV) serologies.
• No history of malignancy,with the exception of successfully treated basal cell or squamous cell carcinoma of the skin.
• Negative cancer screening within previous 6 months:
• complete history & physical examination;
• dermatological screening exam for malignant lesions;
• negative fecal occult blood test & if over age 50 years, negative colonoscopy within previous 7 years;
• negative chest roentgenogram (CXR);
• normal CBC & manual differential;
• negative urinalysis (U/A);
• normal thyroid exam;
• if male, normal testicular examination; if over age 40, digital rectal examination (DRE) and prostate specific antigen (PSA);
• if female, normal pelvic examination with Papanicolaou smear; and
• if female, normal clinical breast exam and if 40 years of age or older, negative mammogram.
• If female and of childbearing potential, willing to use two effective forms of birth control during the study.
• If male, willing to use barrier and spermicide contraception during the study.
• Willing to defer all future blood, blood component or tissue donation. -Able to understand and willing to sign the informed consent.

Exclusion Criteria:

• History of malignancy,with the exception of successfully treated basal cell or squamous cell carcinoma of the skin.
• History of myocardial infarction in previous 12 months.
• History of diabetes mellitus.
• Any immunodeficiency.
• Any current immunosuppressive therapy other than intermittent or low dose corticosteroids.
• Serologic evidence of infection with Hepatitis B, Hepatitis C, or HIV.
• Current participation in any other clinical trial.
• Participation within previous 6 months in any clinical trial of a drug by ocular or systemic administration.
• Any other sight-threatening ocular disease.
• Any chronic ocular medications.
• Any history of retinal vascular disease (compromised blood-retinal barrier.
• Glaucoma.
• Uveitis or other intraocular inflammatory disease.
• Significant lens opacities or other media opacity.
• Ocular lens removal within previous 3 months.
• If female, pregnancy or lactation.
• Any other medical condition, which, in the Investigator's judgment, will interfere with the patient's ability to comply with the protocol, compromises patient safety, or interferes with the interpretation of the study results.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: MA09-hRPE; Patients will undergo subretinal injection of MA09-hRPE	Biological: MA09-hRPE; Cohort 1 50,000 cells Cohort 2 100,000 cells Cohort 2a Better Vision 100,000 cells Cohort 3 150,000 cells Cohort 4 200,000 cells

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The safety and tolerance of transplantation of hESC-derived RPE cells MA09-hRPE	The transplantation of hESC-derived RPE cells MA09-hRPE will be considered safe and tolerated in the absence of: Any grade 2 (NCI grading system) or greater adverse event related to the cell product; Any evidence that the cells are contaminated with an infectious agent; Any evidence that the cells show tumorigenic potential	12 months
Safety Assessments	Adverse Event and Serious Adverse Event assessment; Clinical monitoring; Serial vital signs; Clinical laboratory tests; Directed ophthalmological monitoring; Monitoring of RPE cells acceptance/integrity/rejection; Monitoring of local and systemic infection; Monitoring of tumorigenic cell transformation	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evidence of successful engraftment	Evidence of successful engraftment will consist of: Structural evidence (OCT imaging, fluorescein angiography, autofluorescence photography, slit-lamp examination with fundus photography) that cells have been implanted in the correct location; Electroretinographic evidence (mfERG) showing enhanced activity in the implant location	12 months

Collaborators and Investigators

• Sponsor: Astellas Institute for Regenerative Medicine

Publications and helpful links

General Publications

• Davis JL. The Blunt End: Surgical Challenges of Gene Therapy for Inherited Retinal Diseases. Am J Ophthalmol. 2018 Dec;196:xxv-xxix. doi: 10.1016/j.ajo.2018.08.038. Epub 2018 Sep 5.
• Schwartz SD, Regillo CD, Lam BL, Eliott D, Rosenfeld PJ, Gregori NZ, Hubschman JP, Davis JL, Heilwell G, Spirn M, Maguire J, Gay R, Bateman J, Ostrick RM, Morris D, Vincent M, Anglade E, Del Priore LV, Lanza R. Human embryonic stem cell-derived retinal pigment epithelium in patients with age-related macular degeneration and Stargardt's macular dystrophy: follow-up of two open-label phase 1/2 studies. Lancet. 2015 Feb 7;385(9967):509-16. doi: 10.1016/S0140-6736(14)61376-3. Epub 2014 Oct 15.
• Schwartz SD, Hubschman JP, Heilwell G, Franco-Cardenas V, Pan CK, Ostrick RM, Mickunas E, Gay R, Klimanskaya I, Lanza R. Embryonic stem cell trials for macular degeneration: a preliminary report. Lancet. 2012 Feb 25;379(9817):713-20. doi: 10.1016/S0140-6736(12)60028-2. Epub 2012 Jan 24.

Helpful Links

• Link to results on the Astellas Clinical Study Results website.

Study record dates

Study Major Dates

• Study Start (Actual): June 16, 2011
• Primary Completion (Actual): August 10, 2015
• Study Completion (Actual): August 10, 2015

Study Registration Dates

• First Submitted: April 28, 2011
• First Submitted That Met QC Criteria: April 28, 2011
• First Posted (Estimate): April 29, 2011

Study Record Updates

• Last Update Posted (Actual): July 7, 2021
• Last Update Submitted That Met QC Criteria: July 4, 2021
• Last Verified: June 1, 2021

More Information

Terms related to this study

• Keywords: fundus flavimaculatus; juvenile macular dystrophy; SMD
• Additional Relevant MeSH Terms: Eye Diseases; Retinal Degeneration; Retinal Diseases; Genetic Diseases, Inborn; Eye Diseases, Hereditary; Macular Degeneration; Stargardt Disease
• Other Study ID Numbers: 7316-CL-0001; ACT SMD 01 MA09-hRPE (Other Identifier: Sponsor); ACT MA09-hRPE SMD-001 (Other Identifier: Sponsor)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: Access to anonymized individual participant level data will not be provided for this trial as it meets one or more of the exceptions described on www.clinicalstudydatarequest.com under "Sponsor Specific Details for Astellas."