Allogeneic Regulatory Dendritic Cell (DCreg) Renal Study

Allogeneic Regulatory Dendritic Cell (DCreg) Therapy in Live-Donor Renal Transplant Recipients

This study will evaluate the safety and feasibility of treatment involving a single infusion of donor-derived regulatory dendritic cells (DCreg) in first time, living donor renal transplant recipients.

DCreg will be prepared from monocytes obtained by leukapheresis from prospective (non-mobilized) living kidney donors and infused into the respective recipients 7 days before renal transplantation. This study will enroll 28 subjects (14 recipients, 14 donors). The duration of follow-up will be:

• 1 week following the leukapheresis procedure for donors and
• 2 years following their DCreg infusion for kidney recipients.

Study Overview

• Status: Recruiting
• Conditions: Kidney Transplant; Renal Transplant Recipients
• Intervention / Treatment: Biological: DCreg: 0.5 million cells/kg+SOC; Biological: DCreg: 1.2 million cells/kg+SOC; Biological: DCreg:2.5 to 5.0 million cells/kg+SOC

Detailed Description

This clinical trial is a single-center, open-label, dose-escalation, phase 1 study, enrolling N=14 de novo kidney transplant recipients and their respective living donors. The study objective is to evaluate the safety and feasibility of a single infusion of donor-derived regulatory dendritic cell (DCreg) treatment.

Transplant recipients will receive combination immunosuppressive agents according to the site's Standard of Care (SOC) regimen, with two exceptions:

• mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and
• the pre-transplant dose of MPA will be half the standard post-transplant dose, due to increased drug bioavailability in recipients with low kidney function defined by glomerular filtration rate (GFR).

Consequently, participants will be maintained on triple immunosuppressive therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.

Note: Participants will not be withdrawn from known effective therapy for the purpose of participating in this research.

• Study Type: Interventional
• Enrollment (Estimated): 28
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15213
      • Recruiting
      • University of Pittsburgh, Starzl Transplantation Institute
      • Contact: Rita Johnson, RN; Phone Number: 412-383-8616; Email: Johnsonr1@upmc.edu
      • Contact: Beth Elinoff, RN; Phone Number: 412-624-6611; Email: elinbd@upmc.edu
      • Principal Investigator: Amit D. Tevar, MD, FACS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Donor Eligibility Criteria:

• Able to understand and provide informed consent;
• Meets all standard institutional criteria for kidney donation and Health Agency compliance with kidney donation regulations;
• For females of childbearing potential, a negative urine or serum pregnancy test;

• Negative for tuberculosis by either a negative:

  • Purified Protein Derivative (PPD) test or

  • Result using an approved interferon-gamma release assay (IGRA) blood test, such as QuantiFERON®-Gold TB or T-SPOT.TB assay,

    • Unless the participant has completed treatment for latent tuberculosis, and has a negative chest x-ray.

    • Note:

      1. PPD or IGRA testing documented to have been performed within 52 weeks before transplant is acceptable
      2. Prior recipients of a Bacille Calmette-Guérin (BCG) vaccination must follow the same requirements
• Negative for Human Immunodeficiency Virus type 1 (HIV) -1 (antigen and Nucleic Acid Testing (NAT)), HIV-2, Human T-cell leukemia virus type 1 (HTLV-1), and HTLV-2;
• Negative for hepatitis C (antibody and NAT), hepatitis B (surface antigen and core antibody), and Treponema pallidum infection;
• Negative for West Nile Virus;
• Negative health history for risk factors related to Zika Virus and Creutzfeldt-Jakob disease;
• No live vaccines within 8 weeks prior to leukapheresis;
• No medical condition(s) that the investigator deems incompatible with participation in the trial; and
• No use of investigational drugs within 12 weeks of participation.

Recipient Inclusion Criteria:

• Must be able to understand and provide informed consent;
• Is undergoing first living donor renal transplant;
• For females of childbearing potential, a negative urine or serum pregnancy test upon study entry and agreement to use effective contraception according to Health Agency oversight standards throughout the interval of study participation;
• Cytomegalovirus (CMV) seropositive or, if CMV seronegative must be receiving a kidney from a CMV seronegative donor;

• Negative for tuberculosis by either negative:

  • Purified Protein Derivative (PPD) test or

  • Result using an approved interferon-gamma release assay (IGRA) blood test, such as QuantiFERON®-Gold TB or T-SPOT.TB assay.

    • Exception: If the participant has completed treatment for latent tuberculosis, and has a negative chest x-ray.

    • Note:

      1. PPD or IGRA testing documented to have been performed within 52 weeks before transplant is acceptable.
      2. Prior recipients of a Bacille Calmette-Guérin (BCG) vaccination must follow the same requirements as referenced above.
• And meets all standard institutional criteria for kidney transplant.

Study Exclusion Criteria:

• Panel Reactive Antibody (PRA >20%);
• Positive T or B Cell Flow Crossmatch prior to transplant;
• Presence of donor specific antibody (DSA) ≥ to mean fluorescence intensity (MFI) of 1000, or DSA between 500 and 1000, if a specific shared epitope pattern is present;
• Recipient of multi-organ transplant;
• Any prior renal or extra-renal transplant;
• Epstein-Barr Virus (EBV) Immunoglobulin G (IgG) seronegative status;
• Seropositivity for HIV-1, hepatitis B core antigen, or hepatitis C virus (HCV) antibody (if hepatitis C antibody positive, confirm negative infection by HCV RNA), or positivity for hepatitis B surface antigen;
• History of malignancy other than non-melanomatous skin cancer;

• High risk for recurrence of renal disease:

  • Hemolytic Uremic Syndrome Thrombotic Thrombocytopenic Purpura (HUS-TTP),
  • Focal Segmental Glomerular Sclerosis (FSGS), or
  • Aggressive native kidney disease.
• Significant coronary artery disease, Ejection Fraction <30% or prior acute myocardial infarction;
• Compensated and decompensated cirrhosis of liver and/or portal hypertension;
• Chronic Obstructive Pulmonary Disease requiring nasal oxygen, and/or pulmonary hypertension (mean pulmonary pressure >45mm/hg);
• Any history of stroke with neurological deficit;
• Any condition that, in the opinion of the investigator, confers excessive risk for participation in this phase 1 study;
• Presence of a condition that requires treatment with an immunosuppressive agent, other than a physiologic dose of corticosteroid;
• Live vaccines within 8 weeks prior to transplant;
• Use of investigational drugs within 12 weeks of participation;
• Women receiving a kidney from a man who has fathered her child(ren), whether or not carried to term; or
• Women receiving a kidney from her biological child.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: DCreg: 0.5 million cells/kg+SOC; N=3 participants will receive 0.5 (± 0.1) million cells/kg body weight as a single infusion. Standard of Care (SOC) immunosuppressive agents (ISA): Participants will receive combination ISA according to the site's SOC regimen, with two exceptions: mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and; the pre-transplant dose of MPA will be half the standard post-transplant dose due to increased drug bioavailability in recipients with low glomerular filtration rate (GFR). Participants will be maintained on triple IS therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.	Biological: DCreg: 0.5 million cells/kg+SOC; DCreg 0.5 (±0.1) million cells/kilogram body weight infused as a single dose. Standard of Care (SOC) immunosuppressive agents (ISA): Participants will receive combination ISA according to the site's SOC regimen, with two exceptions: mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and; the pre-transplant dose of MPA will be half the standard post-transplant dose due to increased drug bioavailability in recipients with low glomerular filtration rate (GFR). Participants will be maintained on triple IS therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.; Other Names: Regulatory Donor-Derived Dendritic Cells (DCreg)
Experimental: DCreg: 1.2 million cells/kg+SOC; N=3 participants will receive 1.2 (± 0.2) million cells/kg body weight as a single infusion. Standard of Care (SOC) immunosuppressive agents (ISA): Participants will receive combination ISA according to the site's SOC regimen, with two exceptions: mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and; the pre-transplant dose of MPA will be half the standard post-transplant dose due to increased drug bioavailability in recipients with low glomerular filtration rate (GFR). Participants will be maintained on triple IS therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.	Biological: DCreg: 1.2 million cells/kg+SOC; DCreg 1.2 (±02) million cells/kilogram body weight infused as a single dose. Standard of Care (SOC) immunosuppressive agents (ISA): Participants will receive combination ISA according to the site's SOC regimen, with two exceptions: mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and; the pre-transplant dose of MPA will be half the standard post-transplant dose due to increased drug bioavailability in recipients with low glomerular filtration rate (GFR). Participants will be maintained on triple IS therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.; Other Names: Regulatory Donor-Derived Dendritic Cells (DCreg)
Experimental: DCreg:2.5 to 5.0 million cells/kg+SOC; N=8 participants will receive 25 to 5.0 million cells /kg body weight as a single infusion. Standard of Care (SOC) immunosuppressive agents (ISA): Participants will receive combination ISA according to the site's SOC regimen, with two exceptions: mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and; the pre-transplant dose of MPA will be half the standard post-transplant dose due to increased drug bioavailability in recipients with low glomerular filtration rate (GFR). Participants will be maintained on triple IS therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.	Biological: DCreg:2.5 to 5.0 million cells/kg+SOC; DCreg 2.5 to 5.0 million cells/kilogram body weight infused as a single dose. Standard of Care (SOC) immunosuppressive agents (ISA): Participants will receive combination ISA according to the site's SOC regimen, with two exceptions: mycophenolic acid (MPA) will be initiated 7 days before transplant, at the time of donor DCreg infusion, instead of on the day of transplant; and; the pre-transplant dose of MPA will be half the standard post-transplant dose due to increased drug bioavailability in recipients with low glomerular filtration rate (GFR). Participants will be maintained on triple IS therapy with MPA, tacrolimus, and prednisone after transplant, a combination regimen widely applied as SOC at many transplant centers in North America and worldwide.; Other Names: Regulatory Donor-Derived Dendritic Cells (DCreg)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Composite Outcome: Proportion of Participants who Experience any of the Pre-Specified Safety Events	Safety will be assessed by summarizing the proportion of participants who experience any of the following events from the initiation of the regulatory dendritic cells (DCreg) infusion administered 7 days prior to kidney transplant to 1 year post-transplant: Recipient death attributed to receipt of DCreg,; NCI-CTCAE Grade 4 or higher DCreg infusion reaction,; NCI-CTCAE Grade 4 or higher infection,; Malignancy other than non-melanoma skin cancer,; Pre-transplant Donor Specific Antibodies (DSA),; Post-transplant DSA,; Biopsy-proven acute rejection (BPAR) by BANFF 2017 criteria (grade ≥2A), or; Non-surgical graft loss.Reference: National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE, version 5.0).	Seven Days Prior to Transplant Surgery(e.g. Day of Regulatory Dendritic Cells (DCreg) Infusion) up to 1-Year Post-Transplant

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Death Attributed to Participant Receipt of Regulatory Dendritic Cells (DCreg)	The occurrence of death among participants who receive DCreg treatment.	Seven Days Prior to Transplant Surgery (e.g. Day of Regulatory Dendritic Cells (DCreg) Infusion) up to 1-Year Post-Transplant
Incidence of Adverse Event: CTCAE Grade 4 or Higher Infusion Reaction	The number of Grade 4 or higher infusion reaction(s) among participants who receive regulatory dendritic cells (DCreg) infusion, graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE, version 5.0).	Seven Days Prior to Transplant Surgery (e.g. Day of Regulatory Dendritic Cells (DCreg) Infusion) up to 1-Year Post-Transplant
Incidence of Adverse Event:CTCAE Grade 4 or Higher Infection	The number of Grade 4 or higher infection(s) among participants who receive regulatory dendritic cells (DCreg) infusion, graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE, version 5.0).	Seven Days Prior to Transplant Surgery (e.g. Day of Regulatory Dendritic Cells (DCreg) Infusion) up to 1-Year Post-Transplant
Incidence of Adverse Event: Malignancy	The number of malignancies among participants who receive regulatory dendritic cells (DCreg) infusion. Not included in this incidence outcome: non-melanoma skin cancer(s).	Seven Days Prior to Transplant Surgery(e.g. Day of Regulatory Dendritic Cells (DCreg) Infusion) up to 1-Year Post-Transplant
Incidence of Pre-Transplant Donor Specific Antibodies (DSA)	The number of pre-transplant DSA among participants occurring after DCreg infusion and before transplant.	Baseline (Seven Days Prior to Transplant Surgery, "Pre" -Regulatory Dendritic Cells (DCreg)) Infusion) up to within 48 Hours of Transplant
Incidence of Post-Transplant Donor Specific Antibodies (DSA)	A de novo DSA occurring within the first year post-transplant.	Day 0 (Transplant Surgery) up to 1-Year Post-Transplant
Incidence of Biopsy-Proven Acute Rejection	Acute kidney allograft rejection is defined by a kidney (renal) allograft biopsy classification of grade 2A or higher. Classification method: Banff 2013. The Banff 2013 classification for antibody-mediated rejection is a recognized standard in renal allograft pathology.	Day 0 (Transplant Surgery) up to 1-Year Post-Transplant
Incidence of Non-Surgical Graft Loss	Graft loss not associated with the transplant surgery.	Day 0 (Transplant Surgery) up to 1-Year Post-Transplant

Collaborators and Investigators

• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
• Collaborators: University of Pittsburgh
• Investigators: Study Chair: Amit D. Tevar, MD, FACS, University of Pittsburgh: Starzl Transplantation Institute

Publications and helpful links

General Publications

• Haas M, Sis B, Racusen LC, Solez K, Glotz D, Colvin RB, Castro MC, David DS, David-Neto E, Bagnasco SM, Cendales LC, Cornell LD, Demetris AJ, Drachenberg CB, Farver CF, Farris AB 3rd, Gibson IW, Kraus E, Liapis H, Loupy A, Nickeleit V, Randhawa P, Rodriguez ER, Rush D, Smith RN, Tan CD, Wallace WD, Mengel M; Banff meeting report writing committee. Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant. 2014 Feb;14(2):272-83. doi: 10.1111/ajt.12590. Erratum In: Am J Transplant. 2015 Oct;15(10):2784. Rangel, Erika [corrected to Rangel, Erika B].
• Haas M. The Revised (2013) Banff Classification for Antibody-Mediated Rejection of Renal Allografts: Update, Difficulties, and Future Considerations. Am J Transplant. 2016 May;16(5):1352-7. doi: 10.1111/ajt.13661. Epub 2016 Feb 4.

Helpful Links

• NIH NCI Common Terminology Criteria for Adverse Events (CTCAE)

Study record dates

Study Major Dates

• Study Start (Actual): April 10, 2019
• Primary Completion (Estimated): July 1, 2025
• Study Completion (Estimated): July 1, 2025

Study Registration Dates

• First Submitted: October 29, 2018
• First Submitted That Met QC Criteria: October 29, 2018
• First Posted (Actual): October 31, 2018

Study Record Updates

• Last Update Posted (Actual): July 14, 2023
• Last Update Submitted That Met QC Criteria: July 13, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: donor recipient pairs; allogeneic regulatory dendritic cell therapy (DCreg); DCreg therapy; de novo (first) live-donor renal transplant recipients
• Other Study ID Numbers: DAIT RTB-006; RTB-006 (Other Identifier: Sponsor)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No