- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04186650
Ex Vivo Gene Therapy Clinical Trial for RDEB Using Genetically Corrected Autologous Skin Equivalent Grafts (EBGraft)
Phase I/II ex Vivo Gene Therapy Clinical Trial for RDEB Using Autologous Skin Equivalent Grafts Genetically Corrected With a COL7A1-encoding SIN Retroviral Vector
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Recessive Dystrophic Epidermolysis Bullosa (RDEB) is a severe orphan genetic disease responsible for skin and mucosal detachments due to a loss of adhesion of the epidermis to the underlying dermis. The disease is caused by loss of function mutations of the COL7A1 encoding type VII collagen (C7) which forms anchoring fibers, which are essential structures for dermal-epidermal adherence. Current treatments are only symptomatic and do not effectively treat or prevent the occurrence of cutaneous and mucosal detachments responsible for local and systemic complications that threaten the vital prognosis.
EBGRAFT is a prospective open-label international monocentric phase I/II clinical trial. It aims to treat 3 adult subjects with RDEB, expressing residual C7 levels, by genetically corrected autologous skin equivalent grafts.
The skin equivalent consists of keratinocytes and fibroblasts from the patient, genetically corrected ex vivo with a secure Self INactivating (SIN) retroviral vector expressing the COL7A1 cDNA under the control of the ubiquitous human promoter EF1a.
Each patient will be grafted sequentially at Necker Hospital in Paris using autologous genetically corrected skin equivalents of approximately 300 cm2 (up to 6 grafts of 50 cm2 each).
The main objective is to evaluate the safety of autologous skin equivalent grafts genetically corrected with a SIN COL7A1 retroviral vector (RV) in adults with RDEB.
The secondary objectives are:
- To evaluate the efficacy of transplanting autologous skin equivalent genetically corrected with RV SIN COL7A1 in adults with RDEB.
- To evaluate the immune response against recombinant type VII collagen (C7).
This clinical trial should evaluate whether the grafting of these genetically corrected autologous skin equivalents is well tolerated and whether they restore normal dermal-epidermal adherence of the grafted areas. The proposed treatment aims to obtain a permanent correction of the grafted areas, allowing skin healing and reducing pain. It has the potential to reduce itching, to prevent the occurrence of blisters and skin detachments, reduce the risk of infections, the duration and cost of care and also the risk of development of squamous cell carcinomas in the grafted areas.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Locations
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Paris, France, 75743
- Institut Imagine Necker Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Clinical and molecular diagnosis of RDEB with confirmed bi-allelic COL7A1 mutations
- Reduced staining of C7 on skin biopsy, measured by immunofluorescence microscopy (IF)
- A reduced number of/or morphologically abnormal anchoring fibrils confirmed by TEM
- Detection of non-collagenous-1 domain (NC-1) of C7 on skin biopsy, measured by immunofluorescence microscopy (IF) and/or Western blot (WB) analysis
- Presence of ≥100cm2 of blistered and/or erosive skin areas including chronic wounds suitable for skin grafting
- Ability to undergo anaesthesia for skin grafting procedures
- Subjects aged 18 years, willing and able to give informed consent
Exclusion Criteria:
- Recipients of other investigational medicinal products within 6 months prior to enrolment into this study
- Past medical history of biopsy proven skin malignancy
- Immunotherapy including oral corticosteroids (Prednisolone >1mg/kg) for more than one week (intranasal and topical preparations are permitted) or chemotherapy within 60 days of enrolment into this study
- Known allergy to any of the constituents of the investigational medicinal product (IMP) including Penicillin
Subjects with BOTH:
- positive serum antibodies to C7 confirmed by ELISA and
- positive IIF with binding to the base of salt split skin and/or
- positive Western blot
- Positive results for HIV, Hepatitis BsAg, Hepatitis BcAb, Hepatitis C IgG, HTLV1&2 or Syphilis serology
- Clinically significant medical, psychological or laboratory abnormalities limiting the ability of the subject to travel to the trial site(s) and to undergo grafting and follow-up procedures, as determined by the Investigator
- Absence of adequate social support
- Subjects who are pregnant, breast-feeding or of child-bearing potential who are neither abstinent nor practicing an acceptable means of contraception when this is in line with the usual and preferred lifestyle of the subject, as determined by the Investigator, for the duration of the trial
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Autologous genetically modified tissue-engineered skin graft
Graft of SIN RV-mediated COL7A1 gene-modified autologous skin equivalent
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Graft of SIN RV-mediated COL7A1 gene-modified autologous skin equivalent
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Safety of grafting SIN RV-mediated COL7A1 gene-modified autologous skin equivalent: Adverse Events (AE), Serious Adverse Events (SAEs), Adverse Reactions (ARs) and Serious Adverse Reactions (SARs)
Time Frame: Month 12 post grafting.
|
The primary objective is to evaluate the safety of autologous autologous skin equivalent grafts genetically corrected with a SIN COL7A1 retroviral vector (RV) in adults with RDEB Primary Endpoints: Record of Adverse Events (AE), Serious Adverse Events (SAEs), Adverse Reactions (ARs) and Serious Adverse Reactions (SARs). |
Month 12 post grafting.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in C7 protein expression
Time Frame: Month 1, Month 3, Month 6, Month 12 post grafting.
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Skin biopsy analysis of grafted skin compared to baseline for : C7 protein expression by immunofluorescence microscopy (IF) using several specific antibodies |
Month 1, Month 3, Month 6, Month 12 post grafting.
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Change in anchoring fibrils number
Time Frame: Month 1, Month 3, Month 6, Month 12 post grafting.
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Count of anchoring fibril (AF) at the dermal-epidermal junction (DEJ) by transmission electron microscopy (TEM) will be performed on skin biopsies and
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Month 1, Month 3, Month 6, Month 12 post grafting.
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Change in scar quality: Vancouver Scar Scale (VSS)
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Scar quality will be measured using the Vancouver Scar Scale (VSS) and compared to baseline at several time points.
Minimum value=0, Maximum value=12.
Lower value is better.
|
Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Changes in blister number over the grafted skin
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Blister formation will be monitored and counted by a skilled dermatologist and compared to baseline at several time points.
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Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Changes in clinical appearance of grafted skin
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Clinical appearance of the grafted skin areas will be assessed by 3D photographic reconstruction using a CANFIELD Vectra H1 device and compared to baseline at several time points.
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Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Changes in pruritus of grafted skin
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Pruritus will be measured by the 5D pruritus score and compared to baseline at several time points.
Minimum value=4, Maximum value=35.
Lower value is better.
|
Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in Quality of life: QOLEB questionnaire (Quality of Life for Epidermolysis Bullosa)
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Quality of life will be measured using the specific QOLEB questionnaire (Quality of Life for Epidermolysis Bullosa) and compared to baseline at several time points. Minimum value=0, Maximum value=51. Lower value is better. |
Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in Birmingham Epidermolysis Score (BEBS)
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in disease severity will be assessed by the Birmingham Epidermolysis Score (BEBS). Score will be compared to baseline at several timepoints. Minimum value=0, Maximum value=100. Lower value is better. |
Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) - Activity
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in disease severity will be assessed by the Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI).
Score will be compared to baseline at several timepoints.
Score measure activity (minimum value=0, maximum value=276).
Lower value is better.
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Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) - Damage
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in disease severity will be assessed by the Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI).
Score will be compared to baseline at several timepoints.
Score measure damage (minimum value=0, maximum value=230).
Lower value is better.
|
Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB).
Time Frame: Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Change in disease severity will be assessed by the instrument for Scoring Clinical Outcomes of Research for Epidermolysis Bullosa (iscorEB).
Score will be compared to baseline at several timepoints.
Minimum value=0, Maximum value=120.
Lower value is better.
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Month 1, Month 2, Month 3, Month 6, Month 12 post grafting.
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Evaluation of the humoral immune response against recombinant C7
Time Frame: Month 1, Month 6, Month 12 post grafting.
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Detection of circulating anti-C7 antibodies in patient blood by ELISA and/or indirect immunofluorescence (IIF) on split skin at several time points
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Month 1, Month 6, Month 12 post grafting.
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Evaluation of the cytotoxic immune response against recombinant C7
Time Frame: Month 1, Month 6, Month 12 post grafting.
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Detection of T-cell responses to the full length C7 in patient blood by ELISPOT assay.
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Month 1, Month 6, Month 12 post grafting.
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Collaborators and Investigators
Publications and helpful links
General Publications
- Gaucher S, Lwin SM, Titeux M, Abdul-Wahab A, Pironon N, Izmiryan A, Miskinyte S, Ganier C, Duchatelet S, Mellerio JE, Bourrat E, McGrath JA, Hovnanian A. EBGene trial: patient preselection outcomes for the European GENEGRAFT ex vivo phase I/II gene therapy trial for recessive dystrophic epidermolysis bullosa. Br J Dermatol. 2020 Mar;182(3):794-797. doi: 10.1111/bjd.18559. Epub 2019 Nov 27. No abstract available.
- Titeux M, Pendaries V, Zanta-Boussif MA, Decha A, Pironon N, Tonasso L, Mejia JE, Brice A, Danos O, Hovnanian A. SIN retroviral vectors expressing COL7A1 under human promoters for ex vivo gene therapy of recessive dystrophic epidermolysis bullosa. Mol Ther. 2010 Aug;18(8):1509-18. doi: 10.1038/mt.2010.91. Epub 2010 May 18.
- Hennig K, Raasch L, Kolbe C, Weidner S, Leisegang M, Uckert W, Titeux M, Hovnanian A, Kuehlcke K, Loew R. HEK293-based production platform for gamma-retroviral (self-inactivating) vectors: application for safe and efficient transfer of COL7A1 cDNA. Hum Gene Ther Clin Dev. 2014 Dec;25(4):218-28. doi: 10.1089/humc.2014.083.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- C12-48
- 2016-002790-35 (EudraCT Number)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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