RAPA-501 Therapy for ALS

Phase 2/3 Trial of Autologous Hybrid TREG/Th2 Cell (RAPA-501) Therapy for Amyotrophic Lateral Sclerosis

RAPA-501-ALS is a phase 2/3 expansion cohort study of RAPA-501 autologous hybrid TREG/Th2 cells in patients living with amyotrophic lateral sclerosis (pwALS).

Study Overview

• Status: Recruiting
• Conditions: Amyotrophic Lateral Sclerosis
• Intervention / Treatment: Biological: RAPA-501 Autologous T cells

Detailed Description

This is an open-label, non-randomized, multi-center phase 2/3 study evaluating RAPA-501 T cell therapy in pwALS on an expansion cohort.

After a subject consents to the study, an apheresis procedure will be performed to collect cells to manufacture the investigational product, RAPA-501 T cells. RAPA-501 cells are manufactured ex vivo using epigenetic reprogramming to yield a T cell population that is enriched for a dual anti-inflammatory phenotype based on hybrid TREG and Th2 differentiation. RAPA-501 cells express both the TREG and Th2 transcription factors FOXP3 and GATA3, are enriched for expression of the ATP ectonucleotidase molecules CD39 and CD73, are enriched for the T cell homing molecule CD103, and suppress both effector T cell inflammatory molecules and CNS microglial cell inflammatory molecules.

This study consists of a phase 2/3 expansion cohort that is evaluating RAPA-501 T cell therapy at the dose of 80 x 10EE6 cells per infusion, with up to 4 infusions separated by six weeks between doses (infusion at time 0, and then after week 6, 12, and 18). Study subjects are then followed at the treatment site at 24 weeks and 30 weeks on-study; then, subjects are followed remotely using surveys for two years to capture major clinical events and assess survival. The primary objective in the expansion cohort is to determine the feasibility and safety of the highest established safe dose of RAPA-501 (80 x 10EE6 cells per infusion) in patients with standard-risk ALS (as defining by study entry values of: SVC greater than or equal to 70% of predicted normal; time interval since first ALS symptom, 24 months or less; and ALSFRS-R score between 34 and 45). Secondary study objectives relate to assessing the potential efficacy of RAPA-501 therapy through monitoring of ALSFRS-R scores, SVC values, time to King's stage transition, and survival. To enhance an ability to determine potential efficacy, these parameters will be compared to two comparator arms using machine learning algorithms developed by Origent Data Sciences, namely: (1) a virtual intra-patient control cohort (patient serves as own control); and (2) a comparator arm developed by prognostic mapping to the PRO-ACT database. In addition, secondary study objectives relate to study of pre- and post-therapy blood samples (serum and cells) for markers of inflammation and neurodegeneration.

In the initial phase 1/2 study design, patients received therapy on Cohort 1 (low-dose RAPA-501; 20 x 10EE6 cells per infusion), Cohort 2 (high-dose RAPA-501; 80 x 10EE6 cells per infusion), and Cohort 3A (low-dose RAPA-501 when administered after a 3-day host conditioning regimen consisting of pentostatin plus cyclophosphamide. At the time of study amendment to add the expansion cohort, some patients already enrolled to the phase 1/2 aspect of the trial will continue to receive their initially designated cohort therapy and follow-up evaluation.

• Study Type: Interventional
• Enrollment (Estimated): 41
• Phase: Phase 2; Phase 3

Contacts and Locations

• Study Contact: Name: Daniel Fowler, M.D. Chief Medical Officer, RAPA Therapeutics, LLC; Phone Number: (301) 518-3104; Email: dan@rapatherapeutics.com
• Study Contact Backup: Name: Jennifer Sunga Regulatory Affairs Associate, RAPA Therapeutics, LLC; Phone Number: (571) 277-4916; Email: jsunga@rapatherapeutics.com

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Recruiting
      • Massachusetts General Hospital
      • Principal Investigator: James Berry, M.D.
      • Contact: Jacqueline Topping; Phone Number: 617-643-6036; Email: JTOPPING@mgh.harvard.edu
      • Contact: Lisa Lichtenegger; Phone Number: 617-643-9005; Email: llichtenegger@mgh.harvard.edu
  • New Jersey
    • Hackensack, New Jersey, United States, 07601
      • Recruiting
      • Hackensack University Medical Center
      • Contact: Michele Donato Principal Investigator; Phone Number: 551-996-5855; Email: michele.donato@hackensackmeridian.org
      • Principal Investigator: Michele Donato, M.D

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male or female patients ≥ 18 years of age.
2. Patients with sporadic or familial amyotrophic lateral sclerosis (ALS) diagnosed as laboratory-supported possible, probable, or definite according to World Federation of Neurology El Escorial Criteria.
3. . Less than or equal to 24 months since ALS symptom onset.
4. Total ALSFRS-R score between 34 and 45.
5. Must have a source of autologous T cells potentially sufficient to manufacture RAPA-501 cells, as defined by a peripheral CD3+ T cell count ≥ 500 cells per μl.
6. Patients may continue riluzole (Rilutek®), and/or edaravone (Radicava®), and/or sodium phenylbutyrate/taurusodial (Relyvrio™) if on a stable dose for at least 30 days prior to the screening visit.
7. Patients must be ≥ 2 two weeks removed from major surgery or investigational therapy.
8. Patients must have recovered from clinical toxicities ([resolution of CTCAE(v5) [version 5] toxicity to a value of ≤ 2].).
9. Serum creatinine ≤ less than or equal to 2.0 mg/dL.
10. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 x upper limit of normal (ULN).
11. Bilirubin ≤ 1.5 (except if due to Gilbert's disease).
12. Pulmonary slow vital capacity (SVC) ≥ 70% of predicted normal.
13. No history of abnormal bleeding tendency.
14. Voluntary written consent must be given before performance of any study related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient participant at any time without prejudice to future medical care.

Exclusion Criteria:

1. Active uncontrolled infection.
2. Hypertension not adequately controlled by ≤ 3 medications.
3. History of documented pulmonary embolus within 6 months of enrollment.
4. Clinically significant cardiac pathology, as defined by: myocardial infarction within 6 months prior to enrollment, Class III or IV heart failure according to NYHA, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities.
5. Patients with history of coronary artery bypass grafting or angioplasty will receive a cardiology evaluation and be considered on a case-by-case basis.
6. HIV, hepatitis B, or hepatitis C seropositive.
7. Pregnancy or breastfeeding patients.
8. Patients of Subjects of childbearing age, or males who have a partner of childbearing potential, who are unwilling to practice contraception.
9. Patients Subjects may be excluded at the Principal Investigator discretion of the PI or if it is deemed that allowing participation would represent an unacceptable medical or psychiatric risk.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Phase 2/3 Expansion Cohort, Single-agent RAPA-501 T cells; 80 x 10^6 cells per infusion (no host conditioning)	Biological: RAPA-501 Autologous T cells; TREG/Th2 cells; Other Names: RAPA-501 cells
Experimental: Phase 1/2 Only, Single-agent RAPA-501 T cells (dose level Arm 1); Dose level 1 is 20 x 10^6 cells/infusion	Biological: RAPA-501 Autologous T cells; TREG/Th2 cells; Other Names: RAPA-501 cells
Experimental: : Phase 1/2 Only, Single-agent RAPA-501 T cells (dose level Arm 2); Dose level 2 is 80 x 10^6 cells/infusion	Biological: RAPA-501 Autologous T cells; TREG/Th2 cells; Other Names: RAPA-501 cells
Experimental: Phase 1/2 Only, RAPA-501 + PC Regimen (Arm 3A); RAPA-501 T cell therapy preceded by the 3-day pentostatin-cyclophosphamide (PC) regimen	Biological: RAPA-501 Autologous T cells; TREG/Th2 cells; Other Names: RAPA-501 cells

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
In the expansion cohort enrolling standard-risk pwALS, determine the feasibility and safety of the highest established safe dose of RAPA-501 (80 x 10^6 cells per infusion).	Through 30 Weeks On-Study

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Characterize immune system parameters pre- and post-therapy.	Specifically, relative to pretreatment patient peripheral blood values, determine whether study interventions: (a) increase circulating Th2 and TREG cells; (b) reduce circulating Th1 cells; (c) increase T cell expression of programmed death-1 (PD-1); and (d) reduce inflammatory cytokines IL-1-beta, IL-6, and TNF-alpha.	Through 30 Weeks On-Study
Relative to pretreatment values, characterize the potential effect of RAPA-501 therapy on serum markers of neurodegeneration (neurofilament light, NfL).		Through 30 Weeks On-Study
Relative to pretreatment values, characterize the potential effect of RAPA-501 therapy on pulmonary function, as measured by slow vital capacity measurements (SVC, percent of predicted normal).		Through 30 Weeks On-Study
Relative to pretreatment values, characterize the potential effect of RAPA-501 therapy on hand grip strength using hand-held dynamometry.		Through 30 Weeks On-Study
Using a virtual control cohort and prognostic matching comparator arm (Origent algorithm), determine the potential effect of RAPA-501 therapy on disease progression (ALSFRS-R), pulmonary function (SVC), time to King's stage transition, and survival.		Through 2 Years and 30 Weeks On-Study

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cerebrospinal fluid assessment	To assess cerebrospinal fluid pre- and post- therapy for content of inflammation molecules and neurodegeneration molecules.	Six months after treatment initiation.
Neuroinflammation assessment	Assess neuroinflammation in vivo using PET scan that incorporates a translocator protein radiotracer.	Six months after treatment initiation.

Collaborators and Investigators

• Sponsor: Rapa Therapeutics LLC
• Collaborators: Massachusetts General Hospital; Hackensack Meridian Health
• Investigators: Study Director: Daniel Fowler, M.D., Rapa Therapeutics LLC

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2020
• Primary Completion (Estimated): July 1, 2025
• Study Completion (Estimated): July 1, 2025

Study Registration Dates

• First Submitted: January 3, 2020
• First Submitted That Met QC Criteria: January 3, 2020
• First Posted (Actual): January 7, 2020

Study Record Updates

• Last Update Posted (Actual): August 29, 2023
• Last Update Submitted That Met QC Criteria: August 25, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: Amyotrophic Lateral Sclerosis; Autologous TREG/Th2 cell therapy; RAPA-501
• Additional Relevant MeSH Terms: Pathologic Processes; Metabolic Diseases; Central Nervous System Diseases; Nervous System Diseases; Neuromuscular Diseases; Neurodegenerative Diseases; Spinal Cord Diseases; TDP-43 Proteinopathies; Proteostasis Deficiencies; Sclerosis; Motor Neuron Disease; Amyotrophic Lateral Sclerosis
• Other Study ID Numbers: RAPA-501-ALS

Drug and device information, study documents

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