Study Evaluating a Gene Therapy for IPEX Syndrome Through the Expression of FOXP3 on Deficient T Cells to Produce Tregs-like. (THERIPEX)
A Phase I/II Open-label, Non-randomized, Monocentric, Single-arm Study Evaluating the Safety and Efficacy of Induced CD4+ Treg by LV Vector Transduction Expressing the FOXP3 cDNA (FOXP3-T4) in Patients With IPEX Syndrome
The purpose of this study is to evaluate the safety and efficacy of FOXP3-T4 (an autologous gene therapy) alone or in combination with low-dose IL-2 for the treatment of IPEX syndrome. The therapy involves the transplantation of autologous CD4+ T-cells transduced ex vivo with the LV-EF1a-FOXP3-LNGFR lentiviral vector. The study follows a staggered approach: the first two patients will receive FOXP3-T4 monotherapy. Subsequent patients will receive FOXP3-T4 followed if needed by low-dose IL-2 treatment consisting of a daily dose for 5 days, then weekly administrations for 3 months.
The study aims to stabilize autoimmune manifestations and potentially cure the underlying disease, ultimately allowing for the discontinuation of ongoing immunosuppressive treatments.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
IPEX syndrome is a primary immunodeficiency caused by hemizygous mutations in the gene FOXP3, which encodes an essential transcription factor required to maintain immunological tolerance by thymus-derived regulatory T (Treg) cells. The most common presentation suggestive of the diagnosis of IPEX syndrome is the classical triad of enteropathy, type I diabetes (TID), and eczema in neonatal onset. Still, it is now well established that IPEX syndrome comprises a broad spectrum of clinical manifestations with different degrees of severity and evolution.
Currently, the only curative treatment for the severe form is allogeneic hematopoietic stem cell transplantation (HSCT). However, because of its significant toxicity, it can be proposed only for more severe presentations and when an HLA identical donor is available. Moreover, the post-HSCT prognosis is also linked to prior disease activity and organ failures.
This clinical study aims to assess a new therapeutical strategy consisting of the conversion of the IPEX patient's CD4+T-cells into functional Treg-like cells by transducing them with an optimized bidirectional lentivirus vector expressing human FOXP3 and a truncated form of the low-affinity nerve growth factor receptor (ΔLNGFR) allowing the selection of the transduced cells. To favour Treg-like cells engraftment and expansion, the FOXP3-T4 infusion may be combined with subcutaneous injection of low-dose IL-2, if needed. Injecting FOXP3-T4 T-reg-like cells into IPEX patients is expected to stably improve the autoimmune manifestations and even cure the underlying disease, allowing the ongoing immunosuppressive treatments to be stopped.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Fáze 2
- Fáze 1
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Marina CAVAZZANA, MD, PhD
- Telefonní číslo: + 33 01 44 49 50 68
- E-mail: m.cavazzana@aphp.fr
Studijní záloha kontaktů
- Jméno: Aline DECHANET, Project Manager
- Telefonní číslo: +33 01 44 38 17 11
- E-mail: aline.dechanet@aphp.fr
Studijní místa
-
-
Île-de-France Region
-
Paris, Île-de-France Region, Francie, 75015
- Department of Biotherapy, Hopital Necker Enfants malades
-
Kontakt:
- Marina CAVAZZANA, MD, PHD
- Telefonní číslo: +33 01 44 49 50 68
- E-mail: m.cavazzana@aphp.fr
-
-
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dítě
- Dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- Male patients only
- Patients aged from 1 - 45 years of age (the first three patients will be aged between 10 - 45 years of age)
- Patient with IPEX syndrome caused by mutation of the FOXP3 gene
- Patients are eligible from the second line of treatment onward, even those under controlled disease
- Patient with recurrent IPEX symptoms, under immune suppressive medications
- Patient for whom HSCT is not feasible or when no suitable compatible donor is available
- Patients who have had prior allogeneic blood stem cell transplantation (HSCT) with engraftment failure defined as no intake of donor cells
- Patient or parental, guardian's patient signed informed consent
- Male participants of reproductive potential with a partner of childbearing potential (WOCBP): willing to use an effective method of contraception during the trial and for at least 12 months post-infusion
- Affiliation to a French or European social security scheme
Exclusion Criteria:
- Unwillingness to return for follow-up during the 2-year study and during the 15 years of long term follow up study.
- Patient with short life expectancy
- Patient on AME (state medical aid) (unless exemption from affiliation).
- Diagnosis of a significant psychiatric disorder of the patient that could seriously impede the ability to participate in the study.
- Eligible for an HLA matched sibling or matched unrelated donor blood stem cell transplant (HLA 10/10) and be willing to undergo transplant.
- Patients with uncontrolled or ongoing active infections.
- HIV-1 or 2 or HTLV-1 infections.
- Patients with severe IPEX clinical presentation needing a rapid allogeneic HSCT treatment within 3 months.
- Patients with known history of hypersensitivity to IL-2 or any component of the formulation (mannitol, sodium lauryl sulfate, monosodium phosphate dehydrate, disodium phosphate dehydrate, glucose.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: N/A
- Intervenční model: Přiřazení jedné skupiny
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Experimentální: FOXP3-T4 drug product
FOXP3-T4 is a genetically modified cell therapy product consisting of autologous CD4+ T-cells transduced ex vivo with a self-inactivating bidirectional lentiviral vector (LV-EF1a-FOXP3-LNGFR) expressing the FOXP3 and LNGFR cDNAs.
|
Each patient will receive a single IV infusion of FOXP3-T4, autologous gene-modified CD4+ T-transduced ex vivo with a self-inactivating lentiviral vector (LV-EF1a.FOXP3-LNGFR)
The first two patients included in the study will not receive IL-2 treatment.
The others will receive the first injection the FOXP3-T4 treatment and if needed IL2-treatment.
For IL2 treatment, patients will receive a daily dose for 5 days, followed by an administration per week for 3 months (ILT-101)
Ostatní jména:
|
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Frequency of clinical AEs and pathological variations of laboratory parameters
Časové okno: Up to 24 months post-infusion
|
Number of clinical AEs
|
Up to 24 months post-infusion
|
|
Severity of clinical AEs and pathological variations of laboratory parameters
Časové okno: Up to 24 months post-infusion
|
Grading will be performed according to the CTCAE (Common Terminology Criteria for Adverse Events) current version.
Severity is rated on a scale of Grade 1 (Mild) to Grade 5 (Death).
|
Up to 24 months post-infusion
|
|
Incidence of clinically detectable lymphoproliferation and abnormal clonal dominance
Časové okno: Up to 24 months post-infusion
|
This is measured via Vector Insertion Site Analysis (VISA)
|
Up to 24 months post-infusion
|
|
Incidence of clinically detectable lymphoproliferation and abnormal clonal dominance
Časové okno: Beyond 3 months to 24 months post-infusion
|
This is measured by proliferation of LNGFR+ cells
|
Beyond 3 months to 24 months post-infusion
|
|
Detection of Replication-Competent Lentivirus (RCL)
Časové okno: Up to 24 months post-infusion
|
Up to 24 months post-infusion
|
|
|
Persistence of recirculating LNGFR+among CD4+ T cells
Časové okno: at 3 months post-infusion
|
Percentage of LNGFR+ among CD4+ T cells
|
at 3 months post-infusion
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Persistence of FOXP3-T4 Cells
Časové okno: Up to 24 months post-infusion
|
Persistence of recirculating LNGFR among CD4+ T cells
|
Up to 24 months post-infusion
|
|
Phenotyping
Časové okno: Up to 24 months post-infusion
|
Deeper phenotyping of FOXP3-T4 (CD4+LNGFR+ CD25+ FOXP3+ CD127low)
|
Up to 24 months post-infusion
|
|
Vector Copy Number (VCN) Analysis
Časové okno: Up to 24 months post-infusion
|
Quantification of the transgene copy number (VCN) on drug product and on sorted T-CD4+
|
Up to 24 months post-infusion
|
|
Immunophenotyping T and B cells if no change is detected from the baseline (e.g. before treatment), the immunological phenotype
Časové okno: Beyond 3 months to 24 months post-infusion
|
Beyond 3 months to 24 months post-infusion
|
|
|
TCR repertoire
Časové okno: At 3 months, 12 months and 24 months, post-infusion
|
Evaluated by NGS before and after the treatment with FOXP3-T4
|
At 3 months, 12 months and 24 months, post-infusion
|
|
Autoantibodies dosage
Časové okno: At 3 months, 6 months, 12 months and 24 months post-infusion
|
At 3 months, 6 months, 12 months and 24 months post-infusion
|
|
|
Organ-Specific Remission: Skin disease
Časové okno: Up to 24 months post-infusion
|
Diminution of the skin lesions severity
|
Up to 24 months post-infusion
|
|
Organ-Specific Remission: Skin disease
Časové okno: Up to 24 months post-infusion
|
Diminution of inflammation in the skin biopsy
|
Up to 24 months post-infusion
|
|
Organ-Specific Remission: Endocrine System Function
Časové okno: Up to 24 months post-infusion
|
Evaluation of the functions of endocrine glands
|
Up to 24 months post-infusion
|
|
Organ-Specific Remission: Endocrine System Function
Časové okno: Up to 24 months post-infusion
|
Reduction of insulin dose administrered
|
Up to 24 months post-infusion
|
|
Organ-Specific Remission: Endocrine System Function
Časové okno: Up to 24 months post-infusion
|
Reduction of HBA1C
|
Up to 24 months post-infusion
|
|
Organ-Specific Remission: Renal function
Časové okno: Up to 24 months post-infusion months
|
Improvement of creatine and creatine clearance
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Renal function
Časové okno: Up to 24 months post-infusion months
|
Improvement of proteinuria
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Renal function
Časové okno: Up to 24 months post-infusion months
|
Improvement of tubular effect
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Digestive System
Časové okno: Up to 24 months post-infusion months
|
Change in the weight curve
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Digestive System
Časové okno: Up to 24 months post-infusion months
|
Change in diarrhea incidence
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Digestive System
Časové okno: Up to 24 months post-infusion months
|
Decrease of fecal calprotectin
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Musculoskeletal System
Časové okno: Up to 24 months post-infusion months
|
Improvement of arthritis evaluated by physical examination
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Respiratory Function
Časové okno: Up to 24 months post-infusion months
|
Improvement of asthma evaluated by physical examination
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: General status
Časové okno: Up to 24 months post-infusion months
|
Improvement of performance status : Lansky and Karnofsky scores range from 100 to 10
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Blood count
Časové okno: Up to 24 months post-infusion months
|
Presence of autoimmune hemolytic anemia
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Blood count
Časové okno: Up to 24 months post-infusion months
|
Presence of thrombocytopenia
|
Up to 24 months post-infusion months
|
|
Organ-Specific Remission: Eye
Časové okno: Up to 24 months post-infusion months
|
Improvement of blepheratis evaluated by physical examination.
|
Up to 24 months post-infusion months
|
|
Reduction of Concomitant Therapy
Časové okno: Up to 24 months
|
Reduction of corticosteroid therapy or immunosuppressive treatment
|
Up to 24 months
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Spolupracovníci
Spolupracovníci
Vyšetřovatelé
Vyšetřovatelé
- Studijní židle: Emmanuelle SIX, MD, PhD, Institut Imagine
Publikace a užitečné odkazy
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
Další identifikační čísla studie
Další identifikační čísla studie
- APHP251137
- 2025-523305-15-00 (Ctis)
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .