Interventional Study of Implantation of hESC-derived RPE in Patients With RP Due to Monogenic Mutation

November 27, 2023 updated by: Centre d'Etude des Cellules Souches

STREAM: A Phase 1/2, Open-label, Safety, Tolerability and Preliminary Efficacy Study of Implantation Into One Eye of hESC-derived RPE in Patients With Retinitis Pigmentosa Due to Monogenic Mutation

Phase I/II open-label, safety, tolerability and preliminary efficacy study of implantation into one eye of hESC-derived RPE (Human Embryonic Stem Cell Derived Retinal Pigment Epithelium (RPE)) in patients with retinitis pigmentosa due to monogenic mutation.

Study non randomized single group assignment consisting in 2 sequential cohorts of patients:

  • First cohort of 2 patients with very advanced loss of visual acuity (legally blind)
  • Second cohort of 10 patients with less advanced loss of visual acuity:

Study Overview

Status

Active, not recruiting

Detailed Description

Monocentric study (Hospital of 15-20 at Paris) of duration of 106 weeks.

At total,12 evaluable patients will be enrolled and assigned in 2 cohorts as described above in brief summary.

Expected follow-up for one patient is about 64 weeks including 8 weeks of screening and baseline period and 56 weeks of follow-up after implantation of hESC-derived RPE.

After 56 weeks of follow-up, patients will be enrolled in a long term follow-up study during 4 additional years.

The primary objective is to assess safety and tolerability of implantation of the Investigational Medecinal Product (ISTEM-01) in patients with retinitis pigmentosa.

Secondary objectives are:

  • To evaluate the placement and position of the patch
  • To assess preliminary efficacy based on:
  • Evaluation of visual function
  • Eye fundus
  • Evaluation of photoreceptor survival

Assessment of visual function by Diagnosys-Full-field stimulus threshold (D-FST) is the only exploratory objective.

Study Type

Interventional

Enrollment (Actual)

7

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Paris, France, 75012
        • •Centre Hospitalier National d'Ophtalmologie (CHNO) des Quinze-Vingts

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Documented diagnosis of retinitis pigmentosa based on a genetic test confirming the presence of a monogenic mutation that affects a gene involved in the visual signalling process specifically at the level of RPEs, namely RPE65 or LRAT, or MerTK
  • 18 years old ≤ Age ≤ 65 years old

For patient of the first cohort:

  • Visual acuity ≤ 20/200 in the best eye (legally blind)

    - For patient of the second cohort:

  • 20/63 > Visual acuity > 20/200 in the worst eye And
  • Visible photoreceptor outer nuclear layer (ONL) on a spectral domain optical coherence tomography (OCT) scan

For the two cohorts:

  • Negative serum pregnancy test in women of childbearing potential (a woman who is two years post-menopausal confirmed by a physician or surgically sterile is not considered to be of childbearing potential)
  • Female patients of childbearing potential (if sexually active), committed to use two methods of contraception starting from the enrollment, during Mycophenolate Mofetil (MMF) treatment and for 6 weeks after the last dose of MMF
  • Sexually active men (including vasectomized men) committed to use condoms during from the first day of MMF treatment and for at least 90 days after cessation of treatment
  • Signed informed consents by the patient or legal guardian(s). For patients unable to give consent, authorization to participate to the study will be collected close to their legally authorized representative
  • Affiliated to or a beneficiary of a health care system

Exclusion Criteria:

  • - Patient unable or unwilling to comply with the protocol requirements
  • History of allergy or sensitivity to one of the products used during the study
  • Patients with known serious allergies to the fluorescein
  • Patients with a contraindication to general anesthesia
  • Prior treatment with a gene or cell therapy product
  • Patients with chronic hepatitis B or C, i.e. positive hepatitis B surface antigen or hepatitis C RNA viral load positive
  • Patients infected with Human immunodeficiency virus (HIV)
  • Anti-HLA antibodies positive at screening
  • Pregnancy or breastfeeding
  • Presence of any ocular disease or ocular media opacity which in the opinion of the investigator precludes accurate evaluation
  • Participation in another drug or device clinical study within last 6 months prior to baseline
  • Patients known to be affected by pathologies for which the symptoms or associated treatments can alter the visual function and/or affect the retina
  • Systemic corticosteroid therapy or other immunosuppressive / immunomodulating or anti-retroviral drugs within 2 months prior to baseline
  • Patients with a contraindication to immunosuppressive/immunomodulating therapy (MMF) such as severe chronic renal impairment, severe digestive system disease, Lesch-Nyhan disease, Kelley-Seegmiller syndrome…
  • Acute illness or infection within 4 weeks of the anticipated administration of study medication which may interfere with study assessments and immunosuppressive/immunomodulating therapy
  • Any other condition or history that, in the opinion of the Investigator, may compromise the safety or compliance of the patient or would preclude the patient from successful completion of the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Implantation of a therapeutical patch
All the patients will receive a single central subretinal implantation in one eye of a monolayer of Human Embryonic Stem Cells-derived Retinal Pigmented Epithelium (hESC-derived RPE). The implanted eye will be the one with the worst visual acuity.
Implantation into one eye of hESC-derived RPE (Human Embryonic Stem Cell Derived Retinal Pigment Epithelium (RPE))

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety assessment
Time Frame: From Baseline until Week 56
Safety and tolerability measured by the incidence of Adverse Events or Serious Adverse Events throughout the study
From Baseline until Week 56

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Position of therapeutic patch
Time Frame: From baseline until Week 56
Position of the therapeutic patch by serial images assessment
From baseline until Week 56
Placement of the therapeutic patch
Time Frame: From Baseline until Week 56
Placement of the therapeutic patch by serial spectral domain Ocular Coherence Tomography (OCT) scan at baseline and by study visit
From Baseline until Week 56
Change in leakage or perfusion
Time Frame: At baseline and weeks 24, 48, and 56
Change in leakage or perfusion in normal fundal vasculature and presence of abnormal vasculature by fundus fluorescein angiography
At baseline and weeks 24, 48, and 56
Change in thickness of RPE layer
Time Frame: At weeks 4, 8, 16, 24, 36, 48 and 56
Change in thickness of RPE layer by B-mode orbital ultrasound
At weeks 4, 8, 16, 24, 36, 48 and 56

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Stéphane BERTIN, MD, Centre des 15-20

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 19, 2019

Primary Completion (Actual)

June 22, 2023

Study Completion (Estimated)

December 15, 2026

Study Registration Dates

First Submitted

May 22, 2019

First Submitted That Met QC Criteria

May 23, 2019

First Posted (Actual)

May 24, 2019

Study Record Updates

Last Update Posted (Actual)

November 28, 2023

Last Update Submitted That Met QC Criteria

November 27, 2023

Last Verified

November 1, 2023

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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