A Phase 1 interventional study of Recombinant Adeno-Associated Virus Acid Alpha-Glucosidase and Rapamycin in Pompe Disease, sponsored by University of Florida. Completed at 1 site in United States. Open to participants aged 18 Years to 50 Years. Per ClinicalTrials.gov, last updated 2022-04-05.
Sponsored by University of Florida · Phase 1, Interventional, and Treatment
A recombinant AAV vector has been generated to carry the codon-optimized acid alpha-glucosidase (coGAA) gene expressed from a human desmin enhancer/promoter (DES). The proposed clinical trial is a within-participant, double-blind, randomized, phase I controlled study evaluating the toxicology, biodistribution and potential activity of re-administration of rAAV9-DES-hGAA injected intramuscularly into the TA. Nine participants (18 to 50-years old) who reside within the United States with Late-Onset Pompe Disease (LOPD) will be included. The goal of the immune modulation strategy is to ablate B-cells (Rituximab and Sirolimus) prior to the initial exposure to the study agent in one leg and the subsequent exposure of the same vector to the contralateral leg after four months. At each study agent dosing, the contralateral leg will receive excipient. Patients will act as their own controls. Repeated measures, at baseline and during the following 3 months after each injection, will assess the safety, biochemical and functional impact of the vector.
Enrolling in this study will entail participating in 18 months of study-related visits. Patients will be asked to come to the Clinical and Translational Research Building at the University of Florida for a series of onsite study visits.
All the visits will be performed as outpatient procedures at the Clinical Research Center (CRC) and at other facilities at the University of Florida. Overnight observation will not be needed, however, patients will be asked to stay overnight in a hotel near the University of Florida. During the first 4 months after each injection, patients will be asked to perform outpatient laboratory work at a laboratory facility convenient for them.
In addition, during this study patients will be asked to take medications that will modulate the ability of their immune system to react against foreign agents including the gene transfer agent. The purpose of these medications is to improve the activity of the GAA within the body. Patients will receive a Rituximab injection 21 days prior to the first injection of the study agent and 7 days before each injection of the study agent and the day of the first injection. Rituximab will be delivered by infusion that may last 2-6 hours. Patients will need to take another medication (Sirolimus) every day starting 7 days before the first injection of the study agent until four months after the second injection of the study agent.
The following discusses what will occur at each visit:
Baseline Baseline Evaluation and first Rituximab infusion - Day -22/-21/-20
Rituximab infusion - Day -6
Patient will begin Rapamycin.
1st Injection - Day 0/1
On day 1, blood tests will be done.
Outpatient lab work - Day 3/7/15/30/60
Onsite visit - Day 89/90
Rituximab infusion - Day 114
The patient will receive the 4th Rituximab infusion, it might last between 2-6 hours.
2nd Injection - Day 121/122
On day 122, blood tests will be done.
Outpatient lab work - Day 124/128/135/150/180
Onsite visit - Day 209/210
Onsite visit - Day 365
Onsite visit - Day 520
151 studies on the registry are indexed under Glycogen Storage Disease Type II; 30 are open to participants now.
This study's enrollment of 2 is below the median of 17 across 81 interventional studies indexed under Glycogen Storage Disease Type II.
Browse Glycogen Storage Disease Type II studies →University of Florida is the lead sponsor of 1,254 studies on the registry; 201 are open to participants now.
Of its 170 completed or terminated interventional studies of FDA-regulated products, 136 (80%) have results posted.
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Exclusion Criteria:
Each subject will receive Rituxan and Rapamycin prior to the initial exposure to the study agent in one leg and the subsequent exposure of the same vector to the contralateral leg after four months. Diphenhydramine and acetaminophen will be provided before each Rituxan dose. Immune Globulin will be administered to each subject every other month after first exposure to Rituxan and as clinical necessary. Lidocaine will be administered through percutaneous infiltration before injection of the study agent. Side of administration will be randomized at first Recombinant Adeno-Associated Virus Acid Alpha-Glucosidase injection.
Genetic: Recombinant Adeno-Associated Virus Acid Alpha-Glucosidase · Drug: Rapamycin · Drug: Rituxan · Drug: Diphenhydramine · Drug: Acetaminophen · Drug: Lidocaine · Drug: LMX 4 Topical Cream
Each subject will receive Rituxan and Rapamycin prior to the initial exposure to the study agent in one leg and the subsequent exposure of the same vector to the contralateral leg after four months. Diphenhydramine and acetaminophen will be provided before each Rituxan dose. Immune Globulin will be administered to each subject every other month after first exposure to Rituxan and as clinical necessary. Lidocaine will be administered through percutaneous infiltration before injection of the study agent. Side of administration will be randomized at first saline injection.
Drug: Rapamycin · Other: saline · Drug: Rituxan · Drug: Diphenhydramine · Drug: Acetaminophen · Drug: Lidocaine · Drug: LMX 4 Topical Cream
The dose selected for this study is a fixed dose of 4.6 x 10\^13 vg per TA muscle (range of 7.64 x 10\^11 vg/gm to 4.6 x 10\^11 vg/gm based on TA weight).
Also known as: rAAV9-DES-hGAA
Patients will receive Rapamycin (dose 0.6-2 mg/m\^2/day, adjusted to maintain a trough serum sirolimus level of 2-4 ng/mL.) every day starting from 7 days before first injection of AAV9 until four months after second injection.
Also known as: Sirolimus
Same volume as rAAV9-DES-hGAA injection will be used.
Also known as: Excipient
Patients will receive Rituxan (dose: 750 mg/m\^2 twice) 21 and 7 day prior first AAV9 injection, with a Rituxan dose 375 mg/m\^2 on the day of the injection. Rituxan will be repeated 7 days prior to the 2nd injection of the vector. The maintenance dose of Rituxan will be 375 mg/m\^2.
Also known as: Rituximab
25-50mg will be provided before each Rituximab dose.
Also known as: Benadryl
We will provide 650 mg of tylenol before each dose of Rituximab.
Also known as: Tylenol
Lidocaine will be used based on standard of care: Percutaneous infiltration, concentration 0.5-1%, 1-10 mL, 5-300mg total dose.
Also known as: Xylocaine
Topical anesthesia cream will be used prior to gene therapy/saline injection.
Also known as: Lidocaine 4%
Safety of rAAV9-DES-hGAA vector in LOPD by blood and urine test.
Safety will be tested by clinical pathology tests, blood assay for vector genomes, antibodies against GAA and T-cell ELISPOT against GAA and AAV.
Time frame: 520 days
Neurophysiological tests will be performed for neuro function of rAAV9-DES-hGAA vector.
Neurophysiological tests: Surface testing of the common fibular nerve and neuromuscular junction transmission.
Time frame: 520 days
Muscle biopsy will be performed for muscular function of rAAV9-DES-hGAA vector.
Muscle biopsy for biochemistry and immunochemistry tests.
Time frame: 520 days
Clinical tests will be performed for function of rAAV9-DES-hGAA vector.
Clinical tests: 10 meter walk test and muscle strength test.
Time frame: 520 days
Magnetic Resonance Imaging will be performed for visualization of muscle with rAAV9-DES-hGAA vector.
MRI will provide a non-invasive means of evaluating maximum cross-sectional area (CSAmax) - an index of muscle mass - and the MR proton traverse relaxation time (T2) - an index of muscle damage and edema.
Time frame: 520 days
Spectroscopy will be performed for function of rAAV9-DES-hGAA vector.
MRS will provide a non-invasive means of evaluating glycogen concentration in muscle.
Time frame: 520 days
Plan to share: Undecided
This study is completed, as verified in Mar 2022. You cannot join it, but the record below documents what was studied.
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Glycogen Storage Disease Type II→
University of Florida