STA-5326 Meslylate to Treat Gut Inflammation Associated With Common Variable Immunodeficiency
Condition: Common Variable Immunodeficiency
MeSH terms: Immunologic Deficiency Syndromes; Common Variable Immunodeficiency; Inflammation
Study type: Interventional
Phase: Phase 1

Summary: 
      This study will determine whether an experimental medicine, STA-5326 mesylate, is safe to use
      in patients with common variable immunodeficiency (CVID) who have inflammation of the gut. It
      will also determine if patients who take this drug show improvement in their symptoms,
      decrease in inflammatory chemicals in the gut, changes in their immune cells, and improvement
      in how their gut is functioning to absorb food.

      Patients between 18 and 75 years of age with CVID and chronic diarrhea or involuntary weight
      loss of more than 5 percent of their past body weight over the past 12 months may be eligible
      for this study. Candidates are screened with a review of their medical records, a medical
      history and physical examination, blood, urine and stool tests, chest x-rays and skin test
      for exposure to tuberculosis, and a hydrogen breath test. For the latter, breath samples are
      collected before and every 20 minutes (for 2 hours) after the subject drinks a sugar
      solution. This test determines the digestive effects of bacteria in the upper intestine.
      Samples are collected by having the subject blow into a balloon.

      Participants undergo the following tests and procedures:

      Immune System and Gastrointestinal Evaluation

        -  48-hour stool fat collection (measures the amount of undigested fat in the stool):
           Subjects keep a diary of what they eat for a 48-hour period. At the beginning of the 48
           hours they take two dye capsules and then take another two capsules 48 hours later. They
           collect a stool sample when they pass the second set of capsules in their bowel
           movement. An additional 24-hour stool collection is tested for loss of protein in the
           stool.

        -  D-xylose absorption test (measures the ability of the gut to absorb nutrients): Subjects
           drink a solution of d-xylose (a sugar substitute). Blood samples are collected before
           and 1 hour after drinking the solution.

        -  Upper endoscopy: A thin flexible lighted tube is advanced through the mouth to evaluate
           the esophagus, stomach and beginning of the small intestine.

        -  Lower endoscopy: A thin flexible lighted tube is advanced through the rectum to evaluate
           the colon.

      Treatment Period (Study days 1 to 57)

        -  Physical examination - study days 1, 8, 15, 29, 43 and 57

        -  Blood samples to test the levels of STA-5326 in the blood. On study days 1 and 57,
           samples are collected before the medication dose and 1, 2, 4, 6 and 8 hours after the
           dose; on day 29, one sample is collected before the medication dose.

        -  Blood samples for routine safety testing - study days 1, 8, 15, 29, 43 and 57

        -  Medication history - study days 1, 8, 15, 29, 43 and 57

        -  Interview about pain, discomfort, and well being - study days 1, 8, 15, 29, 43 and 57

        -  Pregnancy test for women who can become pregnant - study days 15, 43, and 57

        -  D-xylose absorption test - study days 29 and 57

        -  Electrocardiogram - study days 29 and 57

        -  Urine test - study days 29 and 57

        -  Blood test for research on immune cells - study day 57

        -  Repeat endoscopies and studies of gut function (24- and 48-hour stool collections)

      Follow-up period (Day 85 and day 113)

      -Physical examination, blood tests, medication history, questions about pain, discomfort and
      well being
    

Detailed description: 
      The purpose of this study is to assess the toxicity of the oral IL-12/23 inhibitor STA-5326
      mesylate in subjects with common variable immunodeficiency (CVID) and associated symptomatic
      gastrointestinal inflammation. Common variable immunodeficiency is a clinically heterogeneous
      disorder characterized by decreased serum immunoglobulin IgG and IgA levels. In addition to
      chronic or recurrent pyogenic sino-pulmonary infections, many patients develop non-infectious
      gastrointestinal manifestations that can be disabling or fatal. Currently there is no
      standard therapy for the associated gastrointestinal disease outside of empiric nutritional
      intervention for weight loss and non-specific anti-diarrheal agents.

      Recently gut inflammation complicating CVID has been characterized as a Th1 inflammatory
      response, with excess cytokine production associated with diarrhea and weight loss as well as
      reduced D-xylose absorption and steatorrhea. This protocol represents the first attempt to
      test specific anti-IL-12 therapy in this patient group; it has been previously shown that
      therapy targeted to IL-12/23 successfully treated the Th1 gut inflammation of Crohn's
      disease. While this protocol is designed to measure the safety of STA-5326 mesylate in CVID
      patients, it will also measure effects on symptoms, gut function, expression of immune cell
      surface markers and production of cytokines from blood and gut mucosal mononuclear cells.

      CVID patients with gastrointestinal symptoms of malabsorption, maldigestion, and chronic
      diarrhea will be enrolled into this study. Subjects (up to a total of 10 individuals) will
      receive STA-5326 mesylate 100 mg per os (PO) once daily (QD) (equivalent to 70 mg STA-5326
      free base) for 8 weeks. Subjects will have pretreatment and end-of-study procedures,
      including upper and lower endoscopies, to measure changes in immune responses and physiologic
      measures of gut function, as well as routine safety monitoring throughout the treatment
      period. Variables will include safety (adverse event rate), clinical (weight, stool
      frequency, results of gut absorption tests), and laboratory (lymphocyte and cytokine assays)
      parameters for descriptive summary statistical analysis (n, mean, median, standard deviation,
      minimum and maximum range).
    

Intervention name(s): STA-5326
Intervention type(s): Drug
Primary purpose: Treatment
Keywords: T Cell; Lymphocyte; Lamina Propria; Malabsorption; Colonoscopy; Common Variable Immunodeficiency; CVID; Gastrointestinal Inflammation