Phase 1 Trial of Type II Collagen (CII) APL A12 in Rheumatoid Arthritis Patients
Condition: Rheumatoid Arthritis
MeSH terms: Arthritis; Arthritis, Rheumatoid
Intervention: APLA12; Placebo
Intervention description: Intervention: Drug treatment will be stopped or interrupted if indicated. Medical care will be provided at no cost to the patient.; Drug treatment will be stopped or interrupted if indicated. Medical care will be provided at no cost to the patient.
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 22.0
Sex: All
Minimum age: 18 Years
Maximum age: 85 Years
Healthy volunteers: No

Summary:

      This is a Phase I clinical trial to determine whether orally administered APL A12 at one or
      more doses is superior to placebo in effecting a 25% reduction in interferon (IFN)
      stimulation index in 1(II)-stimulated culture of peripheral blood mononuclear (PBMC) obtained
      from patients with Rheumatoid Arthritis (RA), which will be the primary outcome variable. In
      an effort to learn more about the mechanism of action of APL A12, the investigators will
      assess Th1/Th2/Th3 cytokine production in supernatants from 48h and 144h cultures of PBMC
      stimulated by 1(II) and by APL A12 above. The investigators will assess function of CD4+
      CD25+ T regs to determine whether APL A12 improves their suppressive function. Flow cytometry
      combined with intracellular cytokine staining will be used in an effort to determine which T
      cell subset(s) is/are experiencing shifts in cytokine expression.
    

Eligibility criteria:

        Inclusion Criteria:

        Patients must meet the following criteria for participation in the study.

          -  Male or female; age > 18 years.

          -  American College of Rheumatology (ACR) 1988 revised criteria for rheumatoid arthritis.

          -  Onset of disease age 16 or older.

          -  Onset of disease at least 3 months prior to enrollment.

          -  RA patients ages 18-85 with RA of 3 month duration which in the opinion of the
             examining rheumatologist is "clinically stable" and will likely not require adjustment
             of doses of Disease-modifying antirheumatic drugs (DMARDS), NSAIDS, prednisone,
             anti-tumor necrosis factor (anti-TNF) alpha therapies for the 16 weeks of the
             treatment phase of the study.

          -  Patients must agree to discontinue all "herbal remedies" as described in this
             protocol.

          -  Women of childbearing age will be advised to use effective means of contraception for
             the treatment phase of the trial and for 90 days thereafter. They must have a negative
             urine pregnancy test at the randomization visit. (Required by the FDA.)

          -  Men will be advised to use effective means of contraception for the treatment phase of
             the trial and for 90 days thereafter. (Required by the FDA.)

          -  Crohn's Disease Activity Index (CDAI) less than or equal to 30 at the baseline visit.

          -  Patients with a past history of malignant neoplasm will be eligible if they are 1 or
             greater years with no recurrence of malignant neoplasm.

        Exclusion Criteria:

          -  Inability to render an informed consent in accordance with institutional guidelines.

          -  Participation in another clinical research study involving the evaluation of another
             investigational drug within 90 days of entry into this study.

          -  RA patients on >7.5 mg prednisone a day.

          -  RA patients with intra-articular corticosteroid injections during the previous 30
             days.

          -  Concurrent serious medical condition which in the opinion of the investigator makes
             the patient inappropriate for the study. Hepatitis B abd/or C patients with inactive
             disease (as determined by PI) will be enrolled.

          -  Positive urine pregnancy test

          -  Age 85 years or greater.

          -  Use of "fish oil" within the previous 4 weeks of the baseline visit.

          -  Therapy consisting of auranofin or cyclophosphamide (all other DMARDs are allowed).

          -  Previous autologous or heterologous stem cell transplantation.

          -  Active malignant neoplasm or past treatment for malignant neoplasm 1 year from
             screening visit.

          -  Use of oral CII within the past 1 year. (Since oral tolerance is short-lived, we will
             permit patients in the study who have been off oral CII for > 1 year)

          -  Diabetes requiring insulin or on oral medications must be well managed at baseline.
             Adjustment of insulin or on oral medications will be allowed during the study.

          -  Serum creatinine 2.0 mcg/dL.

          -  An 1(II) IFN value <100% of the PBS IFN value within 1 month or less prior to the
             baseline and less than 25% reduction in APL A12 + 1(II) IFN from 1(II) IFN
             concentration.

          -  CDAI > 30 at the baseline visit.