Efficacy Study of GS010 for Treatment of Vision Loss From 7 Months to 1 Year From Onset in LHON Due to the ND4 Mutation (REVERSE)
Condition: Optic, Atrophy, Hereditary, Leber
MeSH terms: Atrophy
Intervention: GS010; Sham Intravitreal Injection
Intervention description: Both eyes of each participant will receive standard antiseptic preparation, administration of topical local ocular anesthetic agents and will undergo pupillary dilation. Administration of an intra-ocular pressure lowering agent will precede treatment for every participant.
GS010-treated Eyes: GS010 is a recombinant adeno-associated viral vector serotype 2 (rAAV2/2) containing the wild-type ND4 gene (rAAV2/2-ND4). Participants will receive a single dose of GS010 in one of their randomly selected eyes, via intravitreal injection containing 9E10 viral genomes in 90μL balanced salt solution (BSS) plus 0.001% Pluronic F68®.; Both eyes of each participant will receive standard antiseptic preparation, administration of topical local ocular anesthetic agents and will undergo pupillary dilation. Administration of an intra-ocular pressure lowering agent will precede treatment for every participant.
Sham-treated Eyes: One eye of each participant will undergo sham injection. Sham Intravitreal injection will be performed by applying pressure to the eye at the location of a typical intravitreal injection procedure using the blunt end of a syringe without a needle.
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 37.0
Sex: All
Minimum age: 15 Years
Healthy volunteers: No
Keywords: Leber Hereditary Optic Neuropathy; Leber Hereditary Optic Atrophy; Heredity Optic Atrophy; Eye Diseases; Hereditary Eye Diseases; Inborn Genetic Disease; Genetic Therapy; Intravitreal Injections; Mitochondrial Disease; AAV2 Vectors; Nervous System Diseases; Neurodegenerative Disease; Heredodegenerative Disorders of the Nervous System

Summary:

      The goal of this clinical trial is to assess the effectiveness of GS010, a gene therapy, in
      improving the visual outcome in participants with Leber Hereditary Optic Neuropathy (LHON)
      due to the G11778A ND4 mitochondrial mutation when vision loss is present for more than six
      months and up to one year.
    

Eligibility criteria:

        Inclusion Criteria:

        Selection Criteria:

        Participants must meet all the following criteria at the Screening Visit (Visit 1) in order
        to be included into the study.

          1. Age 15 years or older.

          2. Onset of vision loss based on medically documented history or participants testimony,
             in both eyes for 181 and ≤365 days in duration.

          3. Each eye of the participant maintaining visual ability to allow at least for counting
             of the examiner's fingers at any distance.

          4. Female participants (if of childbearing potential) must agree to use effective methods
             of birth control up to 6 months after IVT injection and male participants must agree
             to use condoms for up to 6 months after IVT injection.

          5. Ability to obtain adequate pupillary dilation to permit thorough ocular examination
             and testing.

          6. Signed written informed consent.

        Inclusion Criteria:

        Participants included in the study must satisfy all the following criteria at the Inclusion
        Visit (Visit 2).

          1. Documented results of genotyping showing the presence of the G11778A mutation in the
             ND4 gene and the absence of the other primary LHON-associated mutations (ND1 or ND6)
             in the participant's mitochondrial DNA.

          2. Review of all selection criteria to ensure continued compliance.

          3. Have a negative test for infection with human immunodeficiency virus (HIV).

          4. Have a negative pregnancy test for women of childbearing potential (a woman who is two
             years post-menopausal or surgically sterile is not considered to be of childbearing
             potential).

        Exclusion Criteria:

        Non-Selection Criteria:

        Participants who meet at least one of the following criteria at the Screening Visit (Visit
        1) will not be included into the study.

          1. Any known allergy or hypersensitivity to GS010 or its constituents.

          2. Contraindication to IVT injection.

          3. IVT drug delivery to either eye within 30 days prior to the Screening Visit (Visit 1).

          4. Previous vitrectomy in either eye.

          5. Narrow angle in either eye contra-indicating pupillary dilation.

          6. Presence of disorders of the ocular media, such as the cornea and lens, which may
             interfere with visual acuity and other ocular assessments during the study period.

          7. Vision disorders, other than LHON, involving visual disability or with the potential
             to cause further vision loss during the trial period.

          8. Causes of optic neuropathy other than LHON and glaucoma.

          9. Participants with known mutations of other genes involved in pathological retinal or
             optic nerve conditions.

         10. Presence of ocular or systemic disease, other than LHON, whose pathology or associated
             treatments might affect the retina or the optic nerve.

         11. History of amblyopia associated with a Snellen visual acuity equivalent of worse than
             20/80 (equivalent to 6/24 at 6 meters, decimal acuity 0.25, LogMAR +0.6) in the
             affected eye.

         12. Presence of ocular conditions, which in the opinion of the Investigator will prevent
             good quality SD-OCT imaging from being obtained.

         13. Presence, in either eye, of uncontrolled glaucoma, defined as an IOP greater than 25
             mmHg, despite maximal medical therapy with intraocular pressure (IOP)-lowering agents.

         14. Active ocular inflammation or history of idiopathic or autoimmune-associated uveitis.

         15. Participants participating in another clinical trial and receiving an IMP within 90
             days prior to the Screening Visit (Visit 1).

         16. Previous treatment with an ocular gene therapy product.

         17. Participants who have undergone ocular surgery of clinical relevance (per Investigator
             opinion) within 90 days preceding the Screening Visit (Visit 1).

         18. Female participants who are or who intend to breast feed during the trial period.

        Exclusion Criteria:

        Participants who meet at least one of the following criteria at the Inclusion Visit (Visit
        2) will not be included in the study.

          1. Any non-selection criteria which may have appeared after the screening visit.

          2. Participants taking idebenone who have not completely discontinued the idebenone at
             least 7 days prior to Visit 2. If the participant has not discontinued idebenone at
             least 7 days prior to Visit 2, the visit may be delayed until the 7-day period is
             complete.

          3. Presence, at the time of study inclusion, of infectious conjunctivitis, keratitis,
             scleritis or endophthalmitis in either eye.

          4. Presence of systemic illness, including alcohol and drug abuse (except nicotine), or
             medically significant abnormal laboratory values that are deemed by the Investigator
             to preclude the participant's safe participation in the study.

          5. Presence of illness or disease that, in the opinion of the Investigator, include
             symptoms and/or the associated treatments that can alter visual function, for instance
             cancers or pathology of the central nervous system.

          6. Any medical or psychological condition that, in the opinion of the Investigator, may
             compromise the safe participation of the participant in the study or would preclude
             compliance with the study protocol or ability of the participant to successfully
             complete the study.

          7. Participants unable or unwilling to comply with the protocol requirements.