A Research Trial of Aralast in New Onset Diabetes (RETAIN)

Study Overview
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Brief Summary
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The drug Alpha-1 Antitrypsin (AAT, Aralast NP) is being tested in this study as an anti-inflammatory drug (a medication that decreases inflammation, which is part of the body's normal ability to fight infection and respond to injuries) that affects the cells thought to be involved in the development of type 1 diabetes mellitus (T1DM, T1D). All subjects enrolled in this study have new-onset T1DM (diagnosis of T1DM within 100 days of Visit 0; T1DM diagnosis fulfilling American Diabetes Association standard T1DM criteria). The focus of Part I of this trial (NCT01183468) is pharmacokinetics (PK), pharmacodynamics (PD) and safety. Upon completion of Part I, including a satisfactory safety review, enrollment in Part II (NCT01183455, Phase II Clinical Trial) will begin.

Detailed Description
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Researchers are interested in conducting this study to assess whether Aralast NP (AAT, Alpha-1 Antitrypsin ) will help slow the progression of T1DM. Part I of this study has two parts:-1a and -1b: Part 1a (Complete): An open-label, dose-escalation, PK, PD and safety study. Participants receive 12 intravenous (IV) infusions of Aralast NP. Infusions 1 through 6 are administered at 45 mg/kg/wk and infusions 7 through 12 are administered at 90 mg/kg/wk. Part Ia consists of two groups: Subjects aged 16 - 35 years at enrollment with new-onset T1DM Subjects aged 8 -15 years at enrollment with new-onset T1DM. Part 1b (study terminated prior to subject enrollment): An open-label, dose-escalation PK, PD and safety study in which participants receive 12 infusions of Aralast NP. Infusions 1 through 6 are administered at 90 mg/kg/wk and infusions 7 through 12 are administered at 180 mg/kg/wk. Part Ib consists of two groups: Subjects aged 16 - 35 years at enrollment with new-onset T1DM Subjects 8 - 15 years at enrollment with new-onset T1DM. Participants in Part Ib do not roll over into Part II (Refer to NCT01183455).

Official Title
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Effect of Intravenous Alpha-1 Antitrypsin on Preserving Beta-cell Function in New-onset Type 1 Diabetes Mellitus (ITN041AI)

Conditions
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Diabetes Mellitus, Type 1

Intervention / Treatment
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* Biological: Aralast NP 45 mg dose
* Biological: Aralast NP 90 mg dose
* Biological: Aralast NP 180 mg dose


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with T1DM within the past 100 days (of enrollment) Positive for at least one diabetes-related autoantibody (Anti-GAD; Anti-insulin, if obtained within 10 days of the onset of insulin therapy; IA-2 antibody and/or ICA, or ZnT8.) Peak stimulated C-peptide level > 0.2 pmol/mL following a mixed meal tolerance test (MMTT) Exclusion Criteria: Severe active disease (chronic active hepatitis; cardiac, pulmonary disease, hepatic, renal or immunodeficiency) History of any bleeding or clotting factor deficiencies, or stroke History of vascular disease or significant vascular abnormalities Positive serology of exposure to (hepatitis B virus) HBV, HCV (hepatitis C virus), HIV (human immunodeficiency virus) or toxoplasmosis Clinically active infection with EBV (Epstein-Barr virus), CMV (cytomegalovirus), or tuberculosis(TB) Prior or current use of oral, inhaled or intranasal glucocorticoids, or any medication known to cause a significant, ongoing change in the course of T1DM or immunologic status Prior treatment with Alpha 1-Antitrypsin (Aralast NP, AAT) or hypersensitivity to alpha 1-antitrypsin or human plasma-derived products Current or prior (within the last 30 days) use of metformin, sulfonylureas, glinides, thiazolidinediones, exenatide, liraglutide, DPP-IV inhibitors or amylin Current use of any medication known to influence glucose tolerance (e.g., beta-blockers, angiotensin-converting enzyme inhibitors, interferons, quinidine anti-malarial drugs, lithium, niacin) Females who are pregnant or lactating, or are unwilling to defer pregnancy during study participation IgA (immunoglobulin A) deficiency Uncontrolled hypertension Current life-threatening malignancy Any condition that in the investigator's opinion may compromise study participation or may confound the interpretation of the study results.

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Part 1a(Aralast NP)-Subjects Aged 16-35 Yrs<br>Subjects aged 16-35 years at enrollment with new-onset type 1 diabetes mellitus (T1DM) received Aralast NP 45 mg/kg by intravenous (IV) infusion once a week for 6 weeks. Following the Week 6 infusion, participants underwent a minimum 3-week washout period. After the washout period, each participant proceeded to a high dose of Aralast NP 90 mg/kg by IV infusion for the next 6 weeks, for a total of 12 infusions. | Biological: Aralast NP 45 mg dose<br>* - 45 mg/kg/week<br>* Other names: AAT;Biological: Aralast NP 90 mg dose<br>* - 90 mg/kg/week<br>* Other names: AAT;|
| Experimental: Part 1a (Aralast NP)-Subjects 8-15 Yrs<br>Subjects aged 8-15 years at enrollment with new-onset type 1 diabetes mellitus (T1DM) received Aralast NP 45 mg/kg by IV infusion once a week for 6 weeks. Following the Week 6 infusion, participants underwent a minimum 3-week washout period. After the washout period, each participant proceeded to a high dose of Aralast NP 90 mg/kg by IV infusion for the next 6 weeks, for a total of 12 infusions. | Biological: Aralast NP 45 mg dose<br>* - 45 mg/kg/week<br>* Other names: AAT;Biological: Aralast NP 90 mg dose<br>* - 90 mg/kg/week<br>* Other names: AAT;|
| Experimental: Part 1b (Aralast NP)--Subjects Aged 18-35 Yrs<br>Aralast NP 90 mg/kg/wk by IV infusion once a week for 6 weeks. Following the Week 6 infusion, participants undergo a minimum 3-wk washout period than then, each participant proceeds to high dose Aralast NP 180 mg/kg/wk by IV infusion for the next 6 weeks, for a total of 12 infusions. | Biological: Aralast NP 90 mg dose<br>* - 90 mg/kg/week<br>* Other names: AAT;Biological: Aralast NP 180 mg dose<br>* - 180 mg/kg/week<br>* Other names: AAT;|
| Experimental: Part 1b (Aralast NP)-Subjects 8-17 Yrs<br>Aralast NP 90 mg/kg/wk by IV infusion once a week for 6 weeks. Following the Week 6 infusion, participants undergo a minimum 3-wk washout period than then, each participant proceeds to high dose Aralast NP 180 mg/kg/wk by IV infusion for the next 6 weeks, for a total of 12 infusions. | Biological: Aralast NP 90 mg dose<br>* - 90 mg/kg/week<br>* Other names: AAT;Biological: Aralast NP 180 mg dose<br>* - 180 mg/kg/week<br>* Other names: AAT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| C-peptide 2-hour AUC in Response to a Mixed-meal Tolerance Test at Week 52 | No results for the primary outcome measure are available since the study was terminated prior to reaching the outcome measure time frame of 52 weeks. | Week 52 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes Mellitus, Type 1 (new-onset), Diabetes Mellitus, Insulin-Dependent (new-onset), new-onset T1DM, new-onset T1D, Diabetes Mellitus, Juvenile-Onset, Diabetes, Autoimmune, Aralast NP, Alpha-1 Antitrypsin, AAT