Efficacy and Safety Study of Autologous Hematopoietic Stem Cell Transplantation to Treat New Onset Type 1 Diabetes

Study Overview
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Brief Summary
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Type 1 diabetes is an autoimmune disease and results from T cell autoimmunity mediated destruction of the majority of insulin-producing pancreatic β-cells. Hence,the development of new therapies to control T cell autoimmunity, and to preserve the remaining β-cell function will be of great significance in managing patients with type 1 diabetes Autologous nonmyeloablative hematopoietic stem cell transplantation (AHST) has been tested for the treatment of patients with new onset of type 1 diabetes. This therapeutic strategy can result in exogenous insulin independence by destroying pathogenic memory T cells and preserving the remaining β-cell function. However, little is known about the efficacy of AHST in the dynamics of immunocompetent cell reconstitution and how the reconstituted immune system regulates β-cell specific antibody response. Furthermore, many Chinese patients at diagnosis of type 1 diabetes have progressed to develop diabetic ketoacidosis (DKA). Whether treatment with AHST could still achieve adequate glycemic control and preserve the β-cell function and what the factors are associated with the therapeutic efficacy have not been explored. This is a phase Ⅱ clinical trial in patients who have been diagnosed with type 1 diabetes within the previous 12 months.This study is to determine: The effects of autologous hematopoietic stem cell transplantation on the reconstitution of immune system β-cell preservation following stem cell transplantation The potential factors affecting efficacy of stem cell transplantation Whether this new therapy is safe.

Detailed Description
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Patients diagnosed with type 1 diabetes within the previous 12 months will be recruited into this study.Hematopoietic stem cells were mobilized with cyclophosphamide (CY, 2.0g/m2) and granulocyte colony stimulating factor (10 μg/kg per day) and then collected from peripheral blood by leukapheresis and cryopreserved. The cells were infused after conditioning with CY (200 mg/kg) and rabbit antithymocyte globulin (4.5 mg/kg). All the included patients undergoing AHST complied with blood glucose self-monitoring and scheduled medical appointments.Their blood samples were obtained for measuring the frequency of lymphocytes and the levels of plasma hemoglobin A1c (HbA1c), serum C-peptide, islet antibodies, and cytokines longitudinally. Ages Eligible for Study: no more than 35 years Genders Eligible for Study: both Islet Autoantibodies Eligible for Study: positive for glutamic acid decarboxylase antibody (GADA), protein tyrosine phosphatase antibody (IA-2A), islet cell antibody (ICA) and/or insulin autoantibody (IAAs)

Official Title
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Prospective Study of Autologous Hematopoietic Stem Cell Transplantation to Treat New Onset Type 1 Diabetes

Conditions
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Type 1 Diabetes

Intervention / Treatment
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* Procedure: immunosuppression and stem cell transplantation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diagnosis of diabetes according to the guidelines of the World Health Organization 1999 the duration of diabetes is no more than 12 months positive for for glutamic acid decarboxylase antibody (GADA), protein tyrosine phosphatase antibody (IA-2A), islet cell antibody (ICA) and/or insulin autoantibody (IAAs) Exclusion Criteria: pregnancy mental disorders blood diseases the presence of any other severe diseases that could potentially influence the transplantation outcomes

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: stem cell transplantation<br> | Procedure: immunosuppression and stem cell transplantation<br>* Hematopoietic stem cells were mobilized with cyclophosphamide (CY, 2.0 g/m2) and granulocyte colonystimulating factor (10 μg/kg per day) and then collected from peripheral blood by leukapheresis and cryopreserved. The cells were infused after conditioning with CY (200 mg/kg) and rabbit antithymocyte globulin (4.5 mg/kg).<br>* Other names: nonmyeloablative stem cell transplantation;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in C-peptide levels during standard-meal tolerance test from baseline to different time points after transplantation |  | 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in serum levels of HbA1c from baseline to different time points after transplantation |  | 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years | 
| Temporal changes of exogenous insulin requirement from baseline to different time points after transplantation |  | 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years | 
| Dynamic changes in islet antibody status from baseline to different time points after transplantation |  | 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years | 
| Dynamic changes in lymphocyte immunophenotyping and cytokine profiles from baseline to different time points after transplantation |  | 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years | 
| mortality and dysfunction of other endocrine glands |  | up to 10 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Type 1 diabetes, stem cell, C-peptide, Immune function