Safety Study of rhASM Enzyme Replacement Therapy in Adults With Acid Sphingomyelinase Deficiency (Niemann-Pick Disease)

Study Overview
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Brief Summary
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The purpose of this study is to determine the safe range of single doses of rhASM administered to adults with ASM deficiency.

Detailed Description
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ASM deficiency (ASMD), also known as Niemann-Pick A and B disease, is a rare genetic disorder in which reduced activity of the lysosomal enzyme, ASM, leads to the accumulation of sphingomyelin primarily in macrophages throughout the body. This deficiency results in characteristic features such as hepatosplenomegaly, thrombocytopenia, interstitial lung disease, growth retardation, coronary artery disease, fatigue, and in severe cases, neurodegeneration with death in early childhood. There is no specific treatment for this disease. This Phase 1 safety study will seek to enroll a minimum of 12 and a maximum of 30 eligible adults patients with ASMD with each patient participating for approximately 7 weeks.

Official Title
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A Phase I, Single-Center, Single Dose, Dose Escalation Study of Recombinant Human Acid Sphingomyelinase (rhASM) in Adults With Acid Sphingomyelinase Deficiency (ASMD)

Conditions
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Acid Sphingomyelinase Deficiency, Niemann-Pick Disease

Intervention / Treatment
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* Drug: rhASM
* Drug: rhASM
* Drug: rhASM
* Drug: rhASM
* Drug: rhASM


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed, informed consent by the patient or legal guardian prior to performing any study-related procedures; Have ≤ 0.2 nmol/hr/mg protein ASM activity in peripheral leukocytes, as measured by the reference laboratory; Have a diffusing capacity (DLco) > 30% of the predicted normal value; Have a spleen volume ≥ 2x normal Female patients of childbearing potential must have a serum pregnancy test negative for β-hCG and agree to use a reliable birth control method for the duration of the study. Exclusion Criteria: Is pregnant or lactating; Has received an investigational drug within 30 days prior to study enrollment; Has a medical condition, including serious intercurrent illness, active hepatitis B or C or human immunodeficiency virus (HIV) infection, cirrhosis, > stage 3 liver fibrosis, INR >1.5, platelet count < 60.0x10^3/µL, significant cardiac disease (e.g. pulmonary artery pressure > 40 mm Hg, moderate or severe valvular dysfunction, or < 40% left ventricular ejection fraction by echocardiography (ECHO)), or any other extenuating circumstances that may significantly interfere with study compliance including all prescribed evaluations and follow-up activities; Has had a major organ transplant (e.g. bone marrow or liver); Has had a total splenectomy; Has an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value >250 IU/L or a total bilirubin >3.6 mg/dL; Is unwilling or unable to avoid the use of alcohol, medications that may decrease rhASM activity, medications or herbal supplements that may cause or prolong bleeding, and the use of medications or herbal supplements with potential hepatoxicity within 14 days prior to and 28 days afte the rhASM infusion.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: 1<br> | Drug: rhASM<br>* Single dose of 0.03mg/kg body weight IV<br>|
| Experimental: 2<br> | Drug: rhASM<br>* Single dose of 0.1mg/kg body weight IV<br>|
| Experimental: 3<br> | Drug: rhASM<br>* Single dose of 0.3mg/kg body weight IV<br>|
| Experimental: 4<br> | Drug: rhASM<br>* Single dose of 0.6mg/kg body weight IV<br>|
| Experimental: 5<br> | Drug: rhASM<br>* Single dose of 1.0mg/kg body weight IV<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety assessments via physical exam,AE reporting,telemetry heartrate monitoring,ECG,ECHO,clinical lab evaluations,liver and adrenal function tests,cytokine testing,adrenal hormone levels,lipid profile,chest Xrays,liver biopsies,MRI of internal |  | Pre-, During-, and Post-infusion (up to 72 hrs); 14 day and 28 day follow-up visit | 
| Immune Response Measure |  | Pre-infusion and final visit (Day 28) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PK measurements |  | Pre- and Post-infusion up to 72 hrs. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acid sphingomyelinase deficiency, Niemann-Pick disease, Lysosomal storage disorder, Enzyme replacement therapy, Treatment