Clinical trial NCT06528080: Clinical Study of LY-M001 Injection in the Treatment of Adolescents With Type I Gaucher Disease
Official title: A Prospective, Single-center, Open-arm, Single-arm Clinical Study to Evaluate the Safety and Efficacy of a Single Intravenous Infusion of LY-M001 Injection in Adolescents With Type I Gaucher Disease
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: EARLY_PHASE1
Conditions: Gaucher Disease
Lead sponsor: Shanghai Jiao Tong University School of Medicine
Sponsor class: OTHER
First posted: 2024-07-30
Enrollment: 9
Sex: ALL
Minimum age (years): 12
Maximum age (years): 18
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study was to evaluate the safety, tolerability, efficacy, immunogenicity, PD and PK characteristics of LY-M001 injection in children with GD1 aged 12 years ≤ age \< 18 years. This study mainly includes the main study stage and the long-term follow-up study stage.

Detailed description: The study planned to enroll 6-9 patients with GD1 for 5 years, with a total of 34 follow-up visits. The main study period was 52 weeks, and the long-term follow-up period was 53 weeks to 5 years after administration.

In this study, three dose groups were preset, and the first subject was enrolled with 1.0× 1013 vg/kg as the initial dose (the first dose group). After the safety was determined by DLT observation, subsequent subjects were enrolled. The first dose group is scheduled to complete 3 patients with Gaucher disease type I, and these 3 subjects will complete safety evaluation for at least 28 days after administration. Based on safety and efficacy data, it will be decided by SRC discussion to increase to the next dose group, and 3 patients with Gaucher disease type I will be reenrolled in the next dose group. In addition, according to the safety data and effectiveness data of the first subject within 28 days, the SRC comprehensively determines whether the DLT observation period needs to be extended.

This is an open clinical study without blindness.

Eligibility criteria: Inclusion Criteria:

1. The subject and/or parent, caregiver, or legal representative must be willing and able to provide written informed consent/consent for the study in accordance with applicable regulations and guidelines and comply with all study access and procedures, including the use of any data collection devices that can be used to directly record participant data;
2. Gender is not limited, 12 years old ≤ 18 years old;
3. Patients with double allele mutation of glucocerebrosidase gene (GBA1) and decreased glucocerebrosidase activity were confirmed by laboratory tests and met the clinical manifestations of type I Gaucher disease;
4. Subjects were newly treated or treated patients with type I Gaucher disease; For patients treated with enzyme replacement therapy (ERT) or substrate clearance therapy (SRT) before screening, 5 drug half-lives are required before administration;
5. The subject is willing to participate in all study follow-up and comply with all study procedures and evaluations;
6. The subject must be willing to refrain from donating blood, organs, tissues, or cells at any time after receiving treatment;
7. Pregnant Women (WOCBP) subjects tested negative for pregnancy. Note: WOCBP is defined as a female subject who has not achieved postmenopausal status (continuous amenorrhea for at least 12 months with no clear cause other than menopause) after menstruating, and who has no surgical (i.e., bilateral ovariectomy, fallopian tube removal, and/or hysterectomy) or other investigator identified cause of permanent infertility (e.g., mallear tube agenesis).

Exclusion Criteria:

1. Positive AAV8 neutralizing antibody (antibody titer \> 1:10).
2. Patients with type II or III Gaucher disease (GD2 or GD3), or with suspected Gaucher disease as assessed by the investigator (e.g., subjects with Gaucher disease-related central nervous system manifestations or abnormal electroencephalogram \[EEG\] examination).
3. Active and progressive bone diseases that are expected to require surgical treatment within the next 6 months.
4. The subjects were judged by the investigator to have idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), thrombocytopenia, anemia, hepatomeglia, splenomeglia, and/or osteoporosis unrelated to GD (bone mineral density z-score ±2).
5. Treatment with an investigational drug in another clinical study within 28 days prior to screening or 5 half-lives, whichever is older.
6. Evidence of a history of clinically significant liver disease or hepatotoxin exposure that meets, but is not limited to, any of the following at the time of screening:

   ① Progressive hepatomegaly larger than 3 times the normal volume

   ② History of stage 2 or above hepatic fibrosis

   ③AST, ALT, or TBIL were 1.5 times higher than the upper limit of normal (ULN)

   ④ Immune hepatitis Hepatitis B surface antigen (HBsAg) positive, and hepatitis B virus deoxyribonucleic acid (HBV-DNA) positive (HBV-DNA\>103 copy number /mL); Or take hepatitis B drugs (such as interferon, lamivudine, adefovir and entecavir); Or hepatitis C virus (HCV) antibody positive.
7. The subject's blood indicators have any of the following:

   ① The hemoglobin value was \<8.0 g/dL

   ② Platelet count \<40 × 109/L
8. Refractory epilepsy.
9. Human immunodeficiency virus (HIV) antibody positive or treponema syphilis antibody positive.
10. Subjects had significant clinical comorbidities (such as malignant tumors, primary biliary cirrhosis, or autoimmune liver disease) that the investigators believed might affect the study data or confounding the findings.
11. Subjects have received or plan to receive bone marrow transplantation, hematopoietic stem cell transplantation, and/or major organ transplantation, including but not limited to liver transplantation, kidney transplantation, etc.
12. 3 months before screening, subjects received treatment with erythropoietin, whole blood transfusion, or red blood cell transfusion; Or received platelet transfusion 1 month before screening.
13. Allergic to any component of LY-M001 injection.
14. Previous treatment with any type of gene therapy or cell therapy.
15. Use of systemic immunosuppressant or steroid therapy within 3 months prior to administration (other than immunosuppressive therapy prescribed for prophylactic administration).
16. Any condition in which the subject is unable to undergo magnetic resonance imaging (MRI) studies (including hypersensitivity to anesthetics or contrast agents).
17. Have received live attenuated vaccine within 4 months prior to screening or plan to receive live attenuated vaccine during clinical trials.
18. Other situations in which the investigator considers the subject inappropriate for study participation.

Primary outcomes:
measure: Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability]
timeFrame: Within 52 weeks of infusion
Secondary outcomes:
measure: pharmacodynamics on blood glucocerebrosidase
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: pharmacodynamics on Blood glucose sphingosine
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on Liver volume
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on spleen volume
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on Hemoglobin levels
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on platelet counts
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on Bone mineral density (BMD)
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on bone marrow load (BMB) after administration
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on GD patient Quality of Life scale score
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Effectiveness of symptom improvement on GD Fatigue Scale-14 score
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: Immunogenicity of production of AAV8 anti-drug antibodies (ADA) in the blood
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: immunogenicity of production of AAV8 neutralizing antibody (NAb) in the blood
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: immunogenicity of production of anti-drug antibody (ADA) in the blood
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
measure: immunogenicity in the cells
timeFrame: at 52 weeks after infusion and Week 53 to 5 years after infusion of LY-M001
Other outcomes:
Locations:
city: Shanghai
country: China
facility: Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University
state: Shanghai
Study officials:
affiliation: Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University
name: xiumin wang, PhD
role: STUDY_DIRECTOR
References: