PD - Parkinson's Disease
Conditions
Keywords
Parkinson's Disease, Ataxia, Dopaminergic, Dyskinesia, PD, Neurodegenerative Disease, Brain Disease, CNS, Movement Disorder, Central Nervous System Disease, FDOPA, MRI, Corpus striatum
Brief summary
To evaluate the safety and efficacy of transplantation of human induced pluripotent stem cell-derived dopaminergic progenitors, CT1-DAP001, into the corpus striatum in patients with Parkinson's disease
Detailed description
Single-center, open-label, uncontrolled. The primary objective of this study is to evaluate the safety of CT1-DAP001 in subjects with Parkinson's disease by determining the incidence and severity of adverse events, especially graft expansion, after transplantation into the corpus striatum. Other objectives are to evaluate the efficacy of CT1-DAP001 through the assessment of Parkinson's disease symptoms and clinical severity or progression.
Interventions
COMBINATION_PRODUCTHuman induced pluripotent stem cell-derived dopaminergic progenitors (CT1-DAP001)
Investigational PET agents will be synthesized at UCSD and administered to subjects according to the local institutional guidelines. IND applications for these agents are linked with the IND application for the study product, CT1-DAP001. The IND applications for the PET radiopharmaceuticals contains the manufacturing method, specifications, quality testing, clinical usage, and safety and efficacy information for individual PET agents. Investigational Cell Injector Suniviion needle: The investigational instrument will be used to administer dopaminergic progenitors into the putamen. After aspirating cells, the instrument will be attached to a Leksell stereotactic frame to administer the cells into the brain.
Sponsors
University of California, San Diego
Sumitomo Pharma America, Inc.
Kyoto University
Sumitomo Pharma Co., Ltd.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
This study will be conducted as a single-center, open-label, uncontrolled study to evaluate the safety of transplantation of CT1-DAP001 as the primary objective, and as a secondary objective, to evaluate efficacy. Seven (7) subjects with PD will be followed up for 24 months after transplantation of approximately 4.2-5.4 × 106 dopaminergic progenitors per side into the bilateral putamen.
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. The subject has a diagnosis of PD (clinically established or clinically probable) in accordance with the MDS Clinical Diagnostic Criteria for Parkinson's Disease (2015). 2. The subject has an inadequate response to drug treatments. 3. The subject is ≥ 40 years and ≤ 75 years of age at the time of informed consent. 4. The subject has had PD for at least 5 years. 5. The subject has both ON and OFF (as demonstrated by the MDS-UPDRS Part III and a symptom diary). 6. The subject does not have a debilitating dyskinesia score greater than or equal to 3 on the MDS-UPDRS. 7. The subject is in stage 2 or higher on the Hoehn and Yahr scale at OFF time. 8. The subject is in stage 3 or lower on the Hoehn and Yahr scale at ON time. 9. The subject has an L-dopa response of 30% or more without influence of antiparkinsonian drugs. 10. The subject has the following organ functions as determined by laboratory tests at Screening visit: 1. Neutrophil count ≥ 2,000/μL 2. Platelet count ≥ 5.0 × 104/μL 3. AST, ALT ≤ 3.0 × upper limit of normal 4. Total bilirubin ≤ 1.5 × upper limit of normal 5. eGFR ≥ 60 mL/min/1.73 m2 (As part of Creatinine testing, an estimated glomerular filtration rate (mL/min/1.73 m2)will be calculated based on the CKD-EPI 2021 equation) 11. The subject is willing to avoid pregnancy using abstinence, highly effective means of birth control, surgical sterility, or menopause. 12. The subject is willing to comply with the protocol-required assessments. 13. The subject provides written informed consent to participate in the study. If the subject cannot sign due to physical constraints, verbal consent may be provided with signature of a Legally Authorized Representative.
Exclusion criteria
1. The subject has an abnormal brain MRI suggestive of brain pathology other than Parkinson's disease. 2. Atypical parkinsonism (Parkinsonism-Plus syndrome, secondary parkinsonism, hereditary parkinsonism). 3. The subject has clinical indication or diagnosis of abnormal immune function. 4. The subject has been diagnosed with a major neurocognitive disorder such as dementia, or is high risk for this. 5. The subject has bleeding tendency or abnormal coagulation function as evidenced by platelets \<50 or PT/PTT \> 1.5x normal. 6. The subject is HBs antigen-positive, or HBs antibody- or HBc antibody-positive with evidence of HBV-DNA. 7. The subject is anti-HIV antibody positive. 8. The subject is anti-HTLV-1 antibody-positive. 9. The subject has active infection such as hepatitis C or syphilis (STS/TPHA). 10. The subject has hypersensitivity or contraindication to tacrolimus, concomitant drugs (e.g., levodopa, carbidopa, MRI contrast), and/or their components. 11. Contraindications to general anesthesia as evaluated by subject matter experts. 12. The subject has a serious allergy to a component (e.g., gentamicin, component of bovine origin, or component of porcine origin) used in the preparation of the study product. 13. The subject has any of the following conditions/diseases concurrently: 1. Active malignancy 2. Epilepsy 3. Psychiatric disease (e.g., uncontrolled anxiety or depression, bipolar disorder, schizophrenia) 4. Diabetes mellitus with poorly controlled blood glucose (glycosylated hemoglobin \> 9.0%, or fasting plasma glucose (FPG) ≥ 200 mg/dL (11.1 mmol/L). 5. Other serious concurrent diseases (e.g., cerebrovascular disorder, heart disease, chronic respiratory disease, inadequately controlled hypertension) as determined by the investigator. 14. The subject has a history of any of the following: 1. Prior malignancy \< 5 years prior to Screening. Patients who had prior malignancies within 5 years and in complete remission with expected survival of more than 5 years are not excluded 2. Epilepsy 3. Cerebral hemorrhage or stroke 4. Psychiatric disease (e.g., uncontrolled anxiety or depression, bipolar disorder, schizophrenia) 5. Congenital long QT syndrome 6. Pallidotomy, thalamotomy, or Deep Brain Stimulation 15. The subject is pregnant or lactating or does not agree to avoid pregnancy throughout the study. 16. The subject has undergone transplantation of human iPSC-derived dopaminergic progenitors. 17. The subject, in the opinion of the investigator or sub investigator, is not appropriate to conduct the study safely.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence And Severity Of Adverse Events | 24 months | For adverse events reported, the severity will be assessed, and the incidence in the treatment period will be determined. |
| ACCEPTABILITY | 24 months | Assessed by presence or absence of graft expansion (\> 3 cm3) in the brain at 24 months after transplantation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Improvement or worsening of involuntary movements | 24 months | Assessed by dyskinesia score, measured as the change in dyskinesia score from Baseline to each post-transplantation time point. |
| ACCURACY | 24 months | Assessed by FDOPA (MRI) of tissue expansion The expansion on MRI will be assessed at each time point of measurement * day before transplantation, * immediately after transplantation, * day after transplantation, * 4 weeks, 12 weeks, 6 months, 18 months, (if clinically indicated) * 12 months, 24 months after transplantation |
| MDS-UPDRS Part III totalscore (at OFF time) | 24 months | This endpoint is defined as the change in UPDRS Part III score at OFF time from Baseline to each post-transplantation time point. The efficacy will be assessed based on MDS-UPDRS Part III total score at OFF time at 24 months after cell transplantation. 1. Excellent response defined as a decrease of ≥ 5 2. Good response defined as a decrease of 0 to 4 |
| MDS-UPDRS Part III totalscore (at ON time) | 24 months | This endpoint is defined as the change in UPDRS Part III score at ON time from Baseline to each post-transplantation time point. |
| Average daily ON duration (with or without dyskinesia) and OFF duration | 24 months | This endpoint is defined as the change in daily ON duration (with or without dyskinesia) or OFF duration from Baseline to each post-transplantation time point. |
| L-dopa equivalent dose | 24 months | This endpoint is defined as the change in L-dopa equivalent dose from Baseline to 4 weeks, 12 weeks, 6 months, 12 months, 18 months, or 24 months after transplantation. Formula to convert to the L-dopa dose: L-dopa 100 mg = pramipexole salt 1 mg = ropinirole 5 mg = rotigotine 7.5 mg = bromocriptine 10 mg = pergolide 1 mg = cabergoline 1.5 mg = selegiline 10 mg = amantadine 100 mg = apomorphine 10 mg |
Countries
United States
Contacts
CONTACTAlpha Stem Cell Clinic
PRINCIPAL_INVESTIGATORJoseph Ciacci, MD
University of California, San Diego
Outcome results
None listed