Summary

for people ages 18-70 (full criteria)
at San Francisco, California
study started
estimated completion:
Sandy Feng

Description

Summary

This is a single-center, prospective, open-label, non-randomized clinical trial exploring cellular therapy to facilitate immunosuppression withdrawal in liver transplant recipients.

Official Title

A Phase I/II Drug Withdrawal Study of Alloantigen-Specific Tregs in Liver Transplantation

Details

The researchers in this study plan to enroll 9 participants. Eligible participants will receive a single dose of Treg product (arTreg). The target dose is 100 to 500 x 106 total cells. However, if a minimum arTreg dose of 30 to < 100 x 106 cells is manufactured, the product will be infused. Participants who receive at least the minimum arTreg dose referenced, as a result of low cell yield, will be included in intent-to-treat (ITT) analysis.

Participants who successfully withdraw from all immunosuppression will undergo a research biopsy at 52 weeks following drug discontinuation to determine whether they meet the primary efficacy outcome of operational tolerance. Participants determined to be operationally tolerant will be followed until 104 weeks following drug discontinuation and have a research biopsy at that time to confirm that they remain operationally tolerant. Participants who fail drug withdrawal after 52 weeks but before 104 weeks will be followed until week 104 or 12 weeks after resuming immunosuppression, whichever is longer. The research biopsy at week 104 will be optional for these participants.

Participants who do not successfully withdraw from all immunosuppression will complete 104 weeks of High Intensity Safety Follow-up after failing immunosuppression withdrawal.

IMPORTANT NOTICE: The National Institute of Allergy and Infectious Diseases and the Immune Tolerance Network do not recommend the discontinuation of immunosuppressive therapy for recipients of cell, organ, or tissue transplants outside of physician-directed, controlled clinical studies. Discontinuation of prescribed immunosuppressive therapy can result in serious health consequences and should only be performed in certain rare circumstances, upon the recommendation and with the guidance of your health care provider.

Keywords

Liver Transplant alloantigen-reactive Tregs ( arTreg) immunosuppression operational tolerance Cyclophosphamide Everolimus Sirolimus Mesna arTreg leukapheresis

Eligibility

You can join if…

Open to people ages 18-70

Eligibility:

Recipient:

  • Individuals must meet all of the following criteria to be eligible for this study:
  • Able to understand and provide informed consent
  • End-stage liver disease and listed for a living or deceased-donor primary solitary liver transplant
  • Agreement to use contraception
  • Negative test for hepatitis C infection by hepatitis C virus (HCV) PCR RNA
  • For candidates with a history of HCV, completed treatment for HCV
  • Positive Epstein-Barr virus (EBV) antibody test and
  • Immunizations are up-to-date based on the Advisory Committee on Immunization Practices (ACIP) recommendations, unless the investigator determines that administering a recommended immunization is not in the participant's best interest.

Living Donor:

  • Living donors must meet all of the following criteria to be eligible for this study:
  • Able to understand and provide informed consent
  • Meets site-specific clinical donor eligibility requirements
  • Meets donor eligibility manufacturing requirements within 7 days prior to blood collection for manufacturing and
  • Willingness to donate appropriate biologic samples.

Deceased Donor:

Deceased donors must meet the following criteria for their recipients to be eligible for this study:

  1. Meets site-specific clinical donor eligibility requirements and
  2. Meets donor eligibility manufacturing requirements.

Note:

  • There are several stages to this study.
  • Eligibility is evaluated at many time points during the study to assess whether a participant is safe to proceed to the next study stage.

You CAN'T join if...

Recipient:

-Individuals who meet any of the following criteria will not be eligible for this study:

  1. History of previous organ, tissue or cell transplant requiring or potentially requiring immunosuppression
  2. For cytomegalovirus (CMV) antibody negative recipients, a (CMV) antibody positive donor
  3. Known contraindication to cyclophosphamide or Mesna administration
  4. Serologic evidence of human immunodeficiency virus (HIV)-1/2 infection
  5. The need for chronic anti-coagulation that cannot be safely discontinued for a minimum of 1 week to safely perform a liver biopsy
  6. End stage liver disease secondary to autoimmune etiology (autoimmune hepatitis,primary biliary cirrhosis, or primary sclerosing cholangitis) or other contraindications to drug withdrawal
  7. Psychological, familial, sociological or geographical factors potentially hampering compliance with the study protocol and follow-up visit schedule
  8. Any form of substance abuse, psychiatric disorder, or other condition that, in the opinion of the investigator, may interfere with study compliance
  9. Use of investigational drugs within 8 weeks of study enrollment

--Note: Participation in a concurrent ex vivo liver perfusion study is not exclusionary

  1. . History of ischemic heart disease requiring revascularization, history of or current treatment for dysrhythmia, or evidence of congestive heart failure, unless cleared by a cardiologist
  2. . Past or current medical problems, treatments or findings that are not listed above,which, in the opinion of the investigator, may:

-- pose additional risks from participation in the study,

-- interfere with the candidate's ability to comply with study requirements, or

  • impact the quality or interpretation of the data obtained from the study.
  • . History of malignancy with a risk of recurrence judged by the investigator to be >1%,except for:

-- hepatocellular carcinoma,

  • adequately treated in-situ cervical carcinoma, or
  • adequately treated basal or squamous cell carcinoma of the skin.
  • . Chronic use of systemic glucocorticoids or other immunosuppressives, or biologic immunomodulators.

Living Donor:

Living donors who meet the following criteria will not be eligible for this study:

  1. Any condition that, in the opinion of the investigator, may pose additional risks from participation in the study, may:
  2. interfere with the participant's ability to comply with study requirements or
  3. impact the quality or interpretation of the data obtained from the study.

Deceased Donor:

Recipients of livers from deceased donors who meet the following criteria are ineligible for this study:

  1. Any condition that, in the opinion of the investigator, may pose additional risks or may impact the quality or interpretation of the data obtained from the study.

Location

  • University of California, San Francisco not yet accepting patients
    San Francisco California 94143 United States

Details

Status
not yet accepting patients
Start Date
Completion Date
(estimated)
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Links
National Institute of Allergy and Infectious Diseases (NIAID)
Division of Allergy, Immunology, and Transplantation (DAIT)
Immune Tolerance Network web site
ID
NCT03654040
Phase
Phase 1/2
Lead Scientist
Sandy Feng
Study Type
Interventional
Last Updated
August 28, 2018