This is a prospective phase 2, single-arm, mono-center pilot study. It has been designed to investigate whether giving the combination therapy consisting of minimal islet transplantation (1500 EIQ/Kg body weight), Thymoglobulin® (ATG), Rapamune® (rapamycin) and Neulasta® (pegfilgastrim) to patients with Type 1 Diabetes (T1D) at onset is safe and secondarily, if it will preserve insulin production. It will involve 6 patients with new-onset T1D. Each patient will be involved in the study for a screening period and a post-islet transplantation study period of 52±2 weeks, to include 1 treatment cycles of 12 weeks, assessment during treatment and 5 follow-up visits scheduled at weeks 2±1 (14 days), 4±1 (month 1), 12±2 (month 3), 26±2 (month 6) and 52±2 (month 12).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
6
One thousand and five hundred (1,500) equivalent islet for Kg of body weight, isolated from a single brain-dead donor, will be infused into the patient's liver.
ATG will be administered IV (central vein) at a total dose of 6 mg/kg up to day 6 post-transplant
Pegylated G-CSF (6 mg/dose) will be administered SC every 2 weeks for 6 doses (12 weeks) beginning after the last ATG infusion
Rapamycin will be administered orally at a starting dose of 0.2 mg/kg once a day, then targeted to blood trough level of 8-10 ng/mL and suspended one month after transplant.
IRCCS San Raffaele Scientific Institute
Milan, Italy
plasma C-peptide AUC (mixed meal tolerance test [MMTT])
Mean change from baseline of stimulated plasma C-peptide AUC (mixed meal tolerance test \[MMTT\])
Time frame: 52 weeks
Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs)
Time frame: 52 weeks
plasma C-peptide AUC (MMTT)
Mean change from baseline in stimulated plasma C-peptide AUC (MMTT) at week 4, 12, 26 and month 18, 24, 36, 48, 60
Time frame: 4,12, 26 weeks and 18, 24, 36, 48, 60 months
stimulated plasma C-peptide
Maximum stimulated plasma C-peptide (the highest value at any time point during the MMTT after the mixed meal injection) at baseline, week 4, week 12, week 26 and week 52 and month 18, 24, 36, 48, 60
Time frame: 4,12, 26 weeks and 12, 18, 24, 36, 48, 60 months
glucagon AUC (MMTT)
Mean change from baseline in glucagon AUC (MMTT) at week 4, week 12, week 26 and week 52
Time frame: 4,12, 26, 52 weeks
HbA1c
Change from baseline in HbA1c at week 52 and HbA1c over time
Time frame: 4,12, 26 weeks and 12, 18, 24, 36, 48, 60 months
daily insulin dose
Change from baseline in mean daily insulin dose for the 3 days preceding the visit at weeks 4, 12, 26, 52 and month 18, 24, 36, 48, 60. The mean daily insulin dose value will be calculated, in units of U/kg/day, as the mean of the values of amount of insulin used per day on each of the 3 consecutive days.
Time frame: 4,12, 26 weeks and 12, 18, 24, 36, 48, 60 months
hypoglycaemic events
Number of hypoglycaemic events with confirmed self plasma glucose monitoring \<3.1 mmol/L (\<56 mg/dL) and/or requiring 3rd party intervention (i.e., severe, documented symptomatic and asymptomatic hypoglycaemic events) overall and in 3 monthly intervals
Time frame: 4,12, 26 weeks and 12, 18, 24, 36, 48, 60 months
72-hour Continuous Glucose Monitoring
Time spent with a plasma glucose \<3.9 mmol/L, between 3.9 and 10.0 mmol/L, and \>10.0 mmol/L, respectively as performed by 72-hour CGM at baseline, week 26, week 52 and month 24, 36, 48, 60
Time frame: 26 and 52 weeks and 24, 36, 48, 60 months
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