A single cohort, open-label pilot study of the safety and tolerability of a single infusion of autologous CD4+ T-cells genetically modified with an HR2, C34-peptide conjugated to the CXCR4 N-terminus using a lentiviral vector in HIV-infected subjects. This is a first in human study of C34-CXCR4 T cells
There will be a single cohort in this study, which consists of subjects with well-controlled HIV replication on HAART. Within this cohort will be 3 escalating doses of T-cell infusions. A modified 3+3+3 dose-escalation design will be followed, in which the standard dose-escalation algorithm is stopped when a maximum of 9 evaluable subjects or a DLT stopping point has been reached, whichever comes first. At each dose level, three patients are treated. For dose levels 1 and 2, if 0/3 subjects have a dose limiting toxicity (DLT), then the dose is escalated. If 1/3 has a DLT (grade 3 or higher unexpected, related adverse event \[AE\]) at a dose level then 3 additional patients are treated at that dosage before escalating, and if \<2/6 have DLT (i.e. no additional DLT is observed) then the dose is escalated to the next planned dose level and patients treated until a maximum of 9 evaluable subjects has been reached. The study will comprise of 5 steps: Step 1, all participants will undergo leukapheresis to obtain CD4 positive T-cells that will be genetically modified. A second leukapheresis and a rectal biopsy will provide baseline specimens to evaluate the size of the HIV reservoir Step 2, all participants will receive a single infusion of C34-CXCR4-modified CD4+ T-cells at one of 3 dose levels. The first 3 subjects will receive dose level 1 of 0.8-1x109 transduced CD4+T-cells. Provided no dose limiting toxicity (DLT) is seen at the first dose level, the next 3 subjects will receive infusion at the 2nd dose level of 2.4-3x109 transduced CD4+ T-cells. If no DLT occurs at that dose, the final 3 subjects will receive the 3rd dose level of 0.8-1x1010 transduced CD4+ T-cells. In the event of a DLT (grade 3 or higher unexpected, related AE) recruitment will be paused pending DSMB decision. Step 3 all participants will participate in a 16-week analytical treatment interruption beginning 4 weeks after T-cell infusion. At the end of step 3 all participants will undergo mini-leukapheresis and rectal biopsy Step 4 all participants will be advised to resume antiretroviral therapy and will be followed until plasma HIV RNA falls below the limit of detection. In Step 5 all participants will undergo leukapheresis and rectal biopsy at 52 weeks post infusion. At the completion of the study, participants will be asked to participate in a long-term follow-up study as required by regulatory authorities.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
9
all participants will receive a single infusion of C34-CXCR4-modified CD4+ T-cells at one of 3 dose levels. The first 3 subjects will receive dose level 1 of 0.8-1x109 transduced CD4+T-cells. Provided no dose limiting toxicity (DLT) is seen at the first dose level, the next 3 subjects will receive infusion at the 2nd dose level of 2.4-3x109 transduced CD4+ T-cells. If no DLT occurs at that dose, the final 3 subjects will receive the 3rd dose level of 0.8-1x1010 transduced CD4+ T-cells. In the event of a DLT (grade 3 or higher unexpected, related AE) recruitment will be paused pending DSMB decision
University of Pennsylvania
Philadelphia, Pennsylvania, United States
The Number of Subjects With Treatment Related Adverse Events
assessed by DAIDS AE grading table v2.0 November 2014
Time frame: one year
Compare the Percentage of Enriched Modified Cells C34-CXCR4 Modifiec T- Cells
Time frame: 2 weeks post infusion, prior to ARV reinitiation, weeks 12, 16 and 20
Compare the Change Between CD4 Count
Time frame: Baseline, week 2 post infusion, prior to ARV initiation, weeks 12, 16 20
Compare Viral Set Point Log 10 HIV RNA Level
Time frame: week 2 post infusion, prior to ARV initiation, week 12, 16, 20
Evaluate Cell Mediated Response (Immunogenicity) Using Flow Cytometry
Time frame: baseline through 1 year
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