The primary purpose of the Phase I portion of the study is to determine the safety profile and preliminary evidence of efficacy associated with infusion of autologous gene-corrected hematopoietic stem cells.
The study is a pediatric non-randomized open-label Phase I clinical trial. This will include a safety evaluation and preliminary assessment of the efficacy of hematopoietic gene therapy consisting of autologous CD34+ enriched cells transduced with a lentiviral vector carrying the ITGB2 gene in subjects with severe Leukocyte Adhesion Deficiency-I (LAD-I). Subjects will undergo mobilization and collection of peripheral blood hematopoietic stem cells (HSCs) with granulocyte-colony stimulating factor (G-CSF) and plerixafor or bone marrow harvest in select circumstances. HSCs will then be transduced with the therapeutic vector (Chim.hCD18-LV), with the intent of enabling stable integration of the provirus in the genome of stem and progenitor cells. If the number of CD34+ cells that are cryopreserved is at least 4×10E6 total CD34+ cells/kg, subjects will receive myeloablative conditioning with intravenous busulfan. The gene-modified CD34+ cells will be then transplanted back into the subject. Once engrafted, it is anticipated that the gene-modified stem and progenitor cells will enable hematopoiesis, generating blood cells in which the integrated therapeutic gene (ITGB2) will be transcribed and translated to produce the therapeutic CD18 protein with a preferential high expression in mature myeloid cells. Leukocytes expressing a functional CD18 will have the capability to arrest on endothelial surfaces and extravasate to infectious sites, enabling a competent antimicrobial response and reversing the clinical disorder.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
CD34+ enriched hematopoietic stem cells from subjects with severe LAD-I transduced ex vivo with lentiviral vector carrying the ITGB2 gene, Chim-CD18-WPRE.
Hospital Infantil Universitario Niño Jesús (HIUNJ)
Madrid, Spain
Number of participants with treatment-related adverse events as assessed by United States (US) National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v.5.0
Evaluation of safety associated with treatment with RP-L201
Time frame: 2 years
Survival following infusion of RP-L201
Evaluation of survival as determined by the proportion of subjects alive at age 2 (24 months) and at least 1-year post infusion without allogeneic hematopoietic stem cell transplant
Time frame: 2 years
CD18 expression after infusion of RP-L201
Determination of the percentage of subjects in whom infusion of RP-L201 results in a change in the percentage of neutrophils expressing CD18 to at least 10% in 2 years
Time frame: 2 years
Genetic correction after infusion of RP-L201
Determination of whether infusion of RP-L201 results in vector copy number/cell of at least 0.1 in peripheral blood neutrophils carrying the therapeutic Chim.hCD18-LV provirus at 6 months post-infusion
Time frame: 6 months
Incidence of infections after infusion of RP-L201
Determination of the incidence and severity of bacterial or other infections (subsequent to hematopoietic reconstitution)
Time frame: 2 years
Assessment of number of participants with a change in LAD-I-associated neutrophilia after infusion of RP-L201
Evaluation of change to partially normal or to normal levels of LAD-I-associated neutrophilia
Time frame: 2 years
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Assessment of number of participants with a change in skin lesions or periodontal abnormalities after infusion of RP-L201
Evaluation of resolution (partial or complete) of any underlying skin lesions or periodontal abnormalities
Time frame: 2 years
Assessment of overall survival after infusion of RP-L201
Evaluation of overall survival (beyond age 2 years and beyond the initial year subsequent to investigational therapy)
Time frame: 2 years