Patients with MPS IIIA have a clinical disorder marked by severe and progressive brain disease and neurological symptoms due to the accumulation of undigested glycosaminoglycans in all cells of the body. This study will be the first in human clinical trial to explore the safety, tolerability and clinical efficacy of ex vivo gene therapy (autologous CD34+ cells transduced with a lentiviral vector containing the human SGSH gene) in MPSIIIA patients. Following treatment with the gene therapy patients will be followed up for a minimum of 3 years.
MPS IIIA is caused by a deficiency of the heparan-N-sulfatase (SGSH) enzyme, leading to the accumulation of the glycosaminoglycan heparan sulphate in the lysosomes. Untreated patients of MPS IIIA experience rapid and progressive neurologic deterioration. To date, there is no effective disease-modifying treatment for patients suffering from MPS IIIA. This study aims to recruit 3 to 5 patients with MPS IIIA who satisfy the inclusion and exclusion criteria and provide full consent, between 3 months and 24 months of age. The investigational medicinal product (IMP) will be a cell-based gene therapy that uses genetically modified autologous CD34+ haematopoietic stem cells transduced with a lentiviral vector containing the human SGSH gene. Patients will be followed up for a minimum of 3 years after gene therapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
5
Autologous CD34+ haematopoietic stem cells from MPS IIIA patients will be genetically modified ex vivo using CD11b.SGSH Lentiviral vector (LV), a self-inactivating LV expressing the SGSH gene codon optimized for human use and regulated by a human CD11b myeloid-specific promoter. Cells will be cryopreserved prior to patient administration.
Manchester University NHS Foundation Trust
Manchester, United Kingdom
To evaluate the tolerability of the IMP in MPS IIIA patients: scale
Adverse events will be recorded and graded according to an adapted Pediatric Clinical Toxicity Scale from the National Institute Allergy and Infectious Diseases (NIAID), Autoimmuno-deficiency Syndrome (AIDS) Division
Time frame: up to 3 years
To evaluate the biological efficacy of IMP post-treatment: expression of SGSH in total leukocytes
Measured by the expression of SGSH in total leukocytes within or above normal range at 12 months post-IMP treatment
Time frame: 12 months post gene therapy
To assess the safety of the IMP in MPS IIIA patients
Presence of replication competent virus and integration events in the leukocytes
Time frame: up to 3 years
To evaluate overall survival
Overall survival at 36 months post IMP administration compared to natural history data
Time frame: up to 3 years
To evaluate peripheral engraftment of the IMP
Measured as absence of engraftment failure or delayed hematological reconstitution within the first 6 weeks of IMP delivery. Defined as three independent and consecutive days with absolute Neutrophil Count (ANC) \>500/mm3 and/or Platelets \>20,000/mm3 without transfusions, and/or Hb \>8.0 g/dL without transfusions.
Time frame: within 42 days of treatments
Change in adaptive behaviour
Measured using the Vineland Adaptive Behaviour scales against natural history of MPSIIIA
Time frame: up to 3 years (multiple visits)
Change in cognitive function
Measurement of cognitive score (standard scores, age equivalent scores and development quotient) using the Bayley Scales of Infant Development, 3rd Edition \[BSID-III\] or Kaufman Assessment Battery for Children, 2nd Edition \[KABC-II\] against natural history of MPSIIIA
Time frame: up to 3 years (multiple visits)
Change in patient behaviour
Measured using the Sanfilippo Behaviour Rating Scale against natural history of MPSIIIA
Time frame: up to 3 years
Change in patient quality of life
Measured using the Infant Toddler Quality of Life questionnaire against natural history of MPSIIIA
Time frame: Up to 3 years
Change in patient's daily living
Measured using the Children sleep Questionnaire against natural history data
Time frame: Up to 3 years
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