PBKR03 is a gene therapy for Krabbe Disease (Globoid cell leukodystrophy) intended to deliver a functional copy of the GALC gene to the brain and peripheral tissues. This study will evaluate the safety, tolerability and efficacy of this treatment by first evaluating two different doses in two different age groups, then confirming the optimal dose to be used for confirmation of safety and efficacy.
PBKR03 is an adeno-associated viral vector serotype Hu68 carrying the gene encoding for human galactosylceramidase, GALC, formulated as a solution for injection into the cisterna magna. This is a global interventional, multicenter, single-arm, dose escalation, study of PBKR03 delivered as a one-time dose administered into the cisterna magna of subjects with early infantile Krabbe Disease. The dose-ranging portion of the study will enroll independent dose escalation cohorts in two age groups of subjects with early infantile Krabbe disease: * Cohort 1: 3 subjects aged ≥4 to \<9 months will receive the low dose (Dose I) * Cohort 2: 3 subjects aged ≥4 to \<9 months will receive the high dose (Dose II) * Cohort 3: 3 subjects aged ≥1 to \<4 months will receive the low dose (Dose I) * Cohort 4: 3 subjects aged ≥1 to \<4 months will receive the high dose (Dose II) Part 1 of the study will enroll a total of four cohorts, enrolled sequentially with separate age-based dose-escalation cohorts. Enrollment will initiate in Cohort 1. Following completion of Cohort 1, simultaneous enrollment in Cohort 2 and Cohort 3 will occur. Cohort 4 will follow completion of cohort 3. The confirmatory cohort, Part 2, will enroll subjects with early infantile Krabbe Disease, aged \>1 to \<9 months. These subjects will receive a dose chosen based on the data obtained in part 1 of the study This will be a 2-year study with a 3-year safety extension.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
24
Single dose of PBKR03, via intra cisterna magna
Ann & Robert Lurie
Chicago, Illinois, United States
New York-Presbyterian
New York, New York, United States
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
University of Utah School of Medicine
Salt Lake City, Utah, United States
Number of participants with treatment-related adverse events (AEs) and serious adverse events (SAEs) at Grade 3 or higher within 24 months of dosing
Assess the number of adverse events and serious adverse events at Grade 3 or higher as assessed by CTCAEv5.0
Time frame: Up to 5 years (multiple visits)
Change from baseline in nerve conduction and velocity in motor nerve conduction studies
NCS will measure velocity and amplitude in distal segments of the median, peroneal and tibial motor nerves to evaluate effects on peripheral nerve integrity.
Time frame: From baseline to 5 years (multiple visits)
Change from baseline in nerve conduction and velocity in sensory nerve conduction studies
NCS will measure velocity and amplitude in distal segments of the sural, radial and median sensory nerves to evaluate effects on peripheral nerve integrity
Time frame: From baseline to 5 years (multiple visits)
Number of Participants with Clinically Significant Laboratory Abnormalities as Measured Using Hematology, Chemistry and Coagulation Tests
Assess the number of participants with clinically significant laboratory changes including hematology, serum chemistry, and coagulation tests
Time frame: Up to 5 years (multiple visits)
Assess Humoral Response Against the Vector and Transgene in Serum
Assess serum antibody titers against AAVhu68 and against GALC following ICM administration of PBKR03
Time frame: Up to 5 years (multiple visits)
Assess Humoral Response Against the Vector and Transgene in CSF
Assess antibody titers in the cerebrospinal fluid against AAVhu68 and against GALC following ICM administration of PBKR03
Time frame: Up to 5 years (multiple visits)
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Hospital De Clinicas De Porto Alegre
Porto Alegre, Brazil
Montreal Children's Hospital
Montreal, Canada
Shaare Zadek Medical Center
Jerusalem, Israel
Amsterdam UMC
Amsterdam, Netherlands
Manchester University
Manchester, United Kingdom
Change from Baseline in Developmental Milestones as Assessed by the Bayley Scale of Infant and Toddler Development, Third Edition
Assess changes in the developmental age and the total number of developmental milestones using the Bayley Scale of Infant and Toddler Development, Third Edition instrument
Time frame: From baseline to 2 years (multiple visits)
Change from Baseline in Developmental Milestones as Assessed by the Vineland Adaptive Behavior Scale-II
Assess changes in the developmental age and the total number of developmental milestones using the Vineland Adaptive Behavior Scale-II instrument
Time frame: From baseline to 2 years (multiple visits)
Change in Biomarkers of GALC Activity in Blood
Assess change in biomarkers of GALC activity in blood when compared with baseline
Time frame: From baseline to 2 years (multiple visits)
Change in Biomarkers of GALC Activity in CSF
Assess change in biomarkers of GALC activity when compared with baseline
Time frame: From baseline to 2 years (multiple visits)
Change in Biomarkers of GALC Substrates in Blood
Assess change in concentration of GALC substrates in blood
Time frame: From baseline to 2 years (multiple visits)
Change in Biomarkers of GALC Substrates in CSF
Assess change in concentration of GALC in CSF when compared with baseline
Time frame: From baseline to 2 years (multiple visits)
Change in Concentration of Biomarker of Disease Progression in Plasma
Assess change in neurofilament light chain (NfL) concentration as a marker for neurodegeneration and disease progression in plasma
Time frame: From baseline to 2 years (multiple visits)
Change in Concentration of Biomarker of Disease Progression in CSF
Assess change in neurofilament light chain concentration (NfL) as a marker for neurodegeneration and disease progression in CSF
Time frame: From baseline to 2 years (multiple visits)
Change in Brain Anatomy as Assessed by MRI
Assess change in disease severity, volumetric MRI measures, brain diffusivity, and white matter lesions by MRI imaging
Time frame: From baseline to 2 years (multiple visits)
Change in Quality of Life Using Pediatric Quality of Life Scale
Assess change in quality of life as measured by Pediatric Quality of Life Scale (Peds QL)
Time frame: From baseline to 2 years (multiple visits)
Change in Quality of Life Using Pediatric Quality of Life Scales
Assess change in quality of life as measured by the Pediatric Quality of Life - Infant Scale (PedsQL-IS)
Time frame: From baseline to 2 years (multiple visits)
Change in Ventilator-Free Survival Compared with Natural History Data
Assess change compared with natural history data in ventilator-free survival and chronic ventilatory support.
Time frame: From baseline to 2 years (multiple visits)
Incidence of Feeding Tube Placement at or Before Month 24
Though speech and swallowing assessment, study participants will be evaluated to determine whether a feeding tube is warranted
Time frame: 24 months