The primary objective of this study is to evaluate the safety and tolerability of SPOT-03 administered by intravenous (IV) infusion to DMD patients. In addition, this study will preliminarily investigate the changes in dystrophin nucleic acid concentration, dystrophin protein expression and engraftment, anti-dystrophin antibodies and cytokine profiles, as well as fat tissue mas and lean tissue mass following SPOT-03 administrations.
This is a FIH, open-label, single-arm, and single-center exploratory clinical study of SPOT-03 administered via IV infusion for DMD patients. SPOT-03 is a muscle-targeted extracellular vesicles (EVs) loaded with full-length dystrophin nucleic acid. The targeting ability of SPOT-03 is conferred by molecular targeting peptides on the EVs membrane, enabling the delivery of dystrophin nucleic acid as a gene therapy product for DMD. The study has two dose groups: Group I: 4.0E+11 dystrophin nucleic acid copies/kg, administered 8 times Group II: 4.0E+11 dystrophin nucleic acid copies/kg, administered 32 times The study will have a Screening Period of 30 days, during which patients or their legal guardian written informed consent will be obtained before Screening assessments and eligibility will be determined. A total of 6 to 9 DMD patients aged 2 to less than 8 years will be enrolled in this study according to the inclusion criteria. Complete data from at least 3 subjects will be obtained for Group II. All subjects will begin oral tacrolimus (0.05-0.2 mg/kg/d, adjustable according to actual clinical conditions) 3 days before the initial administration of SPOT-03 (D-3) and, with the duration aligned to the treatment schedule: 4 weeks for Group I and 16 weeks for Group II. In group I, the first dose of SPOT-03 will be administered by intravenous infusion on D1, followed by twice a week administration (once every 4 days) for a total of 8 doses. In group II, the first dose of SPOT-03 will be administered by intravenous infusion on D1, followed by twice a week administration (once every 4 days) for a total of 32 doses. After all subjects in the previous dose group have completed SPOT-03 administrations, the next dose group may proceed after the investigators and sponsors have discussed and determined that there are no serious adverse reactions related to the drug. Safety tests and evaluations will be conducted for the patients during each administration and follow-up.
Study Type
INTERVENTIONAL
Allocation
NA
SPOT-03 injection administered via IV infusion
Shanghai Children's Medical Center
Shanghai, Shanghai Municipality, China
RECRUITINGNumber of Participants with Treatment-Related Adverse Events Following Intravenous (IV) Infusion of SPOT-03 in DMD patients
Safety and tolerability of SPOT-03 will be assessed by collection and quantification of all adverse events, graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
Time frame: From enrollment through 1-year post-treatment
Concentration of Dystrophin Nucleic Acid in Blood
Dystrophin nucleic acid concentration measured in blood of DMD patients before and after IV infusion of SPOT-03. Quantification is performed by qPCR.
Time frame: 70 weeks
Concentration of Dystrophin Nucleic Acid in Muscles
Dystrophin nucleic acid concentration measured in muscles of DMD patients at baseline, during the treatment (only Group II) and after the last IV infusion (dose 8 for Group I and dose 32 for Group II) of SPOT-03. Quantification is performed by qPCR.
Time frame: 16 weeks
Percent of Normal Dystrophin Protein Expression in Muscles
Dystrophin protein measured in muscles of DMD patients at baseline, during the treatment (only Group II) and after the last IV infusion (dose 8 for Group I and dose 32 for Group II) of SPOT-03, expressed as percent of the mean wild-type level in healthy individuals without DMD or Becker muscular dystrophy. Quantification is performed by Western Blot.
Time frame: 16 weeks
Percentage of Dystrophin-Positive Fibers in Muscles
Fiber intensity and dystrophin-positive fibers measured in muscles of DMD patients at baseline and after the last IV infusion (dose 8 for Group I and dose 32 for Group II) of SPOT-03. Quantification is performed by Immunofluorescence (IF) / Immunohistochemistry (IHC).
Time frame: 16 weeks
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Purpose
TREATMENT
Masking
NONE
Enrollment
9
Concentration of Cytokines in Serum
Immunogenicity assessment will be measured by evaluating the changes of cytokines levels (TNF-α, INF-γ, IL-2, IL-6, and IL-10) in the serum of DMD patients before and after IV infusion of SPOT-03.
Time frame: 70 weeks
Concentration of Anti-Dystrophin Antibody in Serum
Anti-dystrophin antibody concentration measured in the serum of DMD patients before and after IV infusion of SPOT-03. Quantification is performed by enzyme-linked immunosorbent assay (ELISA).
Time frame: 70 weeks
Adipose Tissue and Lean Tissue Mass (only Group II)
Adipose tissue and lean tissue mass of DMD patients measured at baseline, after IV infusion of SPOT-03, and during follow-up period. Quantification is performed by Dual-Energy X-ray Absorptiometry (DEXA).
Time frame: 70 weeks