This study primarily involves the use of BCT301, an anti-CD19 Chemically induced pluripotent stem cell (CiPSC)-derived CAR-iT cells, for the treatment of patients with refractory autoimmune diseases, aiming to evaluate its safety, tolerability, and dose-limiting toxicities(DLT), and to determine the recommended therapeutic dose for further investigation. Additionally, the study assesses the efficacy of BCT301 cell injection in refractory autoimmune diseases, as well as the pharmacokinetic (PK) and pharmacodynamic (PD) characteristics in study participants.
Autoimmune diseases are a class of disorders caused by abnormal immune responses against the body's own tissues or organs. Although significant therapeutic advances have been made, such as the use of biologics (e.g., rituximab), most available drugs can only alleviate symptoms or slow disease progression, rather than achieve a complete cure.BCT301 cell injection is a CD19-targeted CAR-iT (chemically induced T-cell) therapy derived from human chemically induced pluripotent stem cells (CiPSCs) through chemical reprogramming technology. Starting from healthy donor cells, human CiPSCs are generated via small molecule-based reprogramming, followed by induced hematopoietic differentiation, iT-cell differentiation and expansion, and finally CAR lentiviral transduction to produce the off-the-shelf, CD19-targeted CAR-iT cell product (BCT301 cell injection). This approach holds promise as a potentially effective treatment strategy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
BCT301, an anti-CD19 Chemically induced pluripotent stem cell (CiPSC)-derived CAR-iT cells.Participants will receive a single infusion of BCT301 cell injection at escalating dose levels.Prior to infusion, patients undergo a lymphodepleting conditioning regimen with fludarabine and cyclophosphamide given intravenously for three consecutive days.
Dose-limiting toxicities of BCT301
Adverse events occurring within 28 days post-infusion that were possibly, probably, or definitely related to BCT301 cell injection (per NCI-CTCAE v5.0).
Time frame: 28 days
Efficacy of refractory systemic lupus erythematosus(SLE)- The change of SLEDAI-2K
The primary efficacy endpoint will be the change from baseline in the SLEDAI-2K score. The SLEDAI-2K is a validated index for assessing SLE disease activity, with scores ranging from 0 to 105. A higher score indicates worse disease activity.
Time frame: 90, 180, 360 days
Efficacy of refractory SLE-The change of PGA
The Physician Global Assessment (PGA) will be used to evaluate overall SLE disease activity. The PGA is a clinician's determination of disease activity based on history and physical exam, independent of laboratory results. It is scored on a scale from 0 to 3, where a higher score indicates worse disease activity.
Time frame: 90, 180, 360 days
Efficacy of refractory SLE-The change of SF36
The SF-36 health survey will be employed as a patient-reported outcome to assess health-related quality of life. This 36-item questionnaire generates scores from 0 to 100 across eight health domains and two summary components (Physical and Mental). A lower score indicates a worse health state
Time frame: 90, 180, 360 days
Efficacy of refractory SLE-The change of antibodies
Changes in autoantibody titers (e.g., anti-dsDNA) will be assessed as a serological outcome. A higher autoantibody titer reflects more severe underlying immunologic activity
Time frame: 90, 180, 360 days
Efficacy of refractory systemic sclerosis (SSc)-The change of mRSS
The modified Rodnan Skin Score (mRSS) will be the primary endpoint to assess skin disease activity. The mRSS evaluates skin thickness in 17 body areas, with each scored from 0 (normal) to 3 (severe thickening). The total score ranges from 0 to 51, where a higher score indicates worse skin involvement and a poorer prognosis.
Time frame: 90, 180, 360 days
Efficacy of refractory SSc-The change of CRISS
The Combined Response Index for Systemic Sclerosis (CRISS) will be used as the primary composite endpoint. This index calculates a probability of improvement (score from 0.0 to 1.0) by integrating changes in skin thickness (mRSS), physician and patient global assessments, functional ability (HAQ-DI), and the absence of new organ damage. A higher score indicates a better treatment response, while a score of 0 indicates treatment failure.
Time frame: 90, 180, 360 days
Efficacy of refractory SSc-The change of antibodies
Changes in autoantibody titers (e.g., anti-SCL70) will be assessed as a serological outcome. A higher autoantibody titer reflects more severe underlying immunologic activity.
Time frame: 90, 180, 360 days
Efficacy of refractory Antiphospholipid Syndrome (APS)-new onset thrombotic event
The primary efficacy endpoint is the time to first new objectively confirmed arterial or venous thrombotic event. The occurrence of a new thrombotic event is considered a treatment failure, as it directly demonstrates the failure of the therapy.
Time frame: 90, 180, 360 days
Efficacy of refractory APS-The change of antibodies
Reduction in titers of antiphospholipid antibodies (aCL, anti-β2GPI, and LA) will be assessed as a key biomarker of response. A decrease in these antibody levels is interpreted as evidence of a positive immunologic treatment effect.
Time frame: 90, 180, 360 days
Efficacy of refractory APS-The change of platelet
In patients with baseline thrombocytopenia, an increase in platelet count is considered a positive indicator of treatment efficacy, signifying control of the underlying autoimmune and consumptive processes in APS.
Time frame: 90, 180, 360 days
Efficacy of refractory APS- The change of fibrinogen
In patients with baseline hypofibrinogenemia, an increase in fibrinogen level is considered a positive indicator of treatment efficacy
Time frame: 90、180、360 days
Efficacy of refractory inflammatory myositis (IM)-The change of TIS
Total Improvement ScoreThe Total Improvement Score (TIS) will be the primary endpoint to define treatment response. The TIS is a composite score (range 0-15) quantifying improvement from baseline across six core domains: muscle strength, physical function, physician and patient global assessments, muscle enzymes, and extramuscular activity. A TIS of ≥ 20 is defined as a clinically meaningful treatment response, with a higher score indicating a greater magnitude of improvement.
Time frame: 90, 180, 360 days
Efficacy of refractory IM-The change of CK
Serum Creatine Kinase (CK) level will be assessed as a key biomarker of muscle inflammation. A reduction in CK from baseline, is a defined indicator of positive biochemical treatment response.
Time frame: 90, 180, 360 days
Efficacy of refractory IM-The change of antibodies
Reduction in titers of antibodies (e.g. anti-MDA5) will be assessed as a key biomarker of response. A decrease in these antibody levels is interpreted as evidence of a positive immunologic treatment effect.
Time frame: 90, 180, 360 days
Efficacy of refractory Sjögren's Disease(SjD)-The change of ESSDAI
The EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) will be the primary endpoint to assess systemic disease activity. The ESSDAI scores 12 organ domains, with a total range from 0 (no activity) to 123 (maximal activity). A reduction in the ESSDAI score of ≥3 points from baseline defines a clinically meaningful treatment response, indicating effective suppression of systemic disease.
Time frame: 90, 180, 360 days
Efficacy of refractory SjD- Achieving STAR response or not
The Sjögren's Tool for Assessing Response (STAR) will be used as a key patient-reported outcome. The STAR quantifies symptom burden on a scale from 0 (none) to 10 (worst imaginable). A decrease from baseline of ≥1 point in the STAR score defines a clinically meaningful treatment response, indicating a significant reduction in the patient's experience of core symptoms like dryness, fatigue, and pain.
Time frame: 90, 180, 360 days
Efficacy of refractory SjD-The change of antibodies
Changes in autoantibody titers (e.g., anti-SSA) will be assessed as a serological outcome. A reduction in titer is considered a favorable immunologic response to therapy.
Time frame: 90, 180, 360 days
Efficacy of refractory SjD-The change of immune globulin
Changes in immune globulin will be assessed as a serological outcome. A reduction in titer is considered a favorable immunologic response to therapy.
Time frame: 90, 180, 360 days
Efficacy of refractory ANCA associated vasculitis (AAV)-The change of BVAS
The Birmingham Vasculitis Activity Score (BVAS) will be the primary endpoint to assess disease activity. The BVAS quantifies new or worsening vasculitis symptoms across nine organ systems. The total score ranges from 0 (no activity) to over 50, where a higher score indicates worse disease. A reduction in BVAS, particularly to 0, defines treatment response.
Time frame: 90, 180, 360 days
Efficacy of refractory AAV-The change of antibody
Serial quantitative ANCA titers (anti-PR3 and anti-MPO) will be assessed as a serological biomarker of response. A significant decrease in ANCA titer is considered a favorable indicator of treatment efficacy.
Time frame: 90, 180, 360 days
pharmacokinetic (PK)
time to peak (Tmax)
Time frame: 0-28 days
pharmacokinetic (PK)
peak concentration (Cmax)
Time frame: 0-28 days
pharmacokinetic (PK)
area under the concentration-time curve
Time frame: 0-28 days
pharmacokinetic (PK)
area under the concentration-time curve
Time frame: 0-90 days
pharmacodynamic (PD)
The count of B cells in peripheral blood post-infusion.
Time frame: 0-28 days
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