This study is a single-center, open-label, single-arm, non-randomized, single-dose, dose-escalation investigator-initiated trial (IIT) designed to evaluate the safety, tolerability, and preliminary efficacy of NKG001 Injection administered via different dosing regimens (intravenous \[IV\] alone or intravenous combined with intrathecal \[IV+IT\]) in subjects with Type 1 or Type 2 spinal muscular atrophy (SMA). A total of 13-21 SMA subjects aged ≤60 months are planned to be enrolled. Based on age at enrollment, subjects will be stratified into two age cohorts for independent evaluation: Age Cohort 1: subjects aged \<24 months at dosing; Age Cohort 2: subjects aged ≥24 months and ≤60 months at dosing. Eligible subjects must carry 2 or 3 copies of the SMN2 gene. Note: Subjects with 3 SMN2 copies must be able to sit independently but unable to walk independently. Four dose cohorts are planned as follows: S1: 6.0 × 10\^13 vg/kg, IV S2: 1.2 × 10\^14 vg/kg, IV S3: 6.0 × 10\^13 vg/kg, IV + 6 × 10\^13 vg/person, IT S4: 6.0 × 10\^13 vg/kg, IV + 1.2 × 10\^14 vg/person, IT Subjects in the S1 cohort (2 SMN2 copies and aged \<24 months at dosing) and the S2 cohort (2 or 3 SMN2 copies and aged ≤60 months at dosing) will receive a single intravenous administration of NKG001 Injection. Subjects in the S3 and S4 cohorts will receive a single administration of NKG001 Injection via combined intravenous and intrathecal routes. In each of these two cohorts, the first enrolled subject must have 2 SMN2 copies and be aged \<24 months at dosing, while the remaining subjects may have either 2 or 3 SMN2 copies and be aged ≤60 months at dosing.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
21
NKG001 Injection
Xiangya Hospital of Central South University
Changsha, Hunan, China
Number of Participants Who Experienced Adverse Events (AEs) and Serious Adverse Events (SAEs) During the Study.
Assess the number of AEs and SAEs as characterized by Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
Time frame: Up to 24 months
Incidence of Dose-Limiting Toxicities (DLTs) Within 30 Days After Administration.
DLTs are defined according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
Time frame: Up to 30 days
Change From Baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) Score (Participants aged <24 months at dosing)
Assess 16 types of muscle movements, each given a score from zero (the person can't complete the movement) to 4 (the person can complete the movement on their own, without assistance) to produce a score of 0 to 64.
Time frame: UP to 24 months
Change From Baseline in Hammersmith Infant Neurological Examination (HINE) Section 2 (Participants aged <24 months at dosing)
HINE Section 2, the motor milestones portion of the HINE, includes 8 items. Total HINE score is the sum of points from each item and can range from 0 to 26. A positive change from baseline indicates a better outcome.
Time frame: Baseline, Month 6, Month 12, Month 18, Month 24
Proportion of Participants Who Survival at 14 Month of Age (Participants aged <24 months at dosing).
Survival is defined by the avoidance of the combined endpoint of either (a) death or (b) permanent ventilation, which is defined by tracheostomy or by the requirement of ≥ 16 hours of respiratory assistance per day (via non-invasive ventilatory support) for ≥ 14 consecutive days in the absence of an acute reversible illness, excluding perioperative ventilation.
Time frame: Up to 14 month of age
Proportion of Participants Maintaining Growth Without Non-oral Nutrition at 18 Month of Age (Participants aged <24 months at dosing).
The ability to maintain growth without non-oral nutrition is defined as the subject not requiring nutrition via nasogastric tube, gastric tube, enteral, parenteral, or intravenous routes, while maintaining body weight (not less than 2 standard deviations below the mean body weight for children of the same age and sex).
Time frame: Up to 18 month of age
Proportion of Ventilator-independent Participants at 18 Month of Age (Participants aged <24 months at dosing).
Independence from ventilator support is defined as no requirement for daily ventilator support/use in the absence of acute reversible disease, excluding perioperative ventilation.
Time frame: Up to 18 month of age
Change From Baseline in Revised Upper Limb Module (RULM) Total Score (Participants aged ≥24 months and ≤60 months at dosing).
The RULM is a specific assessment of motor performance in the upper limbs from childhood through adulthood in ambulatory and non-ambulatory individuals with SMA. The scale consists of 19 scorable items: 18 items scored on 0 (unable) to 2 (full achievement) scale, and one item that is scored from 0 (unable) to 1 (able). Total scores range from 0-37 points. Higher scores reflect higher level of motor ability.
Time frame: Up to 24 months
Change From Baseline in MFM-32 Score (Participants aged ≥24 months and ≤60 months at dosing).
The MFM-32 is a generic neuromuscular scale consisting of 32 items. Items belong to one of three different dimensions: Standing and transfers D1; Axial and proximal mobility D2; Distal motor ability D3. Each item is scored on a scale from 0 (cannot perform) to 3 (performs the task completely and normally), higher scores reflect higher level of motor ability.
Time frame: Up to 24 months
Change From Baseline in Hammersmith Functional Motor Scale-Expanded (HFMSE) Score (All age groups)
Assess change from baseline in HFMSE score (33 items, 0-66 points).
Time frame: Baseline, Month 6, Month 12, Month 18, Month 24
Proportion of Participants Who Achieve The World Health Organization (WHO) motor milestones (All age groups).
WHO motor milestones and performance criteria included sitting without support for at least 10 seconds, Hands-and-knees crawling at least three in a row, standing with assistance for at least 10 seconds, walking with assistance at least five steps, standing alone for at least 10 seconds, and walking alone. Assess proportion of participants achieving any new WHO motor milestone.
Time frame: Baseline, Month 6, Month 12, Month 18, Month 24
Change From Baseline in CMAP (All age groups)
Assess motor neuron function via change from baseline in CMAP within 24 months after treatment, assessed per dose cohort independently.
Time frame: Baseline, Month 6, Month 12, Month 18, Month 24
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