Long-term Function of Beta Cell Allografts in Non-uremic Type 1 Diabetic Patients
NCT ID: NCT00798785
Last Updated: 2013-12-30
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
PHASE1/PHASE2
50 participants
INTERVENTIONAL
2006-10-31
2014-12-31
Brief Summary
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The general objectives of this work are:
1. To increase and maintain the functional beta-cell mass after islet transplantation under a condition of low-dose tacrolimus
2. To co-investigate the potential of alternative sites for encapsulated beta-cells
Detailed Description
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2. Aim 2: To increase functional beta cell mass by adding basilixumab at second implantation
3. Aim 3: To assess the influence of down-tapering the tacrolimus dose during posttransplant years 2-5 on these data, on metabolic control, on the prevalence of hypoglycemia and on safety parameters.
4. Aim 4: To investigate the potential of the peritoneum and omentum as an alternative site for encapsulated beta-cells.
5. Aim 5: To investigate the potential of the brachioradial muscle as an alternative site for encapsulated beta-cells.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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group I ATG-MMF-TAC
Two clinical implants in the liver:
First implant: ATG-fresenium Maintained immunosuppression: MMF-TAC n=30
ATG-MMF-TAC
ATG-fresenium for max 6 consecutive days depending on CD3 count, starting the day before transplantation.
Tacrolimus levels for 2 years between 8-10 ng/ml.
At year 2: randomization:
group A: till 48 months: tacrolimus levels 8-10 ng/ml 48-60 months: tacrolimus levels 6-8 ng/ml group B: 24-36 months: 6-8 ng/ml 36-60 months: 4-6 ng/ml A subgroup of these patients will receive a sub clinical implant subcutaneous (total n=5) at the time of the first clinical implant in the liver.
group II ATG-Rituximab-MMF-TAC
Two clinical implants in the liver:
First Implant: ATG fresenium + Rituximab Maintained immunosuppression: MMF-TAC n=5
ATG-Rituximab-MMF-TAC
ATG-fresenium for max 6 consecutive days depending on CD3 count, starting the day before transplantation.
Rituximab: the day before transplantation, day 5; 12 and 19 after implantation. Tacrolimus levels for 2 years between 8-10 ng/ml.
At year 2: randomization:
group A: till 48 months: tacrolimus levels 8-10 ng/ml 48-60 months: tacrolimus levels 6-8 ng/ml group B: 24-36 months: 6-8 ng/ml 36-60 months: 4-6 ng/ml A subgroup of these patients will receive a sub clinical implant, subcutaneous at the time of the first clinical implant in the liver.
group III ATG-Basilixumab-MMF-TAC
Two clinical implants in the liver:
First implant: ATG-fresenium Second implant: basilixumab Maintained immunosuppression: MMF-TAC n=5
ATG-basilixumab-MMF-TAC
First transplantation:
ATG-fresenium for max 6 consecutive days depending on CD3 count, starting the day before transplantation.
Second transplantation:
Basilixumab:
the day before the second transplantation followed by 4days after transplantation.
Tacrolimus levels for 2 years between 8-10 ng/ml.
At year 2: randomization:
group A: till 48 months: tacrolimus levels 8-10 ng/ml 48-60 months: tacrolimus levels 6-8 ng/ml group B: 24-36 months: 6-8 ng/ml 36-60 months: 4-6 ng/ml A subgroup of these patients will receive a sub clinical implant, subcutaneous at the time of the first clinical implant in the liver.
group IV omentum
Two clinical implants: first in the omentum followed by a clinical implant in the liver:
First implant: ATG-fresenium Maintained immunosuppression: MMF-TAC n=10
omentum
Two clinical implants: first in omentum followed by a clinical implant in the liver:
In a group of 10 patients, a clinical implant in the omentum will be implanted. If random C-peptide levels \>= 0.5 ng/ml are measured at 2 months post-transplantation, a second omental implant will be done. If no clinical relevant beta cell graft function is measured, two intraportal implants will be given as a compassionate use procedure. An interim analysis after 5 patients has to shown clinical relevant function at month 2 in 3 out of 5 patients before the subsequent 5 patients can be transplanted in the omentum.
Interventions
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ATG-MMF-TAC
ATG-fresenium for max 6 consecutive days depending on CD3 count, starting the day before transplantation.
Tacrolimus levels for 2 years between 8-10 ng/ml.
At year 2: randomization:
group A: till 48 months: tacrolimus levels 8-10 ng/ml 48-60 months: tacrolimus levels 6-8 ng/ml group B: 24-36 months: 6-8 ng/ml 36-60 months: 4-6 ng/ml A subgroup of these patients will receive a sub clinical implant subcutaneous (total n=5) at the time of the first clinical implant in the liver.
ATG-Rituximab-MMF-TAC
ATG-fresenium for max 6 consecutive days depending on CD3 count, starting the day before transplantation.
Rituximab: the day before transplantation, day 5; 12 and 19 after implantation. Tacrolimus levels for 2 years between 8-10 ng/ml.
At year 2: randomization:
group A: till 48 months: tacrolimus levels 8-10 ng/ml 48-60 months: tacrolimus levels 6-8 ng/ml group B: 24-36 months: 6-8 ng/ml 36-60 months: 4-6 ng/ml A subgroup of these patients will receive a sub clinical implant, subcutaneous at the time of the first clinical implant in the liver.
ATG-basilixumab-MMF-TAC
First transplantation:
ATG-fresenium for max 6 consecutive days depending on CD3 count, starting the day before transplantation.
Second transplantation:
Basilixumab:
the day before the second transplantation followed by 4days after transplantation.
Tacrolimus levels for 2 years between 8-10 ng/ml.
At year 2: randomization:
group A: till 48 months: tacrolimus levels 8-10 ng/ml 48-60 months: tacrolimus levels 6-8 ng/ml group B: 24-36 months: 6-8 ng/ml 36-60 months: 4-6 ng/ml A subgroup of these patients will receive a sub clinical implant, subcutaneous at the time of the first clinical implant in the liver.
omentum
Two clinical implants: first in omentum followed by a clinical implant in the liver:
In a group of 10 patients, a clinical implant in the omentum will be implanted. If random C-peptide levels \>= 0.5 ng/ml are measured at 2 months post-transplantation, a second omental implant will be done. If no clinical relevant beta cell graft function is measured, two intraportal implants will be given as a compassionate use procedure. An interim analysis after 5 patients has to shown clinical relevant function at month 2 in 3 out of 5 patients before the subsequent 5 patients can be transplanted in the omentum.
Eligibility Criteria
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Inclusion Criteria
* Body weight \< 100 kg; patients with a bodyweight of \< 80kg, will receive priority
* Patients with a BMI ≤ 27 kg/m2 will receive priority
* Type 1 insulin-dependent diabetes
* C-peptide \< 0.07 nmol/l (\<0.2 µg/l) 6 min. after glucagon IV (1mg) (glycemia \> 180 mg/dl)
* Intensive insulin therapy for more than two years, patients with insulin pump during at least 2 months before inclusion will receive priority
* Patients should have at least one of the following chronic complications of diabetes:
* Plasma creatinine \<2 mg/dl and albuminuria 30-1000 mg/ 24hrs on 3 separate determinations (\>1 month) outside an episode of illness, despite intake of ACE inhibitors; mean systolic blood pressure should be under 130 mmHg and mean diastolic blood pressure under 85 mmHg, when measured at home with ambulatory BP monitoring
* Moderate or severe non-proliferative or proliferative retinopathy
* Hypoglycemic unawareness
* Cooperative and reliable patient giving informed consent by signature
Exclusion Criteria
* EBV antibody negativity
* HIV 1 \& 2 antibody positivity
* CMV IgM positivity
* Plasma creatinine ≥ 2 mg/dl and/or albuminuria ≥1000 mg/24 hrs
* History of thrombosis or pulmonary embolism
* History of malignancy, tuberculosis or chronic viral hepatitis
* History of any other serious illness which could be relevant for the protocol
* Presence of HLA antibodies
* Blood donation within one month prior to screening or during the study
* Symptoms and/or signs of infection, particularly (present or past) endocarditis, osteomyelitis, past tuberculosis with requirement for therapy
* Any history of hepatic or neoplastic disease
* Any history of renal disease (except diabetes)
* Abnormal liver function tests and /or NMR of liver
* Hemoglobinopathy
* History of any illness that, in the opinion of the investigator, might confound the results of the study or pose additional risks to the patient
* Pregnancy or use of inadequate contraception by female patients of childbearing potential
* Use of illicit drugs or overconsumption of alcohol (\> 3 beers/day) or history of drug or alcohol abuse
* Being legally incapacitated, having significant emotional problems at the time of the study, or having a history of psychiatric disorders
* Having received antidepressant medications during the last 6 months
* Having participated the last 12 months or participating in another clinical study
18 Years
65 Years
ALL
No
Sponsors
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AZ-VUB
OTHER
Responsible Party
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Bart Keymeulen
UZ Brussels
Principal Investigators
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Bart Keymeulen, MD PhD
Role: PRINCIPAL_INVESTIGATOR
University Hospital Brussel
Locations
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Universitair Ziekenhuis Antwerpen
Antwerp, , Belgium
University Hospital Brussels
Brussels, , Belgium
Hopital Erasme
Brussels, , Belgium
University Hospital Leuven
Leuven, , Belgium
Countries
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Central Contacts
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Facility Contacts
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Christophe De Block, MD,PhD
Role: primary
Bart Keymeulen, MD PhD
Role: primary
Laurent Crenier, MD
Role: primary
Pieter Gillard, MD PhD
Role: primary
Da Hae Lee, MD
Role: backup
References
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Lee D, Keymeulen B, Hilbrands R, Ling Z, Van de Velde U, Jacobs-Tulleneers-Thevissen D, Maleux G, Lapauw B, Crenier L, De Block C, Mathieu C, Pipeleers D, Gillard P. Age and Early Graft Function Relate With Risk-Benefit Ratio of Allogenic Islet Transplantation Under Antithymocyte Globulin-Mycophenolate Mofetil-Tacrolimus Immune Suppression. Transplantation. 2017 Sep;101(9):2218-2227. doi: 10.1097/TP.0000000000001543.
Keymeulen B, Gillard P, Mathieu C, Movahedi B, Maleux G, Delvaux G, Ysebaert D, Roep B, Vandemeulebroucke E, Marichal M, In 't Veld P, Bogdani M, Hendrieckx C, Gorus F, Ling Z, van Rood J, Pipeleers D. Correlation between beta cell mass and glycemic control in type 1 diabetic recipients of islet cell graft. Proc Natl Acad Sci U S A. 2006 Nov 14;103(46):17444-9. doi: 10.1073/pnas.0608141103. Epub 2006 Nov 7.
Movahedi B, Keymeulen B, Lauwers MH, Goes E, Cools N, Delvaux G. Laparoscopic approach for human islet transplantation into a defined liver segment in type-1 diabetic patients. Transpl Int. 2003 Mar;16(3):186-90. doi: 10.1007/s00147-002-0517-7. Epub 2003 Feb 15.
Maleux G, Gillard P, Keymeulen B, Pipeleers D, Ling Z, Heye S, Thijs M, Mathieu C, Marchal G. Feasibility, safety, and efficacy of percutaneous transhepatic injection of beta-cell grafts. J Vasc Interv Radiol. 2005 Dec;16(12):1693-7. doi: 10.1097/01.RVI.0000182506.88739.39.
Lee D, Gillard P, Hilbrands R, Ling Z, Van de Velde U, Jacobs-Tulleneers-Thevissen D, Maleux G, Lapauw B, Crenier L, De Block C, Mathieu C, Pipeleers D, Keymeulen B. Use of Culture to Reach Metabolically Adequate Beta-cell Dose by Combining Donor Islet Cell Isolates for Transplantation in Type 1 Diabetes Patients. Transplantation. 2020 Oct;104(10):e295-e302. doi: 10.1097/TP.0000000000003321.
Balke EM, Demeester S, Lee D, Gillard P, Hilbrands R, Van de Velde U, Van der Auwera BJ, Ling Z, Roep BO, Pipeleers DG, Keymeulen B, Gorus FK. SLC30A8 polymorphism and BMI complement HLA-A*24 as risk factors for poor graft function in islet allograft recipients. Diabetologia. 2018 Jul;61(7):1623-1632. doi: 10.1007/s00125-018-4609-z. Epub 2018 Apr 20.
Other Identifiers
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BK_TX_06
Identifier Type: -
Identifier Source: org_study_id