Minimal Islet Transplant at Diabetes Onset

NCT ID: NCT02505893

Last Updated: 2024-02-22

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 6 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-04-30
• Study Completion Date: 2023-12-31

Brief Summary

This is a prospective phase 2, single-arm, mono-center pilot study. It has been designed to investigate whether giving the combination therapy consisting of minimal islet transplantation (1500 EIQ/Kg body weight), Thymoglobulin® (ATG), Rapamune® (rapamycin) and Neulasta® (pegfilgastrim) to patients with Type 1 Diabetes (T1D) at onset is safe and secondarily, if it will preserve insulin production. It will involve 6 patients with new-onset T1D. Each patient will be involved in the study for a screening period and a post-islet transplantation study period of 52±2 weeks, to include 1 treatment cycles of 12 weeks, assessment during treatment and 5 follow-up visits scheduled at weeks 2±1 (14 days), 4±1 (month 1), 12±2 (month 3), 26±2 (month 6) and 52±2 (month 12).

Conditions

Diabetes Mellitus, Type 1

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Treated

The investigational treatment will be islet transplant in the presence of induction with ATG/G-CSF and rapamycin treatment for one month. One thousand and five hundred (1,500) equivalent islet for Kg of body weight, isolated from a single brain-dead donor, will be infused into the patient's liver. ATG will be administered IV (central vein) at a total dose of 6 mg/kg up to day 6 post-transplant. Pegylated G-CSF (6 mg/dose) will be administered SC every 2 weeks for 6 doses (12 weeks) beginning after the last ATG infusion. Rapamycin will be administered orally at a starting dose of 0.2 mg/kg once a day, then targeted to blood trough level of 8-10 ng/mL and suspended one month after transplant.

Group Type: EXPERIMENTAL

Human pancreatic islet

Intervention Type: BIOLOGICAL

One thousand and five hundred (1,500) equivalent islet for Kg of body weight, isolated from a single brain-dead donor, will be infused into the patient's liver.

ATG

Intervention Type: DRUG

ATG will be administered IV (central vein) at a total dose of 6 mg/kg up to day 6 post-transplant

Pegylated G-CSF

Intervention Type: DRUG

Pegylated G-CSF (6 mg/dose) will be administered SC every 2 weeks for 6 doses (12 weeks) beginning after the last ATG infusion

Rapamycin

Intervention Type: DRUG

Rapamycin will be administered orally at a starting dose of 0.2 mg/kg once a day, then targeted to blood trough level of 8-10 ng/mL and suspended one month after transplant.

Interventions

Human pancreatic islet

One thousand and five hundred (1,500) equivalent islet for Kg of body weight, isolated from a single brain-dead donor, will be infused into the patient's liver.

Intervention Type: BIOLOGICAL

ATG

ATG will be administered IV (central vein) at a total dose of 6 mg/kg up to day 6 post-transplant

Intervention Type: DRUG

Pegylated G-CSF

Pegylated G-CSF (6 mg/dose) will be administered SC every 2 weeks for 6 doses (12 weeks) beginning after the last ATG infusion

Intervention Type: DRUG

Rapamycin

Rapamycin will be administered orally at a starting dose of 0.2 mg/kg once a day, then targeted to blood trough level of 8-10 ng/mL and suspended one month after transplant.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Ability to provide written informed consent
• Mentally stable and able to comply with the protocol procedures for the duration of the study, including scheduled follow-up visits and examinations
• New-onset T1D (diagnosis of diabetes within 180 days prior to enrolment). Documentation of the diagnosis of T1DM (and not just insulin deficiency), including the date of diagnosis, must be obtained from the diagnosing physician.
• Residual beta-cell function (fasting C-peptide >0.3 ng/mLwhen plasma glucose level is > 70 mg/dL and ≤ 200 mg/dL.
• Positive for at least one of the following autoantibodies typically associated with T1DM: antibody to glutamic acid decarboxylase (anti-GAD) antibody to protein tyrosine phosphatase-like protein (anti-IA-2), zinc transporter autoantibodies; or an insulin autoantibody (IAA). Please note: A subject who is positive for IAA and negative for the other autoantibodies will not be eligible if the subject has been using insulin for a total of ≥7 days.
• Currently requires insulin for T1DM treatment, or has required insulin therapy (for at least 7 days) for diabetes at some time between the date of diagnosis and the first dose of study drug. Note: subjects currently taking twice daily commercially available pre-mixed insulin will not be eligible.
• MinimalHLA I A and B mismatch and at least one HLA DR match

Exclusion Criteria

• Body mass index (BMI) ≥ 32.0 kg/m2 or patient weight ≤50kg
• Insulin requirement of >1.0 IU/kg/day
• HbA1c >10%
• Blood Pressure: SBP >160 mmHg or DBP >100 mmHg.
• Chronic disease apart from diabetes, including type 2 diabetes
• Moderate to severe renal impairment as per calculated creatinine clearance (CLcr) < 90 mL/min according to the Cockcroft-Gault formula (Cockcroft-Gault , 1976)
• Presence or history of macroalbuminuria (>300mg/g creatinine).
• Hepatic dysfunction defined by increased ALT/AST upper limit of normal (ULN) and increased total bilirubin > 3 mg/dL [>51.3 μmol/L]
• Pregnant or breast feeding women. Unwillingness to use effective contraceptive measures up to 4 months after the end of study drug administration (females and males)
• Active infection including hepatitis B, hepatitis C, HIV, or tuberculosis (TB) as determined by a positive skin test or clinical presentation, or under treatment for suspected TB. Positive tests are acceptable only if associated with a history of previous vaccination in the absence of any sign of active infection. Positive tests are otherwise not acceptable, even in the absence of any active infection at the time of evaluation.
• Negative screen for Epstein-Barr Virus (EBV) by IgG determination
• Invasive aspergillus, histoplasmosis, or coccidioidomycosis infection within one year prior to study enrollment
• Any history of malignancy except for completely resected squamous or basal cell carcinoma of the skin
• Known active alcohol or substance abuse
• Baseline Hb below the lower limits of normal at the local laboratory; lymphopenia (<1,000/µL), neutropenia (<1,500/µL), or thrombocytopenia (platelets <100,000/µL). Participants with lymphopenia are allowed if the investigator determines there is no additional risk and obtains clearance from a hematologist
• A history of Factor V deficiency
• Any coagulopathy or medical condition requiring long-term anticoagulant therapy (e.g., warfarin) after transplantation (low-dose aspirin treatment is allowed) or patients with an international normalized ratio (INR) >1.5
• Severe co-existing cardiac disease, characterized by any one of these conditions:

• a) recent myocardial infarction (within past 6 months)
• b) evidence of ischemia on functional cardiac exam within the last year
• c) left ventricular ejection fraction <30%.
• Symptomatic cholecystolithiasis.
• Acute or chronic pancreatitis.
• Symptomatic peptic ulcer disease.
• Severe unremitting diarrhea, vomiting or other gastrointestinal disorders potentially interfering with the ability to absorb oral medications
• Hyperlipidemia despite medical therapy (fasting low-density lipoprotein [LDL] cholesterol >130 mg/dL, treated or untreated; and/or fasting triglycerides >200 mg/dL)
• Receiving treatment for a medical condition requiring chronic use of systemic steroids, except for the use of ≥ 5 mg prednisone daily, or an equivalent dose of hydrocortisone, for physiological replacement only.
• Treatment with any anti-diabetic medication other than insulin within 4 weeks of enrollment
• Use of any investigational agents within 4 weeks of enrollment.
• Administration of live attenuated vaccine(s) within 2 months of enrollment.
• Any medical condition that, in the opinion of the investigator, will interfere with safe participation in the trial.
• Treatment with any immunosuppressive regimen at the time of enrollment.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Italian Diabetes Foundation

OTHER

Sponsor Role: collaborator

Ospedale San Raffaele

OTHER

Sponsor Role: lead

Responsible Party

Lorenzo Piemonti

Deputy Director Diabetes Researh Institute

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Lorenzo Piemonti, MD

Role: PRINCIPAL_INVESTIGATOR

IRCCS Ospedale San Raffaele

Emanuele Bosi, MD

Role: STUDY_CHAIR

IRCCS Ospedale San Raffaele

Locations

IRCCS San Raffaele Scientific Institute

Milan, , Italy

Countries

Italy

Other Identifiers

DRI-MITO 1/2014

Identifier Type: -

Identifier Source: org_study_id