RECRUITING

Base Editing for Mutation Repair in Hematopoietic Stem & Progenitor Cells for X-Linked Chronic Granulomatous Disease

Conditions

Chronic Granulomatous Disease (CGD)X-Linked Chronic Granulomatous Disease base editing Gene Editing

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

Background: Chronic granulomatous disease (CGD) is a rare immune disorder caused by a mutation in the CYBB gene. People with CGD have white blood cells that do not work properly and are at greater risk of getting infections. Gene therapy using lentivector has helped people with CGD. Researchers want to know if the base-edited stem cells can improve the white cells' functioning and result in fewer CGD-related infections. Objective: To learn if base-edited stem cells will correct the white blood cells in people with CGD. Eligibility: Males aged 18 years and older with X-linked CGD. Design: This is a non-randomized study. Participants with the specific mutation under study will be screened during the initial phase. During the development phase, participants will undergo apheresis to collect stem cells for base-editing correction of the mutation. During the treatment phase, participants will receive the base-edited cells after chemotherapy with busulfan. Participants will remain in the hospital until their immunity recovers. Participants will be maintained on sirolimus to prevent an immune response to the new protein expressed by the base-edited cells. Follow-up visits will continue for 15 years....

Official Title

Phase 1/2 Trial of Base Editing for Mutation Repair in Hematopoietic Stem & Progenitor Cells for X-linked Chronic Granulomatous Disease

Quick Facts

Study Start:2024-04-17

Study Completion:2032-12-31

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT06325709

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years to 75 Years

Sexes Eligible for Study:MALE

Accepts Healthy Volunteers:No

Standard Ages:ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
* Confirmed CYBB c.676 C\>T mutation. * Male patients. * Clinically stable and eligible to undergo apheresis and conditioning chemotherapy. * History of at least one prior serious infection or inflammatory complication requiring hospitalization despite conventional therapy. * In the experience of a qualified clinical investigator, the patient has a poor prognosis. * Able and willing to use a highly effective method of contraception, AND partner has communicated her willingness through subject to do same, if engaging in potentially reproductive sex from the signing of the informed consent and for 6 months after IMP infusion. Acceptable methods of contraception include the following: * Hormonal contraception in continuously effective use by female partner. * Male or female condom with spermicide as indicated. * Diaphragm or cervical cap in consistent and effective pattern of use with a spermicide by female partner. * Intrauterine device in-situ throughout above period by female partner.	* Untreated, acute infection. * Elevated anti-gp91 specific autoantibodies \>2 x ULN * Elevated anti-gp91 specific T cells (\>10 fold) * Anti-platelet antibody screening with \>1 anti-platelet antibody positive in the presence of an ongoing brain infection; OR \>1 anti-platelet antibody positive and considered unsafe for study participation after consultation with hematology specialist. * Known hypersensitivity to busulfan or any component of the product. * Contraindications for administration of busulfan. * Any current or pre-existing hematologic malignancy. * Chronic infections that are considered unsafe for participation in the study by Infectious Disease Consultant. * Cardiac abnormalities and neurological abnormalities that are deemed unsafe to participate in the study. * Childhood malignancy (occurring before 18 years of age) in the patient or a first degree relative, or previously diagnosed known genotype of the participant conferring a predisposition to cancer (no DNA or other testing for cancer predisposition genes will be performed as part of the screen for this protocol). * Hematological parameters unsafe for apheresis or above Grade 2 Common Terminology Criteria for Adverse Events (CTCAE) criteria until improved. * Hepatic dysfunction- alanine aminotransferase (ALT \>3.0 - 5.0 x upper limit of normal \[ULN\]), aspartate aminotransferase (AST \>3.0 - 5.0 x ULN), bilirubin (\>1.5 - 3.0 x ULN). * Renal dysfunction-serum creatinine \>1.5 - 3.0 x ULN or creatinine clearance 59-30 mL/min/1.73 m\^2. * Coagulation dysfunction- Prothrombin INR or Partial thromboplastin time \>2 x ULN (patients on controlled anticoagulation agents will not be excluded for therapeutic levels). * Uncontrolled hypertension- Systolic BP 140-159 mm Hg or diastolic BP 90-99 mm Hg. * Abnormal blood chemistries- Hyperkalemia (K \>5.5 - 6.0 mmol/L), Hypokalemia (\<LLN - 3.0 mmol/L and requiring intervention); OR Hypercalcemia (corrected serum calcium \>11.5 - 12.5 mg/dL), Hypocalcemia (corrected serum calcium \<8.0 -7.0 mg/dL) * Cytogenetic abnormalities evidenced on bone marrow aspirate. * Pulmonary dysfunction FEV1\<25% predicted. * Previous treatment with gene therapy or gene editing products. * Previous receipt of non-HLA matched donor granulocyte transfusions. * Any other condition that, in the opinion of the investigator, may unduly compromise the safety or compliance of the patient, or would make successful study completion highly unlikely.

Inclusion Criteria

Exclusion Criteria

* Confirmed CYBB c.676 C\>T mutation.
* Male patients.
* Clinically stable and eligible to undergo apheresis and conditioning chemotherapy.
* History of at least one prior serious infection or inflammatory complication requiring hospitalization despite conventional therapy.
* In the experience of a qualified clinical investigator, the patient has a poor prognosis.
* Able and willing to use a highly effective method of contraception, AND partner has communicated her willingness through subject to do same, if engaging in potentially reproductive sex from the signing of the informed consent and for 6 months after IMP infusion. Acceptable methods of contraception include the following:
* Hormonal contraception in continuously effective use by female partner.
* Male or female condom with spermicide as indicated.
* Diaphragm or cervical cap in consistent and effective pattern of use with a spermicide by female partner.
* Intrauterine device in-situ throughout above period by female partner.

* Untreated, acute infection.
* Elevated anti-gp91 specific autoantibodies \>2 x ULN
* Elevated anti-gp91 specific T cells (\>10 fold)
* Anti-platelet antibody screening with \>1 anti-platelet antibody positive in the presence of an ongoing brain infection; OR \>1 anti-platelet antibody positive and considered unsafe for study participation after consultation with hematology specialist.
* Known hypersensitivity to busulfan or any component of the product.
* Contraindications for administration of busulfan.
* Any current or pre-existing hematologic malignancy.
* Chronic infections that are considered unsafe for participation in the study by Infectious Disease Consultant.
* Cardiac abnormalities and neurological abnormalities that are deemed unsafe to participate in the study.
* Childhood malignancy (occurring before 18 years of age) in the patient or a first degree relative, or previously diagnosed known genotype of the participant conferring a predisposition to cancer (no DNA or other testing for cancer predisposition genes will be performed as part of the screen for this protocol).
* Hematological parameters unsafe for apheresis or above Grade 2 Common Terminology Criteria for Adverse Events (CTCAE) criteria until improved.
* Hepatic dysfunction- alanine aminotransferase (ALT \>3.0 - 5.0 x upper limit of normal \[ULN\]), aspartate aminotransferase (AST \>3.0 - 5.0 x ULN), bilirubin (\>1.5 - 3.0 x ULN).
* Renal dysfunction-serum creatinine \>1.5 - 3.0 x ULN or creatinine clearance 59-30 mL/min/1.73 m\^2.
* Coagulation dysfunction- Prothrombin INR or Partial thromboplastin time \>2 x ULN (patients on controlled anticoagulation agents will not be excluded for therapeutic levels).
* Uncontrolled hypertension- Systolic BP 140-159 mm Hg or diastolic BP 90-99 mm Hg.
* Abnormal blood chemistries- Hyperkalemia (K \>5.5 - 6.0 mmol/L), Hypokalemia (\<LLN - 3.0 mmol/L and requiring intervention); OR Hypercalcemia (corrected serum calcium \>11.5 - 12.5 mg/dL), Hypocalcemia (corrected serum calcium \<8.0 -7.0 mg/dL)
* Cytogenetic abnormalities evidenced on bone marrow aspirate.
* Pulmonary dysfunction FEV1\<25% predicted.
* Previous treatment with gene therapy or gene editing products.
* Previous receipt of non-HLA matched donor granulocyte transfusions.
* Any other condition that, in the opinion of the investigator, may unduly compromise the safety or compliance of the patient, or would make successful study completion highly unlikely.

Contacts and Locations

Study Contact

Suk S De Ravin, M.D.

CONTACT

(301) 496-6772

sderavin@mail.nih.gov

Principal Investigator

Suk S De Ravin, M.D.

PRINCIPAL_INVESTIGATOR

National Institute of Allergy and Infectious Diseases (NIAID)

Study Locations (Sites)

National Institutes of Health Clinical Center

Bethesda, Maryland, 20892

United States

Collaborators and Investigators

Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)

Suk S De Ravin, M.D., PRINCIPAL_INVESTIGATOR, National Institute of Allergy and Infectious Diseases (NIAID)

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2024-04-17

Study Completion Date2032-12-31

Study Record Updates

Study Start Date2024-04-17

Study Completion Date2032-12-31

Terms related to this study

Keywords Provided by Researchers

base editing
Gene Editing

Additional Relevant MeSH Terms

Chronic Granulomatous Disease (CGD)
X-Linked Chronic Granulomatous Disease