Phase 1 Study to Evaluate the Safety of ATA188 in Subjects With Progressive and Relapsing-Remitting Multiple Sclerosis

Overview

About this study

This is a multicenter, open-label, two-population, single-arm study with a sequential dose-escalation and dose-expansion in adult subjects with progressive forms of multiple sclerosis (MS) and an in adult subjects with relapsed remitting multiple sclerosis (RRMS).

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

A subject will be considered eligible to participate in this study if all of the following are satisfied:

  • History of MS, with progressive forms of MS or RRMS as defined by the 2010 Revised McDonald criteria for the diagnosis of MS:
    • Subjects with RRMS must have failed a health authority approved treatment.
  • Positive EBV serology
  • Males and females of the following ages:
    • 18 to 65 years of age for subjects with progressive forms of MS;
    • 18 to 45 years of age for subjects with RRMS.
  • EDSS scores as follows:
    • 3.0 to 6.5 for subjects with progressive forms of MS;
    • 2.0 to 5.5 for subjects with RRMS.
  • Willing and able to provide written informed consent.

Exclusion Criteria:

A subject will not be eligible to participate in the study if any of the following criteria are met:

  • Active clinical relapse between providing informed consent and enrollment (ie, date of the first dose of ATA188)
  • Concurrent serious uncontrolled or unresolved medical condition, such as infection, limiting protocol compliance or exposing the subject to unacceptable risk.
  • Positive serology and/or nucleic acid testing (NAT) for human immunodeficiency virus (HIV).
  • Serology and/or NAT indicating active hepatitis B virus (HBV) infection or carrier status for HBV (Note: A positive serology for HBV indicating a previous but cleared infection with HBV is not an exclusion criterion).
  • Serology and/or NAT indicating active hepatitis C virus (HCV) infection.
  • Positive serology for syphilis or human T cell lymphotrophic virus I/II (HTLV).
  • Significant non-malignant disease (eg, severe cardiac or respiratory dysfunction).
  • Uncontrolled psychosis, uncontrolled depression or suicide risk, substance dependence, or any other psychiatric condition that may compromise the ability to participate in this trial.
  • Clinically significant abnormalities of full blood count, renal function, or hepatic function:
    • Elevated liver function tests, including total bilirubin (TBILI) > 1.5× the upper limit of normal (ULN; unless subject has documented Gilbert's disease), aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3.0×ULN;
    • Subjects with both a creatinine > 1.5×ULN and an estimated creatinine clearance of < 60 mL/min (using the Cockcroft-Gault equation);
    • Hemoglobin < 10 g/dL; platelet < 100×109/L; absolute neutrophil count < 1.5×109/L.
  • Any contraindication to MRI and/or Gd, eg, any object that is reactive to strong static magnetic, pulsed-gradient fields including any metallic fragments or foreign body (eg, aneurysm clip(s), pacemakers, electronic implants, shunts).
  • Prior cancers, except successfully treated non-melanoma skin cancer or carcinoma in situ of the cervix, with a ≥ 5% chance of recurrence within 12 months of providing informed consent.
  • Immunomodulatory therapy, (in order of increasing washout period) as follows:
    • Treatment with corticosteroids within 2 weeks of providing informed consent;
    • Treatment with glatiramer acetate or IFNβ within 4 weeks of providing informed consent;
    • Treatment with dimethyl fumarate within 4 weeks of providing informed consent;
    • Treatment with a B-cell depleting agent within 6 months of providing informed consent;
    • Treatment with methotrexate, azathioprine, or cyclosporine within 6 months of providing informed consent;
    • Treatment with fingolimod within 9 months of providing informed consent;
    • Treatment with natalizumab within 12 months of providing informed consent;
    • Treatment with teriflunomide within 12 months of providing informed consent unless patient has completed an accelerated clearance with cholestyramine;
    • Treatment with mitoxantrone, cyclophosphamide, cladribine, or any other immunosuppressant or cytotoxic therapy within 12 months of providing informed consent, or determined by the investigator to have residual immune suppression from these treatments;
    • Any previous treatment with alemtuzumab.
  • Antithymocyte globulin or similar anti-T cell antibody therapy ≤ 4 weeks of providing informed consent.
  • Female of childbearing potential unwilling to use a highly effective method of contraception (ie, one that results in pregnancy less than 1% per year when used consistently and correctly), eg, implants, injectables, combined oral contraceptives, some intrauterine contraceptive devices, sexual abstinence, or a vasectomized partner, and/or unwilling to refrain from donating eggs while undergoing treatment with ATA188 and for 3 months after the last dose OR Men with a female partner of childbearing potential unwilling to use a highly effective contraceptive measure and/or unwilling to refrain from donating sperm while undergoing treatment with ATA188 and for 3 months after the last dose.
  • Women who are breastfeeding.
  • Pregnancy.
  • Inability to comply with study procedures.
  • Previous treatment with EBV T cell therapy.

 

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status

Scottsdale/Phoenix, Ariz.

Mayo Clinic principal investigator

Jonathan Carter, M.D.

Closed for enrollment

More information

Publications

  • Mounting evidence indicates that infection with Epstein-Barr virus (EBV) has a major role in the pathogenesis of multiple sclerosis (MS). Defective elimination of EBV-infected B cells by CD8 T cells might cause MS by allowing EBV-infected autoreactive B cells to accumulate in the brain. Here we undertake a comprehensive analysis of the T-cell response to EBV in MS, using flow cytometry and intracellular IFN-γ staining to measure T-cell responses to EBV-infected autologous lymphoblastoid cell lines and pools of human leukocyte antigen (HLA)-class-I-restricted peptides from EBV lytic or latent proteins and cytomegalovirus (CMV), in 95 patients and 56 EBV-seropositive healthy subjects. In 20 HLA-A2 healthy subjects and 20 HLA-A2 patients we also analysed CD8 T cells specific for individual peptides, measured by binding to HLA-peptide complexes and production of IFN-γ, TNF-α and IL-2. We found a decreased CD8 T-cell response to EBV lytic, but not CMV lytic, antigens at the onset of MS and at all subsequent disease stages. CD8 T cells directed against EBV latent antigens were increased but had reduced cytokine polyfunctionality indicating T-cell exhaustion. During attacks the EBV-specific CD4 and CD8 T-cell populations expanded, with increased functionality of latent-specific CD8 T cells. With increasing disease duration, EBV-specific CD4 and CD8 T cells progressively declined, consistent with T-cell exhaustion. The anti-EBNA1 IgG titre correlated inversely with the EBV-specific CD8 T-cell frequency. We postulate that defective CD8 T-cell control of EBV reactivation leads to an expanded population of latently infected cells, including autoreactive B cells. Read More on PubMed
  • Defective control of Epstein-Barr virus (EBV) infection by cytotoxic CD8(+) T cells might predispose to multiple sclerosis (MS) by allowing EBV-infected autoreactive B cells to accumulate in the central nervous system. We have treated a patient with secondary progressive MS with in vitro-expanded autologous EBV-specific CD8(+) T cells directed against viral latent proteins. This adoptive immunotherapy had no adverse effects and the patient showed clinical improvement with reduced disease activity on magnetic resonance imaging and decreased intrathecal immunoglobulin production. This is the first report of the use of EBV-specific adoptive immunotherapy to treat MS or any other autoimmune disease. Read More on PubMed

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