Gene therapy to improve Factor VIII production in hemophilia A patients

Phase I Study Evaluating Safety and Feasibility of Hematopoietic Stem Cell Gene Transfer That Targets Factor VIII Delivery from Platelets for Patients with Hemophilia a

This study is testing a new gene therapy to see if it can help men with severe hemophilia A produce more of the Factor VIII protein that helps their blood clot.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 5 (estimated)
• Ages: 18 Years and up
• Sex: Male
• Sponsor: Medical College of Wisconsin (Academic / other)
• Locations: 1 site (Milwaukee, Wisconsin)
• Trial ID: NCT03818763 on ClinicalTrials.gov

What this trial studies

This Phase I study aims to explore a novel gene therapy approach for treating severe hemophilia A. The study involves collecting a patient's own stem cells through apheresis, which are then genetically modified using a lentiviral vector to produce Factor VIII in platelets. After modification, these stem cells will be reintroduced into the patient to potentially enhance their platelet production of this crucial protein. The trial is open-label and nonrandomized, focusing on a small cohort of adult males with a history of FVIII inhibitors.

Who should consider this trial

Good fit: Ideal candidates are adult males over 18 with a confirmed diagnosis of severe hemophilia A and a history of FVIII inhibitors.

Not a fit: Patients who are female or do not have severe hemophilia A are unlikely to benefit from this study.

Why it matters

Potential benefit: If successful, this therapy could significantly improve the management of hemophilia A by enabling patients to produce their own Factor VIII.

How similar studies have performed: While gene therapy for hemophilia is a novel approach, similar studies have shown promising results in other conditions, indicating potential for success.

Eligibility criteria

Inclusion Criteria:

Study population will include: adult males \>18 years of age with a diagnosis of severe hemophilia A and currently active or a history of FVIII inhibitors (≥0.6 BU). Females will be excluded because hemophilia A is an X-linked disorder that is extremely rare in females.

1. Confirmed diagnosis of severe hemophilia A by undetectable plasma factor VIII:C by a one-stage PTT-based assay and coatest chromogenic factor VIII assay. Subjects with currently active or a history of positive FVIII inhibitor titers (≥0.6 BU) irrespective of their titer or current inhibitor status will be included for enrollment.
2. Subject may be prescribed prophylactic therapy with factor VIII bypassing agents or factor VIII mimetics prior to referral for inclusion in the study.
3. Subjects who are treated on demand using factor VIII bypassing agents must have a history of four or more bleeding episodes requiring treatment in the six-month period prior to referral for inclusion in the study.
4. Adequate bone marrow reserve as demonstrated by ANC \>1.5/cu.mm; Hemoglobin \>9g/dL; Platelets \>100,000/microliter.
5. Adequate renal function, defined as creatinine clearance\>60 ml/min (Cockroft-Gault formula)
6. Adequate liver function, defined as defined as total bilirubin ≤1.5 times the upper limit of normal (ULN) (excluding Gilbert's syndrome), both AST and ALT ≤3 times ULN at the time of screening, and no clinical signs or known laboratory/radiographic evidence consistent with cirrhosis.
7. Subject must sign an informed consent after explanation of the study and having questions answered.
8. Subject must be willing and able to document type of bleeding episodes and treatment in a paper or electronic diary during the study.
9. Subject must be willing to return for regular follow-up visits during the 15-year study.

Exclusion Criteria:

* A potential subject who meets any of the following exclusion criteria is ineligible to participate in the study.

  1. Therapy with factor VIII with the intent of immune tolerance induction within 30 days prior to inclusion within the study.
  2. Enrollment in another interventional clinical trial within 60 days prior to study inclusion.
  3. Medical contraindication to PBSC cytokine mobilization, use of GCSF, PBSC apheresis procedure or conditioning regimen.
  4. Medically significant organ dysfunction that would prevent compliance with conditioning or would severely limit the probability of survival based on clinical status.
  5. Those with a known co-existing clinically significant thrombophilic disorder, or as determined by the presence of any of the below identified on screening laboratory assessments:

     * FV Leiden
     * Protein S deficiency
     * Protein C deficiency
     * Prothrombin mutation (G20210A)
     * D-dimer \>3 x the upper limit of normal (ULN) at Screening All known patients with the above and any patient with a personal or significant family history of thrombotic events (DVT, PE, arterial clots) as deemed by the principal investigator will be screened for the above disorders.
  6. Active invasive malignancy (Non-melanoma skin cancers and carcinoma in situ are not excluded).
  7. Known bone marrow disorders or abnormal bone marrow cytogenetics.
  8. Fertile males who are unwilling to use contraceptive techniques during and for the twelve months following treatment.
  9. Life expectancy severely limited by disease(s) other than hemophilia A.
  10. Patients with HIV, hepatitis B, hepatitis C (with an AST/ALT \> 3 times the upper limit of normal).
  11. Other active infectious disease that is a contraindicat ion for immunosuppressive therapy.
  12. Patients who have elective surgery scheduled during the study period.

Where this trial is running

Milwaukee, Wisconsin

• Froedtert Hospital and the Medical College of Wisconsin — Milwaukee, Wisconsin, United States (Recruiting)

Study contacts

• Principal investigator: Mary Eapen, MD — Froedtert Hosptial and Medical College of Wisconsin
• Study coordinator: Mary Eapen, MD

Conditions Hemophilia a; Gene Therapy