Immunotherapy using Treg cells for Crohn's Disease

A First in Human Feasibility Study of T Regulatory Cells (TR004) for Inflammatory Bowel Disease Using (ex Vivo) Treg Expansion

This study is testing a new treatment for Crohn's Disease that uses specially modified immune cells to see if they can help people who haven't found relief with regular medications.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 4 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: King's College London (Academic / other)
• Drugs / interventions: vedolizumab, ustekinumab, methotrexate, immunotherapy
• Locations: 1 site (London)
• Trial ID: NCT03185000 on ClinicalTrials.gov

What this trial studies

The TRIBUTE trial is investigating a novel treatment for Crohn's Disease (CD) using regulatory T-cells (Tregs) immunotherapy. This approach involves extracting white blood cells from patients, expanding them in a laboratory, and then administering them back to the patient to help modulate the immune response and reduce inflammation in the gut. The trial aims to recruit four patients with moderate to severe CD who have not responded to standard treatments. This first-in-human feasibility study will assess the safety and potential efficacy of this personalized cellular therapy.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 to 80 with moderate to severe Crohn's Disease who have failed to respond to at least two standard treatments.

Not a fit: Patients with mild Crohn's Disease or those who have not yet tried standard treatments may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients with Crohn's Disease who have not responded to existing medications.

How similar studies have performed: While cellular therapies are emerging, this specific approach using Tregs for Crohn's Disease is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

1. Able and willing to provide written informed consent and able to comply with the protocol requirements
2. Male or female aged between 18 and 80 (inclusive) years of age at date of consent
3. A diagnosis of Crohn's disease (CD) established ≥12 weeks prior to date of consent by standard clinical, radiological, endoscopic and histological criteria
4. Documented moderate-to-severe CD with a Crohn's Disease Activity Index (CDAI) \>= 220 within 3 months of date of consent
5. Active CD (mucosal inflammation) including ulceration, as assessed by colonoscopy at screening
6. Failure to tolerate or to respond to at least 2 prior lines of standard CD medication intended to induce or maintain remission, as determined by the referring gastroenterologist. Examples of such medications include, but are not limited to, azathioprine, mercaptopurine, methotrexate, vedolizumab, ustekinumab or anti-tumour necrosis factor antibody therapy. This does not include steroids and 5-ASA medications
7. Stable doses of concomitant medications
8. Normal or non-clinically significant electrocardiogram (ECG), as assessed by the Investigator at screening
9. Negative stool test for Clostridium difficile and faecal culture for standard pathogens at screening. For non-pathogenic organism, inclusion will be at the discretion of the Principal Investigator (PI)
10. Negative serology for HIV, Hepatitis B (cAb and sAg), Hepatitis C, HTLV and Syphilis at screening
11. Subject is judged by the principal investigator to be in otherwise good health based upon the results of all screening investigations in combination with medical history and physical examination

Exclusion Criteria:

1. A diagnosis of ulcerative colitis or IBD-unclassified
2. CD treatment-naïve patients, defined as patients who have never received or have refused standard CD treatment
3. History of clinically significant drug or alcohol abuse in the last 12 months prior to date of consent
4. Any history of major immune deficiency disorder, except Crohn's disease
5. Patients with a history of pulmonary embolism or deep vein thrombosis. Current or recent history (within 1 year prior to screening) of major organ or system failure or condition, acute or chronic that in the opinion of the investigator should preclude enrollment, except Crohn's disease
6. History of intestinal resection or intra-abdominal surgery within 6 months prior to date of consent
7. Requirement for immediate or imminent surgical, endoscopic or radiological intervention for indications including (but not limited to) toxic megacolon, obstruction, massive haemorrhage, perforation, sepsis, or intra-abdominal or perianal abscess
8. Patients with ileostomy or colostomy
9. Patients with short bowel syndrome (less than 1.5m of small bowel)
10. Complication of Crohn's disease such as strictures/stenosis, penetrating disease, or any other manifestation that might require surgery.
11. Patient has received therapeutic enema or suppository, other than required for endoscopy, within 14 days prior to date of consent and/or during the screening period
12. Patients who are currently using anticoagulants including but not limited to warfarin, heparin, enoxaparin, dabigatran, apixaban, rivaroxaban (note that anti-platelet agents such as aspirin up to 325mg daily or clopidogrel are permitted)
13. Use of corticosteroids on the day of leukapheresis sampling, prior to the procedure. Dosing should be delayed until after the procedure has been completed. This must be checked prior to the appointment and rescheduled if use is confirmed.
14. Current medically significant infection i.e. infection(s) requiring treatment with intravenous (IV) anti-infectives within 30 days prior to date of consent or oral anti-infectives for non-Crohn's disease related infections within 14 days prior to screening visit
15. Subject with an active systemic viral infection or any active viral infection that based on the investigator's clinical assessment makes the patient unsuitable for the study
16. History of tuberculosis (TB), unless there is documented evidence of completion of a full course of anti-TB treatment prior to screening. For patients with latent TB, as defined by a physician specialised in TB, they must have received prophylactic treatment for 4 weeks minimum prior to dosing
17. History of moderate to severe congestive heart failure (NYHA class III or IV), recent cerebrovascular accident (within 6 months of screening) and any other condition which, in the opinion of the investigator, would put the subject at risk by participation in the study
18. Subject with a previous history (within 12 months of consent) of dysplasia of the gastrointestinal tract, or found to have dysplasia in any biopsy performed during the screening endoscopy unless this is deemed to be a sporadic adenoma and has been completely removed
19. Significant laboratory abnormalities:

    Hb \< 100g/L or WBC \< 3.5 x 109/L or Plt \< 100 x 109/L Creatinine \> 1.5x ULN Total bilirubin \> 34 µmol/L or ALT \> 2x ULN or GGT \> 2xULN. Elevated unconjugated bilirubin related to Gilbert's syndrome is allowed
20. Anti-TNF or ustekinumab therapy within 8 weeks of study dosing (day 0). Vedolizumab therapy within 5 half-lives (15 weeks) of dosing. Exposure to cyclosporine or tacrolimus within 2 weeks of date of consent
21. Patient currently receiving total parenteral nutrition (TPN) or plan to receive TPN at any time during the course of the study
22. Received another investigational drug within 60 days of anticipated study date of consent or 5 half lives whichever is greater
23. Patient who previously received stem cell transplantation
24. Current evidence of dysplasia or history of malignancy within the last 5 years of date of consent (except successfully treated squamous cell or basal cell carcinoma, without metastases or localised carcinoma in situ of the cervix)
25. Pregnant and lactating patients (females of childbearing potential with a positive serum pregnancy test at screening visit 1 or day -1 at week 0)
26. Female patients of childbearing potential (i.e. not post-menopausal or surgically sterilised) who are not willing to use effective methods of contraception (included but not limited to hormonal contraception, Intrauterine devices, sexual abstinence, vasectomised partner) to prevent pregnancy or abstain from heterosexual activity for the duration of the trial up to W21 visit
27. Male patients who are not willing to use an effective method of contraception (condoms) for the duration of the study up to W21 visit, when engaging in sexual activity with a female of childbearing potential
28. Allergy to any component / excipients used for the manufacture of TR004
29. Patient is considered by the investigator, for any reason, to be an unsuitable candidate for the study

Where this trial is running

London

• Guy's Hospital - Guy's and St Thomas' NHS Foundation Trust — London, United Kingdom (Recruiting)

Study contacts

• Principal investigator: Peter Irving, Dr — King's College London
• Study coordinator: Peter Irving, Dr

Conditions Crohn Disease