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HIVPhase 1Zinc-FingerNCT00842634

Autologous T-Cells Genetically Modified at the CCR5 Gene by Zinc Finger Nucleases SB-728 for HIV

A Phase 1 study testing ZFN modified T cells and Structured Treatment Interruption in people with HIV and HIV Infections, run by University of Pennsylvania at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This research study is being carried out to study a new way to possibly treat HIV. This agent is called a "Zinc Finger Nuclease" or ZFN for short. ZFNs are proteins that can delete another protein named CCR5. This CCR5 protein is required for certain common types of HIV (CCR5 tropic) to enter into and infect T-cells. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
HIV, HIV Infections
What is being tested?
ZFN modified T cells and Structured Treatment Interruption
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
12 participants
Where
2 sitesUnited States
Study dates
Jan 2009to Jan 2013
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Cohort 1 Only:
  • Patients who have been on two more HAART regimens and have failed due to resistance or tolerance (no changes to treatment within 4 weeks of study entry), and who have no viable treatment options likely to result in complete viral suppression.
  • CD4+ T cell count of ≥200 cells/mm3
  • HIV-1 RNA ≥2000 copies/mL obtained within 60 days prior to study entry performed with an ultrasensitive HIV-1 PCR assay.
  • Two HIV-1 RNA levels <150,000 copies/mL obtained within 60 days prior to study entry performed with an ultrasensitive HIV-1 PCR assay. These HIV-1 RNA measurements must be at least 48 hours apart and may include the HIV-1 RNA measurement done at the time of the screening visit.
  • Ongoing treatment with HIV entry inhibitors such as enfurvitide or maraviroc are excluded
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  • Cohort 2 Only:
  • On a stable antiretroviral medication (no changes to treatment within 4 weeks of study entry) and be willing to continue on current antiretroviral therapy for the duration of the study until undergoing structured treatment interruption.
  • CD4+ T cell count of ≥450 cells/mm3 at screen; and a documented CD4 nadir of not lower than 300 cells/mm.
  • HIV-1 RNA undetectable by ultrasensitive HIV PCR assay obtained within 60 days prior to study entry performed with an ultrasensitive HIV-1 PCR assay.
  • Cohort 3 only:
  • On a stable antiretroviral medication (no changes to treatment within 4 weeks of study entry) and be willing to continue on current antiretroviral therapy for the duration of the study.
  • CD4+ T cell count that is persistently <500 cells/mm3 despite at least 2 years of stable HAART and >200 cells/mm3 at screen
  • Subjects must have received at least 2 continuous years of therapy and have had undetectable viral loads by ultrasensitive assay since 6 months of therapy. Subjects who have had a single viral load blip at any point in this time, or who experience intermittent isolated episodes of detectable low-level viremia (detectable but <1000 copies RNA/mL; blips) will remain eligible.
  • Subjects who are currently taking maraviroc or have received maraviroc within 6 months of study entry are excluded.
  • HIV-1 infection, as documented by ELISA and confirmed by Western blot at any time prior to study entry. HIV-1 culture, HIV-1 antigen, plasma HIV-1 RNA, or a second antibody test by a method other than ELISA is acceptable as an alternative confirmatory test.
  • Adequate venous access and no other contraindications for leukapheresis.
  • Laboratory values obtained at screen. Hemoglobin: ≥ 10.0 (males); ≥ 9.5 (females) g/dL Absolute neutrophil count (ANC): ≥ 1000/mm3 Platelet count: ≥ 100,000/mm3 Serum creatinine: ≤ 1.5 mg/dL (133µ mol/L) Aspartate aminotransferase (AST) or alanine aminotransferase (ALT): ≤ 2.5 times the upper limit of normal (ULN).
  • Subjects must be willing to comply with study-mandated evaluations; including not changing their antiretroviral regimen (unless medically indicated) for 2 months in step 2 (Cohort 1) or until undergoing structured treatment interruption (Cohort 2).
  • Karnofsky Performance Score of 70 or higher

Who cannot join

  • Acute or chronic hepatitis B or hepatitis C infection
  • Current or prior AIDS diagnosis (Cohort 1 and 2 only)
  • History of cancer or malignancy, (basal cell or squamous cell carcinoma of the skin allowed)
  • History or problems with uncontrolled heart disease, bleeding or hemodynamic instability.
  • Have been previously treated with any HIV experimental vaccine within 6 months prior to screening, or any previous gene therapy using an integrating vector.
  • Use of the following medications within the last 30 days: chronic corticosteroids, hydroxyurea, or immunomodulating agents (e.g., interleukin-2, interferon-alpha or gamma, granulocyte colony stimulating factors, etc.)
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  • Breast-feeding, pregnant, or unwilling to use acceptable methods of birth control.
  • Use of aspirin, dyprydamole, warfarin or any other medication that is likely to affect platelet function or other aspects of blood coagulation during the 2-week period prior to leukapheresis.
  • Active drug or alcohol use or dependence that in the opinion of the investigator, would interfere with adherence to study requirements
  • Serious illness requiring systemic treatment and/or hospitalization within 30 days prior to study entry.
  • Receipt of a vaccination within 30 days prior to study entry.
  • Have an allergy or hypersensitivity to study product excipients (human serum albumin, DMSO and Dextran 40).
  • Currently taking medications called HIV entry inhibitors such as enfuvirtide or maraviroc

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

  • Jacobi Medical Cener

    The Bronx, New York, 10461

Other trials in United States

About this study

Official title: A Phase I Study of Autologous T-Cells Genetically Modified at the CCR5 Gene by Zinc Finger Nucleases SB-728 in HIV-Infected Patients

This research study is being carried out to study a new way to possibly treat HIV. This agent is called a "Zinc Finger Nuclease" or ZFN for short. ZFNs are proteins that can delete another protein named CCR5. This CCR5 protein is required for certain common types of HIV (CCR5 tropic) to enter into and infect T-cells. T-cells are one of the white blood cells used by the body to fight HIV. The most important T-cells are those called "CD4 T-cells."

Some people are born without CCR5 on their T-cells. These people remain healthy and are resistant to infection with HIV. Other people have a low number of CCR5 on their T-cells, and their HIV disease is less severe and is slower to cause disease (AIDS).

Read more

In order to delete the CCR5 protein on the T cells, this study will isolate large numbers of T-cells from subjects, and then deliver the ZFNs using a delivery vehicle called a viral vector. The viral vector used in this study is called an adenoviral vector. The vector is added to the cells at the beginning of the manufacture process and the ZFNs knock out the CCR5 protein. By the time T-cells are returned to subjects, there is minimal adenovirus or ZFN present. The removal of the CCR5 protein on the T-cells subjects receive, however, is permanent.

The purpose of this research study is to find out whether "zinc finger" modified T-cells are

  1. safe to give to humans and
  2. find how "zinc finger" modified T cell affects HIV

This is an experimental study. Laboratory studies have shown that when CD4 T-cells are modified with "zinc fingers", HIV is prevented from killing the CD4 T cells. On the basis of these laboratory results, there is the potential that "zinc fingers" may work in humans infected with HIV and improve their immune system by allowing their CD4 T-cells to survive longer (HIV usually kills T cells it infects).

All subjects who receive ZFN Modified CD4+T cells will enroll in a Long Term, Follow-up study to monitor subjects. Subjects will be followed every 3 months for four years. If the ZFN Modified CD4+T cells are no longer found in the blood after four years, then subjects will be contacted yearly for the next 6 years. If the ZFN Modified CD4+T cells are found in the blood at year four, then the subjects will continue to be seen once a year until the ZFN Modified CD4+T cells are no longer found in the blood for a maximum of 10 years.

Read the detailed description

Cohort 1 - Patients who have failed two more HAART regimens (6 subjects)

Cohort 2 - Patients doing well on a stable antiretroviral medication (6 subjects)

Cohort 3 - Patients who have an undetectable viral load on HAART who have exhibited suboptimal CD4+ T cell gains during long term antiretroviral therapy. This group will not participate in the structured treatment interruption. (6 subjects)

  1. Eligibility: Physical Exam, Medical History, Blood Draws for clinical labs and research.
  2. 1st Procedure to collect T cells (called apheresis)
  3. 2nd Procedure to collect T cells (called apheresis occurs ~3 weeks after 1st Apheresis)and Rectal Biopsy
  4. Clinic visit: Physical Exam, Blood Draw for clinical labs and research (~1 to 2 weeks after 2nd Apheresis)
  5. Infusion of ZFN modified T cells (~2weeks after Clinic Visit) Cohort 1 and Cohort 3 only:
  6. Follow up Clinic Visits 48, 72 hours; 1,2,3,6 weeks; 2,3,6, 9 months after ZFN infusion.

Cohort 2 Only:

  1. Stop Antiretroviral Medications 4 Weeks after ZFN modified T cell Infusion.
  2. Follow-up Clinic Visits 6, 8, 10, 12, 16, weeks after ZFN modified T cell Infusion.
  3. Restart Antiretroviral Medications 20 weeks after ZFN modified T cell Infusion.
  4. Follow-up Clinic Visits: monthly visits until no detectable HIV found in blood.
Conditions
HIV, HIV Infections
Being tested
ZFN modified T cells, Structured Treatment Interruption
Keywords
HIV, Treatment Experienced
Medical subject headings
HIV Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ZFN modified T cellsBiological

    A single infusion of 5-10 billion ZFN Modified CD4+ T Cells

  • Structured Treatment InterruptionOther

    Stop Taking HAART Medication for up to 12 weeks (4 weeks after infusion to 16 weeks after infusion)

Study groups in NCT00842634
Study groupRoleWhat they receive
Cohort 1ExperimentalPatients who have failed two more HAART regimens
Receives: Biological: ZFN modified T cells
Cohort 2ExperimentalPatients doing well on a stable antiretroviral medication
Receives: Biological: ZFN modified T cells; Other: Structured Treatment Interruption
Cohort 3ExperimentalPatients who have an undetectable viral load on HAART who have exhibited suboptimal CD4+ T cell gains during long term antiretroviral therapy. This group will not participate in the structured treatment interruption.
Receives: Biological: ZFN modified T cells

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Safety - Treatment related adverse events

    Measured: Cohort 1, Cohort 3 approximately 1 year from screening. Cohort 2 approximately 40 weeks from screening

Secondary outcomes (7)
  1. Compare the percent of CD4+ and CD8+ T cells that secrete cytokines as a response to stimulation by HIV-specific antigens after the infusion of αCCR5 ZFN-modified autologous T cells

    Measured: 8 weeks after the infusion of αCCR5 ZFN-modified autologous T cells

  2. Compare the CD4+ and CD8+ T cells response following stimulation by HIVspecific antigens, at baseline and 8 weeks after the infusion of CCR5 ZFN-modified autologous T cells.

    Measured: 8 weeks after the infusion of CCR5 ZFN-modified autologous T cells

  3. To evaluate the change between baseline CD4+ T-cell count and the average of two consecutive CD4+ T-cell count values after dosing and just prior to initiation of a new drug regimen or at weeks 8 and 12, whichever comes first.

    Measured: week 8 or 12

  4. Cohort 1: To evaluate the change between baseline log10 HIV-1 RNA level and the average of two consecutive viral load measurements of log10 HIV-1 RNA levels after dosing.

    Measured: weeks 8 and 12

  5. Cohort 2: To evaluate the time to recrudescence to >500 copies/ml viral load, and viral set point following STI as defined by the average of week 12 and 16 readings (week 8 and 12 post STI).

    Measured: Week 8 and Week 12

  6. To examine the persistence of CCR5 ZFN-modified autologous T cells in peripheral blood and gut mucosae.

    Measured: Cohort 1,3: Week 6 and Month 9. Cohort 2: Day 21, Week 16

  7. To monitor for viral drift from CCR5 to CXCR4 trophic virus post treatment using the Monogram Trofile assay, and change in genotypic viral resistance profile using the Monogram GenSeq assay.

    Measured: Cohort 2 only: Week 16

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Feb 2009 (estimated)
  2. Study startJan 2009
  3. Primary completionJan 2013
  4. Study completionJan 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
12 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00842634
Sponsor's protocol ID
806383
Acronym
Zinc-Finger
Status last verified
Feb 2019
First submitted
4 Feb 2009
Last updated
8 Feb 2019
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Tebas P, Stein D, Tang WW, Frank I, Wang SQ, Lee G, Spratt SK, Surosky RT, Giedlin MA, Nichol G, Holmes MC, Gregory PD, Ando DG, Kalos M, Collman RG, Binder-Scholl G, Plesa G, Hwang WT, Levine BL, June CH. Gene editing of CCR5 in autologous CD4 T cells of persons infected with HIV. N Engl J Med. 2014 Mar 6;370(10):901-10. doi: 10.1056/NEJMoa1300662.

    PubMed 24597865

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing ZFN modified T cells and Structured Treatment Interruption in people with HIV and HIV Infections, run by University of Pennsylvania at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 20 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Feb 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Safety - Treatment related adverse events (time frame: Cohort 1, Cohort 3 approximately 1 year from screening. Cohort 2 approximately 40 weeks from screening). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00842634, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Feb 2019.

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