Open-label Investigation of the Safety and Efficacy of DIABECELL in Patients With Type 1 Diabetes Mellitus

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Living Cell Technologies
ClinicalTrials.gov Identifier:
NCT01736228
First received: November 26, 2012
Last updated: October 20, 2013
Last verified: October 2013
  Purpose

The purpose of this study is to establish the efficacy and safety of xenotransplantation of DIABECELL [immunoprotected (alginate-encapsulated) porcine islets] in patients with established type 1 diabetes mellitus


Condition Intervention Phase
Type 1 Diabetes
Device: DIABECELL
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase IIb Open-label Investigation of the Safety and Efficacy of DIABECELL [Immunoprotected (Alginate-Encapsulated) Porcine Islets for Xenotransplantation] in Patients With Type 1 Diabetes Mellitus

Resource links provided by NLM:


Further study details as provided by Living Cell Technologies:

Primary Outcome Measures:
  • to establish the efficacy and safety of DIABECELL [ Time Frame: 52 weeks ] [ Designated as safety issue: Yes ]
    1. Restoration of sustained euglycaemia, in particular avoidance of severe hypoglycaemia, with a reduction in unaware hypoglycaemic events, without an increase in insulin dose
    2. Safety of xenotransplantation of DIABECELL [immunoprotected (alginate-encapsulated) porcine islets]


Secondary Outcome Measures:
  • Porcine β-cell function as demonstrated by measurement of porcine pro-insulin in xenotransplant recipients [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]
  • Improvement in the quality-of-life of xenotransplant recipients [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 20
Study Start Date: November 2012
Estimated Study Completion Date: December 2014
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: DIABECELL
two transplants of 10,000 IEQ/kg DIABECELL (administered at least 12 weeks apart)- total of 20,000 IEQ/kg
Device: DIABECELL
two transplants of 10,000 IEQ/kg DIABECELL (administered at least 12 weeks apart)- total of 20,000 IEQ/kg

Detailed Description:

Intraperitoneal islet transplantation has the potential to ameliorate type 1 diabetes mellitus and avert the long-term consequences of chronic diabetes which cannot be achieved by conventional insulin treatment.

As donor human islets are not available in sufficient numbers, porcine islets are the best alternative source as they are recognised as the most physiologically compatible xenogeneic insulin-producing cells. Although the use of pig-derived cells raises the risk of xenotic infections, this can be minimised by obtaining cells from designated pathogen-free (DPF) animals bred in isolation and monitored to be free of specified pathogens. The worldwide experience to date in more than 200 patients who have received transplants of pig tissue has not demonstrated evidence of transmitted xenotic infections.

As animal-derived tissues have to be protected from immune rejection when transplanted into humans, transplants are usually accompanied by immunosuppressive therapy. However, porcine islets are preferably transplanted without the use of immunosuppressive drugs which cause significant morbidity. To protect them from immune rejection, the islets can be encapsulated in alginate microcapsules which permit the inward passage of nutrients and glucose and the outward passage of insulin. Alginate-encapsulated porcine islets transplanted without immunosuppressive drugs have survived rejection for many months in animal studies.

DIABECELL comprises neonatal porcine islets encapsulated in alginate microcapsules. DIABECELL has been safely transplanted in healthy and diabetic mice, rats, rabbits, dogs and non-human primates. Following DIABECELL transplants, the requirement for daily insulin was significantly reduced in diabetic rats and non-human primates.

The optimal dose and frequency of transplantation of the current DIABECELL preparation for the treatment of type 1 diabetes in humans can only be determined in clinical trials. The intention of this phase IIb clinical trial is to obtain at least 52 weeks safety and preliminary efficacy data in type 1 diabetic patients following transplantation of two effective doses of DIABECELL into the peritoneal cavity.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adults (males or females) in the age range 18 to 65 years
  • Diagnosis of type 1 diabetes mellitus (minimum duration of 5 years) in accordance with the American Diabetes Association's criteria. Patients should have been treated continuously with insulin since diagnosis (Expert Committee on the Diagnosis and Classification of Diabetes Mellitus 2002)
  • Patients with established brittle type I diabetes mellitus with a well-documented chronic history of metabolic instability who cannot achieve acceptable metabolic control (which may include treatment with the use of a continuous insulin infusion pump) without experiencing multiple episodes of hypoglycaemia, often with unawareness
  • Patients with an HbA1C ≤12% prior to receiving their first xenotransplant
  • Plasma C-peptide <0.3 ng/mL following a glucagon stimulation test (Scheen et al. 1996)
  • If female, no childbearing capability (those who are more than two years postmenopausal or have undergone voluntary sterilisation can be considered for enrolment) or if childbearing potential, agree to the insertion of an intrauterine device (IUD) for the duration of the study
  • Provision of written informed consent. Patients will be required to agree to comply with all tests and visits specified in the protocol, and they (and their partners/close contacts) will also be required to consent to long-term microbiological monitoring, which is an integral part of the study

Exclusion Criteria:

  • Type 2 diabetes, defined as age of onset >30 years and/or a history of treatment with oral hypoglycaemic medications and/or insulin resistance (defined as an insulin dose requirement ≥1.2 U/kg/day)
  • An HbA1C >12% prior to receipt of the first xenotransplant Body mass index (BMI) ≥28 kg/m2
  • Active infection, with plasma C-reactive protein ≥10 mg/L at baseline
  • Previous receipt of an organ, skin graft, or other tissue transplant from a human or animal donor
  • Treatment with immunosuppressive medications for another medical condition
  • Previous history of peritoneal disease or abnormal findings at baseline laparoscopy
  • Previous abdominal surgery, excluding uncomplicated appendectomy, cholecystectomy or caesarean section
  • History of pelvic inflammatory disease or endometriosis
  • Inability to tolerate oral medications or a history of significant malabsorption
  • HIV antibody and/or risk factors for HIV infection
  • Positive hepatitis C antibody, positive hepatitis B surface antigen and hepatitis B core antibody
  • Kidney disease, defined as serum creatinine >130 μmol/L in men and >110 μmol/L in women and/or urinary albumin >500 mg/L and/or haematuria and/or active urinary sediment or casts
  • Diabetes microvascular complications defined as untreated, potentially vision-threatening proliferative or pre-proliferative retinopathy or maculopathy; painful peripheral neuropathy; autonomic neuropathy manifesting as postural hypotension; gastroparesis or diabetic enteropathy
  • Serious comorbid conditions that are likely to affect participation in the study, including:

    1. Previous coronary heart disease manifesting as non-ST elevation myocardial infarction (NSTEMI), Q-wave infarction or unstable angina; coronary artery bypass graft (CABG); or percutaneous angioplasty
    2. Previous cerebrovascular disease manifesting as transient ischaemic attacks (TIAs) or stroke
    3. Peripheral vascular disease with previous amputation
    4. History of New York Heart Association (NYHA) class II, III or IV congestive heart failure (CHF) and/or chronic atrial fibrillation
    5. Chronic obstructive pulmonary disease (COPD) or asthma with previous hospitalisation for decompensation; a requirement for mechanical ventilation at any stage; or long-term treatment with oral corticosteroids
    6. Liver disease with abnormal liver function tests defined as serum bilirubin ≥20 µmol/L, and/or ALT ≥100 U/L, and/or GGT ≥100 U/L, and/or albumin <35 g/L
    7. Haematological disorders, including haemoglobin ≤110 g/L or platelet count <80 x 109/L
    8. Peptic ulcer disease and/or history of previous gastrointestinal bleeding
    9. Malignancy other than basal cell carcinoma
    10. History of epilepsy
    11. Untreated hypothyroidism
    12. Known adrenal insufficiency
  • History of drug, substance or alcohol addiction
  • Any factor detected from psychometric evaluation at Visit 2 pre-transplant during the screening period which may in the opinion of the Clinical Psychologist affect an individual's ability to fully participate in the study
  • Any other condition that, in the opinion of the Investigator, may interfere with adherence to the study protocol, including dementia, mental illness, or a history of non-adherence to appointments or treatments
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01736228

Locations
Argentina
Hospital Interzonal General de Agudos Eva Perón
San Martin, Buenos Aires, Argentina, 3200
Sponsors and Collaborators
Living Cell Technologies
Investigators
Principal Investigator: Adrián Abalovich Eva Perón Hospital, San Martín,
  More Information

Additional Information:
No publications provided

Responsible Party: Living Cell Technologies
ClinicalTrials.gov Identifier: NCT01736228     History of Changes
Other Study ID Numbers: LCT/DIA-12
Study First Received: November 26, 2012
Last Updated: October 20, 2013
Health Authority: Argentina: Ministry of Health

Keywords provided by Living Cell Technologies:
xenotransplantation
type 1 diabetes
porcine islets

Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases

ClinicalTrials.gov processed this record on September 18, 2014