884: Thymus Transplantation With Immunosuppression
Study Details
Study Description
Brief Summary
The research purpose is to determine if thymus transplantation with immunosuppression is a safe and effective treatment for complete DiGeorge anomaly. The research includes studies to evaluate whether thymus transplantation results in complete DiGeorge anomaly subjects developing a normal immune system.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 1 |
Detailed Description
DiGeorge anomaly is a complex of cardiac defects, parathyroid deficiency, and thymus absence, resulting in profound T-cell deficiency. There is a spectrum of disease in DiGeorge anomaly with respect to all three defects. For complete DiGeorge anomaly subjects with severe T cell defect, the PI had shown that thymus transplantation is safe and efficacious without pretransplantation immunosuppression and with pretransplantation Thymoglobulin and cyclosporine.
Some DiGeorge patients have very poor T cell function and are at risk of death from infection or other immune problems; however, these patients have enough T cell function to reject grafts. This protocol was designed for these patients. Atypical phenotype and some typical phenotype DiGeorge subjects were included in this protocol.
Atypical complete DiGeorge anomaly patients have rash, lymphadenopathy, and oligoclonal T cell proliferations. The T cells have no markers of thymic function (they do not co-express CD45RA and CD62L; they do not contain T cell receptor rearrangement excision circles, TRECs).
Typical complete DiGeorge anomaly patients in this protocol are those whose PHA response >20 fold. Although these patients have very low T cell function, it may be enough to reject a transplant, so Thymoglobulin was used.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: 1 Thymus Tissue for Transplantation |
Biological: Thymus Tissue for Transplantation
3 Thymoglobulin doses given prior to thymus tx. Atypical subjects given Cyclosporine (Csa) pre-tx. Desired Csa concentration 180-300ng/ml. If post-tx T cell count remained <4000/cumm Csa weaned over 8 weeks. If T cell >4,000/cumm, Csa held at 180-300ng/ml.
Thymus tissue, donor, & mother of donor were screened for transplant safety. In operating room, thymic slices were transplanted into quadriceps muscle in 1 or both legs.
Subjects had routine blood research immune evaluations. 2-3 months post-tx, open biopsy of allograft. Immune blood studies continued on surviving subjects until January 2010. Biological Mother: Mother provided blood sample used for DNA extraction, to identify/look for maternal T cell presence in recipient pre-tx, and/or for immune testing post-tx.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Safety & tolerability of Thymoglobulin and cyclosporine followed by thymus transplantation: Survival at 1 year post-transplantation. [1 year post-transplantation]
Secondary Outcome Measures
- Use of additional post transplant immunosuppression after that listed in the protocol. [The post thymus transplantation period]
Use of additional post transplant immunosuppression after that listed in the protocol.
- Allograft biopsy used to evaluate graft rejection [2 to 4 months post-transplant]
Evidence of thymus allograft rejection by immunohistochemistry of biopsy
- CD3 count [10 - 14 months post-transplantation]
CD3 count in cells/mm3
- Thymopoiesis [2-4 months after thymus transplantation]
Evidence of thymopoiesis in thymus allograft by immunohistochemistry of a biopsy
- CD4 count [10-14 months after thymus transplantation]
CD4 count in cells/mm3
- CD8 count [10-14 months after thymus transplantation]
CD8 count in cells/mm3
- naive CD4 count [10-14 months after thymus transplantation]
naive CD4 count in cells/mm3
- naive CD8 count [10-14 months after thymus transplantation]
naive CD8 count in cells/mm3
Eligibility Criteria
Criteria
Transplant Inclusion
-
No age limit
-
Thyroid studies must be done and if abnormal, must be on therapy
DiGeorge diagnosis - must have 1 symptom from the following list:
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Heart defect
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Hypocalcemia requiring replacement
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22q11 hemizygosity
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10p13 hemizygosity
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CHARGE association
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Abnormal ears plus mother with diabetes (type I, type II, or gestational)
Atypical Diagnosis:
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Must have, or have had, a rash. If rash present, biopsy of rash must show T cells in skin. If rash & adenopathy resolved, must still have oligoclonal T cells.
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Within 1 month of tx must have PHA response >20 fold above background or >5,000 cpm, whichever is higher, or response can be < this.
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Circulating CD3+ T cells >50/mm3 but CD45RA+CD62L+CD3+ T cells <50/mm or <5% of CD3 count, whichever is higher (must be done 2x)
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Immunoscope with >40% oligoclonal TCRBV families. A 2nd test per sponsor discretion if T cell numbers increase or activation status changes.
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If TREC done pre-tx must have TRECs <100 per 100,000 CD3+ cells.
Typical Diagnosis:
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Circulating CD3+ CD45RA+ CD62L+ T cells and <50/mm3 or <5% of total T cells
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PHA response >20 fold above background or >5,000 cpm, whichever is higher.
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2 studies must show similar immunological findings qualify for this study.
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TRECs, if done, should be <100/100,000 CD3 cells
Transplant Exclusion:
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Heart surgery <4 weeks pre-tx date
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Heart surgery anticipated w/in 3 months of proposed tx
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Rejection by surgeon or anesthesiologist as surgical candidates
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Lack of sufficient muscle tissue to accept 0.2 grams/kg transplant
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Duke University Medical Center | Durham | North Carolina | United States | 27710 |
Sponsors and Collaborators
- Enzyvant Therapeutics GmBH
- National Institutes of Health (NIH)
- National Institute of Allergy and Infectious Diseases (NIAID)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
- Principal Investigator: M. Louise Markert, MD, PhD, Duke University Medical Center, Pediatrics, Allergy & Immunology
Study Documents (Full-Text)
None provided.More Information
Publications
- Chinn IK, Olson JA, Skinner MA, McCarthy EA, Gupton SE, Chen DF, Bonilla FA, Roberts RL, Kanariou MG, Devlin BH, Markert ML. Mechanisms of tolerance to parental parathyroid tissue when combined with human allogeneic thymus transplantation. J Allergy Clin Immunol. 2010 Oct;126(4):814-820.e8. doi: 10.1016/j.jaci.2010.07.016. Epub 2010 Sep 15.
- Markert ML, Sarzotti M, Ozaki DA, Sempowski GD, Rhein ME, Hale LP, Le Deist F, Alexieff MJ, Li J, Hauser ER, Haynes BF, Rice HE, Skinner MA, Mahaffey SM, Jaggers J, Stein LD, Mill MR. Thymus transplantation in complete DiGeorge syndrome: immunologic and safety evaluations in 12 patients. Blood. 2003 Aug 1;102(3):1121-30. Epub 2003 Apr 17.
- Pro00013734
- R01AI047040
- R01AI054843
- 3R56AI047040-11A1S1
- R56 Bridge R01AI4704011A1
- 2R01AI047040-11A2
- 5K12HD043494-09
- #884