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Granulomatous Disease, Chronic, X-linkedPhase 1/2NCT02234934

Study of Gene Therapy Using a Lentiviral Vector to Treat X-linked Chronic Granulomatous Disease

A Phase 1/2 study testing Lentiviral G1XCGD Gene Therapy in people with Granulomatous Disease, Chronic, X-linked, run by University of California, Los Angeles at 3 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

Chronic Granulomatous Disease (CGD) is an inherited immunodeficiency disorder which results from defects that prevent white blood cells from effectively killing bacteria, fungi and other microorganisms. Chronic granulomatous inflammation may compromise vital organs and account for additional morbidity. Read more about this study

Who is it for?
Ages 23 months and older, men only
Conditions the study is for
Granulomatous Disease, Chronic, X-linked
What is being tested?
Lentiviral G1XCGD Gene Therapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
3 sitesUnited States
Study dates
29 Oct 2015to 1 Dec 2024
Phase
Phase 1/2
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 23 months and older
  • Men only
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • (Part A \& B)
  • Male X-CGD patients > 23 months of age
  • Molecular diagnosis confirmed by DNA sequencing and supported by laboratory evidence for absent or reduction > 95% of the biochemical activity of the NADPH-oxidase
  • At least one prior, ongoing or refractory severe infection and/or inflammatory complications requiring hospitalization despite conventional therapy
  • No 10/10 HLA-matched donor available after initial search of NMDP registries
  • No co-infection with Human Immunodeficiency Virus (HIV)-1 or -2, hepatitis B virus or hepatitis C virus, adenovirus, parvovirus B 19 or toxoplasmosis, or active infection with CMV
  • Written informed consent for adult patient, and assent for pediatric subjects seven years or older.
  • Parental/guardian and, where appropriate, child's signed consent/assent

Who cannot join

  • Age < 23 months
  • 10/10 HLA identical (A,B,C,DR,DQ) family or unrelated or cord blood donor unless there is deemed to be an unacceptable risk associated with an allogeneic procedure
  • Contraindication for leukapheresis or bone marrow harvest (anemia Hb <8g/dl, cardiovascular instability, severe coagulopathy)
  • Appropriate organ function as outlined below must be observed within 8 weeks of entering this trial.
  • Hematologic
  • Anemia (hemoglobin < 8 g/dL).
Show all 44Show fewer
  • Neutropenia (absolute granulocyte count <1,000/mm3)
  • Thrombocytopenia (platelet count < 150,000/mm3).
  • PT or PTT > 2X the upper limits of normal (patients with a correctable deficiency controlled on medication will not be excluded).
  • Cytogenetic abnormalities known to be associated with hematopoietic defect on peripheral blood or bone marrow.
  • Infectious
  • Evidence of co-infection with HIV-1, HIV-2, hepatitis B, Hepatitis C, adenovirus, parvovirus B19, toxoplasmosis. CMV infection is allowable as long as the infection is under control.
  • Pulmonary
  • Resting O2 saturation by pulse oximetry < 90% on room air.
  • Cardiac
  • Abnormal electrocardiogram (EKG) indicating cardiac pathology.
  • Uncorrected congenital cardiac malformation with clinical symptomatology.
  • Active cardiac disease, including clinical evidence of congestive heart failure, cyanosis, hypotension.
  • Poor cardiac function as evidenced by LV ejection fraction < 40% on echocardiogram.
  • Neurologic
  • Significant neurologic abnormality by examination.
  • Uncontrolled seizure disorder.
  • Renal
  • Renal insufficiency: serum creatinine ≥ 1.5 mg/dl, or ≥ 3+ proteinuria.
  • Abnormal serum sodium, potassium, calcium, magnesium, phosphate at grade III or IV by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
  • Hepatic/GI:
  • Serum transaminases > 5X the upper limit of normal (ULN).
  • Serum bilirubin > 2X ULN.
  • Serum glucose > 1.5x ULN.
  • Oncologic
  • Evidence of active malignant disease
  • General
  • Expected survival < 6 months
  • Major congenital anomaly
  • Ineligible for autologous HSCT by the criteria at the clinical site.
  • Contraindication for administration of conditioning medication. (Known sensitivity to Busulfan)
  • Administration of gamma-interferon within 30 days before the infusion of transduced, autologous CD34+ cells.
  • Participation in another experimental therapeutic protocol within 6 months prior to baseline and during the study period.
  • Tested positive (definitive) for the presence of multiple types (2 or more) of anti-platelet antibodies.
  • Any other condition that, in the opinion of the Investigator, may compromise the safety or compliance of the patient or would preclude the patient from successful study completion.
  • Patient/Parent/Guardian unable or unwilling to comply with the protocol requirements.
  • Part B Additional exclusion criteria:
  • Patients >12 years of age at enrolment
  • Patients ≤12 years of age with a body weight >40kg at enrolment

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • National Institutes of Health

    Bethesda, Maryland, 20892

  • Children's Hospital Boston

    Boston, Massachusetts, 90095

  • University of California, Los Angeles (UCLA)

    Los Angeles, California, 90095

Other trials in United States

About this study

Official title: A Two-Part, Phase I/II, Non Randomized, Multicenter, Open-Label Study of G1XCGD (Lentiviral Vector Transduced CD34+ Cells) in Patients With X-Linked Chronic Granulomatous Disease

Chronic Granulomatous Disease (CGD) is an inherited immunodeficiency disorder which results from defects that prevent white blood cells from effectively killing bacteria, fungi and other microorganisms. Chronic granulomatous inflammation may compromise vital organs and account for additional morbidity. CGD is thought to affect approximately 1 in 200,000 persons, although the real incidence might be higher due to under-diagnosis of milder phenotypes.

The first gene therapy approaches in X-CGD have shown that effective gene therapy requires bone-marrow (BM) conditioning with chemotherapy to make space for the gene-modified cells to engraft. These studies demonstrated that transplantation of gene modified stem cells led to production of white blood cells that could clear existing infections. However, some trials using mouse-derived retroviral vectors were complicated by the development of myelodysplasia and leukemia-like growth of blood cells. This trial will evaluate a new lentiviral vector that may be able to correct the defect, but have much lower risk for the complication.

This study is a two-part, prospective non-controlled, non-randomized Phase I/II clinical trial to assess the safety, feasibility and efficacy of cellular gene therapy in patients with chronic granulomatous disease using transplantation of autologous bone marrow CD34+ cells transduced ex vivo by the G1XCGD lentiviral vector containing the human CGD gene. Primary objectives include evaluation of safety and evaluation of efficacy by biochemical and functional reconstitution in progeny of engrafted cells and stability at 12 months. Secondary objectives include evaluation of clinical efficacy, longitudinal evaluation of clinical effect in terms of augmented immunity against bacterial and fungal infection, transduction of CD34+ hematopoietic cells from X-CGD patients by ex vivo lentivirus-mediated gene transfer, and evaluation of engraftment kinetics and stability. Approximately 3-6 patients will be treated per site with a goal of 16 total patients to be treated with G1XCGD lentiviral vector.

Read the detailed description

The therapeutic product to be evaluated is autologous CD34+ hematopoietic stem cells (HSC) modified by ex vivo transduction using the pCCLchimGP91WPRE lentiviral vector (G1XCGD Modified Autologous BM CD34 cells) containing the human CGD gene. The G1XCGD lentiviral vector is a 3rd generation self-inactivating lentiviral vector which directs gp91phox expression from a codon-optimized form of the CYBB gene preferentially to myeloid cells, with a modified WPRE (PRE4).

G1XCGD is an integrative, 3rd generation replication-defective, self-inactivating (SIN) HIV-derived Lentiviral (LV) vector, with a mutated Woodchuck hepatitis virus Posttranscriptional Regulatory Element (WPRE) sequence. A LV vector derived from HIV-1 has been chosen with respect to LV natural properties: they are genetically stable, permanently integrate into the genome of transduced cells and provide long-term gene expression in vitro and in vivo. The transduction of Hematopoietic Stem Cells (HSC) with such LV can be achieved after limited pre-activation of the cells in short-term cultures with cytokines, in conditions that are compatible with the preservation of the self-renewing capacities of these cells. These properties make these LV suitable for ex-vivo gene therapy strategies using HSC.

G1XCGD provirus includes a chimeric promoter designed to regulate the transgene expression in myeloid cells and a transgene called GP91 (also known as CYBB), which is a codon-optimized cDNA sequence of the human CYBB gene also known as GP91-PHOX or NOX2 gene. The promoter is a synthetic chimeric element created by the fusion of c-Fes and Cathepsin G minimal 5'-flanking regions. Cathepsin G is a serine protease stored in the azurophil granules of neutrophil granulocytes. Part of the chimeric promoter contains binding sites for myeloid transcription factors C/EBP and PU.1 from the upstream region of the transcription start site of the Cathepsin G gene. The other part of the chimeric promoter is a human c-Fes sequence that has been added to enhance the Cathepsin G promoter activity in granulocytic cells. The resulting chimeric promoter is able to i) regulate the expression of the GP91 transgene in myeloid cells in a specific manner, and ii) to effectively restore NADPH-oxidase activity in granulocytes, as reported by Santilli et al. (Santilli et al., 2011) and confirmed in preclinical studies conducted with the G1XCGD vector. The GP91 transgene codes for the 570 amino-acid cytochrome b-245, a 91 kD beta polypeptide that is also known as the NADPH-oxidase catalytic subunit gp91-phox, or cytochrome b-245 heavy chain, or gp91-phox protein.

Being tested
Lentiviral G1XCGD Gene Therapy
Keywords
Gene Therapy, X-Linked Chronic Granulomatous Disease (X-CGD), Lentiviral Vector
Medical subject headings
Granulomatous Disease, Chronic

What participants receive

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

  • Lentiviral G1XCGD Gene TherapyBiological

    Also called G1XCGD (pCCLChimGp91/VSVg lentiviral vector)

    The investigational product is patient-specific and corresponds to autologous CD34+ cells transduced ex vivo with the G1XCGD vector in their final suspension. The starting materials used for the production of the investigational product consist of the viral vector and the patient's CD34+ cells.

    The G1XCGD vector is used to transduce autologous CD34+ cells ex vivo. These transduced cells are then frozen, and an aliquot tested and characterized for quality. If the cell product passes release criteria, it is thawed at bedside and infused into the patient after the patient has received myelo-ablative conditioning. The cell/product dose will consist of at least 3 x 10^6 cells per kg of body weight transduced ex vivo with 1 x 10^8 IG/mL of lentiviral vector to achieve > 0.3 integrated copies per cell.

Study groups in NCT02234934
Study groupRoleWhat they receive
Lentiviral G1XCGD Gene Therapy, Part AExperimentalTransplantation with autologous CD34+ stem cells corrected with X1XCGD lentiviral vector after myeloreductive conditioning
Receives: Biological: Lentiviral G1XCGD Gene Therapy
Lentiviral G1XCGD Gene Therapy, Part BExperimentalTransplantation with autologous CD34+ stem cells corrected with X1XCGD lentiviral vector after modified myeloreductive conditioning including increased monitoring and rescue treatment
Receives: Biological: Lentiviral G1XCGD Gene Therapy

What is being measured

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

  1. The incidence of adverse events assessed by CTCAE v4

    Record clinical significant adverse events, laboratory abnormalities, monitor overall adverse events for the study as a whole, including serious adverse events

    Measured: up to 2 years

  2. Measuring percentage of subjects who have ≥ 10% oxidase positive granulocytes

    Oxidase positive granulocytes for each subject will be assessed by DHR flow cytometry

    Measured: At month 12 after transplant

Timeline

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

  1. First posted9 Sep 2014 (estimated)
  2. Study start29 Oct 2015
  3. Primary completion1 Sep 2024
  4. Study completion1 Dec 2024

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 1/2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
10 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02234934
Sponsor's protocol ID
G1XCGD
Other IDs
2P01HL073104
Status last verified
May 2025
First submitted
4 Sep 2014
Last updated
2 May 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: Results will be published in scientific literature once trial is completed and data analysis is done.

Publications

  • Santilli G, Almarza E, Brendel C, Choi U, Beilin C, Blundell MP, Haria S, Parsley KL, Kinnon C, Malech HL, Bueren JA, Grez M, Thrasher AJ. Biochemical correction of X-CGD by a novel chimeric promoter regulating high levels of transgene expression in myeloid cells. Mol Ther. 2011 Jan;19(1):122-32. doi: 10.1038/mt.2010.226. Epub 2010 Oct 26.

    PubMed 20978475
  • Brendel C, Rothe M, Santilli G, Charrier S, Stein S, Kunkel H, Abriss D, Muller-Kuller U, Gaspar B, Modlich U, Galy A, Schambach A, Thrasher AJ, Grez M. Non-Clinical Efficacy and Safety Studies on G1XCGD, a Lentiviral Vector for Ex Vivo Gene Therapy of X-Linked Chronic Granulomatous Disease. Hum Gene Ther Clin Dev. 2018 Jun;29(2):69-79. doi: 10.1089/humc.2017.245. Epub 2018 Apr 17.

    PubMed 29664709

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Lentiviral G1XCGD Gene Therapy in people with Granulomatous Disease, Chronic, X-linked, run by University of California, Los Angeles at 3 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 8 inclusion and 44 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 2 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 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 combined 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.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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?

The incidence of adverse events assessed by CTCAE v4 (time frame: up to 2 years). The study lists 2 primary outcomes in all. 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 NCT02234934, which also lists 2 linked publications.

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 2 May 2025.

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