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Antibody-mediated RejectionEUROEXPORT-DSANCT06112951

A Prospective Randomized Trial of ECP in Subclinical AMR

A study testing Extracorporeal Photopheresis in people with Antibody-mediated Rejection and Lung Transplant Rejection, run by Medical University of Vienna at 7 sites in 7 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to evaluate the therapeutic effect of extracorporeal photopheresis in subclinical antibody-mediated rejection after lung transplantation.The main questions it aims to answer are: 1. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Extracorporeal Photopheresis
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
80 participants
Where
7 sitesin 7 countries
Study dates
1 Mar 2024to 1 Jun 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

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

  • Bilateral lung transplantation
  • dnDSAs > 3 months with a MFI > 1000
  • No signs of allograft dysfunction
  • Alemtuzumab induction therapy
  • Retransplantation
  • Multi-organ transplantation
  • > 12 months after transplantation

Who cannot join

None listed.

Trial locations and contacts

7 sites in 7 countries. Contact the study team or a site near you to ask about taking part.

7 sites in 7 countries

Austria1 site, 1 recruiting
  • Medical University of Vienna

    Vienna, 1090

    Alberto Benazzo, MD PhD, 00436766093043, alberto.benazzo@meduniwien.ac.at

    Alberto Benazzo, MD PhD

    Recruiting

Other trials in Austria

Belgium1 site, 1 recruiting
  • UZ Leuven

    Leuven

    Robin Vos

    Not yet recruiting

Other trials in Belgium

Croatia1 site, 1 recruiting
  • University Hospital Center Zagreb

    Zagreb

    Feđa Džubur

    Not yet recruiting

Other trials in Croatia

Denmark1 site, 1 recruiting
  • Copenhagen University Hospital, Rigshospitalet

    Copenhagen

    Michael Perch

    Not yet recruiting

Other trials in Denmark

France1 site, 1 recruiting
  • Hôpital Foch

    Suresnes

    Jonathan Messika

    Not yet recruiting

Other trials in France

Italy1 site, 1 recruiting
  • Policlinico San Matteo Pavia Fondazione IRCCS

    Pavia

    Federica Meloni

    Not yet recruiting

Other trials in Italy

Slovenia1 site, 1 recruiting
  • University Medical Centre Ljubljana

    Ljubljana

    Matevž Harlander

    Not yet recruiting

Other trials in Slovenia

About this study

Official title: The Use of Extracorporeal Photopheresis as Immunomodulatory Therapy of Subclinical Antibody-mediated Rejection After Lung Transplantation: a Prospective RCT

The goal of this clinical trial is to evaluate the therapeutic effect of extracorporeal photopheresis in subclinical antibody-mediated rejection after lung transplantation.The main questions it aims to answer are:

  1. Does ECP therapy result in a significant reduction in MFI (Mean Fluorescence Intensity) from the baseline MFI in clinically stable patients with persistent (>6 months) dnDSAs (MFI>1000)?
  2. What is the impact of ECP therapy on the following outcomes in these patients: ACR, clinical AMR, CLAD, infections, drop-out rate, survival, adverse events?
Read more

Participants will be randomized into two groups. Each group will include 40 patients. The control group will be observed and no active treatment will be administered. The treatment group will receive extracorporeal photopheresis. First, a two-day treatment cycle will be performed once every second week for the first two months. Then, a two-day treatment cycle will be performed once a month for 6 months.

Researchers will compare the two groups regarding: MFI value, development of ACR, clinical AMR, CLAD, infections, survival, adverse events, immunophenotyping, miRNA expression profiling, cytokine expression, gene expression signature of PBMCs and proteomic characterization.

Read the detailed description

Donor-specific antibodies (DSA) and antibody-mediated rejection have gained significant attention recently due to their serious consequences, but there are limited effective treatments for persistent DSAs in patients without graft dysfunction due to their associated severe side effects. Our center demonstrated that extracorporeal photopheresis (ECP) can potentially reduce the mean fluorescence intensity of dnDSAs in recipients with antibody-mediated rejection (AMR), suggesting it as a safe option for treating subclinical AMR with dnDSAs and inducing tolerogenic immunomodulation in this complex population.

The hypothesis underlying the proposed randomized controlled trial is that ECP might have the potential to reduce the burden of de novo donor-specific antibodies after lung transplantation, by modulating host humoral alloresponse and promoting tolerance, without provoking side effects.

Our primary objective is to evaluate the therapeutic effect of ECP in terms of reduction of dnDSAs titer in clinically stable patients with persistent (>6 months) dnDSAs (MFI>1000). As secondary objective, we intend to assess the therapeutic effect of ECP on incidence of clinical AMR, ACR, CLAD, survival and occurrence of infectious complications as well as the rate of adverse effects. Our experimental objectives are to provide an in-depth analysis of the immunological effects of ECP.

80 patients with persistent dnDSAs (> 3 months) with a MFI > 1000 will be randomized into two groups. Each group will include 40 patients. Patients will be stratified according to the presence of HLA-DQ. The control group will be observed and no active treatment will be administered. This is our standard of care in the studied clinical situation. Treatment group will receive extracorporeal photopheresis. First, a two-day treatment cycle will be performed once every second week for the first two months. Then, a two-day treatment cycle will be performed once a month for 6 months. To elucidate the specific mechanisms of ECP in modulating humoral alloresponse, a series of studies are planned: 1) flow cytometric immunophenotyping, 2) miRNA expression profiling, 3) cytokine expression, 4) gene expression signature of PBMCs, 5) proteomic characterization.

The proposed study aims to address this clinical need by investigating the effects of a safe therapeutic modality such as ECP. This study may have a dual benefit: first, it may reduce the burden of dnDSAs in lung transplant recipients, thereby reducing the incidence of antibody-mediated rejection, and second, it may promote host tolerance to the graft. In addition, we will investigate the immunomodulatory mechanisms of ECP in the context of humoral allogeneic response, which has not been previously investigated.

Being tested
Extracorporeal Photopheresis

What participants receive

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

  • Extracorporeal PhotopheresisProcedure or surgery

    Patients randomized into the interventional group will receive ECP. ECP will be started within one week after randomization. Initially a two-day treatment cycle will be performed once every second week for the first two months. Then, a two-day treatment cycle will be performed once a month for 6 months.

Study groups in NCT06112951
Study groupRoleWhat they receive
Treatment GroupExperimentalTreatment group will receive extracorporeal photopheresis. First, a two-day treatment cycle will be performed once every second week for the first two months. Then, a two-day treatment cycle will be performed once a month for 6 months.
Receives: Procedure: Extracorporeal Photopheresis
Control GroupNo interventionControl group will be observed and no active treatment will be administered. This is our standard of care in the studied clinical situation.

What is being measured

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

  1. Reduction of dnDSA titer from baseline MFI

    Difference of MFI values at the start and at the end of the six month period

    Measured: 6 months

Secondary outcomes (1)
  1. Incidence of clinical AMR, ACR, CLAD, survival, infectious complications, adverse effects

    Incidence of clinical AMR, ACR, CLAD, survival, infectious complications, adverse effects

    Measured: 6 months

Timeline

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

  1. First posted2 Nov 2023
  2. Study start1 Mar 2024
  3. Primary completion1 Mar 2027 (estimated)
  4. Study completion1 Jun 2027 (estimated)

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06112951
Sponsor's protocol ID
1578/2023
Acronym
EUROEXPORT-DSA
Status last verified
Jul 2024
First submitted
9 Oct 2023
Last updated
9 Jul 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There is not a plan to make IPD available.

Publications

  • Chambers DC, Perch M, Zuckermann A, Cherikh WS, Harhay MO, Hayes D Jr, Hsich E, Khush KK, Potena L, Sadavarte A, Lindblad K, Singh TP, Stehlik J; International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report - 2021; Focus on recipient characteristics. J Heart Lung Transplant. 2021 Oct;40(10):1060-1072. doi: 10.1016/j.healun.2021.07.021. Epub 2021 Jul 31.

    PubMed 34446355
  • Benazzo A, Auner S, Boehm PM, Morscher A, Schwarz S, Vidmar B, Dzubur F, Schweiger T, Hoda AM, Moser B, Matilla JR, Murakozy G, Lang G, Taghavi S, Klepetko W, Hoetzenecker K, Jaksch P. Outcomes with alemtuzumab induction therapy in lung transplantation: a comprehensive large-scale single-center analysis. Transpl Int. 2021 Dec;34(12):2633-2643. doi: 10.1111/tri.14153. Epub 2021 Nov 16.

    PubMed 34738249
  • Iasella CJ, Ensor CR, Marrari M, Mangiola M, Xu Q, Nolley E, Moore CA, Morrell MR, Pilewski JM, Sanchez PG, McDyer JF, Zeevi A. Donor-specific antibody characteristics, including persistence and complement-binding capacity, increase risk for chronic lung allograft dysfunction. J Heart Lung Transplant. 2020 Dec;39(12):1417-1425. doi: 10.1016/j.healun.2020.09.003. Epub 2020 Sep 10.

    PubMed 32981841
  • Benazzo A, Worel N, Schwarz S, Just U, Nechay A, Lambers C, Bohmig G, Fischer G, Koren D, Murakozy G, Knobler R, Klepetko W, Hoetzenecker K, Jaksch P. Outcome of Extracorporeal Photopheresis as an Add-On Therapy for Antibody-Mediated Rejection in Lung Transplant Recipients. Transfus Med Hemother. 2020 Jun;47(3):205-213. doi: 10.1159/000508170. Epub 2020 May 5.

    PubMed 32595425
  • Gasparro FP, Felli A, Schmitt IM. Psoralen photobiology: the relationship between DNA damage, chromatin structure, transcription, and immunogenic effects. Recent Results Cancer Res. 1997;143:101-27. doi: 10.1007/978-3-642-60393-8_8. No abstract available.

    PubMed 8912415
  • Kurts C, Kosaka H, Carbone FR, Miller JF, Heath WR. Class I-restricted cross-presentation of exogenous self-antigens leads to deletion of autoreactive CD8(+) T cells. J Exp Med. 1997 Jul 21;186(2):239-45. doi: 10.1084/jem.186.2.239.

    PubMed 9221753
  • Maeda A, Schwarz A, Bullinger A, Morita A, Peritt D, Schwarz T. Experimental extracorporeal photopheresis inhibits the sensitization and effector phases of contact hypersensitivity via two mechanisms: generation of IL-10 and induction of regulatory T cells. J Immunol. 2008 Nov 1;181(9):5956-62. doi: 10.4049/jimmunol.181.9.5956.

    PubMed 18941184
  • Maeda A, Schwarz A, Kernebeck K, Gross N, Aragane Y, Peritt D, Schwarz T. Intravenous infusion of syngeneic apoptotic cells by photopheresis induces antigen-specific regulatory T cells. J Immunol. 2005 May 15;174(10):5968-76. doi: 10.4049/jimmunol.174.10.5968.

    PubMed 15879089
  • Edelson RL. Mechanistic insights into extracorporeal photochemotherapy: efficient induction of monocyte-to-dendritic cell maturation. Transfus Apher Sci. 2014 Jun;50(3):322-9. doi: 10.1016/j.transci.2013.07.031. Epub 2013 Aug 8.

    PubMed 23978554
  • Knobler R. Extracorporeal photochemotherapy--present and future. Vox Sang. 2000;78 Suppl 2:197-201.

    PubMed 10938952
  • Teruel Montoya R, López-Godino O, Garcia-Barbera N, et al. Identification of Circulating microRNA Signatures As Potential Noninvasive Biomarkers for Prediction to Response to Extracorporeal Photoapheresis in Patients with Graft Versus Host Disease. Blood 2019;134:4466-.

  • Bozzini S, Del Fante C, Morosini M, Berezhinskiy HO, Auner S, Cattaneo E, Della Zoppa M, Pandolfi L, Cacciatore R, Perotti C, Hoetzenecker K, Jaksch P, Benazzo A, Meloni F. Mechanisms of Action of Extracorporeal Photopheresis in the Control of Bronchiolitis Obliterans Syndrome (BOS): Involvement of Circulating miRNAs. Cells. 2022 Mar 25;11(7):1117. doi: 10.3390/cells11071117.

    PubMed 35406680
  • Morrell MR, Despotis GJ, Lublin DM, Patterson GA, Trulock EP, Hachem RR. The efficacy of photopheresis for bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant. 2010 Apr;29(4):424-31. doi: 10.1016/j.healun.2009.08.029. Epub 2009 Oct 22.

    PubMed 19853479
  • Jaksch P, Scheed A, Keplinger M, Ernst MB, Dani T, Just U, Nahavandi H, Klepetko W, Knobler R. A prospective interventional study on the use of extracorporeal photopheresis in patients with bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant. 2012 Sep;31(9):950-7. doi: 10.1016/j.healun.2012.05.002.

    PubMed 22884382
  • Greer M, Liu B, Magnusson JM, Fuehner T, Schmidt BMW, Deluca D, Falk C, Ius F, Welte T. Assessing treatment outcomes in CLAD: The Hannover-extracorporeal photopheresis model. J Heart Lung Transplant. 2023 Feb;42(2):209-217. doi: 10.1016/j.healun.2022.09.022. Epub 2022 Oct 5.

    PubMed 37071121

Questions about this trial

What is this clinical trial studying?

A study testing Extracorporeal Photopheresis in people with Antibody-mediated Rejection and Lung Transplant Rejection, run by Medical University of Vienna at 7 sites in 7 countries.

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 7 inclusion and 0 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: looking for participants now, as of the sponsor's last update on 9 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Austria, Belgium, Croatia, Denmark, France and 2 more countries. 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.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Caroline Hillebrand, MD (+4314040069470 ext. +436641107970, caroline.hillebrand@outlook.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Reduction of dnDSA titer from baseline MFI (time frame: 6 months). 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 NCT06112951, which also lists 51 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 9 Jul 2024.

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