Gene Therapy for Huntington's Disease

Recruiting at 1 trial location

Overseen By Andrew Duker, MD

Age: 18+

Sex: Any

Trial Phase: Phase 1 & 2

Sponsor: Spark Therapeutics, Inc.

Must be taking: Cholinesterase inhibitors, Antipsychotics

Must not be taking: Antisense oligonucleotides

Disqualifiers: Deep brain stimulation, Gene therapy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 1 day

53 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that certain medications, like cholinesterase inhibitors, memantine, amantadine, riluzole, antidepressants, benzodiazepines, antipsychotics, and others for motor symptoms, must be at a stable dose for at least 12 weeks before starting the trial and remain stable during the first 12 months. If you are on these medications, you will need to keep your dose unchanged.

What data supports the effectiveness of the treatment SPK-10001 for Huntington's Disease?

Research on similar gene therapies, like the use of adeno-associated virus (AAV) vectors to deliver RNA interference (RNAi) in mouse models, shows promise in reducing harmful proteins and improving symptoms in Huntington's Disease. This suggests that SPK-10001, if it uses similar methods, might also be effective. ^{1 2 3 4 5}

Is gene therapy for Huntington's Disease generally safe in humans?

Gene therapy approaches for Huntington's Disease, like RNA interference, have shown no adverse effects in non-human primates, but some issues were observed in mice. Sodium phenylbutyrate, another treatment, was safe at certain doses in humans, but higher doses caused side effects like vomiting and confusion. ^{6 7 8 9 10}

How does the treatment SPK-10001 for Huntington's Disease differ from other treatments?

SPK-10001 is a gene therapy that likely uses a viral vector to deliver genetic material aimed at reducing the expression of the mutant huntingtin protein, which is the root cause of Huntington's Disease. This approach is unique because it targets the genetic cause of the disease rather than just alleviating symptoms, potentially offering a more effective and long-term solution. ^{1 11 12 13 14}

What is the purpose of this trial?

The main goal of this study is to evaluate the safety, tolerability, and preliminary efficacy of SPK-10001 in participants with Huntington's Disease.

Eligibility Criteria

This trial is for individuals with Huntington's Disease who have specific motor and functional scores, stable medication use for certain conditions, and confirmed genetic markers. Participants must not be on fluctuating doses of medications like cholinesterase inhibitors or antipsychotics.

Inclusion Criteria

I've been on a stable dose of certain brain medications for 12 weeks and can keep the dose the same for the next 12 months.

My antidepressant or benzodiazepine dose has been stable for 12 weeks and will remain so after starting SPK-10001.

My brain scans show early-stage Huntington's disease-related changes.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a one-time, bilateral, intraparenchymal infusion of SPK-10001 or placebo into the caudate and putamen

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety, tolerability, and preliminary efficacy after treatment

12 months

Regular visits (in-person)

Treatment Details

Interventions

• SPK-10001

Trial Overview The study tests the safety and potential benefits of SPK-10001 gene therapy compared to a placebo surgery control in people with Huntington's Disease. It aims to see if this new treatment can improve their condition.

Participant Groups

Group I: SPK-10001 Experimental Treatment 1 Intervention

Group II: Placebo Surgery Control Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Spark Therapeutics, Inc.

Lead Sponsor

Trials

16

Recruited

410+

Findings from Research

Huntington's disease (HD) is a promising target for gene therapy due to its single genetic cause, making it potentially easier to develop effective treatments compared to other movement disorders with multiple genetic factors.

Despite over 100 clinical trials for HD that have largely failed to provide significant benefits beyond symptom management, ongoing research into gene transfer methods and new experimental trials may offer hope for future therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gene Therapy for Huntington's Disease: The Final Strategy for a Cure? Byun, S., Lee, M., Kim, M.[2022]

The study tested two different anti-Htt intrabodies, V(L)12.3 and Happ1, in five mouse models of Huntington's disease (HD), finding that Happ1 significantly improved motor and cognitive functions and reduced neuropathology across multiple models.

Happ1 not only improved symptoms but also extended the lifespan of N171-82Q mice, suggesting that it could be a promising gene therapy for preventing disease progression in HD, while V(L)12.3 showed mixed results and even worsened conditions in some models.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intrabody gene therapy ameliorates motor, cognitive, and neuropathological symptoms in multiple mouse models of Huntington's disease. Southwell, AL., Ko, J., Patterson, PH.[2022]

Huntington's disease (HD) is caused by a genetic mutation in the huntingtin (HTT) gene, leading to severe neurodegeneration and symptoms like involuntary movements and cognitive decline.

Current research is actively exploring various therapeutic options, including small molecules and molecular therapies, to treat HD, highlighting ongoing efforts in both preclinical and clinical development stages.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Therapeutic Strategies for Huntington's Disease. Mrzljak, L., Munoz-Sanjuan, I.[2016]

A phase I study involving 6 subjects with early-stage Huntington's disease demonstrated that intracerebral administration of ciliary neurotrophic factor (CNTF) is safe, with no signs of toxicity observed during the 2-year trial.

While some improvements in electrophysiological results were noted, the variable survival of CNTF-producing cells and low CNTF release in many cases highlight the need for technique enhancements to optimize therapeutic outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuroprotective gene therapy for Huntington's disease, using polymer-encapsulated cells engineered to secrete human ciliary neurotrophic factor: results of a phase I study. Bloch, J., Bachoud-Lévi, AC., Déglon, N., et al.[2012]

AAV-mediated RNA interference (RNAi) effectively reduced levels of both mutant and wild-type huntingtin protein by approximately 40% in the striatum of YAC128 mice, which model Huntington's disease.

This reduction in huntingtin levels was associated with significant improvements in behavioral deficits and a decrease in harmful protein aggregates, without causing notable neurotoxicity, suggesting a promising therapeutic approach for Huntington's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Silencing mutant huntingtin by adeno-associated virus-mediated RNA interference ameliorates disease manifestations in the YAC128 mouse model of Huntington's disease. Stanek, LM., Sardi, SP., Mastis, B., et al.[2021]

Sodium phenylbutyrate (SPB), a histone deacetylase inhibitor, was found to be safe and well-tolerated in humans with Huntington's disease at doses of 12 to 15 g/day, with the maximum tolerated dose being 15 g/day.

While SPB showed no significant laboratory or electrocardiographic abnormalities, higher doses led to toxicity symptoms like vomiting and confusion, indicating the need for careful dose management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sodium phenylbutyrate in Huntington's disease: a dose-finding study. Hogarth, P., Lovrecic, L., Krainc, D.[2013]

The study introduces a new mouse model of Huntington disease (HD), called Hu97/18, which genetically mimics human HD by carrying two human HTT genes and no mouse Hdh genes, allowing for more accurate research into the disease.

This model exhibits key behavioral and neurological symptoms of HD, making it a valuable tool for testing therapies aimed at silencing the mutant huntingtin gene without affecting the normal HTT gene, which is crucial for neuronal health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A fully humanized transgenic mouse model of Huntington disease. Southwell, AL., Warby, SC., Carroll, JB., et al.[2021]

A systematic review identified nine phase III clinical trials for Huntington's Disease treatments, involving eight different drugs, including both FDA-approved medications and those still under investigation.

While there is currently no cure for Huntington's Disease, the review highlights ongoing efforts to develop therapies that can alleviate symptoms, with four of the drugs already approved for use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Huntington's Disease Drug Development: A Phase 3 Pipeline Analysis. Van de Roovaart, HJ., Nguyen, N., Veenstra, TD.[2023]

The RNA interference approach using miHDS1 effectively reduced huntingtin (HTT) expression in Rhesus macaques without causing adverse neurological effects, indicating its potential safety for human application.

However, when tested in normal mice, miHDS1 caused acute neurological deficits due to off-target effects, highlighting the challenges of ensuring safety in animal models that are distantly related to humans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single nucleotide seed modification restores in vivo tolerability of a toxic artificial miRNA sequence in the mouse brain. Monteys, AM., Spengler, RM., Dufour, BD., et al.[2021]

Convection enhanced delivery (CED) of small interfering RNA targeting the huntingtin gene (siHtt) in nonhuman primates resulted in widespread and significant suppression of the huntingtin protein, indicating a promising method for treating Huntington's disease.

The study demonstrated that this method was well tolerated by the brain, suggesting its potential safety for future therapeutic applications in humans with Huntington's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Widespread suppression of huntingtin with convection-enhanced delivery of siRNA. Stiles, DK., Zhang, Z., Ge, P., et al.[2016]

Using small interfering RNAs (siRNAs) to target the huntingtin gene in a mouse model of Huntington's disease led to a significant reduction in the expression of the harmful mutant protein, which is crucial for the disease's progression.

The treatment not only improved motor function and prolonged the lifespan of the mice but also slowed down weight loss, indicating that siRNA-based therapy could be a promising future approach for treating Huntington's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinico-pathological rescue of a model mouse of Huntington's disease by siRNA. Wang, YL., Liu, W., Wada, E., et al.[2016]

AAV9-RNAi injections into the intrajugular vein significantly reduced levels of the toxic mutant huntingtin protein (mHTT) in multiple brain regions and peripheral tissues in a mouse model of Huntington's disease, suggesting a potential for widespread therapeutic effects.

This systemic delivery method not only prevented motor symptoms and brain atrophy but also addressed severe weight loss associated with Huntington's disease, indicating a promising approach for treating various symptoms of the disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intrajugular vein delivery of AAV9-RNAi prevents neuropathological changes and weight loss in Huntington's disease mice. Dufour, BD., Smith, CA., Clark, RL., et al.[2021]

A novel siRNA strategy was developed to specifically silence the harmful mutant huntingtin protein in Huntington's disease without affecting the protective wild-type huntingtin, showing efficacy in both HD fibroblasts and neuroblastoma cells.

This targeted approach not only reduced the activation of caspase-3, a marker of cell stress and apoptosis, but also holds potential for personalized genetic therapies for Huntington's disease and other similar genetic disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Allele-specific silencing of mutant Huntington's disease gene. Zhang, Y., Engelman, J., Friedlander, RM.[2021]

A modified lentiviral vector carrying a small hairpin RNA (shRNA) effectively reduced the expression of the huntingtin protein in striatal neurons derived from induced pluripotent stem cells of Huntington's disease patients, showing promise for treating the disease.

In an in vivo rodent model, this vector not only decreased key pathological features of Huntington's disease but also triggered minimal inflammation, indicating a favorable safety profile for potential clinical use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preclinical Evaluation of a Lentiviral Vector for Huntingtin Silencing. Cambon, K., Zimmer, V., Martineau, S., et al.[2020]

References

1. Korea (South) pubmed.ncbi.nlm.nih.gov

Gene Therapy for Huntington's Disease: The Final Strategy for a Cure? [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Intrabody gene therapy ameliorates motor, cognitive, and neuropathological symptoms in multiple mouse models of Huntington's disease. [2022]

3. Germany pubmed.ncbi.nlm.nih.gov

Therapeutic Strategies for Huntington's Disease. [2016]

4. United States pubmed.ncbi.nlm.nih.gov

Neuroprotective gene therapy for Huntington's disease, using polymer-encapsulated cells engineered to secrete human ciliary neurotrophic factor: results of a phase I study. [2012]

5. United States pubmed.ncbi.nlm.nih.gov

Silencing mutant huntingtin by adeno-associated virus-mediated RNA interference ameliorates disease manifestations in the YAC128 mouse model of Huntington's disease. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Sodium phenylbutyrate in Huntington's disease: a dose-finding study. [2013]

7. England pubmed.ncbi.nlm.nih.gov

A fully humanized transgenic mouse model of Huntington disease. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Huntington's Disease Drug Development: A Phase 3 Pipeline Analysis. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Single nucleotide seed modification restores in vivo tolerability of a toxic artificial miRNA sequence in the mouse brain. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Widespread suppression of huntingtin with convection-enhanced delivery of siRNA. [2016]

11. Ireland pubmed.ncbi.nlm.nih.gov

Clinico-pathological rescue of a model mouse of Huntington's disease by siRNA. [2016]

12. United States pubmed.ncbi.nlm.nih.gov

Intrajugular vein delivery of AAV9-RNAi prevents neuropathological changes and weight loss in Huntington's disease mice. [2021]

13. England pubmed.ncbi.nlm.nih.gov

Allele-specific silencing of mutant Huntington's disease gene. [2021]

14. United States pubmed.ncbi.nlm.nih.gov

Preclinical Evaluation of a Lentiviral Vector for Huntingtin Silencing. [2020]