血液输注细胞疗法,可减缓杜氏肌营养不良症年轻患者的肌肉萎缩

问AI · “废物利用”的供体心脏,如何变身肌肉萎缩“援军”?
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《柳叶刀》(The Lancet发表一项Ⅲ期临床试验,旨在评估细胞疗法deramiocel在晚期杜氏肌营养不良症患者中的有效性和安全性。结果显示,deramiocel有望减缓晚期杜氏肌营养不良症患儿及青年患者的肌肉功能衰退,且对于出现心肌病变的患者,还能减缓心脏损伤。结果表明,该疗法总体安全性良好。研究提示,deramiocel并非针对特定基因突变,因此有望适用于各种类型的杜氏肌营养不良症基因突变患者。识别图中二维码或点击文末阅读原文,查阅原文。



《柳叶刀》(The Lancet发表的一项Ⅲ期临床试验显示,一项名为deramiocel的细胞疗法有望减缓晚期杜氏肌营养不良症(Duchenne muscular dystrophy,DMD)患儿及青年患者的肌肉功能衰退;对于已经出现心肌病变的患者,该疗法还可能减缓心脏损伤进展。这是首个采用供体来源细胞、经血液输注治疗遗传性疾病的细胞治疗Ⅲ期临床试验,也是首个在诊断晚期DMD男孩和青年男性患者群体中开展的试验。该疗法所使用的细胞来源于原计划用于移植但最终未被使用的供体心脏组织。

目前,DMD尚无治愈方法。这是一种严重的遗传性疾病,可导致包括心肌在内的全身肌肉逐渐衰弱无力并发生萎缩。由于致病基因位于X染色体上,因此几乎仅影响男孩和青年男性。随着疾病进展,大多数患者会失去行走能力,并逐渐依赖双臂和双手完成日常活动和维持生活独立性。

HOPE-3研究在美国20个研究中心开展,共纳入106例10–22岁的晚期DMD男性患儿和青年患者。受试者被随机分配接受deramiocel治疗(54例)或安慰剂(52例),入组后1年内在门诊环境下每3个月经静脉输注一次。

一年后,与安慰剂组相比,接受deramiocel治疗的患者上肢功能下降速度更慢。总体来看,其上肢运动功能下降速度较安慰剂组减缓约54%,肘部运动功能下降速度减缓约65%。

在全部受试者中,该疗法对心脏泵血功能无显著改善作用。然而,在64例已发生心肌病且具有可供分析心脏影像资料的患者中,deramiocel较安慰剂更有助于维持心功能。在22例有治疗前后可对比影像资料的患者中,研究人员观察到deramiocel与心肌瘢痕进展减缓相关,这一结果有待进一步研究证实。

该疗法总体安全性良好,研究期间未报告死亡事件。类过敏反应在deramiocel组中的发生率高于安慰剂组(42% vs 15%)。绝大多数不良事件为轻度或中度,且通常在1–2天内消退。最常见的不良事件包括头痛、咳嗽、发热、恶心和心率增快。

研究作者指出,由于deramiocel针对的是疾病导致的肌肉肿胀和瘢痕形成,而非特定基因突变本身,因此该疗法有望适用于各种类型的DMD基因突变患者。心脏疾病是DMD患者死亡的主要原因之一,研究作者呼吁开展进一步研究,以明确本研究观察到的心脏获益是否能够转化为生存期延长等长期临床获益。

文章摘要


Deramiocel治疗晚期杜氏肌营养不良症(HOPE-3):一项随机、双盲、安慰剂对照的Ⅲ期临床试验


背景

杜氏肌营养不良症(DMD)是一种影响骨骼肌和心肌的X连锁遗传性疾病,可因进行性肌病和心肌病导致患者失去行走能力以及过早死亡。Deramiocel是一种来源于心脏的细胞疗法,由人异体心肌球源性细胞(cardiosphere-derived cells)组成。在DMD的Ⅰ–Ⅱ期研究中,deramiocel改善了心脏和骨骼肌功能。本研究旨在评估deramiocel在晚期DMD患者中的有效性和安全性,从而验证HOPE-2研究结果


方法

HOPE-3是一项多中心、随机(1:1)、双盲、安慰剂对照的Ⅲ期临床研究,纳入年龄10岁及以上的DMD患者。研究药物在门诊环境下每3个月通过静脉输注给药一次。在12个月时评估骨骼肌和心脏功能。主要终点为:上肢功能评估量表2.0版(Performance of the Upper Limb 2.0,PUL2.0)总评分在12月时较基线的变化百分比。本研究已在ClinicalTrials.gov注册(NCT05126758)。


结果

2022年6月22日至2024年5月28日期间,共筛查139例受试者,其中106例被随机分配至deramiocel组(n=54)或安慰剂组(n=52),并纳入意向治疗(intention-to-treat)分析人群。与安慰剂组相比,deramiocel组的主要终点改善更明显。对于PUL2.0总评分,12个月时最小二乘均值变化百分比显示,deramiocel组较安慰剂组高4.55%(95% CI 0.47–8.63;p=0.029)。安全性方面,Deramiocel与安慰剂相似。
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解释

Deramiocel能够安全地减缓晚期DMD的疾病进展,并维持骨骼肌功能。作为一种可在门诊环境下实施、每季度给药一次的简单治疗方案,deramiocel有望成为DMD的一种治疗选择,且其疗效不依赖于具体致病基因突变类型END


Funding

Capricor Therapeutics.

Declaration of interests


CMM served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; received grants from and served as site principal investigator for Avidity Biosciences, Edgewise Therapeutics, Insmed, and Italfarmaco, NS Pharma, PTC Therapeutics, Roche, Santhera Pharmaceuticals, Sarepta Therapeutics, and Solid Biosciences; has received grants from California Institute for Regenerative Medicine, Muscular Dystrophy Association, Parent Project Muscular Dystrophy, Shriners Hospitals for Children, Department of Defense, National Institute of Disability Independent Living and Rehabilitation Research, and the US National Institutes of Health (RO1HD35714, 2P01HD033988–06A1, R01NS043264, R01AR061875, R01AR062380, U01NS061799–01A2, P50AR060836, U10NS077422, U01AR065113–01, U24NS107209–01, U24 NS107209, R01DK129793–01, and R01DK125794–01A1); has received consultancy fees from Catalyst Pharmaceuticals, Capricor Therapeutics, Catabasis, Dyne, Edgewise Therapeutics, Italfarmaco, NS Pharma, PTC Therapeutics, Roche, Santhera Pharmaceuticals, Sarepta Therapeutics, and Solid Biosciences; and served on advisory boards for Avidity Biosciences, Catalyst Pharmaceuticals, Edgewise Therapeutics, Entrada Therapeutics, Santhera Pharmaceuticals, Sarepta Therapeutics, Solid Biosciences, and Roche. ASV served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study related meetings and their institutions received payment for the conduct of the study; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Biogen, Argenx, and Blue Oak Nutraceuticals; received payment for expert testimony as medical legal consultant; received support for attending meetings or travel from Argenx and Muscular Dystrophy Association; holds a leadership or fiduciary role for Sjogren’s Foundation; and owns stock or stock options from Blue Oak Nutraceuticals. LR-P served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; served as site principal investigator for Sarepta Therapeutics, Scholar Rock, Genentech, Biohaven, Novartis, PTC Therapeutics, and NS Pharma; received consulting fees and served on advisory boards for Sarepta Therapeutics, Scholar Rock, IFT Therapeutics, Catalyst Pharmaceuticals, Mando Therapeutics, Novartis, Dyne Therapeutics, and Solid Biosciences; and received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Scholar Rock. RJB served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study related meetings and their institutions received payment for the conduct of the study; served as site principal investigator for Ionis Pharmaceuticals; and received consulting fees and served on the Scientific Advisory Board for Sarepta Therapeutics, Biogen, Novartis, Precision BioSciences, Solid Biosciences, Scholar Rock, and BridgeBio Pharma. KMo served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; received support for attending meetings or travel from Capricor Therapeutics; participated on a data safety monitoring board or advisory board for Solid Biosciences, Catalyst Pharmaceuticals, and Sarepta Therapeutics; and holds a leadership or fiduciary role at American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). AV served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; and received consulting fees from Capricor Therapeutics, Biogen, Novartis, PTC Therapeutics, Sarepta Therapeutics, Scholar Rock, Pfizer, Catalyst Pharmaceuticals, Lupin, Entrada Therapeutics, Avidity Biosciences, Solid Biosciences, REGENXBIO, Insmed, Keros Therapeutics, Precision BioSciences, Gruenenthal, Mesoblast, and Italfarmaco. CGL served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; served as site principal investigator for Sarepta Therapeutics, Dyne Therapeutics, Biohaven, Avidity Biosciences, and Novartis; received consulting fees from Sarepta Therapeutics, Genentech, and Italfarmaco; and received payment for expert testimony from Stanford University. SA served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; served as site principal investigator for Sarepta Therapeutics, Dyne Therapeutics, and Satellos Bioscience; received consulting fees from ITF Therapeutics; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Dyne Therapeutics; received support for attending meetings or travel from Dyne Therapeutics; and holds a leadership or fiduciary role as a Board of Director for American Board of Physical Medicine and Rehabilitation as well as a Board Director for Parent Project Muscular Dystrophy. STI served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; and received support for attending meetings or travel from Capricor Therapeutics. KDM served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; served as site principal investigator for PTC Therapeutics, Sarepta Therapeutics, Edgewise Therapeutics, and Italfarmaco; received support for attending meetings or travel from Sarepta Therapeutics; participated on a data safety monitoring board or advisory board for Dyne Therapeutics, Edgewise Therapeutics, and Avidity Biosciences; and holds a leadership or fiduciary role on the Research Advisory Committee for Muscular Dystrophy Association. ECS served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study related meetings and their institutions received payment for the conduct of the study; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Avidity Biosciences, Catalyst Pharmaceuticals, Precision BioSciences, Boehringer Ingelheim, Quince Therapeutics, Entrada, and Italfarmaco; and participated on a data safety monitoring board or advisory board for Solid Biosciences and Edgewise Therapeutics. SJP served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; served as site principal investigator for CSL Behring, Scholar Rock, Pfizer, Sarepta Therapeutics, Satellos Bioscience, Catalyst Pharmaceuticals, PTC Therapeutics, Biogen, Avexis, Solid Biosciences, and FibroGen; received clinical grant support from Muscular Dystrophy Association, Parent Project Muscular Dystrophy, and Cure SMA; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the American Academy of Neurology; received support for attending meetings or travel from Capricor Therapeutics, Muscular Dystrophy Association, Parent Project Muscular Dystrophy, Cure SMA, and the American Board of Psychiatry and Neurology; participated on a data safety monitoring board or advisory board for Solid Biosciences, Catalyst Pharmaceuticals, Sarepta Therapeutics, Entrada Therapeutics, Novartis, and Dyne Therapeutics; and holds a leadership or fiduciary role as a Committee Member on the American Board of Psychiatry and Neurology. NEB, SMB, JAE, KG, PSG, HCP, and CT served as site principal investigators for Capricor Therapeutics; and received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study. RJS served as site principal investigator for Capricor Therapeutics; received reimbursement for travel for study-related meetings and their institutions received payment for the conduct of the study; received research funds from Novartis, Sarepta Therapeutics, Genentech, Argenx, Biohaven, Catalyst Pharmaceuticals and Biogen; and received consulting fees and served on Medical Advisory Board for RegenXBio and Scholar Rock. MT was employed on this study by Medpace and owns equity in Capricor Therapeutics. EMa is an inventor of several patents licensed by Capricor Therapeutics, and owns founder’s equity in Capricor Therapeutics. JHS received grants or contracts from Ametris (R61HL180327/R33, R01HL167969, R01HL164995, R01FD006649, and R01FD006371); received consulting fees from Capricor Therapeutics, Boehringer Ingelheim, Catalyst Pharmaceuticals, Dyne Therapeutics, Keros Therapeutics, Medpace, NS Pharma, Sarepta Therapeutics, Secretome Therapeutics, Sardocor, and Wave Life Sciences; received support for attending meetings or travel from Capricor Therapeutics; participated on a data safety monitoring board or advisory board for Sardocor, Solid Biosciences, ITF Therapeutics, Sarepta Therapeutics, and Boehringer Ingelheim; holds a leadership or fiduciary role as the Chair and Chair Ex Officio of Pediatric and Congenital Heart Disease Section of the Society for Cardiovascular Magnetic Resonance (SCMR PCHD), Steering Committee and Abstract Chair of SCMR Scientific Sessions Planning Committee; and owns stock or stock options from Secretome Therapeutics. CV received payments made to Cincinnati Children’s Hospital Medical Center for cardiac natural history in DMD; received consulting fees either directly or to their employer as well as reimbursement for travel from Capricor Therapeutics; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Capricor Therapeutics; and received support for attending meetings or travel from Capricor Therapeutics. KNH received consulting fees as a masked second reader for CMR analysis from Capricor Therapeutics. JS received consulting fees either directly or to their employer as well as reimbursement for travel from Capricor Therapeutics. EMe received grants or contracts from Sarepta Therapeutics; received consulting fees from PTC Therapeutics, Sarepta Therapeutics, Edgewise Therapeutics, Santhera, Roche, Dyne Therapeutics, Solid Biosciences, Avidity Biosciences, Entrada Therapeutics, and NS Pharma; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sarepta Therapeutics, Santhera, Roche, and Dyne Therapeutics; participated on a data safety monitoring board or advisory board for Sarepta Therapeutics, Santhera, Roche, PTC Therapeutics, Dyne Therapeutics, Solid Biosciences, Avidity Biosciences, Entrada, Edgewise Therapeutics, and NS Pharma. EKH received payment through UC Davis for study site clinical trial operations; received grants or contracts from Sarepta Therapeutics, NS Pharma, Insmed, Santhera, Solid Biosciences, and Parent Project Muscular Dystrophy; received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sarepta Therapeutics and Santhera; received support for attending meetings or travel from Parent Project Muscular Dystrophy; and holds a leadership or fiduciary role on the Scientific Advisory Board for Parent Project Muscular Dystrophy, the Executive Committee for Cooperative International Neuromuscular Research Group, and the Clinical Certification Committee for World Duchenne Organization. KMa, NH, MB, KCB, KAE, MSA, and LM are full time employees of and hold equity in Capricor Therapeutics.



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中文翻译仅供参考,所有内容以英文原文为准。

DOI:  10.1016/S0140-6736(26)01385-1