start date: April 7, 2021
estimated completion: April 2032
last updated: April 9, 2021
phase of development:
Phase 1
size / enrollment: 10
study description: Because fetuses with these LSDs are at increased risk of serious perinatal morbidity and mortality, particularly in the setting of Non-Immune Hydrops Fetalis (NIHF), the administration of the approved enzyme therapy in utero has the potential to significantly improve outcomes for affected fetuses. The perinatal death rate associated with NIHF ranges from 30 to 75%, so development of an in utero approach to treatment could be of significant benefit. The in utero period has been shown to be a time of relative fetal tolerance to immune stimuli, and this tolerance may lead to improved response to ERT in situations where postnatal initiation instead leads to antibody development and impaired response to treatment. It is also probable that in some cases, initiation of ERT in utero leads to improved neurodevelopmental outcomes if the replaced enzyme impacts the neurologic system during critical periods of development.
This is a phase 1 clinical trial to determine the safety and feasibility of fetal enzyme replacement therapy in fetuses with LSD
primary outcomes:
- Number of participants with treatment-related adverse events as assessed by CTCAE v5.0.
Adverse and serious adverse events including, but not limited to, death within 24 hours after the procedure, stillbirth, death prior to initial hospital discharge,increased response with antibody development above that expected with postnatal ERT, and serious related or serious unexpected adverse events exceeding those expected with the natural history of treated disease during the first five years of life, assessed by CTCAE v5.0.
- 6 years
Number of participants to receive the full initial, weight-based dose of enzyme replacement therapy through the fetal umbilical vein, and subsequent doses throughout the pregnancy.
full dose administration compared to the need to halt the intervention prior to administration of a full dose.
- 6 years
Number of participants with the presence and levels of glycosaminoglycans (GAGs) in urine.
Laboratory analysis of urine for GAG levels.
- 6 years
The number of participants with improvement or resolution of hydrops (if present).
Improvement of hydrops via ultrasound and echocardiogram results (if present).
- 6 years
secondary outcomes:
- Number of participants that show measured levels of antibodies against the enzyme.
6 years
inclusion criteria:
• Eligible Ages: 18 - 50
• Eligible Sexes: female
Inclusion Criteria:
Live male or female fetuses at 18 0/7 weeks to 34 6/7 weeks gestation
Diagnosis of one of the 8 included LSDs in utero by genetic or enzymatic analyses performed on amniotic fluid, fetal blood, placental tissue, or other samples through chorionic villus sampling (CVS), amniocentesis, cordocentesis, cell free fetal DNA, or other procedures. In the event that parents are identified as genetic carriers for a LSD, diagnostic testing for the fetus would be performed to confirm the diagnosis
Pregnant women age 18 years to 50 years, carrying a live male or female fetus at 18 0/7 weeks to 34 6/7 weeks gestation
Identified through the above listed means to be carrying a fetus with an LSD.
Ability to give written informed consent and comply with the requirements of the study.
exclusion criteria: Criteria:
Fetuses with a concurrent severe structural anomaly
Fetuses with an additional pathogenic genetic variant not related to the underlying LSD that contribute a significant risk of morbidity or mortality.
Hydrops fetalis will not be an exclusion criterion because ERT has the possibility of significant benefit in this situation.
Women with one or more significant comorbidities that would preclude fetal intervention including, but not limited to:
inability to complete the procedure secondary to maternal body habitus or placental location
significant cardiopulmonary disease
mirror syndrome
end organ failure
altered mental status
placental abruption
active preterm labor
preterm premature rupture of membranes.
Mother will require therapeutic dosing of anticoagulation within 24 hours prior to or following the intervention.
