Transplantation of human neural progenitor cells secreting GDNF into the spinal cord of patients with ALS: a phase 1/2a trial
Robert H. Baloh, Julia Johnson, Pablo Avalos, Peggy Allred, Soshana Svendsen, Genevíève Gowing, Kristina Roxas, Amanda Wu, Becky Donahue, Sheryl Osborne, George Lawless, Brandon Shelley, Koral V Wheeler, Carolyn Prina, Dana S. Fine, Tami Kendra-Romito, Haniah Stokes, Vicki Manoukian, Abirami Muthukumaran, Leslie Garcia, Maria G. Bañuelos, Marlesa Godoy, Catherine Bresee, Hong Yu, Doniel Drazin, Lindsey Ross, Robert Naruse, Harish Babu, Eric A. Macklin, Ashley Vo, Ashraf Elsayegh, Warren G. Tourtellotte, Marcel Maya, Matthew Burford, Frank Diaz, Chirag G. Patil, Richard A. Lewis, Clive N. Svendsen
Abstract
Amyotrophic lateral sclerosis (ALS) involves progressive motor neuron loss, leading to paralysis and death typically within 3-5 years of diagnosis. Dysfunctional astrocytes may contribute to disease and glial cell line-derived neurotrophic factor (GDNF) can be protective. Here we show that human neural progenitor cells transduced with GDNF (CNS10-NPC-GDNF) differentiated to astrocytes protected spinal motor neurons and were safe in animal models. CNS10-NPC-GDNF were transplanted unilaterally into the lumbar spinal cord of 18 ALS participants in a phase 1/2a study (NCT02943850). The primary endpoint of safety at 1 year was met, with no negative effect of the transplant on motor function in the treated leg compared with the untreated leg. Tissue analysis of 13 participants who died of disease progression showed graft survival and GDNF production. Benign neuromas near delivery sites were common incidental findings at post-mortem. This study shows that one administration of engineered neural progenitors can provide new support cells and GDNF delivery to the ALS patient spinal cord for up to 42 months post-transplantation.