A large area of cure-based T1D research is investigating stem cell-based therapy. The goal of this approach is to use stem cells as a renewable source of insulin-producing cells which, when transplanted, would replace beta cells that are destroyed in a person with T1D, thereby allowing them to produce insulin again. This would lessen or eliminate the amount of external insulin required by someone living with T1D (either by injection, pen, or pump) for months or even decades.
In February 2021, Vertex announced the launch of a clinical trial for VX-880, a stem cell-derived therapy people with T1D. VX-880 is delivered via infusion into the hepatic portal vein (liver) and requires the use of chronic immunosuppressive therapy to protect the cells from rejection or immune attack.
UPDATE – June 2023
VX-880 Clinical Trial Phase 1/2 Part B:
Six patients have received full doses of VX-880 at staggered times over the past year and a half. Prior to treatment, all patients had undetectable fasting C-peptide (i.e., no self-secreted insulin, or insulin produced by the body), a history of recurrent severe hypoglycemic events in the year prior to treatment and required an average of 34.0 units of insulin per day.
Following treatment, all six patients are self-secreting insulin, improved HbA1c levels, improved time-in-range on continuous glucose monitoring, and reduction or elimination of exogenous insulin use (i.e., externally administered insulin either by pen, pump or multiple daily injection). Patients with greater than 90 days of follow-up also had elimination of severe hypoglycemic events. Two of the six patients are at least 12 months post-treatment and are currently insulin independent with “normal” HbA1c levels (≤6.0%) and time-in-range levels over 95%.
VX-880 has been well tolerated with only mild-moderate adverse events such as: dehydration, diarrhea, hypomagnesemia and rash.
Based on the result of these safety and efficacy data in Part B, the independent data review committee has recommended moving to Part C of the trial, which allows for concurrent dosing of patients at the full target dose of VX-880. Approximately 10 participants will be enrolled in this stage of the trial in Edmonton, Montreal, Toronto, and Vancouver. For more information, please see ClinicalTrials.gov or Vertex’s website.
VX-264 Clinical Trial Phase 1/2:
This treatment will use the same cell therapy as VX-880, but encapsulate the cells within a device designed to shield the cells from the body’s immune system. Therefore, immunosuppression is not expected to be required. Recruitment is currently ongoing in Edmonton. For more information please see ClinicalTrials.gov or Vertex’s website.
Vertex partners with Lonza (Switzerland) to build a dedicated manufacturing facility for T1D cell therapies
Vertex and Lonza will partner in the process development and scale-up for the manufacturing of the VX-880 and VX-264 product portfolio and co-invest to build a dedicated new facility in Portsmouth, New Hampshire. Operated by Lonza, the facility will span more than 130,000 square feet and is anticipated to create up to 300 new jobs at peak capacity. Construction is scheduled to begin later this year. For more information, please see the full press release here.
VX-880 Clinical Trial Phase 1/2 Part A:
On October 18, 2021, the company announced that the first trial participant to receive VX-880 now needs 91% less insulin 90 days after receiving an infusion of these stem cells – and at just half the target dose.
The success seen with just half the target dose is exciting as it suggests a lower level of this therapy may still yield positive results.
However, it is important to be cautious at the same time, as this result has thus far only been demonstrated in a single individual.
How is success of this clinical trial measured?
VX-880 is being tested in people with T1D who have severe hypoglycemia and impaired hypoglycemia unawareness. The treatment requires immunosuppression, as the transplanted cells do not have any protection from the immune system. This requirement limits the patient population who can be enrolled in the trial.
The primary goal of this phase 1/2 trial is to assess safety, although efficacy will also be measured. Vertex is evaluating efficacy by measuring a few key metrics. This includes measuring C-peptide levels—a marker that directly indicates insulin production by beta cells. The participant in this study had no detectable C-peptide at all pre-infusion. 90 days after infusion of the VX-880 cells, the participant had both fasting and stimulated C-peptide, which directly indicates the presence of basal and glucose-responsive insulin secretion. In other words, the person was making some of their own insulin.
Treatment with VX-880 also led to a significant reduction in HbA1c, improving from 8.6% to 7.2% without severe hypoglycemic events. Even more impressive is that this lower HbA1c was achieved with a 91% daily reduction in insulin administration.
The study also demonstrated patient safety, as during the first 90 days, the participant did not experience any severe adverse events considered related to VX-880. This is important as immunosuppressive drugs do come with potential side effects.
JDRF’s Role
JDRF’s involvement can first be traced back to 2000, when Douglas Melton, Ph.D. was given a JDRF grant to make insulin-producing beta cells from stem cells—which he did in 2014.
Since then:
- In 2015 Dr. Melton founded Semma Therapeutics to develop these stem cells into curative therapies for T1D.
- In 2017, the JDRF T1D Fund made a significant investment in Semma.
- In 2019, Vertex acquired Semma for almost $1 billion USD.
- In March 2021, VX-880 received fast-track designation from the US Food and Drug Administration (FDA).
JDRF globally has prioritized stem cell therapy as a potential cure-based therapy and will continue to investigate and fund the most promising research.
What does this mean for Canadians with T1D?
For VX-880 to be broadly accessible to people with T1D, the cell product needs to both work and function without or with minimal immunosuppressive therapies.
The next step is approval to run clinical trials that could eliminate the need for immunosuppressives.
In the meantime, Vertex will continue their clinical trial for people with T1D who have severe hypoglycemia and are currently enrolling in several sites in the United States.
JDRF Canada will continue to monitor results and provide updates as they are made public.
