Intravenous Gentamicin Therapy for Recessive Dystrophic Epidermolysis Bullosa (RDEB)
| Status: | Recruiting |
|---|---|
| Conditions: | Skin and Soft Tissue Infections, Skin and Soft Tissue Infections |
| Therapuetic Areas: | Dermatology / Plastic Surgery |
| Healthy: | No |
| Age Range: | 7 - Any |
| Updated: | 12/22/2018 |
| Start Date: | July 5, 2018 |
| End Date: | July 2020 |
| Contact: | David Woodley, MD |
| Email: | dwoodley@usc.edu |
| Phone: | 323-865-0956 |
Restoration of Full-Length Type VII Collagen in RDEB Patients With Nonsense Mutations After Intravenous Gentamicin Treatment
Recessive dystrophic epidermolysis bullosa (RDEB) is an incurable, devastating, inherited
skin disease caused by mutations in the COL7A1 gene that encodes for type VII collagen (C7),
the major component of anchoring fibrils (AFs), structures that mediate epidermal-dermal
adherence. Thirty percent of RDEB patients have nonsense mutations. The investigators
recently demonstrated in 5 such patients that intradermal and topical gentamicin induced
"read-through" of their nonsense mutations and created robust and sustained new C7 and AFs at
the dermal-epidermal junction (DEJ) of their skin and also stimulated wound closure and
reduced new blister formation. No untoward side effects occurred. Herein, the investigators
propose evaluating the safety and efficacy of intravenous gentamicin in these patients. In
theory, this intravenous administration has the possibility of treating simultaneously all of
the patients' skin wounds. The milestones will be increased C7 and AFs in the patients' DEJ,
improved EB Disease Activity Scores, and absence of gentamicin side effects.
skin disease caused by mutations in the COL7A1 gene that encodes for type VII collagen (C7),
the major component of anchoring fibrils (AFs), structures that mediate epidermal-dermal
adherence. Thirty percent of RDEB patients have nonsense mutations. The investigators
recently demonstrated in 5 such patients that intradermal and topical gentamicin induced
"read-through" of their nonsense mutations and created robust and sustained new C7 and AFs at
the dermal-epidermal junction (DEJ) of their skin and also stimulated wound closure and
reduced new blister formation. No untoward side effects occurred. Herein, the investigators
propose evaluating the safety and efficacy of intravenous gentamicin in these patients. In
theory, this intravenous administration has the possibility of treating simultaneously all of
the patients' skin wounds. The milestones will be increased C7 and AFs in the patients' DEJ,
improved EB Disease Activity Scores, and absence of gentamicin side effects.
Inclusion Criteria:
- Provision of signed and dated informed consent form
- Stated willingness to comply with all study procedures and availability for the
duration of the study
- Male or female, aged 7 and up can participate in the 14 day IV gentamicin trial. Male
or female, aged 18 and up can participate in the 3 month IV gentamicin trial.
- Been diagnosed with recessive dystrophic epidermolysis bullosa (RDEB) and with a
nonsense mutation in the COL7A1 gene.
- Immunofluorescence evaluation of skin biopsies reveals absence or decreased intensity
of C7 expression at their DEJ (dermal epidermal junction) compared with normal human
skin biopsies.
- Cultured fibroblasts from patient skin synthesize and secrete full-length, 290kDa C7
alpha chains in the presence of supplemented gentamicin (400 μg/ml in culture).
- Ability to sit or lie down for over 30 minutes for IV infusions. For those in the 3
month trial, to be willing to continue treatment at home under the supervision of
licensed and trained infusion nurses.
Exclusion Criteria:
- Recent exposure to gentamicin within the past 6 weeks.
- Pre-existing known auditory impairment.
- Pre-existing known renal impairment.
- Pre-existing known allergies to aminoglycosides or sulfate compounds.
- Pregnancy or lactation
- Current use of medications with known ototoxicity or nephrotoxicity.
- Current enrollment in another experimental clinical trial involving systemic treatment
with C7 or C7 producing products for the treatment of RDEB.
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