NCT06455319

Precision Administration of Anti-thymocyte Globulin With or Without Verapamil

Precision Administration of Anti-thymocyte Globulin With or Without Verapamil in Adolescents and Young Adults With Type 1 Diabetes

• Status: Recruiting
• Phase: Phase 2
• Study type: Interventional
• Enrollment: 60 (estimated)
• Sponsor: University of Florida · Academic / Other
• Sex: All
• Age: 6 Years – 35 Years
• Healthy volunteers: Not accepted

Summary

T cell directed therapy, anti-thymocyte globulin (ATG), in low doses, has been shown to lower HbA1c and preserve endogenous insulin production (measured by C-peptide) in individuals with recently diagnosed type 1 diabetes (T1D). However, not all individuals who received ATG responded to the therapy (i.e., non-responders). Additionally, use of ATG alone does not address inherent beta cell stress. A calcium channel blocker, verapamil, has demonstrated C-peptide preservation in newly diagnosed T1D. Investigators will identify those mostly likely to respond to ATG using an ex vivo predictive biomarker of response to ATG. In addition, Investigators will use sequential therapies to increase efficacy (ATG followed by verapamil) and explore synergistic mechanisms. This will be assessing with in depth immunophenotyping and quantify biomarkers of beta cell stress, cell death, and abnormal prohormone processing. Finally, novel clinical trial endpoints will be assessed for their ability to predict treatment efficacy earlier than the standard endpoint at 1 year.

Detailed description

Investigators will conduct a phase 2 1:1 randomized controlled and blinded trial in Aim 1 comparing stimulated C-peptide (and other measures) between those treated with low-dose ATG and those treated with placebo. Co-primary endpoints include the difference between mean ATG and placebo values of the 2-hr mixed meal tolerance test (MMTT)-stimulated area under the curve (AUC) C-peptide at 12 months (standard T1D trial measure) and the difference between the change in the same measure over the first 6 months. Participants will be stratified based on their ex vivo immune responder signature to allow an equal number of "responders" and "non-responders" in both treatment arms. Following each participant's completion of this 1 year randomized controlled trial (RCT) they will enter Aim 2 and be re-randomized to received verapamil or not in an open-label 1 year extension where mechanistic endpoints will be explored related to immunophenotyping, gene expression, DNA methylation and beta cell markers including markers of beta cell stress and death as well as markers of abnormal prohormone processing.

Conditions

• Type 1 Diabetes

Interventions

Type	Name	Description
DRUG	Anti-thymocyte globulin (ATG)	ATG (brand name Thymoglobulin) a polyclonal T cell antibody preparation. It will be given at low doses (0.5 mg/kg Day 1 then 2 mg/kg Day 2).
DRUG	verapamil extended release capsule	Open label administration at 120, 240 or 360 mg daily based on weight and ECG findings
DRUG	Placebo	I.V. Saline

Timeline

• Start date: 2025-11-12
• Primary completion: 2028-11-01
• Completion: 2030-08-01
• First posted: 2024-06-12
• Last updated: 2025-11-26

Locations

2 sites across 1 country: United States

Regulatory

• FDA-regulated drug study