Effects of an anti-CD5 immunoconjugate (CD5-Plus) in recent onset type I diabetes mellitus

A preliminary investigation

Jay S Skyler, Todd J. Lorenz, Sherwyn Schwartz, George S. Eisenbarth, Daniel Einhorn, Jerry P. Palmer, Jennifer B Marks, Carla Greenbaum, Elizabeth A. Saria, Vera Byers

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Type-I (insulin-dependent) diabetes mellitus is an immunologically mediated disease that results in destruction of the insulin secreting β cells of the pancreas. T cells have been implicated in the pathogenesis of this disease. One novel form of anti-T-cell therapy is the immunoconjugate CD5-Plus®. This agent is composed of the murine IgG1 monoclonal antibody H65, which is directed toward the CD5+ antigen; and ricin A chain, a ribosomal inhibitor protein. We performed a pilot study to evaluate the safety of the immunoconjugate in subjects with type-I diabetes mellitus. We conducted a dose-escalation study using CD5-Plus given as an intravenous infusion for 5 consecutive days. Fifteen subjects (12 men and 3 women) with a mean age of 26 years, a mean duration of diabetes of 4.8 months, and a minimum stimulated C peptide of 0.3 pmol/mL were entered. Six subjects each were treated at the 0.1 and 0.2 mg/kg/day dosage levels, and three subjects were treated at the 0.33 mg/kg/day dose. Glycemic control was determined monthly by recording the glycohemoglobin, total daily insulin requirements, and fasting blood glucoses. β-cell function was measured by determining the C-peptide response to a mixed formula meal (Sustacal®) at baseline and at 1,3,6,9, and 12 months after treatment. The area under the curve (AUC) of the C-peptide response was calculated and, to reduce variability, related to that of the same subject at baseline. An analysis of subjects who retained at least 80% of their baseline β-cell function as measured by the AUC was performed. In addition, logarithms of the normalized areas under the C-peptide curve ( AUC AUC0) were determined, and the regression line was calculated. This line was compared to that generated by a similar analysis in historical controls who had participated in a previous study using placebo and cyclosporine. T cells were rapidly depleted during the infusion course and recovered to normal values within 30 days. No long-term adverse events were reported. The analysis of subjects retaining 80% of their initial AUC suggested a dose-dependent effect that was significant (p < 0.05) by the Cochran-Armitage test for trend in dose response at month 12. The slope of the linear regression line for all subjects was different from zero (p < 0.03), but this was accounted for entirely by the low-dose group. The slope of the regression line in subjects treated at the two higher doses of CD5-Plus did not significantly differ from zero and was similar to the cyclosporine-treated group of a previous study. This study demonstrates that CD5-Plus was tolerated by a group of recent onset type-I diabetic patients and resulted in reversible T-cell depletion. Preliminary efficacy analysis suggests a dose-dependent preservation of β-cell function. A full-scale, randomized, controlled trial to investigate the potential of CD5-Plus to preserve C-peptide function in new onset type-I diabetes is warranted.

Original languageEnglish
Pages (from-to)224-232
Number of pages9
JournalJournal of Diabetic Complications
Volume7
Issue number4
StatePublished - Oct 1 1993

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Immunoconjugates
C-Peptide
Type 1 Diabetes Mellitus
Area Under Curve
T-Lymphocytes
Cyclosporine
CD5 Antigens
Ricin
Ribosomal Proteins
Insulin-Secreting Cells
Cell- and Tissue-Based Therapy
Intravenous Infusions
Meals
Blood Glucose
Pancreas
Linear Models
Fasting
Reference Values
Randomized Controlled Trials
Immunoglobulin G

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Skyler, J. S., Lorenz, T. J., Schwartz, S., Eisenbarth, G. S., Einhorn, D., Palmer, J. P., ... Byers, V. (1993). Effects of an anti-CD5 immunoconjugate (CD5-Plus) in recent onset type I diabetes mellitus: A preliminary investigation. Journal of Diabetic Complications, 7(4), 224-232.

Effects of an anti-CD5 immunoconjugate (CD5-Plus) in recent onset type I diabetes mellitus : A preliminary investigation. / Skyler, Jay S; Lorenz, Todd J.; Schwartz, Sherwyn; Eisenbarth, George S.; Einhorn, Daniel; Palmer, Jerry P.; Marks, Jennifer B; Greenbaum, Carla; Saria, Elizabeth A.; Byers, Vera.

In: Journal of Diabetic Complications, Vol. 7, No. 4, 01.10.1993, p. 224-232.

Research output: Contribution to journalArticle

Skyler, JS, Lorenz, TJ, Schwartz, S, Eisenbarth, GS, Einhorn, D, Palmer, JP, Marks, JB, Greenbaum, C, Saria, EA & Byers, V 1993, 'Effects of an anti-CD5 immunoconjugate (CD5-Plus) in recent onset type I diabetes mellitus: A preliminary investigation', Journal of Diabetic Complications, vol. 7, no. 4, pp. 224-232.
Skyler, Jay S ; Lorenz, Todd J. ; Schwartz, Sherwyn ; Eisenbarth, George S. ; Einhorn, Daniel ; Palmer, Jerry P. ; Marks, Jennifer B ; Greenbaum, Carla ; Saria, Elizabeth A. ; Byers, Vera. / Effects of an anti-CD5 immunoconjugate (CD5-Plus) in recent onset type I diabetes mellitus : A preliminary investigation. In: Journal of Diabetic Complications. 1993 ; Vol. 7, No. 4. pp. 224-232.
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N2 - Type-I (insulin-dependent) diabetes mellitus is an immunologically mediated disease that results in destruction of the insulin secreting β cells of the pancreas. T cells have been implicated in the pathogenesis of this disease. One novel form of anti-T-cell therapy is the immunoconjugate CD5-Plus®. This agent is composed of the murine IgG1 monoclonal antibody H65, which is directed toward the CD5+ antigen; and ricin A chain, a ribosomal inhibitor protein. We performed a pilot study to evaluate the safety of the immunoconjugate in subjects with type-I diabetes mellitus. We conducted a dose-escalation study using CD5-Plus given as an intravenous infusion for 5 consecutive days. Fifteen subjects (12 men and 3 women) with a mean age of 26 years, a mean duration of diabetes of 4.8 months, and a minimum stimulated C peptide of 0.3 pmol/mL were entered. Six subjects each were treated at the 0.1 and 0.2 mg/kg/day dosage levels, and three subjects were treated at the 0.33 mg/kg/day dose. Glycemic control was determined monthly by recording the glycohemoglobin, total daily insulin requirements, and fasting blood glucoses. β-cell function was measured by determining the C-peptide response to a mixed formula meal (Sustacal®) at baseline and at 1,3,6,9, and 12 months after treatment. The area under the curve (AUC) of the C-peptide response was calculated and, to reduce variability, related to that of the same subject at baseline. An analysis of subjects who retained at least 80% of their baseline β-cell function as measured by the AUC was performed. In addition, logarithms of the normalized areas under the C-peptide curve ( AUC AUC0) were determined, and the regression line was calculated. This line was compared to that generated by a similar analysis in historical controls who had participated in a previous study using placebo and cyclosporine. T cells were rapidly depleted during the infusion course and recovered to normal values within 30 days. No long-term adverse events were reported. The analysis of subjects retaining 80% of their initial AUC suggested a dose-dependent effect that was significant (p < 0.05) by the Cochran-Armitage test for trend in dose response at month 12. The slope of the linear regression line for all subjects was different from zero (p < 0.03), but this was accounted for entirely by the low-dose group. The slope of the regression line in subjects treated at the two higher doses of CD5-Plus did not significantly differ from zero and was similar to the cyclosporine-treated group of a previous study. This study demonstrates that CD5-Plus was tolerated by a group of recent onset type-I diabetic patients and resulted in reversible T-cell depletion. Preliminary efficacy analysis suggests a dose-dependent preservation of β-cell function. A full-scale, randomized, controlled trial to investigate the potential of CD5-Plus to preserve C-peptide function in new onset type-I diabetes is warranted.

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