MELPIDA for Hereditary spastic paraplegia type 50 (SPG50)

Inclusion criteria

• {"criterion_text":"- Male or female subjects aged ≥ 6 years at the time of screening"}
• {"criterion_text":"- Molecularly confirmed diagnosis of SPG50, defined as bi-allelic pathogenic variants in the AP4M1 gene, as determined by genomic DNA mutation analysis performed in a CLIA-certified, CE-marked, or equivalent laboratory."}
• {"criterion_text":"- Ability to sit independently for three seconds (corresponding to item 24 of the Gross Motor Function Measure GMFM-88)."}
• {"criterion_text":"- Evidence of neurological dysfunction based on clinical history and physical examination."}
• {"criterion_text":"- Stable dosing of concomitant medications – including anti-spasticity medications, anti-epileptic medications, behavioral management medications, sleep medications, and special diets, supplements or nutritional support – for at least three months prior to screening. Subjects with recent changes in medications (<3 months) may be included at the Investigator’s discretion."}
• {"criterion_text":"- Availability of two legally competent custodial parents or legally acceptable representatives capable of providing informed consent as approved by the EC. In cases where only one parent has sole legal authority to consent, that parent must be able to actively participate in the consent process."}
• {"criterion_text":"- Legally acceptable representatives must be able to attend all scheduled study visits and provide feedback regarding the subject’s symptoms and performance as described in the protocol."}
• {"criterion_text":"- Subjects and caregivers must demonstrate ability to travel to the study center. For safety reasons, during the 30 days following treatment, subjects must domiciled at a location that allows them to reach the clinical site within approximately 90 minutes. As a practical reference, this corresponds to a maximum distance of about 150 km from the site."}
• {"criterion_text":"- Any sexually active male or female subject must be willing to use highly effective contraceptive methods for the full 5 years of the study and use a barrier method of contraception for 6 months post dosing, regardless of any other contraceptive method or sexual orientation."}

Exclusion criteria

• {"criterion_text":"- Inability to participate in the clinical evaluation, as determined by the Principal Investigators."}
• {"criterion_text":"- Any condition that would contraindicate MRI, per local institutional policy."}
• {"criterion_text":"- Any other condition that would preclude the subject from undergoing required study procedures."}
• {"criterion_text":"- Presence of significant AP-4-related CNS impairment or behavioral disturbances that would compromise the scientific rigor or interpretation of study results."}
• {"criterion_text":"- Laboratory abnormalities deemed potentially clinically significant."}
• {"criterion_text":"- Recent or planned elective surgical procedures that could confound the scientific rigor or interpretation of study results."}
• {"criterion_text":"- Failure to obtain valid informed consent."}
• {"criterion_text":"- Reason to believe that the subject or the parents of the subject will not comply with the procedures outlined in the study protocol."}
• {"criterion_text":"- Receipt of an investigational drug within 30 days prior to screening or plans to receive an investigational drug (other than gene therapy) during the study period."}
• {"criterion_text":"- Enrollment and participation in another interventional clinical trial 90 days before the first visit."}
• {"criterion_text":"- Clinically significant abnormal laboratory values (i.e., hemoglobin < 6 or > 20 g/dL; white blood cell > 20,000 per cmm, platelets count < 100,000 per cmm; INR > ULN; GGT, ALT, and AST or total bilirubin > 1.5 × ULN, creatinine ≥ 1.5 mg/dL) prior to gene replacement therapy."}
• {"criterion_text":"- Presence of a concomitant medical condition that precludes lumbar puncture or administration of anesthetic agents for procedures under deep sedation."}
• {"criterion_text":"- Bleeding disorders or any other medical condition or circumstance in which lumbar puncture is contraindicated, per local institutional policy."}
• {"criterion_text":"- Documented cardiomyopathy or significant congenital heart abnormalities."}
• {"criterion_text":"- Inability to undergo sedation safely, in the opinion of the clinical anesthesiologist."}
• {"criterion_text":"- History of severe or life-threatening allergic reactions to sirolimus, tacrolimus, corticosteroids, or gadolinium."}
• {"criterion_text":"- Concomitant illness or requirement for chronic drug treatment that, in the opinion of the Principal Investigator, poses undue risk during gene transfer."}
• {"criterion_text":"- Concomitant chronic drug treatment that would cause clinically significant interactions with study immunosuppressive agents."}

Primary endpoints

• {"endpoint_text":"- Change in total percent score of the eight Major Motor Milestones derived from the Gross Motor Function Measure (GMFM)-88 from baseline at W156.","definition_or_measurement_approach":"Change from baseline measured at week 156 (W156) using the GMFM-88-derived eight Major Motor Milestones total percent score."}

Secondary endpoints

• {"endpoint_text":"- Developmental Milestones – Bayley Scale of Infant and Toddler Development 3rd Edition (Bayley-3) Cognitive Domain – Change in Total Raw Score from Baseline at W156.","definition_or_measurement_approach":"Change from baseline at W156 measured by Bayley-3 Cognitive Domain total raw score."}
• {"endpoint_text":"- Gross and Fine Motor Function (GMFM-88 full scale) – Change in Total Score from Baseline at W156.","definition_or_measurement_approach":"Change from baseline at W156 measured by GMFM-88 full scale total score."}
• {"endpoint_text":"- Disease Severity (Spastic Paraplegia Rating Scale [SPRS]) – Change in Total Score from Baseline at W156.","definition_or_measurement_approach":"Change from baseline at W156 measured by the SPRS total score."}
• {"endpoint_text":"- Disease Severity (Clinical Global Impression [CGI-I]) – Change in Physician-assessed CGI-I from Baseline at W156.","definition_or_measurement_approach":"Change from baseline at W156 assessed by physician-rated CGI-Improvement (CGI-I)."}
• {"endpoint_text":"- Differential Ability Scales, 2nd Edition (DAS-II) - Change in Total Score from Baseline at W156.","definition_or_measurement_approach":"Change from baseline at W156 measured by DAS-II total score."}
• {"endpoint_text":"- Developmental Milestones (Developmental Quotients [DQs]) – Change in DQs for Gross Motor, Adaptive behavior and Cognitive Scores from Base-line.","definition_or_measurement_approach":"Change from baseline in Developmental Quotients for gross motor, adaptive behavior and cognitive domains (no specific timepoint stated beyond study assessments; primary timepoint commonly W156)."}
• {"endpoint_text":"- Axonal Damage (Plasma neurofilament light chain levels [NfL]) – Change in Plasma NfL levels from Baseline.","definition_or_measurement_approach":"Change from baseline in plasma NfL levels (biomarker measurement)."}
• {"endpoint_text":"- Health Related Quality of Life (The Caregiver Priorities and Child Health Index of Life with Disabilities [CPCHILD]) – Change in Total Score from Baseline.","definition_or_measurement_approach":"Change from baseline in CPCHILD total score (caregiver-reported HRQoL instrument)."}
• {"endpoint_text":"- Disease Severity (Parent-rated Global Impression [PGI-I]) – Change in Global Impression as assessed by the primary caregiver from Baseline.","definition_or_measurement_approach":"Change from baseline in parent/caregiver-rated Global Impression (PGI-I)."}
• {"endpoint_text":"- Axonal Damage (Cerebrospinal fluid [CSF] neurofilament light chain levels [NfL]) – Change in CSF NfL levels from Baseline.","definition_or_measurement_approach":"Change from baseline in CSF NfL levels (biomarker measurement)."}
• {"endpoint_text":"- Serum and/or Plasma and CSF biomarkers – Change in Biomarker Levels from Baseline.","definition_or_measurement_approach":"Change from baseline in specified serum/plasma and CSF biomarkers (unspecified panel) measured longitudinally."}
• {"endpoint_text":"- Developmental Milestones (Vineland Adaptive Behavior Scale 3rd Edition [Vineland-3]) – Change in Total Score from Baseline.","definition_or_measurement_approach":"Change from baseline in Vineland-3 total score (adaptive behavior), measured at scheduled visits (primary timepoint W156 for many endpoints)."}

Italy

Earliest CTIS Part Ii Submission Date

10-11-2025

Latest Decision Or Authorization Date

06-02-2026

Processing Time Days

88

Number Of Sites

1

Number Of Participants

5

Primary sponsor

Full Name

Azienda Socio Sanitaria Territoriale Papa Giovanni Xxiii

Organisation Type

Hospital/Clinic/Other health care facility

Country Of Registered Address

Italy

Third parties

• {"country":"Spain","full_name":"Universidad de Navarra","duties_or_roles":"sponsorDuties codes: 4","organisation_type":"Health care"}
• {"country":"Spain","full_name":"Viralgen Vector Core S.L.U.","duties_or_roles":"sponsorDuties codes: 14, 15; value: Manufacturing site","organisation_type":"Pharmaceutical company"}
• {"country":"Lithuania","full_name":"Biomapas UAB","duties_or_roles":"sponsorDuties codes: 8","organisation_type":"Pharmaceutical company"}
• {"country":"Italy","full_name":"Jsb Solutions S.r.l.","duties_or_roles":"sponsorDuties codes: 11, 12","organisation_type":"Pharmaceutical company"}
• {"country":"United States","full_name":"Elpida Therapeutics SPC","duties_or_roles":"sponsorDuties codes: 14, 15; value: MELPIDA Licence holder and supplier","organisation_type":"Pharmaceutical company"}
• {"country":"Spain","full_name":"Advanthera Precise Supply","duties_or_roles":"sponsorDuties codes: 14, 15; value: Batch certification, release and labeling","organisation_type":"Health care"}