Precision Administration of Anti-thymocyte Globulin With or Without Verapamil

Recruiting now · Phase 2 · Has a placebo group

Conditions studied: Type 1 Diabetes

In brief

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.

Key facts

Study ID: NCT06455319
Run by: University of Florida
People needed: 60
Starts: 2025-11-12
Expected to finish: 2030-08-01
Last updated by the study team: 2025-11-26

Who can join

Age: 6 and older, up to 35. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Must be >= 6 years <= 35
Must have a diagnosis of T1D for less than 100 days at randomization
Willing to provide Informed Consent or have a parent or legal guardian provide informed consent if the subject is <18 years of age
Positive for at least one islet cell autoantibody; GAD65A, mIAA, if obtained within 10 days of the onset of insulin therapy, IA-2A, ICA, or ZnT8A
Must have stimulated C-peptide levels of 0.2 pmol/ml measured during a mixed meal tolerance test (MMTT) conducted at least 21 days from diagnosis of diabetes. Randomization should occur within one month (37 days) of the MMTT.
Subjects who are EBV seronegative at screening must be EBV PCR negative within 30 days of randomization and may not have had signs or symptoms of an EBV compatible illness lasting longer than 7 days within 30 days of randomization
Be at least 6 weeks from last live immunization
Participants are required to receive killed influenza vaccination at least 2 weeks prior to randomization when vaccine for the current or upcoming flu season is available
Be willing to forgo live vaccines during the treatment period and for 3 months following last dose of study drug
Be willing to comply with intensive diabetes management

You may not qualify if…

Be immunodeficient or have clinically significant chronic lymphopenia: (Leukopenia (< 3,000 leukocytes /μL), neutropenia (<1,500 neutrophils/μL), lymphopenia (<800 lymphocytes/μL), or thrombocytopenia (<100,000 platelets/μL).
Have active signs or symptoms of acute infection at the time of randomization
Have evidence of prior or current tuberculosis infection as assessed by PPD, interferon gamma release assay or by history
Be currently pregnant or lactating, or anticipate getting pregnant within the two year study period
Require use of other immunosuppressive agents including chronic use of systemic steroids
Have evidence of current or past HIV, Hepatitis B or Hepatitis C infection
Have any complicating medical issues or abnormal clinical laboratory results that may interfere with study conduct, or cause increased risk to include pre-existing cardiac disease, COPD, sickle cell disease, neurological, or blood count abnormalities
Have a history of malignancies other than skin
Evidence of liver dysfunction with AST or ALT greater than 3 times the upper limits of normal
Evidence of renal dysfunction with creatinine greater than 1.5 times the upper limit of normal
Vaccination with a live virus within the last 6 weeks
Current or ongoing use of non-insulin pharmaceuticals that affect glycemic control within prior 7 days of screening
Active participation in another T1D treatment study in the previous 30 days
Prior treatment with any investigational agent to delay beta cell loss in T1D
Known allergy to ATG or Verapamil
Prior treatment with ATG, Verapamil or known allergy to rabbit derived products
Any condition that in the investigator's opinion may adversely affect study participation or may compromise the study results

Where it is running

Barbara Davis Center for Diabetes — Aurora, Colorado, United States (enrolling)
University of Florida — Gainesville, Florida, United States (enrolling)

Full record on ClinicalTrials.gov

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