Safety and Efficacy of AMT-130 in European Adults With Early Manifest Huntington's Disease

Prior treatment

• Evidence of suicide risk, defined as:
  • Suicide attempt within 1 year prior to Screening (Visit 1/1A)
  • Suicidal ideation as defined by a positive response to question 5 on Columbia-Suicide Severity Rating Scale (C-SSRS) Suicidal Ideation Section within 60 days prior to Screening (Visit 1/1A)
  • Significant risk of suicide as judged by the Investigator
• Receipt of an experimental agent within 60 days or five half-lives prior to Screening or anytime over the duration of this study.
• Participation in an investigational trial or investigational paradigm (such as exercise/physical activity, cognitive therapy, brain stimulation, etc.) within 60 days prior to Screening or anytime over the duration of this study.
• Any history of gene therapy, RNA or DNA targeted HD specific investigational agents, such as antisense oligonucleotides (ASOs), cell transplantation or any other experimental brain surgery.
• Hospitalization for any major medical or surgical procedure involving general anesthesia within 12 weeks of Screening or planned during the study.
• Known or suspected intolerance or hypersensitivity to the investigational product(s), closely related compounds, or any of the stated ingredients.

Other illness

• Brain and spinal pathology that may interfere with the surgical delivery of AMT-130 or represents a significant neurologic comorbid disorder.
• Malignancy within 5 years of screening, except for basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated.
• Any known allergy to gadoteridol (ProHance).
• Known immunocompromised status including participants who have undergone organ transplantation or who test positive at Screening for the human immunodeficiency virus (HIV); or who are at risk of pathogen reactivation if immunosuppressed, including participants who test positive at screening for hepatitis C virus antibody (anti-HCV), hepatitis C virus ribonucleic acid (HCV RNA), hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (anti-HBc); or who have history of active tuberculosis or a positive tuberculosis blood test during screening. For participants with an indeterminate tuberculosis blood test result or positive tuberculosis test result, repeat testing is recommended.
• Known allergy, sensitivity, or other contraindication to immunosuppression regimens in this protocol.
• Any participant with an active infection (e.g., coronavirus disease 2019 \[COVID-19\]) at Screening or at the time of treatment that requires medical intervention. Participants may rescreen, or if screened eligible and an open surgical slot is available, may receive treatment after recovery.

Lab values

• Current or recurrent disease (including pre-existing cardiovascular or pulmonary conditions), infection, or other significant concurrent medical condition or medications that could confound clinical and laboratory evaluations or could affect a participant's safety or their ability to undergo a neurosurgical procedure (10+ hour surgical procedure) or comply with the procedures and study visit schedule.
• Screening laboratory values (as measured by the central laboratory):
  • Alanine aminotransferase (ALT) \>2 × upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) \>2 × ULN
  • Total bilirubin \>2 × ULN
  • Alkaline phosphatase (ALP) \>2 × ULN
  • Creatinine \>1.5 × ULN
  • Platelet count \<100,000/mm3
  • Prothrombin time (PT) \>1.2 × ULN
  • Partial thromboplastin time (PTT) \>1.2 × ULN

Other

• Presence of an implanted deep brain stimulation device, ventriculoperitoneal or other CSF shunt, or other implanted catheter
• Any contraindication to lumbar puncture or 3.0 Tesla MRI as per local guidelines.
• Any contraindication to 3.0 Tesla MRI as per local guidelines

• Able and willing to provide written informed consent prior to the study and study-related procedure.
• Male and female participants 25-65 years of age.
• Cohorts 1 \& 2:
  • a DCL of 4 OR
  • a DCL of 3 with either a positive ("Yes") response to the UHDRS Question 80 (multidimensional manifest diagnosis on motor, cognitive, behavioral, functional) or DSM5 criteria for cognitive disorder (American Psychiatric Association, 2013; MDS Task Force criteria).
• Cohort 3:
  • a DCL of 4 OR
  • a DCL of 3 with either a positive ("Yes") response to the UHDRS Question 80 (multidimensional manifest diagnosis on motor, cognitive, behavioral, functional) or DSM5 criteria for cognitive disorder (American Psychiatric Association, 2013; MDS Task Force criteria).
• HTT gene expansion testing with the presence of ≥40 CAG repeats (confirmed by genetic testing at central laboratory).
• Striatal MRI volume requirements per hemisphere:
  • Putamen ≥2.5 cm3 (per side)
  • Caudate ≥2.0 cm3 (per side)
• All HD concomitant medications (addressing motor, behavioral and cognitive symptoms) must be stable for 3 months prior to Screening with no change in clinical symptoms requiring change in medication prior to anticipated administration procedure.
• Able and willing to comply with all procedures and the study visit schedule as outlined in the protocol.
• All female participants of childbearing potential (FCOP) must have negative serum pregnancy test at Screening (and Visit 1A, as appropriate), a negative pregnancy urine dipstick at Baseline, and not be breastfeeding. All FOCPs and sexually mature males must be compliant with highly effective birth control method as outlined in Section 4.5.