Using Topical Sirolimus 2% for Patients With Epidermolysis Bullous Simplex (EBS) Study
Using Topical Sirolimus 2% for Patients With Epidermolysis Bullous Simplex (EBS) Study
Epidermolysis bullosa (EB) simplex is a rare orphan disease caused by a mutation in DNA
 leading to abnormal dominant keratins in the skin. Patients with EB simplex develop lifelong
 painful thick soles on their feet, and current standard of care is supportive. This pilot
 study will target the dominant mutant keratin proteins in the skin to ameliorate the severity
 of EB simplex. The purpose is to improve the function of EB simplex feet with an application
 of topical sirolimus, 2%. The investigators plan on inhibiting the mTOR pathway to down
 regulate the translation of defective keratin proteins and work through anti proliferative
 pathways.
The proposed 40 week pilot study being conducted is a prospective, double-blind, randomized,
 placebo-controlled crossover study. Participants will be assigned to treat both feet with
 either topical sirolimus, 2% cream daily or placebo (vehicle-control) for 12 weeks, followed
 by a 4 week washout period, then re-treatment to both feet will occur by the cross-over
 intervention.

 These studies will exploit the naturally occurring transcriptional regulation of keratin
 sequences, the known gene aberration causing EB simplex, and assess the potential for mTOR
 pathway inhibition in treatment of the patient's plantar lesions. The objective of this study
 is to assess (1) the safety of topical rapamycin for plantar lesions for the treatment of EB
 simplex, and 2) test if topical rapamycin to improves the clinical severity of lesional skin,
 including pain and itch, in subjects with EB simplex at the end of treatment versus baseline
 and compared to an intrasubject placebo treated control. Wound size measurement, quality of
 life evaluation will be assessed using epidermolysis bullosa (QOLEB), and EB disease activity
 and Scarring Index (EBDASI). With the results of this pilot study, physicians would be able
 to transition from supportive care (the current state of the art for EB simplex) to targeted
 molecular therapeutics, leading to improved mobility and quality of life for patients with EB
 simplex.
Inclusion Criteria:

 Subjects must:

 -  Be capable of understanding the purpose and risks of the study and sign a written
 Informed Consent Form (ICF); Legally authorized representative of subjects willing and
 able to give consent for children 4-18 yo.

 -  Be male or female with a diagnosis of EBS

 -  Minimum EBDASI feet activity score of 2/10

 -  Age - 4 years or older

 -  Ability to complete 12 study visits within a 40-week period, each for approximately
 30-60 minutes.

 -  Anticipated life expectancy ≥52 weeks.

 -  Males and females of childbearing potential should be using an effective means of
 contraception.

 -  Laboratory values within the range of normal for the participating institution unless
 the PI feels they are not clinically relevant

 -  Be able to comply with all study requirements

 Exclusion Criteria:

 -  Allergy to sirolimus or components of the vehicle ointment

 -  Pregnancy, breast feeding

 -  Prior history of liver disease

 -  Serious known concurrent medical illness or infection, which could potentially present
 a safety risk and/or prevent compliance with the requirements of the treatment
 program.

 -  Known immunodeficiency virus or syndrome including those with:

 -  Acquired Immunodeficiency Syndrome (AIDS)

 -  Human Immunodeficiency Virus (HIV)

 -  Hepatitis B

 -  Prior history of grafting surgeries or other surgeries in the dermatologic treatment
 area

 -  History of significant condition in the dermatologic treatment area such as trauma,
 which could impair evaluation for the treatment of EBS or non-healing chronic wound.

 -  Use of other investigational drugs within 30 days of the screening visit and/or has
 not recovered from any side effects of prior investigational drugs or procedure in the
 affected area (e.g., a biopsy).

 -  Use of acitretin within the last 1 month

 -  Use of Roaccutane within last 3 months

 -  Botox injections to the feet within the last 6 months.

 -  Participant is planning extra physical activities within the next 3 months.

 -  Amputated foot