Bone Marrow Aspirate Concentrate (BMAC) for Treatment of Critical Limb Ischemia (CLI)

NCT ID: NCT01245335

Last Updated: 2015-12-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

97 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-05-31

Study Completion Date

2015-11-30

Brief Summary

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Critical Limb Ischemia prevents the legs and feet from receiving oxygen and nutrients needed for proper function. This severe lack of blood flow can lead to painful legs while walking or at rest and can result in foot sores, ulcers, gangrene, and even amputation. The purpose of this study is to determine if injections of concentrated bone marrow into damaged tissues will result in improved blood flow. If successful, this treatment could improve blood flow to the lower limb, reduce pain, and reduce the frequency of limb amputations.

Detailed Description

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Bone marrow aspirate is collected and processed by centrifugation to remove red blood cells. The resulting concentrate of cells is injected into ischemic tissues of the lower limb. The purpose of this study is to determine if injections of concentrated bone marrow nucleated cells into ischemic tissues will result in vasculogenesis.

Conditions

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Critical Limb Ischemia

Keywords

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CLI Critical Limb Ischemia PAOD Peripheral Arterial Disease Stem Cells Limb amputation Leg ulcers

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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BMAC Treatment

Intervention- Injection of 40 ml of autologous bone marrow concentrate (BMAC injection) prepared with the SmartPReP2 BMAC System

Group Type ACTIVE_COMPARATOR

BMAC injection

Intervention Type DEVICE

Injection of 40 ml of autologous bone marrow aspirate concentrate (BMAC injection) prepared with the SmartPReP2 BMAC System

Placebo Injection

Injection of placebo (diluted peripheral blood) into ischemic tissue of the lower extremity

Group Type PLACEBO_COMPARATOR

Placebo injection

Intervention Type DEVICE

Injection of placebo into ischemic tissue of the lower extremity

Interventions

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BMAC injection

Injection of 40 ml of autologous bone marrow aspirate concentrate (BMAC injection) prepared with the SmartPReP2 BMAC System

Intervention Type DEVICE

Placebo injection

Injection of placebo into ischemic tissue of the lower extremity

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patient has Peripheral Arterial Occlusive Disease (PAOD) with clinical Rutherford Category 5 disease, as defined in the reporting standards adopted by the Society of Vascular Surgeons(table 1); Minor Tissue loss-focal gangrene with diffuse pedal ischemia
* Patient meets at least one of the following diagnostic criteria in the study limb:

* Ankle artery occlusion pressure absolute ≤60 mmHg or ABI ≤0.6
* Toe artery occlusive pressure \< 50mm Hg or TBI ≤0.6
* There is no reasonable open surgical or endovascular revascularization option as determined by the treating vascular specialist. Factors that may contribute to the determination of inoperability may include:

* Anatomical considerations
* No outflow targets
* No appropriate conduit (i.e. vein for bypass)
* Long segment occlusions or calcified lesions that predict poor outcome with endovascular approaches.

* High risk medical conditions i.e. Unstable cardiac disease.
* History of prior failed revascularization attempts
* The Patient's case was reviewed at the treating institution's Multidisciplinary Vascular Conference where the patient's status as a poor candidate for conventional therapies was confirmed.
* Age ≥18 years and ability to understand the planned treatment
* Subject has read and signed the IRB approved Informed Consent form
* Patients for whom the following medication(s) is prescribed must have a one month stable baseline therapy prior to enrollment: Plavix/asprin therapy, anticoagulation therapy, cholesterol lowering agent, and or blood pressure medication. If any of these medications are not prescribed notation of the reason for omission is to be provided.
* Hematocrit ≥ 28.0%, White Blood Cell count ≤ 14,000, Platelet count ≥ 50,000, Creatinine ≤ 2.5 mg / dL, INR ≤ 1.6 unless on Coumadin, or PTT \<1.5 x control (to avoid bleeding complications) Patients on Coumadin will be corrected prior to the procedure and must have an INR\<1.6 at the time of randomization/surgery.

Exclusion Criteria

* Life expectancy \<6 months due to concomitant illnesses
* History of bone marrow diseases (especially NHL, MDS) that prohibit transplantation
* Terminal renal failure with existing dependence on dialysis or serum creatinine \>2.5 mg/dL
* Known active malignancy or results outside of normal limits from the following tests: PAP, Chest X-ray, PSA, Mammogram, Hemocult unless follow-up studies reveal patient to be cancer free.
* Poorly controlled diabetes mellitus (HgbA1C\>10%)
* Medical risk that precludes anesthesia (conscious sedation), or ASA Class 5
* Life-threatening complications of the ischemia necessitating immediate amputation
* Uncorrected occlusion of the common or external iliac artery on index side
* Absence of any pulsatile Doppler flow below the ankle.
* Extensive necrosis of the index limb or other conditions that make amputation inevitable (Rutherford Category 6).
* Ulceration with exposed bone proximal to the distal metatarsal heads (ie. heel or mid foot)
* Active clinical infection or infection being treated by antibiotics within one week of enrollment
* Treatment with immunosuppressant drugs (including Prednisone \> 5 mg per day).
* Female who is pregnant or nursing, or of child bearing potential and is not using a reliable birth control method.
* Underwent a major open cardiovascular surgical procedure (carotid endarterectomy, arterial aneurysm or bypass surgery, or coronary artery bypass surgery) or a myocardial infarction within the 3 months prior to randomization
* Underwent a successful or partially successful endovascular intervention for peripheral arterial occlusive disease. (ie. Aorta, iliac, femoral, popliteal, or tibial artery angioplasty, stenting, or atherectomy) within the prior 3 months.
* Endovascular coronary intervention (ie. Angioplasty, atherectomy, stenting) within 1 month prior to randomization.

1. The procedure is diagnostic only with no intervention performed, (for example in the case where wire crossing can not be obtained).
2. The treated artery recoils, thromboses, or dissects resulting in occlusion of the treated arterial segment, documented by intraoperative imaging. Note that endovascular procedures with suboptimal results but not meeting criteria 1 or 2 above may qualify for inclusion after 3 months as in #16 above.
* Cerebrovascular accident within 6 months prior to randomization.
* Treatment with topical growth factors or hyperbaric oxygen (HBO) within 30 days, or systemic growth factor treatment within 6 months of enrollment.
* Known hypersensitivity to heparin; or history of heparin-induced thrombocytopenia (HIT).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Harvest Technologies

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mark Iafrati, MD

Role: PRINCIPAL_INVESTIGATOR

Tufts Medical Ctr

Locations

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University of Alabama

Birmingham, Alabama, United States

Site Status

Medical Center of South Arkansas

El Dorado, Arkansas, United States

Site Status

USC Keck School of Medicine

Los Angeles, California, United States

Site Status

Florida Hospital - Vascular Institute of Central Florida

Orlando, Florida, United States

Site Status

Coastal Vascular & Interventional

Pensacola, Florida, United States

Site Status

USF / Tampa General

Tampa, Florida, United States

Site Status

University of Illinois-Chicago

Chicago, Illinois, United States

Site Status

Cadence Health, Central DuPage Hospital

Winfield, Illinois, United States

Site Status

Ochsner Clinic

New Orleans, Louisiana, United States

Site Status

Maine Medical Ctr

Portland, Maine, United States

Site Status

Johns Hopkins Hospital

Baltimore, Maryland, United States

Site Status

Tufts Medical Center

Boston, Massachusetts, United States

Site Status

Beth Israel Deaconess

Boston, Massachusetts, United States

Site Status

Kansas City Vascular

Kansas City, Missouri, United States

Site Status

Mercy Hospital

St Louis, Missouri, United States

Site Status

Dartmouth Hitchcock Medical Ctr

Lebanon, New Hampshire, United States

Site Status

Cooper University Hospital

Camden, New Jersey, United States

Site Status

Holy Name Medical Center

Teaneck, New Jersey, United States

Site Status

North Shore-Long Island Jewish

Lake Success, New York, United States

Site Status

St. Luke's Roosevelt

New York, New York, United States

Site Status

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina, United States

Site Status

Wake Forest Baptist Health

Winston-Salem, North Carolina, United States

Site Status

University of Cincinnati

Cincinnati, Ohio, United States

Site Status

Regional Infectious Disease and Infusion Ctr

Lima, Ohio, United States

Site Status

University of Oklahoma

Tulsa, Oklahoma, United States

Site Status

Oregon Health Science University

Portland, Oregon, United States

Site Status

Rhode Island Hospital

Providence, Rhode Island, United States

Site Status

Roper St Francis Medical Center

Charleston, South Carolina, United States

Site Status

Greenville Health System

Greenville, South Carolina, United States

Site Status

University of Tennessee

Knoxville, Tennessee, United States

Site Status

Baylor Medical Ctr

Dallas, Texas, United States

Site Status

University of Texas - Houston Medical School

Houston, Texas, United States

Site Status

Peace Health Southwest Medical Center

Vancouver, Washington, United States

Site Status

Charleston Area Medical Center Institute

Charleston, West Virginia, United States

Site Status

Countries

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United States

Other Identifiers

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CLI-2011-1

Identifier Type: -

Identifier Source: org_study_id