Autologous Stem Cells for the Treatment of No Option Critical Limb Ischemia

NCT ID: NCT03455335

Last Updated: 2021-03-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 12 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-03-23
• Study Completion Date: 2019-10-31

Brief Summary

The trial is a phase 1b, open label, uncontrolled, non-randomized dose-escalation study of autologous bone marrow-derived MSCs. Following informed consent, patients who meet the criteria will be screened and enrolled. Up to 100 mls of bone marrow will be harvested from the participant from which MSCs will be culture expanded. In this dose escalation study, 3 participants on each cohort will be treated with a targeted dose of either 20 million hMSC; 40 million hMSC; or 80 million hMSC. The cells will be administered to the ischemic leg by 20 intramuscular injections of approximately 0.5ml per injection . Treatment groups will be completed sequentially, beginning with the lowest dose group.

Detailed Description

This is a phase 1b, open label, uncontrolled, non-randomized dose-escalation study to examine the safety of intramuscular autologous transplantation of escalating doses of mesenchymal stem cells to patients with no option critical limb ischemia.

Trial Aims and Objectives: To examine the safety of intramuscular transplantation of escalating doses of autologous bone marrow derived mesenchymal stem cells to patients with no option critical limb ischemia.

Patient Population: Patients with critical limb ischemia who are not candidates for revascularization.

Trial Setting:HRB Clinical Research Facility Galway and Galway University Hospitals.

Trial Intervention:Intramuscular delivery of autologous bone marrow-derived mesenchymal stem cells to patients with no option critical limb ischemia.

Study Design: Open label, uncontrolled, non-randomized, dose escalation study. Sample Size: 9 Method of Participant Assignment:Sequential administration of 3 escalating doses of autologous bone marrow-derived mesenchymal stem cells.

Examination Points: Day 0, 7, 30, 90, 180, 365 and 730 Primary Outcome: Serious adverse events that are attributable to intervention. Secondary Outcomes :Amputation free survival, median time to amputation, TcPo2, ABI, pain scale, ulcer healing, quality of life assessments, collateral vessel formation detected by MRI at 12 months.

Conditions

Critical Limb Ischemia

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

low dose cohort

20 million hMSCs .

Group Type: EXPERIMENTAL

20 million hMSCs

Intervention Type: DRUG

mid dose cohort

40 million hMSCs

Group Type: EXPERIMENTAL

40 million hMSCs

Intervention Type: DRUG

high dose cohort

80 million hMSCs .

Group Type: EXPERIMENTAL

80 million hMSCs

Intervention Type: DRUG

Interventions

20 million hMSCs

Intervention Type: DRUG

40 million hMSCs

Intervention Type: DRUG

80 million hMSCs

Intervention Type: DRUG

Other Intervention Names

20 million hMSCs intramuscularly; 40 million hMSCs intramuscularly; 80 million hMSCs intramuscularly

Eligibility Criteria

Inclusion Criteria

1. Men and women between the ages of 18 and 85

2. Voluntary written informed consent, given before performance of any study-related procedure not part of standard medical care, and with the understanding that consent may be withdrawn at any time without prejudice to future medical care

3. Presented with CLI with rest pain or ulceration with no option for revascularization agreed by an expert panel including an interventional radiologist and vascular surgeon; CLI defined as persistent ischemic rest pain for greater than or equal to 2 weeks and/or ulceration or gangrene of the toe or foot

4. Estimated life expectancy > 6 months as deemed by patient's clinician and/or investigator

5. Suitable candidate for a bone marrow aspiration, deemed by Consultant Haematologist

6. Chronic critical limb ischaemia with rest pain (Rutherford Class 4) or mild-to-moderate tissue loss (Rutherford Class 5) who are not candidates for revascularisation

7. Medically fit to undergo bone marrow harvest and stem cell intramuscular injection

8. One of the following haemodynamic parameters: ankle systolic pressure < 70 mmHg or ABI <0.9 TBI <0 .6 TcPO2 <60mmHg on room air

Exclusion Criteria

1. Has received prior therapy with MSCs

2. Has had previous amputation of the talus or above

3. Has failed revascularization within 2 weeks before entry to the study

4. Known Aortoiliac disease with > 50% stenosis

5. Contraindication to intramuscular procedure, including active infection in the affected limb, or wet gangrene or exposed bone or tendon in lower limb with CLI, or in the opinion of the attending clinician, is unsuitable for intramuscular procedure

6. Severe co-morbidity limiting 6 month survival of patients

7. Abnormal liver function as defined by AST and ALT > 2.5 fold the ULN and total bilirubin > 1.5 ULN

8. Significant cognitive impairment (Mini Mental Status Examination <22)

9. Presence of proliferative retinopathy (in participants with diabetes mellitus only)

10. Presence of poorly controlled diabetes mellitus with HbAIc > 10% within previous 3 months

11. HIV or HBsAg positive

12. Presence of acute coronary syndrome

13. Patient has known active malignancy

14. Pregnancy

15. Likely inability to comply with the protocol or cooperate fully with the investigator and site personnel

16. Patient taking other investigational drugs at the time of enrolment or within 28 days of enrolment

17. Rutherford class 6 CLI

18. Significant bone marrow dysfunction, based on assessment by Haematologist or an established diagnosis of myelodysplasia, or myeloproliferative disorder etc.

19. Bleeding diathesis, coagulopathy, thrombocytopenia etc.

20. Patients in whom delay incurred by attempts at limb salvage using MSCs will adversely affect prognosis in the opinion of the responsible attending clinician

21. Patients with known allergy to foetal bovine serum or trypsin

-

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University Hospital of Limerick

OTHER

Sponsor Role: collaborator

National University of Ireland, Galway, Ireland

OTHER

Sponsor Role: lead

Responsible Party

Professor Tim O Brien

Professor Tim o Brien

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Timothy O Brien, PhD

Role: PRINCIPAL_INVESTIGATOR

NUIG

Locations

Galway University Hospital

Galway, Galway, Ireland

Countries

Ireland

References

Mohamed SA, Howard L, McInerney V, Hayat A, Krawczyk J, Naughton S, Finnerty A, Holohan M, Duffy A, Moloney T, Kavanagh E, Burke P, Liew A, Tubassam M, Walsh SR, O'Brien T. Autologous bone marrow mesenchymal stromal cell therapy for "no-option" critical limb ischemia is limited by karyotype abnormalities. Cytotherapy. 2020 Jun;22(6):313-321. doi: 10.1016/j.jcyt.2020.02.007. Epub 2020 Apr 6.

Reference Type: BACKGROUND

PMID: 32273232 (View on PubMed)

EU Clinical Trials Register Clinical trial results 2013-003447-37 version 1 EU-CTR publication date: of 21 01 January 2021

Reference Type: BACKGROUND

Other Identifiers

2013-001

Identifier Type: -

Identifier Source: org_study_id