Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
UNKNOWN
NA
15 participants
INTERVENTIONAL
2017-08-22
2021-06-01
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
Related Clinical Trials
Explore similar clinical trials based on study characteristics and research focus.
Study of Autologous Bone Marrow Concentrate for the Treatment of Critical Limb Ischemia (CLI)
NCT00498069
Bone Marrow Aspirate Concentrate (BMAC) for Treatment of Critical Limb Ischemia (CLI)
NCT01245335
Feasability Study of Autologous Bone Marrow Aspirate Concentrate for Treatment of CLI
NCT00595257
BMAC & Allograft vs BMP-2
NCT02924571
Autologous Bone Marrow Mononuclear Cell Implantation for Moderate to Severe Peripheral Arterial Disease
NCT00919516
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
NA
SINGLE_GROUP
TREATMENT
NONE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
Avance Nerve Graft with autologous BMAC
The Avance Nerve Graft will be inserted in the area of nerve injury. Between 40 to 60 ml of Bone Marrow Aspirate from the anterior or posterior iliac crest of the pelvis will be harvested . Using SmartPrep centrifuge and 60 ml BMAC kit, 7 to 10 ml of final BMAC will be obtained.
Avance Nerve Graft with Autologous BMAC
The Avance Nerve Graft will be inserted in the area of nerve injury. Between 40 to 60 ml of Bone Marrow Aspirate from the anterior or posterior iliac crest of the pelvis will be harvested. Using SmartPrep centrifuge and 60 ml BMAC kit, 7 to 10 ml of final BMAC will be obtained. Of the 7 to 10 ml of final BMAC that is yielded, half (3.5 to 5 ml) of the final concentrate, will be injected on top of the Avance Nerve Graft following coaptation. The second half (3.5 to 5 ml) of the final concentrate will be inserted into a sterile tube containing culture media and shipped overnight to Cleveland Clinic Lerner Research Institute for cell processing and colony assay to confirm that the BMAC indeed contains autologous bone marrow stem cells.
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
Avance Nerve Graft with Autologous BMAC
The Avance Nerve Graft will be inserted in the area of nerve injury. Between 40 to 60 ml of Bone Marrow Aspirate from the anterior or posterior iliac crest of the pelvis will be harvested. Using SmartPrep centrifuge and 60 ml BMAC kit, 7 to 10 ml of final BMAC will be obtained. Of the 7 to 10 ml of final BMAC that is yielded, half (3.5 to 5 ml) of the final concentrate, will be injected on top of the Avance Nerve Graft following coaptation. The second half (3.5 to 5 ml) of the final concentrate will be inserted into a sterile tube containing culture media and shipped overnight to Cleveland Clinic Lerner Research Institute for cell processing and colony assay to confirm that the BMAC indeed contains autologous bone marrow stem cells.
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
* Undergoing peripheral nerve exploration or grafting with allograft in the upper extremity.
* Subjects must be inpatients or scheduled for surgery at the time of study enrollment.
* Has nerve conduction block injuries to the ulnar, median, radial or musculocutaneous nerve of either upper extremities that is less than two years from injury.
* Be willing to undergo tension free end-to-end nerve graft coaptation on both the proximal and distal portion of the nerve gap with the Avance Nerve Graft.
* Be willing to have bone marrow harvested from own body, concentrated, and applied to the site of nerve injury following the insertion of the Avance Nerve Graft.
* Be willing to participate and able to comply with all aspects of the treatment and evaluation schedule over a 18-month duration.
* Capable of giving their own consent to participate in the study, and willing to sign and date an IRB-approved written informed consent prior to initiation of any study procedures.
* Nerve conduction injury affecting sensory and motor function or solely motor function in the upper extremity.
* Nerve gaps following resection, up to 7 cm, inclusive.
Exclusion Criteria
* Subjects who are undergoing or expected to undergo treatment with chemotherapy, radiation therapy, or other known treatment which affects the growth of neural and/or vascular system.
* History of neurodegenerative disease, neuropathy, or diabetic neuropathy.
* History of chronic ischemic condition of the upper extremity.
* Cognitive limitation or mental illness preventing informed consent.
* Nerve injuries \>2 years post initial injury.
* Any participant who at the discretion of the Investigator is not suitable for inclusion in the study.
18 Years
74 Years
ALL
No
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
Walter Reed National Military Medical Center
FED
Curtis National Hand Center at MedStar Union Memorial Hospital
UNKNOWN
Cleveland Clinic Lerner Research Institute
UNKNOWN
Brooke Army Medical Center
FED
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Julia AV Nuelle
Orthopaedic Hand and Microvascular Surgeon
Principal Investigators
Learn about the lead researchers overseeing the trial and their institutional affiliations.
Julia Nuelle, MD
Role: PRINCIPAL_INVESTIGATOR
Brooke Army Medical Center
Leon J Nesti, MD/PhD
Role: PRINCIPAL_INVESTIGATOR
Walter Reed National Military Medical Center
Kenneth Means, MD
Role: PRINCIPAL_INVESTIGATOR
Curtis Hand Center at MedStar Union Memorial Hospital
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
Curtis National Hand Center at MedStar Union Memorial Hospital
Baltimore, Maryland, United States
Walter Reed National Military Medical Center
Bethesda, Maryland, United States
San Antonio Military Medical Center
Fort Sam Houston, Texas, United States
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
Brooks DN, Weber RV, Chao JD, Rinker BD, Zoldos J, Robichaux MR, Ruggeri SB, Anderson KA, Bonatz EE, Wisotsky SM, Cho MS, Wilson C, Cooper EO, Ingari JV, Safa B, Parrett BM, Buncke GM. Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions. Microsurgery. 2012 Jan;32(1):1-14. doi: 10.1002/micr.20975. Epub 2011 Nov 28.
Berger A, Millesi H. Nerve grafting. Clin Orthop Relat Res. 1978 Jun;(133):49-55.
Brushart, T.M. (2011). Nerve Repair (Oxford University Press).
Centeno CJ, Al-Sayegh H, Freeman MD, Smith J, Murrell WD, Bubnov R. A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. Int Orthop. 2016 Aug;40(8):1755-1765. doi: 10.1007/s00264-016-3162-y. Epub 2016 Mar 30.
Center for Biologics Evaluation and Research, C. for D. and R.H. Cellular & Gene Therapy Guidances - Minimal Manipulation of Human Cells, Tissues, and Cellular and Tissue-Based Products: Draft Guidance.
Chen CJ, Ou YC, Liao SL, Chen WY, Chen SY, Wu CW, Wang CC, Wang WY, Huang YS, Hsu SH. Transplantation of bone marrow stromal cells for peripheral nerve repair. Exp Neurol. 2007 Mar;204(1):443-53. doi: 10.1016/j.expneurol.2006.12.004. Epub 2007 Jan 12.
Cho MS, Rinker BD, Weber RV, Chao JD, Ingari JV, Brooks D, Buncke GM. Functional outcome following nerve repair in the upper extremity using processed nerve allograft. J Hand Surg Am. 2012 Nov;37(11):2340-9. doi: 10.1016/j.jhsa.2012.08.028.
Dezawa M, Takahashi I, Esaki M, Takano M, Sawada H. Sciatic nerve regeneration in rats induced by transplantation of in vitro differentiated bone-marrow stromal cells. Eur J Neurosci. 2001 Dec;14(11):1771-6. doi: 10.1046/j.0953-816x.2001.01814.x.
Ding F, Wu J, Yang Y, Hu W, Zhu Q, Tang X, Liu J, Gu X. Use of tissue-engineered nerve grafts consisting of a chitosan/poly(lactic-co-glycolic acid)-based scaffold included with bone marrow mesenchymal cells for bridging 50-mm dog sciatic nerve gaps. Tissue Eng Part A. 2010 Dec;16(12):3779-90. doi: 10.1089/ten.TEA.2010.0299. Epub 2010 Sep 6.
Ducic I, Fu R, Iorio ML. Innovative treatment of peripheral nerve injuries: combined reconstructive concepts. Ann Plast Surg. 2012 Feb;68(2):180-7. doi: 10.1097/SAP.0b013e3182361b23.
Dvali L, Mackinnon S. Nerve repair, grafting, and nerve transfers. Clin Plast Surg. 2003 Apr;30(2):203-21. doi: 10.1016/s0094-1298(02)00096-2.
Frykman, G., and Gramyk, K. (1991). Results of Nerve Grafting In: Gelberman R. Operative nerve repair and reconstruction. (JB Lippincott).
Galanakos SP, Zoubos AB, Ignatiadis I, Papakostas I, Gerostathopoulos NE, Soucacos PN. Repair of complete nerve lacerations at the forearm: an outcome study using Rosen-Lundborg protocol. Microsurgery. 2011 May;31(4):253-62. doi: 10.1002/micr.20845. Epub 2010 Dec 3.
Graham, James B., Xue, Qing-Shan, Neubauer, Debbie, and Muir, David (2009). A chondroitinase-treated, decellularized nerve allograft compares favorably to the cellular isograft in rat peripheral nerve repair. 2, 19-29
Guo Y, Chen G, Tian G, Tapia C. Sensory recovery following decellularized nerve allograft transplantation for digital nerve repair. J Plast Surg Hand Surg. 2013 Dec;47(6):451-3. doi: 10.3109/2000656X.2013.778862. Epub 2013 Jul 15.
Hegde V, Shonuga O, Ellis S, Fragomen A, Kennedy J, Kudryashov V, Lane JM. A prospective comparison of 3 approved systems for autologous bone marrow concentration demonstrated nonequivalency in progenitor cell number and concentration. J Orthop Trauma. 2014 Oct;28(10):591-8. doi: 10.1097/BOT.0000000000000113.
Hendrich C, Franz E, Waertel G, Krebs R, Jager M. Safety of autologous bone marrow aspiration concentrate transplantation: initial experiences in 101 patients. Orthop Rev (Pavia). 2009 Oct 10;1(2):e32. doi: 10.4081/or.2009.e32.
Hernigou P, Homma Y, Flouzat-Lachaniette CH, Poignard A, Chevallier N, Rouard H. Cancer risk is not increased in patients treated for orthopaedic diseases with autologous bone marrow cell concentrate. J Bone Joint Surg Am. 2013 Dec 18;95(24):2215-21. doi: 10.2106/JBJS.M.00261.
Hu N, Wu H, Xue C, Gong Y, Wu J, Xiao Z, Yang Y, Ding F, Gu X. Long-term outcome of the repair of 50 mm long median nerve defects in rhesus monkeys with marrow mesenchymal stem cells-containing, chitosan-based tissue engineered nerve grafts. Biomaterials. 2013 Jan;34(1):100-11. doi: 10.1016/j.biomaterials.2012.09.020. Epub 2012 Oct 11.
Hu J, Zhu QT, Liu XL, Xu YB, Zhu JK. Repair of extended peripheral nerve lesions in rhesus monkeys using acellular allogenic nerve grafts implanted with autologous mesenchymal stem cells. Exp Neurol. 2007 Apr;204(2):658-66. doi: 10.1016/j.expneurol.2006.11.018. Epub 2007 Jan 10.
IJpma FF, Nicolai JP, Meek MF. Sural nerve donor-site morbidity: thirty-four years of follow-up. Ann Plast Surg. 2006 Oct;57(4):391-5. doi: 10.1097/01.sap.0000221963.66229.b6.
Isaacs J. Major peripheral nerve injuries. Hand Clin. 2013 Aug;29(3):371-82. doi: 10.1016/j.hcl.2013.04.006. Epub 2013 Jun 12.
Jackson WM, Alexander PG, Bulken-Hoover JD, Vogler JA, Ji Y, McKay P, Nesti LJ, Tuan RS. Mesenchymal progenitor cells derived from traumatized muscle enhance neurite growth. J Tissue Eng Regen Med. 2013 Jun;7(6):443-51. doi: 10.1002/term.539. Epub 2012 May 3.
Jager M, Jelinek EM, Wess KM, Scharfstadt A, Jacobson M, Kevy SV, Krauspe R. Bone marrow concentrate: a novel strategy for bone defect treatment. Curr Stem Cell Res Ther. 2009 Jan;4(1):34-43. doi: 10.2174/157488809787169039.
Johnson PJ, Newton P, Hunter DA, Mackinnon SE. Nerve endoneurial microstructure facilitates uniform distribution of regenerative fibers: a post hoc comparison of midgraft nerve fiber densities. J Reconstr Microsurg. 2011 Feb;27(2):83-90. doi: 10.1055/s-0030-1267834. Epub 2010 Oct 13.
Karabekmez FE, Duymaz A, Moran SL. Early clinical outcomes with the use of decellularized nerve allograft for repair of sensory defects within the hand. Hand (N Y). 2009 Sep;4(3):245-9. doi: 10.1007/s11552-009-9195-6. Epub 2009 May 2.
Kragh, Kirby, J.M., and Ficke, J.R. Combat casualty care : lessons learned from OEF and OIF. Chapter 9: Extremity Injury. (2012) Editor-in-chief, Martha K. Lenhart; medical editor, Eric Savitsky; military editor, Brian Eastridge. Pgs. 393-484
Lin MY, Manzano G, Gupta R. Nerve allografts and conduits in peripheral nerve repair. Hand Clin. 2013 Aug;29(3):331-48. doi: 10.1016/j.hcl.2013.04.003.
Lohmeyer JA, Siemers F, Machens HG, Mailander P. The clinical use of artificial nerve conduits for digital nerve repair: a prospective cohort study and literature review. J Reconstr Microsurg. 2009 Jan;25(1):55-61. doi: 10.1055/s-0028-1103505. Epub 2008 Nov 26.
Lundborg G. A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg Am. 2000 May;25(3):391-414. doi: 10.1053/jhsu.2000.4165.
Lundborg G, Rosen B. The two-point discrimination test--time for a re-appraisal? J Hand Surg Br. 2004 Oct;29(5):418-22. doi: 10.1016/j.jhsb.2004.02.008.
Mackinnon SE, Doolabh VB, Novak CB, Trulock EP. Clinical outcome following nerve allograft transplantation. Plast Reconstr Surg. 2001 May;107(6):1419-29. doi: 10.1097/00006534-200105000-00016.
Meek MF, Coert JH, Robinson PH. Poor results after nerve grafting in the upper extremity: Quo vadis? Microsurgery. 2005;25(5):396-402. doi: 10.1002/micr.20137.
Mimura T, Dezawa M, Kanno H, Sawada H, Yamamoto I. Peripheral nerve regeneration by transplantation of bone marrow stromal cell-derived Schwann cells in adult rats. J Neurosurg. 2004 Nov;101(5):806-12. doi: 10.3171/jns.2004.101.5.0806.
Neubauer D, Graham JB, Muir D. Nerve grafts with various sensory and motor fiber compositions are equally effective for the repair of a mixed nerve defect. Exp Neurol. 2010 May;223(1):203-6. doi: 10.1016/j.expneurol.2009.08.013. Epub 2009 Aug 22.
Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998 Jul;45(1):116-22. doi: 10.1097/00005373-199807000-00025.
PRWeb. (2015). AxoGen Inc.'s Avance Nerve Graft Data Presented During Bese Clinical Papers Session at the 70th Annual Meeting of the American Society for Surgery of the Hand. Vocus, Inc. Sep. 10, 2015
Reyes M, Verfaillie CM. Characterization of multipotent adult progenitor cells, a subpopulation of mesenchymal stem cells. Ann N Y Acad Sci. 2001 Jun;938:231-3; discussion 233-5. doi: 10.1111/j.1749-6632.2001.tb03593.x.
Rinker B, Liau JY. A prospective randomized study comparing woven polyglycolic acid and autogenous vein conduits for reconstruction of digital nerve gaps. J Hand Surg Am. 2011 May;36(5):775-81. doi: 10.1016/j.jhsa.2011.01.030. Epub 2011 Apr 12.
Siemionow M, Duggan W, Brzezicki G, Klimczak A, Grykien C, Gatherwright J, Nair D. Peripheral nerve defect repair with epineural tubes supported with bone marrow stromal cells: a preliminary report. Ann Plast Surg. 2011 Jul;67(1):73-84. doi: 10.1097/SAP.0b013e318223c2db.
Taras JS, Amin N, Patel N, McCabe LA. Allograft reconstruction for digital nerve loss. J Hand Surg Am. 2013 Oct;38(10):1965-71. doi: 10.1016/j.jhsa.2013.07.008. Epub 2013 Aug 30.
Wakao S, Hayashi T, Kitada M, Kohama M, Matsue D, Teramoto N, Ose T, Itokazu Y, Koshino K, Watabe H, Iida H, Takamoto T, Tabata Y, Dezawa M. Long-term observation of auto-cell transplantation in non-human primate reveals safety and efficiency of bone marrow stromal cell-derived Schwann cells in peripheral nerve regeneration. Exp Neurol. 2010 Jun;223(2):537-47. doi: 10.1016/j.expneurol.2010.01.022. Epub 2010 Feb 11.
Wang D, Liu XL, Zhu JK, Jiang L, Hu J, Zhang Y, Yang LM, Wang HG, Yi JH. Bridging small-gap peripheral nerve defects using acellular nerve allograft implanted with autologous bone marrow stromal cells in primates. Brain Res. 2008 Jan 10;1188:44-53. doi: 10.1016/j.brainres.2007.09.098. Epub 2007 Oct 18.
Wang D, Liu XL, Zhu JK, Hu J, Jiang L, Zhang Y, Yang LM, Wang HG, Zhu QT, Yi JH, Xi TF. Repairing large radial nerve defects by acellular nerve allografts seeded with autologous bone marrow stromal cells in a monkey model. J Neurotrauma. 2010 Oct;27(10):1935-43. doi: 10.1089/neu.2010.1352.
Wangensteen KJ, Kalliainen LK. Collagen tube conduits in peripheral nerve repair: a retrospective analysis. Hand (N Y). 2010 Sep;5(3):273-7. doi: 10.1007/s11552-009-9245-0. Epub 2009 Nov 24.
Weber RA, Breidenbach WC, Brown RE, Jabaley ME, Mass DP. A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans. Plast Reconstr Surg. 2000 Oct;106(5):1036-45; discussion 1046-8. doi: 10.1097/00006534-200010000-00013.
Whitlock EL, Tuffaha SH, Luciano JP, Yan Y, Hunter DA, Magill CK, Moore AM, Tong AY, Mackinnon SE, Borschel GH. Processed allografts and type I collagen conduits for repair of peripheral nerve gaps. Muscle Nerve. 2009 Jun;39(6):787-99. doi: 10.1002/mus.21220.
Zuniga JR. Sensory outcomes after reconstruction of lingual and inferior alveolar nerve discontinuities using processed nerve allograft--a case series. J Oral Maxillofac Surg. 2015 Apr;73(4):734-44. doi: 10.1016/j.joms.2014.10.030. Epub 2014 Nov 13.
Provided Documents
Download supplemental materials such as informed consent forms, study protocols, or participant manuals.
Document Type: Study Protocol and Statistical Analysis Plan
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
C.2017.074
Identifier Type: -
Identifier Source: org_study_id
More Related Trials
Additional clinical trials that may be relevant based on similarity analysis.