The Use of Exosomes In Craniofacial Neuralgia

NCT ID: NCT04202783

Last Updated: 2022-09-28

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

SUSPENDED

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-01

Study Completion Date

2024-12-01

Brief Summary

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This study is designed to evaluate the safety and efficacy of exosome deployment in patients with Craniofacial Neuralgia. Secondarily, this study is designed to rigorously evaluate for any adverse events that may be related to the administration and reception of exosomes.

Detailed Description

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The present study is designed to amplify the delivery of growth factors and anti-inflammatory agents to localized targets (determined by specific condition) by using focused transcranial ultrasound prior to intravenous infusion of exosomes. Exosomes delivered intravenously can be demonstrated to cross the blood brain barrier naturally. Exosomes are thought to play a normal physiological role in intercellular signaling, and demonstrate anti-inflammatory and pro-growth effects in preclinical models and clinical cases reports. Clinical trials have deployed exosomes intravenously and with intracerebral and intrathecal injection, and have claimed safety and clinical efficacy.

Focused ultrasound has been shown to enhance local blood flow and has been presented as a non-invasive means of targeting delivery of therapeutic agents.

Conditions

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Neuralgia

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

The present study is being undertaken as an open label study to evaluate the safety and feasibility of exosomes as an intervention for patients with craniofacial neuralgia. Baseline and outcome measures in this study utilize validated tests that are appropriate for repeated measures. The present study can be easily implemented because the neuropsychological testing instruments have been in routine clinical deployment providing for a high degree of availability and reliability. Quality assurance is tightly controlled. The study population is sufficiently broad and the conditions of interest are sufficiently prevalent so that recruitment of subjects is not a limiting factor.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Treatment of Craniofacial Neuralgia

All patients will receive the same amount (5mL concentrated) of exosomes delivered via ultrasound-guided, regional epineural injection and the same amount (5mL unconcentrated) delivered via IV. Patients will be given 3 mL of the exosome product intravenously, which contains about 45mg of the exosome product containing 15-21 million neonatal stem cell products, and 3 mL of the exosome hyperconcentrate product delivered epineurally using ultrasound guidance, which contains about 15mg of the exosome product carrying 5-7 million neonatal stem cell products.

Group Type EXPERIMENTAL

Exosomes

Intervention Type OTHER

Focused ultrasound delivery of intravenously-infused exosomes

Interventions

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Exosomes

Focused ultrasound delivery of intravenously-infused exosomes

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Male or Female at least 18 years of age
* Clinical diagnosis of craniofacial neuralgia

Exclusion Criteria

* Subjects unable to give informed consent
* Subjects who would not be able to lay down without excessive movement in a calm environment sufficiently long enough to be able to achieve sleep
* Recent surgery or dental work within 3 months of the scheduled procedure.
* Pregnancy, women who may become pregnant or are breastfeeding
* Advanced terminal illness
* Any active cancer or chemotherapy
* Bone marrow disorder
* Myeloproliferative disorder
* Sickle cell disease
* Primary pulmonary hypertension
* Immunocompromising conditions and/or immunosuppressive therapies
* Macular degeneration
* Subjects with scalp rash or open wounds on the scalp (for example from treatment of squamous cell cancer)
* Advanced kidney, pulmonary, cardiac or liver failure
* Subjects with vascular causes of dementia
* Bleeding disorder, untreated
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Neurological Associates of West Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sheldon Jordan, MD

Role: PRINCIPAL_INVESTIGATOR

Neurological Associates of West Los Angeles

Locations

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Neurological Associates of West LA

Santa Monica, California, United States

Site Status

Countries

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United States

References

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Mikula I. [Craniofacial neuralgias]. Acta Med Croatica. 2008 May;62(2):163-72. Croatian.

Reference Type BACKGROUND
PMID: 18710080 (View on PubMed)

Spina A, Mortini P, Alemanno F, Houdayer E, Iannaccone S. Trigeminal Neuralgia: Toward a Multimodal Approach. World Neurosurg. 2017 Jul;103:220-230. doi: 10.1016/j.wneu.2017.03.126. Epub 2017 Apr 2.

Reference Type BACKGROUND
PMID: 28377244 (View on PubMed)

Rose FC. Trigeminal neuralgia. Arch Neurol. 1999 Sep;56(9):1163-4. doi: 10.1001/archneur.56.9.1163. No abstract available.

Reference Type BACKGROUND
PMID: 10488822 (View on PubMed)

Cruccu G. Trigeminal Neuralgia. Continuum (Minneap Minn). 2017 Apr;23(2, Selected Topics in Outpatient Neurology):396-420. doi: 10.1212/CON.0000000000000451.

Reference Type BACKGROUND
PMID: 28375911 (View on PubMed)

Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia - diagnosis and treatment. Cephalalgia. 2017 Jun;37(7):648-657. doi: 10.1177/0333102416687280. Epub 2017 Jan 11.

Reference Type BACKGROUND
PMID: 28076964 (View on PubMed)

O'Neill F, Nurmikko T, Sommer C. Other facial neuralgias. Cephalalgia. 2017 Jun;37(7):658-669. doi: 10.1177/0333102417689995. Epub 2017 Jan 29.

Reference Type BACKGROUND
PMID: 28133989 (View on PubMed)

Marchetti M, Pinzi V, De Martin E, Ghielmetti F, Fariselli L. Radiosurgery for trigeminal neuralgia: the state of art. Neurol Sci. 2019 May;40(Suppl 1):153-157. doi: 10.1007/s10072-019-03814-6.

Reference Type BACKGROUND
PMID: 30838546 (View on PubMed)

Harding C, Heuser J, Stahl P. Receptor-mediated endocytosis of transferrin and recycling of the transferrin receptor in rat reticulocytes. J Cell Biol. 1983 Aug;97(2):329-39. doi: 10.1083/jcb.97.2.329.

Reference Type BACKGROUND
PMID: 6309857 (View on PubMed)

Pan BT, Teng K, Wu C, Adam M, Johnstone RM. Electron microscopic evidence for externalization of the transferrin receptor in vesicular form in sheep reticulocytes. J Cell Biol. 1985 Sep;101(3):942-8. doi: 10.1083/jcb.101.3.942.

Reference Type BACKGROUND
PMID: 2993317 (View on PubMed)

Johnstone RM, Adam M, Hammond JR, Orr L, Turbide C. Vesicle formation during reticulocyte maturation. Association of plasma membrane activities with released vesicles (exosomes). J Biol Chem. 1987 Jul 5;262(19):9412-20.

Reference Type BACKGROUND
PMID: 3597417 (View on PubMed)

Bollini S, Gentili C, Tasso R, Cancedda R. The Regenerative Role of the Fetal and Adult Stem Cell Secretome. J Clin Med. 2013 Dec 17;2(4):302-27. doi: 10.3390/jcm2040302.

Reference Type BACKGROUND
PMID: 26237150 (View on PubMed)

Balbi C, Piccoli M, Barile L, Papait A, Armirotti A, Principi E, Reverberi D, Pascucci L, Becherini P, Varesio L, Mogni M, Coviello D, Bandiera T, Pozzobon M, Cancedda R, Bollini S. First Characterization of Human Amniotic Fluid Stem Cell Extracellular Vesicles as a Powerful Paracrine Tool Endowed with Regenerative Potential. Stem Cells Transl Med. 2017 May;6(5):1340-1355. doi: 10.1002/sctm.16-0297. Epub 2017 Mar 8.

Reference Type BACKGROUND
PMID: 28271621 (View on PubMed)

Zhang B, Yeo RW, Tan KH, Lim SK. Focus on Extracellular Vesicles: Therapeutic Potential of Stem Cell-Derived Extracellular Vesicles. Int J Mol Sci. 2016 Feb 6;17(2):174. doi: 10.3390/ijms17020174.

Reference Type BACKGROUND
PMID: 26861305 (View on PubMed)

Other Identifiers

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ICSS-2019-019

Identifier Type: -

Identifier Source: org_study_id

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