A Dose-escalation Safety Trial for Intrathecal Autologous Mesenchymal Stem Cell Therapy in Amyotrophic Lateral Sclerosis
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Purpose
The purpose of this study is to determine determine the safety of intraspinal delivery of mesenchymal stem cells (MSCs) to the cerebral spinal fluid of patients with Amyotrophic Lateral Sclerosis (ALS) using a dose-escalation study.
| Condition | Intervention | Phase |
|---|---|---|
|
Amyotrophic Lateral Sclerosis |
Biological: autologous mesenchymal stem cells |
Phase 1 |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Safety Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | A Dose-escalation Safety Trial for Intrathecal Autologous Mesenchymal Stem Cell Therapy in Amyotrophic Lateral Sclerosis |
- Number of patients with dose-limiting toxicities [ Time Frame: 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Number of patients with adverse events [ Time Frame: 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Change in serum sedimentation rate [ Time Frame: baseline, 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Change in C-reactive protein levels [ Time Frame: baseline, 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Change in complete blood counts [ Time Frame: baseline, 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Change in total nucleated cell count in cerebrospinal fluid (CSF) [ Time Frame: baseline, 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Change in protein level in cerebrospinal fluid (CSF) [ Time Frame: baseline, 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
- Number of patients with presence of cancer cells in their cerebrospinal fluid (CSF) [ Time Frame: 2 years after completion of the final infusion ] [ Designated as safety issue: Yes ]
| Estimated Enrollment: | 25 |
| Study Start Date: | May 2012 |
| Estimated Study Completion Date: | May 2014 |
| Estimated Primary Completion Date: | May 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: Autologous Mesenchymal Stem Cells |
Biological: autologous mesenchymal stem cells
There will be five treatment groups of up to five patients each. Groups 1, 2 and 4 will receive a single dose of cells. Groups 3 and 5 will receive 2 doses of cells separated by one month. Intrathecal injections into new subjects will be timed so that there is a minimum of one week between subject injections. The cell dose per group is as follows:
|
Detailed Description:
The primary objective of this study is to determine the safety of intrathecal delivery of autologous mesenchymal stem cells (MSCs) to the cerebrospinal fluid (CSF) of patients with ALS using a dose-escalation study. The trial will include 25 adult, non-ventilator-dependent patients with clinically definite amyotrophic lateral sclerosis (ALS). Cells will be isolated from adipose tissue, expanded ex vivo and then, after ~8 weeks, intrathecal (IT) autologous delivery of MSCs will be performed. There will be 5 treatment groups of up to 5 patients each. Groups 1, 2, and 4 will receive a single dose of cells. Groups 3 and 5 will receive 2 doses of cells separated by 1 month. Groups will be completed sequentially so that patients will not be enrolled into the next treatment group until at least 3 patients in the preceding group have completed the treatment and 1 month of additional observation without significant toxicity. All patients will be followed on a regular basis until death or for a minimum of 2 years after completion of the final infusion. Initial clinical follow-up will be weekly with scheduled blood, CSF and magnetic resonance imaging (MRI) evaluations. After 1 month, patients will have clinical evaluations at 3 month intervals, or earlier if indicated by clinical status.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- All patients must have clinically-defined ALS as defined by the World Federation of Neurology criteria
- Age greater than 18 years
- If female, must be post-menopausal or had a hysterectomy
- Permanent resident or citizen of the United States
- History of a chronic onset of a progressive motor weakness of less than two years duration
- Able to comply with protocol requirements, including MRI testing
- Can provide written informed consent
Exclusion Criteria:
- Any clinically significant medical condition (e.g., within six months of baseline, had myocardial infarction, angina pectoris, and/or congestive heart failure) that, in the opinion of the investigator, would compromise the safety of patient.
- Autoimmunity, including Crohn's disease, rheumatoid arthritis, psoriasis
- Malignancy including melanoma with the exception of localized skin cancers (with no evidence of metastasis, significant invasion, or re-occurrence within three years of baseline). Any other malignancy will not be allowed.
- Active systemic or local infection near the lumbar puncture site
- Other active systemic disease as defined by laboratory abnormalities
- Use of herbal medications or other unapproved drugs
- Enrolled in an investigational drug trial within 30 days of baseline visit
- Kokmen Short Test of Mental Status score <32
- Beck's Depression Inventory score >18
- Presence of a tracheostomy
- Ventilator dependent
Contacts and Locations| United States, Minnesota | |
| Mayo Clinic | Recruiting |
| Rochester, Minnesota, United States, 55905 | |
| Contact: Anthony J. Windebank, MD 507-284-2511 rstalsresearch@mayo.edu | |
| Contact: Nathan P. Staff, MD, PhD 507-284-2511 rstalsresearch@mayo.edu | |
| Principal Investigator: Anthony J. Windebank, MD | |
| Principal Investigator: Nathan P. Staff, MD, PhD | |
More Information
No publications provided
| Responsible Party: | Anthony J. Windebank, Principal Investigator, Mayo Clinic |
| ClinicalTrials.gov Identifier: | NCT01609283 History of Changes |
| Other Study ID Numbers: | 11-008415 |
| Study First Received: | May 18, 2012 |
| Last Updated: | May 29, 2012 |
| Health Authority: | United States: Food and Drug Administration |
Additional relevant MeSH terms:
|
Amyotrophic Lateral Sclerosis Sclerosis Motor Neuron Disease Spinal Cord Diseases Central Nervous System Diseases Nervous System Diseases |
Neurodegenerative Diseases TDP-43 Proteinopathies Neuromuscular Diseases Proteostasis Deficiencies Metabolic Diseases Pathologic Processes |
ClinicalTrials.gov processed this record on May 21, 2013