Induction of Donor Specific Tolerance in Recipients of Cardiac Allografts by Donor Stem Cell Infusion
|Heart Transplantation||Biological: enriched hematopoetic stem cell infusion||Phase 1 Phase 2|
|Study Design:||Intervention Model: Single Group Assignment
Intervention Model Description:
Open labelMasking: No masking
Primary Purpose: Treatment
|Official Title:||1) Induction of Donor-Specific Tolerance in Recipients of Cardiac Allografts by Donor Stem Cell Infusion 2) Induction of Donor-Specific Tolerance by Donor Facilitating Cell (FC): Stem Cell Infusion in Recipients of Hepatic Allografts|
- Enriched Hematopoetic Stem Cell Engraftment [ Time Frame: One month to three years ]
|Study Start Date:||July 2003|
|Study Completion Date:||December 1, 2016|
|Primary Completion Date:||November 7, 2011 (Final data collection date for primary outcome measure)|
Experimental: Cardiac Failure Patients
Recipients treated with an enriched hematopoetic stem cell infusion from the heart donor's bone marrow
Biological: enriched hematopoetic stem cell infusion
Enriched Hematopoetic Stem Cell Infusion
At the present time, heart transplant recipients must take anti-rejection medication to prevent rejection of the donated heart. Even with this medication, chronic rejection is the most common cause of late graft loss. The anti-rejection agents themselves are significantly toxic, with side effects including kidney damage, infection and an increased incidence of cancer. The goal of this study is to allow the patient to develop "tolerance" to the transplanted heart while maintaining a competent immune system. Tolerance enables the transplant recipient's body to recognize the transplanted organ as self rather than foreign tissue. The recipient will not try to reject the donor heart and the need for anti-rejection medication could be dramatically decreased or eliminated entirely. To accomplish this, patients in this study will receive specially treated bone marrow taken from their heart donor. Bone marrow transplant has been shown in animal studies and in humans to induce tolerance following organ transplant.
Two factors limit the application of donor marrow transplant to induce tolerance: 1) preparing the patient for transplant (conditioning); and 2) graft-versus-host disease (GVHD). Traditional conditioning destroys the recipient's immune system and requires that the marrow transplant be successful because the patient is unable to fight off infection if the donor cells do not survive. GVHD occurs when donor immune cells recognize the recipient's cells as foreign tissue and attack them. Severe GVHD can result in death. This study utilizes a new approach to conditioning which leaves the patient's immune system intact. The transplant product is depleted of GVHD-producing cells but retains tolerance-promoting facilitating cells, which are intended to ensure the donor and recipient cells coexists peacefully, a state called mixed chimerism. The toxicity of conditioning and transplantation is significantly reduced.
In this study, we will determine the appropriate cell dose to safely establish mixed chimerism following partial conditioning in heart transplant recipients. The study takes a gradual approach to increasing the cell dose to achieve mixed chimerism. We believe this study will provide a breakthrough in the approach to heart transplantation. Our goal is to evaluate the potential of safely establishing mixed chimerism to induce tolerance following heart transplant and reduce or eliminate the need for anti-rejection therapy.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00497757
|Study Director:||Suzanne T Ildstad, MD||University of Louisville|