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Selected Mesenchymal Stromal Cells to Reduce Inflammation in Patients With PSC and AIH (Merlin)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02997878
Recruitment Status : Recruiting
First Posted : December 20, 2016
Last Update Posted : November 10, 2022
Sponsor:
Collaborator:
NHS Blood and Transplant
Information provided by (Responsible Party):
University of Birmingham

Brief Summary:

MERLIN is an adaptive, single arm, multi-centre, phase IIa multi-disease clinical trial. It is designed to:

i) Determine dose safety of ORBCEL-C™ (selected Mesenchymal stromal cells derived from human umbilical cord) ii) Evaluate treatment activity through assessment of biomarkers (for patients treated at the highest safe dose only (HSD))

This trial will determine the Highest Safe Dose (HSD) that can be administered by observing for occurrence of dose limiting toxicity (DLT).

Upon completion of this trial we hope to be able to justify and conduct separate, larger scale trials using ORBCEL-C™.


Condition or disease Intervention/treatment Phase
Cholangitis, Sclerosing Hepatitis, Autoimmune Biological: Orbcel-C Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 18 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Adaptive, Multicentre, Phase IIa, Multi-disease Trial Investigating the Safety & Activity of a Single Infusion of Selected Mesenchymal Stromal Cells in the Treatment of Patients With Primary Sclerosing Cholangitis & Autoimmune Hepatitis
Actual Study Start Date : December 7, 2018
Estimated Primary Completion Date : March 2023
Estimated Study Completion Date : December 2023


Arm Intervention/treatment
Experimental: PSC patients
Selected Mesenchymal Stromal Cells (dose selection and efficacy) - Orbcel-C. dose selection, combination of 0.5, 1.0,2.5 million cells/kg (3 dose levels). IV single-infusion.
Biological: Orbcel-C
Selected Mesenchymal Stromal Cells derived from human umbilical cord

Experimental: AIH patients
Selected Mesenchymal Stromal Cells (dose selection and efficacy) - Orbcel-C. dose selection, combination of 0.5, 1.0,2.5 million cells/kg (3 dose levels). IV single-infusion.
Biological: Orbcel-C
Selected Mesenchymal Stromal Cells derived from human umbilical cord




Primary Outcome Measures :
  1. Dose finding and incidence of treatment emergent adverse events (safety and tolerability) in all PSC and AIH Patients [ Time Frame: Visit 3 to Visit 5 -14 days ]
    Occurrence of Dose Limiting Toxicity (DLT) over 14 day (Visit 3 to Visit 5) reporting period after ORBCEL-C infusion

  2. Incidence of treatment emergent adverse events (safety and tolerability) for PSC and AIH patients treated at the Highest Safe Dose (HSD) only [ Time Frame: Visit 3 to Visit 8 - 56 days ]
    Determine safety and tolerability by occurrence of Dose Limiting Toxicity (DLT) (Visit 3 to Visit 5 only), Serious Adverse Events (SAEs) and Adverse Events (AEs) throughout trial period (up to Visit 8)

  3. Activity and Safety at the Highest Safe Dose (HSD) of ORBCEL-C in PSC patients, by measure of change in Alkaline Phosphatase (ALP) [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change in Alkaline Phosphatase (ALP) after ORBCEL-C infusion - Examination of change in ALP at Day 28 from Baseline and changes over multiple time-points before and after infusion (Visit 1 to Visit 8)

  4. Activity at the Highest Safe Dose (HSD) of ORBCEL-C in AIH patients, by measure of change in Alanine Aminotransferase (ALT) [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change in Alanine Aminotransferase (ALT) trend after ORBCEL-C infusion. Measurements of ALT will be taken at multiple time points from Visit 1 to Visit 8.


Secondary Outcome Measures :
  1. All patients with Autoimmune Hepatitis (AIH) - Secondary Outcome Measure 1 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in Phenotypic expression of TRegs as measured by flow cytometry (principal secondary outcome)

  2. All patients with Autoimmune Hepatitis (AIH) - Secondary Outcome Measure 2 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in Individual markers of liver biochemistry and function including AST, ALP, GGT, bilirubin, albumin, INR and composite risk score (MELD)

  3. All patients with Autoimmune Hepatitis (AIH) - Secondary Outcome Measure 3 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in marker of immune activation - immunoglobulin G concentrations

  4. All patients with Autoimmune Hepatitis (AIH) - Secondary Outcome Measure 4 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in Non-invasive clinical markers of fibrosis - ELF and transient elastography (Fibroscan®)

  5. All patients with Autoimmune Hepatitis (AIH) - Secondary Outcome Measure 5 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in QoL as measured by Pruritus Visual Analogue Scale, nine-point fatigue severity scale and SF-36v2

  6. All patients with Primary Sclerosing Cholangitis (PSC) - Secondary Outcome Measure 1 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in Phenotypic expression of TRegs as measured by flow cytometry (principal secondary outcome)

  7. All patients with Primary Sclerosing Cholangitis (PSC) - Secondary Outcome Measure 2 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in Individual markers of liver biochemistry and function including aspartate aminotransferase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT), bilirubin, albumin, international normalised ratio [INR] and composite risk scores (Mayo PSC risk score and Model for End Stage Liver Disease [MELD])

  8. All patients with Primary Sclerosing Cholangitis (PSC) - Secondary Outcome Measure 3 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in Non-invasive clinical markers of fibrosis: Enhanced Liver Fibrosis (ELF) and transient elastography (Fibroscan®)

  9. All patients with Primary Sclerosing Cholangitis (PSC) - Secondary Outcome Measure 4 [ Time Frame: Baseline to Visit 8 - Approximately 80 days ]
    Change from baseline at Visit 7, Visit 8 and throughout the trial period (up to Visit 8) following ORBCEL-C™ infusion in QoL as measured by Pruritus Visual Analogue Scale, nine-point fatigue severity scale and SF-36v2 Severity of IBD as measured by the non-endoscopic aspects of the Mayo IBD score - stool frequency, rectal bleeding, and physician's global assessment


Other Outcome Measures:
  1. All patients with PSC and AIH - Exploratory Research Outcome 1 [ Time Frame: Up to Visit 8 (56 days) ]

    Change throughout the trial period up to Visit 8 of the following measured parameters:

    Markers of immune activation including immunoglobulin values and C-reactive protein concentration


  2. All patients with PSC and AIH - Exploratory Research Outcome 2 [ Time Frame: Up to Visit 8 (56 days) ]
    Change throughout the trial period up to Visit 8 of the following measured parameters: Markers of biliary injury including total bile acid levels (these will only be measured prior to infusion at Visit 3 and Visit 7)

  3. All patients with PSC and AIH - Exploratory Research Outcome 3 [ Time Frame: Up to Visit 8 (56 days) ]
    Change throughout the trial period up to Visit 8 of the following measured parameters: Circulating inflammatory cells profile as measured by flow cytometry Endothelial cell activation markers such as VAP-1 and ICAM1

  4. All patients with PSC and AIH - Exploratory Research Outcome 4 [ Time Frame: Up to Visit 8 (56 days) ]
    Change throughout the trial period up to Visit 8 of the following measured parameters: Serum cytokine and chemokine profiles as measured by cytokine array analysis

  5. All patients with PSC and AIH - Exploratory Research Outcome 5 [ Time Frame: Up to Visit 8 (56 days) ]
    Change throughout the trial period up to Visit 8 of the following measured parameters: RNA and micro-RNA profiles in circulating cells as measured by quantitative polymerase chain reaction (qPCR) or equivalent technology



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria - Patients with Primary Sclerosing Cholangitis (PSC):

  1. Age ≥ 18 at Visit 1
  2. Diagnosis of PSC at Visit 1 as evidenced clinically by:

    1. Chronic biochemical cholestasis (elevated serum alkaline phosphatase (ALP) above the upper limit of normal (ULN) and/or gamma-glutamyl transpeptidase (GGT) above the ULN) ≥6 months duration AND
    2. Radiological AND/OR histological evidence of clinically documented PSC
  3. Serum ALP ≥ 1.5 x ULN at Visit 1
  4. Any serum ALP value change is <40% using two sets of laboratory values obtained during screening:

    If a participant fails to confirm an ALP at Visit 2 that is within 40% of the ALP at Visit 1, a further screening ALP (Visit 2a) can be arranged, so long as the variation in ALP was <50%, and the Principal Investigator has no other clinical reason to suggest the participant is clinically unstable. If the ALP is within 40% variance at Visit 2a as compared to visit 1, Trial registration is permitted.

  5. At Visit 2 (and Visit 2a if applicable), it should be confirmed that a patient does not meet any of the exclusion criteria

Inclusion Criteria - Patients with Autoimmune Hepatitis (AIH):

  1. Age ≥ 18 at Visit 1
  2. Established pre-existing clinical diagnosis of AIH confirmed by clinical expert review consistent with the simplified IAIHG criteria (http://www.mdcalc.com/simplified-scoring-autoimmune-hepatitis-aih/) and must include history of a liver biopsy reported compatible with AIH
  3. Active AIH defined by ALT ≥ 1.5 x ULN
  4. Serum ALT must be above ≥ 1.5 x ULN at both Visit 1 and Visit 2
  5. At Visit 2, it should be confirmed that a patient does not meet any of the exclusion criteria
  6. Patients must be on standard-of-care AIH treatment for ≥ 24 weeks -this includes any AIH therapy except biologics
  7. Stable doses of immunosuppression for a minimum period of 4 weeks (28 days) at the time of Visit 1.

Exclusion Criteria - Patients with PSC and AIH:

Patients who meet any of the following exclusion criteria are excluded from participating in the MERLIN trial

  1. Refusal or lacks capacity to give informed consent to participate in trial
  2. Patient who is unable to participate in follow-up assessment
  3. Participation actively, or within 5 half-lives, of another interventional clinical trial
  4. Known hypersensitivity to the investigational product or any of its formulation excipients
  5. Evidence of active malignancy (within 3 years of Visit 1), other than non-melanomatous skin cancer and cervical dysplasia in situ
  6. Major surgical procedure within 30 days at Visit 1
  7. Prior organ transplantation
  8. Active harmful alcohol consumption as evaluated and documented by the Investigator
  9. Poor venous access, therefore unable to support a 22G needle for infusion
  10. Creatinine > 133 μmol/L or being treated with renal replacement therapy at the time of Visit 1
  11. AST or ALT > 10 x ULN
  12. ALP > 10 x ULN
  13. Platelets < 50 x 10^9/L
  14. Total Bilirubin > 2 x ULN
  15. INR > 1.3 (in the absence of concomitant use of Warfarin or equivalent anti-coagulant therapy)
  16. Albumin < 35 g/L
  17. Haemoglobin < 10 g/dL
  18. Past or present evidence of decompensated chronic liver disease:

    1. Radiological or clinical evidence of ascites
    2. Hepatic encephalopathy
    3. Endoscopic evidence for portal hypertensive bleeding
  19. Any active treatment with biologic therapy (monoclonal antibodies)
  20. Clinically severe cardiovascular disease as evaluated by the Investigator
  21. Pregnancy or breast-feeding
  22. Women of child bearing potential who are unwilling to practice effective contraception (i.e. barrier, oral contraceptive pill, implanted contraception, or previous hysterectomy, bilateral oophorectomy) for the duration of the trial up to 90 days after the trial drug is administered. If using hormonal agents the same method must have been used for at least 1 month before trial dosing and patients must use a barrier method during that time period
  23. Non-vasectomised men, sexually active with women of child bearing potential, who are not willing to practice effective contraception (condom with spermicide) for the duration of the trial up to 90 days after the trial drug is administered
  24. Patients with a history of hepatitis C (present or past infection), known positivity for antibody to HIV or any evidence of current or past hepatitis B infection
  25. Presence of an acute/chronic infection or illness that, at the discretion of the Investigator, might compromise the patient's health and safety in the trial
  26. Any symptoms indicative of Covid-19; including fever, chronic/persistent cough, or loss of sense of taste or smell in the preceding two weeks.
  27. Receipt of live vaccination within six weeks prior to Visit 1

Exclusion Criteria Specific to Patients with PSC:

  1. Documented alternative aetiology for sclerosing cholangitis (i.e. secondary sclerosing cholangitis)
  2. A dominant (as determined by Investigator) alternative chronic or active liver injury other than PSC at the time of Visit 1; Patients with possible overlap syndrome with AIH are excluded from the PSC cohort if the Investigator considers AIH as the dominant liver injury
  3. UDCA dose modification within the last 90 days
  4. ALP > 10 x ULN
  5. Evidence of cholangitis within 90 days of Visit 1

    1. Documented evidence of cholangitis by physician
    2. Need for any antibiotics for presumed cholangitis
  6. Any patient taking prophylactic antibiotics to combat recurrent cholangitis
  7. Presence of percutaneous biliary drain, or internal biliary stent
  8. Diagnosed hepatocellular carcinoma or cholangiocarcinoma or high clinical suspicion thereof
  9. Dominant stricture clinically suspicious of cholangiocarcinoma (as determined by Investigator)

Exclusion Criteria for PSC patients with IBD:

  1. Unstable disease as evidenced by:

    1. Documented clinically significant flare within 90 days of enrolment requiring any marked intensification of therapy from baseline maintenance (maintenance therapy = thiopurines, 5- aminosalicylates, or oral prednisolone < 10mg/day; biologics therapy is an exclusion criteria
    2. Requirement for daily prednisolone > 10mg
    3. Mayo Clinic Score ≥ 2 (see Appendix 1 for details) AND clinician assessment of active disease requiring up-titration of treatment; last colonoscopy within last year used for endoscopic component
  2. Any colonoscopic evidence of clinically significant dysplasia at last colonoscopy
  3. Patients who have not had their routine colonoscopy within 24 months prior to planned MSC infusion and are unable to have their screening colonoscopy examination as per standard care prior to Visit 3
  4. A Mayo score/ Disease Activity Index for Ulcerative Colitis of ≥ 5 (https://www.mdcalc.com/mayo-score- disease-activity-index-dai-ulcerative-colitis)

Exclusion Criteria Specific to Patients with AIH:

  1. A dominant (as determined by Investigator) alternative chronic or active liver injury other than AIH at the time of Visit 1; Patients with possible overlap syndrome with PSC are excluded from the AIH cohort if the Investigator considers PSC as the dominant liver injury
  2. AST or ALT > 10 x ULN
  3. Patients on a prednisolone dose of > 20 mg at the time of screening
  4. Treatment with biologic therapy within 24 weeks of the time of screening
  5. Patients with a history of poor compliance with medication
  6. Diagnosed hepatocellular carcinoma or cholangiocarcinoma or high clinical suspicion thereof

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02997878


Contacts
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Contact: Senior Trial Coordinator 01213718198 merlin@trials.bham.ac.uk
Contact: Trial Coordinator 01213718167 merlin@trials.bham.ac.uk

Locations
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United Kingdom
University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Recruiting
Birmingham, West Midlands, United Kingdom, B15 2TT
Sponsors and Collaborators
University of Birmingham
NHS Blood and Transplant
Investigators
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Principal Investigator: Phillip N Newsome, Prof University of Birmingham
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Responsible Party: University of Birmingham
ClinicalTrials.gov Identifier: NCT02997878    
Other Study ID Numbers: RG-13-124
First Posted: December 20, 2016    Key Record Dates
Last Update Posted: November 10, 2022
Last Verified: November 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University of Birmingham:
Autoimmune
AIH
PSC
Liver disease
Cholangitis
Additional relevant MeSH terms:
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Hepatitis
Cholangitis
Hepatitis, Autoimmune
Cholangitis, Sclerosing
Liver Diseases
Digestive System Diseases
Bile Duct Diseases
Biliary Tract Diseases
Hepatitis, Chronic
Autoimmune Diseases
Immune System Diseases