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hCT-MSCs for COVID19 ARDS

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ClinicalTrials.gov Identifier: NCT04399889
Recruitment Status : Recruiting
First Posted : May 22, 2020
Last Update Posted : October 14, 2021
Sponsor:
Collaborator:
The Marcus Foundation
Information provided by (Responsible Party):
Joanne Kurtzberg, MD, Duke University

Brief Summary:

This is a 50 patient, Phase 1/2a multi-center pilot study to test the safety and to describe the preliminary efficacy of intravenous administration of allogenic human cord tissue mesenchymal stromal cells (hCT-MSC) as an investigational agent, under U.S. INDs 19968 (Duke) and 19937 (U Miami) to patients with acute respiratory distress syndrome (ARDS) due to COVID-19 infection (COVID-ARDS). The first 10 consecutive patients will receive investigational MSCs manufactured by Duke. In the second phase of the study, 40 additional patients will be randomized to receive placebo or investigational MSCs manufactured by Duke or University of Miami.

Patients will be eligible for infusion of 3 daily consecutive doses of hCT-MSC or placebo if they have a confirmed diagnosis of COVID-19 and meet clinical and radiographic criteria for ARDS.

Results from the first 10 patients will be compared with concurrent outcomes utilizing standard of care treatments in participating hospitals and in published reports in the medical literature. Results from the additional 40 patients will be combined with the first 10 and analyzed. The trial is relying on focused eligibility of the participants (patients with ARDS), single cohort with short trial time (4 weeks), and simple assessment of clinical outcome (survival, improvement of ARDS). This is a sequential design in the sense that after the first 10 patients are evaluated a decision will be made by the PIs and the Data Safety Monitoring Board whether to proceed with the exploratory randomized portion of the study.


Condition or disease Intervention/treatment Phase
COVID Corona Virus Infection COVID19 Biological: Human cord tissue mesenchymal stromal cells (hCT-MSC) manufactured by Duke University. Other: Placebo Phase 1 Phase 2

Detailed Description:

This is a 50 patient, Phase 1/2a multi-center pilot study to test the safety and to describe the preliminary efficacy of intravenous administration of allogenic human cord tissue mesenchymal stromal cells (hCT- MSC) as an investigational agent, under U.S. INDs 19968 (Duke) and 19937 (U Miami) to patients with acute respiratory distress syndrome (ARDS) due to COVID-19 infection (COVID-ARDS). Patients will be eligible for treatment with 3 daily consecutive doses of hCT-MSC at 1 million cells/kg (max dose 100 million cells) in the phase 1 portion of the study or a fixed dose of 100 million cells daily x 3 days, 12-36 hours apart in the phase 2 portion of the study, if they have a confirmed diagnosis of COVID-19 and meet clinical and radiographic criteria for ARDS. The primary endpoint is short-term safety of hCT-MSC infusions given on this schedule. The key secondary endpoints are 28 day survival, an increase in PaO2/FiO2 ratio by 50% at 96 hours, days to hospital discharge to home or rehab, and number of days requiring mechanical or non-invasive ventilation or high flow nasal cannula.

The study will be executed in two phases. The first 10 consecutive patients will all receive investigational product. The second part of the study is a randomized, controlled trial in 40 additional patients. The overall aim of the study is to establish safety and to gain critical information as to whether patients with COVID-ARDS will benefit from MSC infusions. Results from the first 10 patients will be compared with concurrent outcomes utilizing standard of care treatments in participating hospitals and in published reports in the medical literature. Results from the additional 40 patients will be analyzed as a randomized placebo control trial. The trial is relying on focused eligibility of the participants (patients with ARDS), single cohort with short trial time (4 weeks), and simple assessment of clinical outcome (survival, improvement of ARDS). This is a sequential design in the sense that after the first 10 patients are evaluated a decision will be made by the PIs and the Data Safety Monitoring Board whether to proceed with the exploratory randomized portion of the study.

The MSCs are manufactured from allogeneic cord tissue donated to the Carolinas Cord Blood Bank (CCBB) at Duke University. The CCBB is an FDA licensed public cord blood bank (licensed name DUCORD). Cord tissue is donated by mothers delivering healthy term male babies by Cesarean section, after written informed consent from the newborn infant's mother. Full donor screening and testing is performed in accordance with regulatory requirements (21CFR 1271). The hCT-MSCs will be manufactured in the Marcus Center for Cellular Cures in the Robertson GMP Cell Manufacturing Laboratory and the Clinical Research Cell Manufacturing Program (CRCMP) laboratory, Interdisciplinary Stem Cell Institute (ISCI), Miller School of Medicine, University of Miami. These hCT-MSCs are already being utilized in clinical trials to treat pediatric patients with autism spectrum disorder (IND 17313), cerebral palsy (IND 17921), hypoxic ischemic encephalopathy (IND 17313) and adults with osteoarthritis of the knee (IND18414). To date, over 210 doses of cells have been delivered to patients on these clinical trials with an excellent safety profile. At University of Miami, hCT-MSCs are used in the clinical trial to evaluate cytokine suppression in patients with chronic inflammation due to metabolic syndrome (IND 17324), 12 subjects in the pilot phase of the study had completed the dose without any treatment emergence SAE.

The rationale for using this approach for patients infected with COVID-19 is that ARDS, the rate-limiting complication impacting survival, is caused, at least in part, by a cytokine release syndrome (CRS) which results is severe immune dysregulation. Involved cytokines include IL-6, IL-8, IL-10, THP-1M, TNF-alpha, and others. MSCs have strong anti-inflammatory and immune-modulatory activities without apparent toxicity or further immunosuppression. Approximately 3-5 % of patients with COVID-19 develop ARDS which carries a very high mortality rate (30-60%) due to multi-system organ failure. Effective treatment of ARDS, the most feared complication of COVID-19, may convert the COVID-19 pandemic into a more manageable "flu-like" illness that every American is expected to experience, and most will survive, on an annual basis.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Sequential Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Pilot Study of Safety and Efficacy of Cord Tissue Derived Mesenchymal Stromal Cells (hCT-MSC) in COVID-19 Related Acute Respiratory Distress Syndrome (ARDS)
Actual Study Start Date : June 18, 2020
Estimated Primary Completion Date : April 1, 2022
Estimated Study Completion Date : July 31, 2022


Arm Intervention/treatment
Experimental: Open Label infusion of hCT-MSC
The first 10 consecutive patients will all receive investigational product.
Biological: Human cord tissue mesenchymal stromal cells (hCT-MSC) manufactured by Duke University.
Human cord tissue mesenchymal stromal cells (hCT-MSC) manufactured by Duke University or University of Miami.
Other Name: hCT-MSC

Experimental: Randomized infusion of hCT-MSC
An interim analysis, for safety will be conducted and reviewed by the Data Safety and Monitoring Board (DSMB) after the first 10 patients have completed treatment and reached the 28 day endpoint. If there are no safety concerns, the trial will proceed with enrollment on the phase 2 portion of the study where the subsequent 40 patients will be randomized in a 1:1 fashion between treatment with MSCs and placebo. The investigational product will be further randomized to the MSCs manufactured by Duke or University of Miami. These products are considered to be comparable.
Biological: Human cord tissue mesenchymal stromal cells (hCT-MSC) manufactured by Duke University.
Human cord tissue mesenchymal stromal cells (hCT-MSC) manufactured by Duke University or University of Miami.
Other Name: hCT-MSC

Placebo Comparator: Randomized infusion of Placebo
An interim analysis, for safety will be conducted and reviewed by the Data Safety and Monitoring Board (DSMB) after the first 10 patients have completed treatment and reached the 28 day endpoint. If there are no safety concerns, the trial will proceed with enrollment on the phase 2 portion of the study where the subsequent 40 patients will be randomized in a 1:1 fashion between treatment with MSCs and placebo
Other: Placebo
Placebo will be comprised of 40-80 mL of Plasmalyte-A + 1% Human Serum Albumin (HAS) prepared in an identical container to the one used for cell administration. The placebo product will undergo the same process of sterility testing including release inspection, transport and product custodian.




Primary Outcome Measures :
  1. Safety of the Investigational Product- Infusion Reactions [ Time Frame: 24 hours ]
    Incidence of infusion reactions measured by any one of the following: fever, anaphlyaxis, rash, hypertension, hypotension, tachycardia, nausea, vomiting, or any other new or worsening symptoms associated with the infusion.

  2. Safety of the Investigational Product- delayed reactions [ Time Frame: 28 days ]
    Incidence of later reactions attributed to the investigational product as measured by any one of the following: rash, infection, allergic reaction, or any other delayed symptoms associated with infusion of the investigational product.

  3. Safety of the Investigational Product- formation of anti-HLA antibodies [ Time Frame: 28 days ]
    Formation of new anti-HLA antibodies as measured by an antibody screen test at 28 days post first infusion of the investigational product.


Secondary Outcome Measures :
  1. Time to recovery [ Time Frame: 28 days ]
    Time to recovery, defined as discharge from the hospital (alive) or remaining in the hospital without the need for supplemental oxygen or other COVID-related medical care.

  2. Increase in PaO2/FiO2 ratio [ Time Frame: 4 days after MSCs ]
    Increase in PaO2/FiO2 ratio by 50% by Day 4 (96 hours after first infusion). PaO2/FiO2 may be calculated from an arterial blood gas or imputed from the SpO2/FiO2 table

  3. Days to hospital discharge to home [ Time Frame: 90 days ]
    The number of days from hospitalization to discharge to home

  4. The number of ventilator free days [ Time Frame: 90 days ]
    The number of ventilator free days

  5. Number of days requiring oxygen support [ Time Frame: 7 days ]
    Number of days requiring oxygen support

  6. Percent of screened patients who are enrolled and randomized [ Time Frame: 90 days ]
    Percent of screened patients who are enrolled and randomized



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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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:

  1. The patient or legally authorized representative (LAR) must have the ability to understand and the willingness to provide a signed and dated informed consent form.
  2. Age 18 years and over
  3. The patient agrees to use adequate contraception for the duration of the treatment protocol and for 6 months post treatment.
  4. Positive RT- PCR testing for COVID-19 nucleic acid using nasopharyngeal swabbing or any other site
  5. Patient meets ARDS criteria and is on non-invasive or mechanical ventilation or high flow nasal cannula

    1. bilateral opacities on chest imaging consistent with pulmonary edema
    2. A need for positive pressure ventilation or high flow nasal cannula
    3. PaO2/FiO2 ratio ≤ 300 mmHg by arterial blood gas or SpO2/FiO2 imputation.
    4. Infiltrates not fully explained by cardiac failure or fluid overload in the physician's best clinical judgement
  6. Subjects requiring dialysis as a result of a COVID-19 infection will not be excluded.

Exclusion Criteria:

  1. Evidence of multiorgan failure involving one or more organs, excluding the lungs as defined below:

    1. Presence of shock, defined as MAP < 65 mmHg with signs of peripheral hypoperfusion, or continuous infusion of 2 or more vasopressor or inotrope agents to maintain MAP ≥ 65 mmHg.
    2. Serum bilirubin > 10 mg/dl
    3. Platelet count < 50,000/ml
    4. Subjects requiring dialysis as a result of anything other than a COVID-19 infection will be excluded
  2. Evidence of acquired or congenital immunodeficiency (due to immunosuppressive therapy excluding steroid use for treatment of COVID-19 acute respiratory failure, HIV, previous treatment for cancer, etc.)
  3. History of metastatic cancer diagnosis or treatment in the past 1 year
  4. History of previous treatments with MSCs or other cell therapies
  5. Patient is co-enrolled in any other IND-sponsored clinical trials for COVID-19 or ARDs. Drugs that are administered under emergency use authorizations (EUA) by the FDA are permitted.
  6. Evidence of pregnancy or lactation
  7. Moribund patient not expected to survive >24 hours
  8. Unable/unwilling to deliver lung protective ventilation
  9. Patient is receiving Extracorporeal Membrane Oxygenation (ECMO)

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): NCT04399889


Contacts
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Contact: Erin Arbuckle, MS 919-684-3293 erin.arbuckle@dm.duke.edu
Contact: Linda Brown, RN cordbloodtherapyinfo@dm.duke.edu

Locations
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United States, Florida
Boca Raton Regional Hospital Recruiting
Boca Raton, Florida, United States, 33486
Contact: Margaret Scott, RN    561-955-5784    mscott@baptisthealth.net   
Contact: Frank Vrionis, MD         
Jackson Memorial Hospital Recruiting
Miami, Florida, United States, 33136
Contact: Lina Caceres    305-243-5399    lvc25@med.miami.edu   
University of Miami Hospital Recruiting
Miami, Florida, United States, 33136
Contact: Lina Caceres, NP    305-243-5399    lvc25@med.miami.edu   
United States, New York
New York Medical College Not yet recruiting
Valhalla, New York, United States, 10595
Contact: Mitchell Cairo, MD         
United States, North Carolina
Duke Hospital Recruiting
Durham, North Carolina, United States, 27705
Contact: Joanne Kurtzberg, MD         
Contact: Linda Brown, RN       linda.brown@duke.edu   
Sponsors and Collaborators
Joanne Kurtzberg, MD
The Marcus Foundation
Investigators
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Principal Investigator: Joanne Kurtzberg, MD Duke Health
Principal Investigator: Lingye Chen, MD Duke Health
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Responsible Party: Joanne Kurtzberg, MD, Jerome S. Harris Distinguished Professor of Pediatrics, Duke University
ClinicalTrials.gov Identifier: NCT04399889    
Other Study ID Numbers: Pro00105410
First Posted: May 22, 2020    Key Record Dates
Last Update Posted: October 14, 2021
Last Verified: October 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Joanne Kurtzberg, MD, Duke University:
COVID
Coronavirus infection
COVID19
Covid ARDS
Acute Respiratory Distress Syndrome
ARDS
Additional relevant MeSH terms:
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COVID-19
Coronavirus Infections
Respiratory Distress Syndrome
Infections
Respiratory Tract Infections
Pneumonia, Viral
Pneumonia
Virus Diseases
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
Respiratory Tract Diseases
Respiration Disorders