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Mesenchymal Stem Cell Therapy for Lung Rejection

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. Read our disclaimer for details. Identifier: NCT02181712
Recruitment Status : Completed
First Posted : July 4, 2014
Last Update Posted : August 11, 2017
Information provided by (Responsible Party):
Abba C. Zubair, M.D., Ph.D., Mayo Clinic

Brief Summary:
To assess the safety and feasibility of mesenchymal stem cells therapy in patients with transplant related bronchiolitis obliteran syndrome (BOS)

Condition or disease Intervention/treatment Phase
Lung Transplant Reject Bronchiolitis Obliterans Biological: Mesenchymal stem cell Phase 1

Detailed Description:

The overall clinical development strategy of this project is to conduct this Phase I dose escalation study entitled "A pilot Study to Evaluate the Safety and Feasibility of Mesenchymal Stem Cells to Induce Remission in Lung Transplant Patients Experiencing Treatment-Refractory Moderate Lung Rejection". This study will be performed under this current IND application and will be limited to the proposed 9 subjects (3 subjects in each of dose escalating subject cohorts).

In this application we are proposing to evaluate safety and feasibility of allogeneic, bone marrow (BM) derived mesenchymal stem cells (MSC) to induce remission of moderate treatment refractory bronchiolitis obliterans (BO/BOS). Lung transplant patients with treatment refractory BO/BOS (grade 3) who do not qualify for a second transplant have near 100% mortality or extreme disability. MSCs are multi-potent cells that have the capacity to induce tissue repair and modulate immune response. They have been used successfully in preclinical and clinical studies to treat graft versus host disease (GVHD) and inflammatory bowel disease. Patients that progressed to moderate BO despite adequate medical treatments and who do not qualify for a second transplant will receive intravenous treatments of allogeneic MSC. The safety measure will include tolerance of MSC infusion and absence of significant cardiopulmonary compromise. The feasibility assessment will include ease of recruitment, practical issue of transporting, preparing and infusing the MSCs.

The clinical assessment from this initial safety study is intended to demonstrate safety of human MSC in subjects with BO and to evaluate the cell dose that demonstrates signs of efficacy. Pending favorable safety results and pharmacokinetic and pharamcodynamic data obtained in the current proposed study we will likely conduct additional human studies with a more directed focus on the evaluation of efficacy while collecting additional safety information.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Pilot Study to Evaluate the Safety and Feasibility of Mesenchymal Stem Cells to Induce Remission in Lung Transplant Patients Experiencing Treatment-refractory Moderate Lung Rejection
Study Start Date : July 2014
Actual Primary Completion Date : September 2016
Actual Study Completion Date : December 2016

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Mesenchymal stem cells
2- 4 million MSC per Kg will be infused intravenously. Product will be infused at the rate of 2 - 3 ml/minute during the first 15 minutes and may be adjusted up to 5ml/minutes if tolerable. It is anticipated that the infusion will be completed within approximately 3 hours.
Biological: Mesenchymal stem cell

Primary Outcome Measures :
  1. Number of Participants with serious and non-serious adverse events [ Time Frame: Up to 2 weeks ]
    Patients will be assessed for their capacity to tolerate IV infusion of MSC without acute clinical or physiological deterioration.

  2. Changes in pulmonary function tests [ Time Frame: Up to 2 weeks ]
    Vital signs, pulmonary function tests (FEV1 and FCV) and Borg Dyspnea Index will be evaluated. Chest Radiograph, CBC and serum chemistry will be performed.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria

  1. Age range: 18 - 75 years
  2. Gender: Male of female
  3. Target disease or condition: Lung transplant recipients with treatment refractory moderate BOS. Patient must have diagnosis of treatment refractory BO/BOS Subject must have had, for each of the following three (3) treatment categories, either an inadequate or lost response (recurrence or persistence of symptoms) to a drug in that category within the past 24 months or documented intolerance to a drug in that category at any time. Note that subject may currently be receiving steroids or immunomodulators (see dosage requirements below) at the time of enrollment.
  4. Enhanced steroid therapy
  5. Enhanced immunosuppression
  6. Trial/failure to other therapies like Azythromycin, anti-reflux therapy and others.
  7. Informed consent form (ICF): Each patient will be required to sign an IRB approved ICF. Only subjects who have signed the ICF will be enrolled into the study. The ICF will include elements required by Mayo IRB and FDA in US 21CFR50.
  8. Subject must have adequate renal function; calculated creatinine clearance of greater than 30 ml/min.
  9. Subject must be available for all specified assessments at the study site through the completion of the study.
  10. Subject must provide written ICF and authorization for use of and disclosure of PHI.

Exclusion Criteria

  1. Patients with clinically significant illness with manifestations of significant organ dysfunction which in the judgment of the PI or co-investigator would render the study subject unlikely to tolerate the MSC infusion or complete the study
  2. Evidence or history of malignancy
  3. Evidence or history of autoimmune disorders independent of BO/BOS
  4. Pregnant or breast-feeding
  5. Positive screening for HIV Hepatitis B and Hepatitis C
  6. Evidence of liver dysfunction; Liver profile showing alkaline phosphatase higher than 345 u/L, total bilirubin greater than 1.65 mg/dL, ALT greater than 275 units/L and AST great than 240 units/L.
  7. Evidence of significant cardiac dysfunction
  8. Septicemia with high fever and hemodynamic instability
  9. History of CMV pneumonitis
  10. Patients who received any experimental therapy (drug or biologic) for any indication within 3 months of the study enrollment

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 identifier (NCT number): NCT02181712

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United States, Florida
Mayo Clinic in Florida
Jacksonville, Florida, United States, 32224
Sponsors and Collaborators
Mayo Clinic
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Principal Investigator: Cesar Keller, MD Mayo Clinic
Principal Investigator: Abba C Zubair, MD., PhD Mayo Clinic

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Responsible Party: Abba C. Zubair, M.D., Ph.D., PI, Mayo Clinic Identifier: NCT02181712     History of Changes
Other Study ID Numbers: 14-000025
First Posted: July 4, 2014    Key Record Dates
Last Update Posted: August 11, 2017
Last Verified: August 2017

Keywords provided by Abba C. Zubair, M.D., Ph.D., Mayo Clinic:
Bronchiolitis obliterans
lung transplant
mesenchymal stem cell
cell therapy

Additional relevant MeSH terms:
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Bronchiolitis Obliterans
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Tract Infections