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Human Autologous MSCs for the Treatment of Mid to Late Stage Knee OA

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ClinicalTrials.gov Identifier: NCT02351011
Recruitment Status : Completed
First Posted : January 30, 2015
Last Update Posted : September 27, 2019
Sponsor:
Information provided by (Responsible Party):
Jas Chahal, University Health Network, Toronto

Study Description
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Brief Summary:

Osteoarthritis (OA) is one of the most common forms of arthritis. It is a lasting condition in which the material that cushions the joints, called cartilage, breaks down. This causes the bones to rub against each other, causing inflammation, stiffness, pain and loss of joint movement. Currently, there are few effective treatments available for patients suffering from OA.

Mesenchymal stem cells (MSCs) are cells that have the ability to self-regenerate, which means they have the ability to make copies of themselves and to turn into other kinds of cells (e.g. cartilage cells). Stem cell science shows much promise for the future treatment of osteoarthritis, but much of the research is still in the early stages. In this study, researchers want to determine the safety of MSCs that a patient can tolerate without causing side effects. This will be done by starting at a low dose of MSCs and moving on to the next higher dose level provided there are no safety concerns. Researchers will also be looking at the function of the knee over time, which may give them some insight on the usefulness of MSCs as a treatment option.


Condition or disease Intervention/treatment Phase
Osteoarthritis of Knee Biological: 1 x 10^6 MSCs Biological: 10 x 10^6 MSCs Biological: 50 x 10^6 MSCs Phase 1 Phase 2

Detailed Description:

The trial is a non-randomized, open-label, dose escalation phase I/II clinical trial. A total of 12 participants will be enrolled - patients will be treated in cohorts of 3 to determine the safety and preliminary efficacy of autologous, ex-vivo expanded bone-marrow derived MSC injected into the knee joint in patients with moderate to advanced knee osteoarthritis.

A minimum of three evaluable patients will be entered at each dose level until the maximum tolerated dose (MTD) is reached. Toxicity will be evaluated and graded according to the Common Terminology Criteria (CTC) for Adverse Events, as Grade 3-4. If a patient is discontinued due to a grade 3 or 4 adverse event (i.e. dose-limiting toxicity, DLT), an additional patient will be enrolled at the same dose level to ensure that a minimum of 3 patients are evaluated. If 0/3 patients experience dose-limiting (DLT) at a given dose level, then the dose will be escalated for next cohort of 3 patients. If 1/3 patients experience DLT at a given dose level, then an additional 3 patients will be treated at that dose level. If no other patient experiences a DLT, dose escalation will continue. If DLT occurs in 2/3 or 2/6 patients, dose escalation will stop and the prior dose level will be declared the MTD for the MSC cell infusions in this study.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 12 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Human Autologous Mesenchymal Stromal Cells for the Treatment of Mid to Late Stage Knee Osteoarthritis
Study Start Date : February 2015
Actual Primary Completion Date : December 2018
Actual Study Completion Date : December 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Osteoarthritis

Arms and Interventions
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Arm Intervention/treatment
Experimental: Cohort 1
1 x 10^6 MSCs
 Biological: 1 x 10^6 MSCs
Autologous, bone-marrow derived MSCs
Other Name: Mesenchymal Stromal Cells (MSCs)
Experimental: Cohort 2
10 x 10^6 MSCs
 Biological: 10 x 10^6 MSCs
Autologous, bone-marrow derived MSCs
Other Name: Mesenchymal Stromal Cells (MSCs)
Experimental: Cohort 3
50 x 10^6 MSCs
 Biological: 50 x 10^6 MSCs
Autologous, bone-marrow derived MSCs
Other Name: Mesenchymal Stromal Cells (MSCs)


Outcome Measures
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Primary Outcome Measures :
  1. Safety as determined by the occurrence of local and systemic adverse events and/or serious adverse events. [ Time Frame: 1 to 5 years ]
    Safety as determined by the occurrence of local and systemic adverse events and/or serious adverse events.


Secondary Outcome Measures :
  1. Knee Injury and Osteoarthritis Outcome Score (KOOS) [ Time Frame: 1 year ]
    Knee-joint specific function

  2. Marx Activity Scale (Patient-reported activity) [ Time Frame: 1 year ]
    Patient-reported activity

  3. Short-Form 36 (Health-related quality of life) [ Time Frame: 1 year ]
    Health-related quality of life

  4. Whole Organ MRI Score (WORMS), Gadolinium-enhanced MRI, T2 Mapping (To assess joint structure, inflammation, and cartilage status over time) [ Time Frame: 1 year ]
    To assess joint structure, inflammation, and cartilage status over time

  5. Cartilage oligomeric matrix protein (COMP) [ Time Frame: 1 year ]
    Serum marker of cartilage metabolism

  6. Hyaluronic acid (HA) [ Time Frame: 1 year ]
    Serum pro-inflammatory marker

  7. C-terminal telopeptide of type II collagen (CTXII) [ Time Frame: 1 year ]
    Urine marker of cartilage metabolism

  8. Types I and II collagen cleavage (C1,2C) [ Time Frame: 1 year ]
    Urine marker of cartilage metabolism

  9. Type II collagen cleavage (C2C) [ Time Frame: 1 year ]
    Urine marker of cartilage metabolism

  10. IL-6/TNFα/IL-15 [ Time Frame: 1 year ]
    Synovial fluid pro-inflammatory markers


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   40 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients between 40-65 years of age with symptomatic moderate to severe (Kellgren-Lawrence III or IV) primary osteoarthritis of the knee
  2. Failed conservative management including physical therapy, bracing and/or oral anti-inflammatories for a minimum of six months
  3. No history of prior intra-articular cortisone, hyaluronic acid, or platelet-rich plasma injection within the previous six months
  4. No history of prior arthroscopic knee surgery or open knee surgery on the ipsilateral side within the past year
  5. Adequate bone marrow, liver, and renal functions
  6. Body weight >40 kg
  7. Body Mass Index <30
  8. Negative for (HIV, HTLV1&2, Hep A, B, C, syphilis) infection as determined by approved serological testing
  9. Negative for pregnancy as determined by a serum pregnancy test. Females of childbearing potential will be required to practice abstinence or use an effective form of contraception for 12 months following their MSC injection.
  10. Fluid > 1 cm within the lateral recess of the suprapatellar pouch at the level of the superior pole of the patella with the knee extended.

Exclusion Criteria:

  1. Patients with clinically unstable knee due to the presence of a complete anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and/or posterolateral corner tear
  2. Patients with varus or valgus malalignment >5 degrees as measured by 4 foot standing antero-posterior radiographs
  3. Patients with a history of a previous subtotal medial or lateral meniscectomy
  4. Patients with a history of septic arthritis in the affected joint
  5. Patients with a history of a prior intra-articular knee fracture
  6. Severe bleeding diathesis
  7. Contraindication to bone marrow aspiration and/or biopsy
  8. Active infection
  9. Bone marrow failure
  10. Cytopenia
  11. Patients who have previously received radiotherapy to the pelvis
  12. Patients who have been on chemotherapy from within a year of the date of informed
  13. Patients with positive serological test for (HIV, HTLV1&2, Hep A, B, C, syphilis)
  14. Pregnancy or risk of pregnancy (this includes participants that are not willing to practice active contraception for the duration of the study)
  15. Patients with unforeseen conditions that are deemed unsafe or inappropriate for the study (e.g. patients who are claustrophobic and cannot undergo an MRI) as per the discretion of the principal investigator
Contacts and Locations
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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): NCT02351011


Locations
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Canada, Ontario
Toronto Western Hospital
Toronto, Ontario, Canada, M5T 2S8
Sponsors and Collaborators
Jas Chahal
Investigators
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Principal Investigator: Jas Chahal, MD, MSc Arthritis Program, Toronto Western Hospital
Principal Investigator: Sowmya Viswanathan, PhD Arthritis Program, Toronto Western Hospital & Philip S. Orsino Facility for Cell Therapy
More Information
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Responsible Party: Jas Chahal, Orthopaedic Surgeon, University Health Network, Toronto
ClinicalTrials.gov Identifier: NCT02351011    
Other Study ID Numbers: MSC-001
First Posted: January 30, 2015    Key Record Dates
Last Update Posted: September 27, 2019
Last Verified: September 2019
Additional relevant MeSH terms:
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Osteoarthritis
Osteoarthritis, Knee
Arthritis
 Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases