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AlloGeneic Human Mesenchymal Stem Cells (hMSC) in PAtients With FistuLizing Crohn's Disease Via PErifistula iNjEctions (GALENE) (GALENE)

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ClinicalTrials.gov Identifier: NCT02677350
Recruitment Status : Withdrawn (Study is permanently closed to enrollment)
First Posted : February 9, 2016
Last Update Posted : June 24, 2019
Sponsor:
Information provided by (Responsible Party):
Joshua M Hare, University of Miami

Brief Summary:

To evaluate the role of allogeneic mesenchymal stem cells for treatment of perianal fistulizing Crohn disease.

Twenty (20) Crohn's disease patients with complex or multiple perianal or rectovaginal fistulas will be included and will be scheduled to undergo peri-fistula injections after meeting all inclusion/exclusion criteria's at baseline.

Following the Pilot Phase of four (4) subjects, sixteen (16) subjects are scheduled to undergo perianal injections and after meeting all inclusion/exclusion criteria's, will be evaluated at baseline.


Condition or disease Intervention/treatment Phase
Crohn's Disease Fistulizing Crohn's Disease Stem Cells Drug: Allogeneic Bone Marrow derived Human Mesenchymal Stem Cells (hMSCs) Phase 1

Detailed Description:

Twenty (20) subjects will be treated with 20 million (2 x 10^7) allogeneic MSC's total divided into 10 injections of 2 million cells/cm of tract in 0.5 ml volume (for total volume of 5 ml per visit) at 4 week intervals for a maximum of 4 treatment sessions based on the discretion of the endoscopist at the time of injection..

For patients with more than 6 fistula tracts, the largest of the tracts will be injected.

The first four (4) subjects that receive their initial injections will not be treated less than 5 days apart. As stated in the above response, these first four (4) patients will have an initial safety follow up period of one month prior to proceeding with the treatment of further patients.

Follow up: Clinical (CDAI, PDAI, and perianal examination +/- under anesthesia), and endoscopic ultrasound will be performed at the time of each treatment. MRI evaluation will be performed at screening, 4 weeks after the fourth treatment (week 16) and at 16 months, if fistula closure has not been achieved. Clinical evaluation will be performed at months 1, 3, 6, 12. Endoscopic ultrasound and MRI will also be performed as needed for symptomatic patients if an abscess is suspected.

Duration of Study participation: 17 Months (Follow-up visits will be at 4, 7, 10 and 16 Months post treatment.

The Allo-hMSCs will be supplied from an allogeneic human mesenchymal stem cell source manufactured by the University of Miami.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I, Pilot Trial to Evaluate the Safety and Efficacy of Injection of Allogeneic Mesenchymal Bone-Marrow Derived Human Stem Cells in Patients With Fistulizing Crohn's Disease.
Estimated Study Start Date : December 1, 2019
Estimated Primary Completion Date : December 2025
Estimated Study Completion Date : December 2026

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Crohn's Disease

Arm Intervention/treatment
Experimental: Pilot
Twenty (20) subjects will be treated with 20 million (2 x 10^7) Allogeneic Bone Marrow derived Human Mesenchymal Stem Cells (hMSCs) total divided into 10 injections of 2 million cells/cm of tract in 0.5 ml volume (for total volume of 5 ml per visit) at 4 week intervals for a maximum of 4 treatment sessions based on the discretion of the endoscopist at the time of injection.
Drug: Allogeneic Bone Marrow derived Human Mesenchymal Stem Cells (hMSCs)
Peri-fistula injections
Other Name: allo-hMSCs




Primary Outcome Measures :
  1. Evaluation of treatment emergent adverse events from the bone marrow-derived allogeneic mesenchymal stem cells implant [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]

    Evaluation of treatment emergent adverse events based on viability, safety and tolerance of the bone marrow-derived allogeneic mesenchymal stem cells implant (MSCs) in fistulizing Crohn's Disease patients, defined as:

    • Treatment emergent adverse event (AE) rates, infections, hospitalizations or surgical interventions.
    • Physical examination
    • Vital signs
    • Laboratory tests (biochemistry, hematology, urinalysis)


Secondary Outcome Measures :
  1. Clinically: to assess changes in the Crohn's Disease Activity Index (CDAI), the Perianal Disease Activity Index (PDAI). [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]
    To monitor the number of draining fistulas, fistula healing efficiency, relapse rate among patients who achieved treatment success and amount local inflammation: Complete closure will be defined as absence of discharge and absence of collections of ≥2 cm directly related to the treated fistulas tracts as assessed by perianal examination. Partial closure will be defined as a reduction in >50% draining fistulas or no discharge on finger compression.

  2. Endoscopic assessment of rectum using a limited simplified endoscopic activity score for Crohn's disease (SES-CD) to evaluate extent and severity of ulcers. [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]
    Endoscopic ultrasound and Examination under anesthesia to evaluate baseline fistula state and during each intervention to assess tract closure and abscesses. Remission will be defined as healing of rectal ulcers and/or closure of fistula tracts by endoscopic ultrasonography.

  3. Radiologic assessment using MRI [ Time Frame: Baseline, Month 4, and 16 months only if fistula closure has not been achieved at month 4 ]
    to examine number of tracts, inflammation in tracts, and extent of fibrosis or regenerative tissue via MRI assessment. Radiologic remission will be defined as substitution of tracts with fibrosis or regenerative tissue.

  4. Evaluate symptomatic patients. [ Time Frame: Month 4 and Month 16 ]
    Endoscopic ultrasound and MRI will be used to evaluate symptomatic patients.

  5. Evaluate the effect of local treatment with allogeneic bmMSCs using the short Inflammatory Bowel Disease Questionnaire (sIBDQ) [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]
    To evaluate the effect of local treatment with allogeneic bmMSCs on the quality of life of patients with fistulizing CD using the short Inflammatory Bowel Disease Questionnaire (sIBDQ)

  6. Evaluate the effect of local treatment with allogeneic bmMSCs using the Short Form (SF)-36 score [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]
    To evaluate the effect of local treatment with allogeneic bmMSCs on the quality of life of patients with fistulizing CD using the Short Form (SF)-36 score

  7. C-reactive protein (CRP) [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]
    To summarize the changes from baseline compared to 12 weeks in serum C-reactive protein

  8. Major Adverse Events [ Time Frame: At each intervention and 7, 10, and 16 months after last intervention ]
    • Incidence of the Major Adverse Events endpoint, defined as the composite incidence of (1) death (2) hospitalization for worsening fistulizing disease (3) or infection caused by the intervention.



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:

  1. Provide written informed consent.
  2. Male and Female subjects ≥ 18 years of age at the time of signing the Informed Consent Form.
  3. Subjects with Fistulizing Crohn´s disease with complex perianal fistula, multiple perianal fistulas, or rectovaginal fistula(s). The complex perianal fistula is defined as a trans-sphincteric, supra-sphincteric or an extra-sphincteric tract. Patients with multiple fistulas, "horseshoe" fistula," or any fistula with fecal incontinence as a result of the Crohn's disease itself or because of previous anal fistula surgery that cannot have more surgery are also eligible.
  4. If drainage of abscess is needed, it should be done 2 or more weeks prior to onset of therapy.
  5. Have had Crohn's Disease (CD) diagnosed at least 6 months prior to enrollment based on clinical, endoscopic, anatomic/pathologic and/or radiologic criteria.
  6. Have a CDAI score <350.
  7. During the course of the subject's Crohn's disease (CD), subject must have received anti-Tumor Necrosis Factor (TNF) agents or immunomodulators which did not heal the CD fistulas. If anti-TNFs or immunomodulators are contraindicated or led to adverse events, patients must have failed conservative therapy with antibiotics, or setons, or surgical intervention.
  8. Subject who are currently receiving anti-TNFs, antibiotics, 5-aminosalicylic acid, azathioprine, 6-mercaptopurine, methotrexate, prednisone, or any similar drugs at the time of enrollment as long as the following criteria are met:

    1. The patient must have been on the anti-TNF for at least 4 months
    2. The dose of 5-aminosalicylic acid (5-ASA) must have been stable for at least 4 weeks prior to enrollment.
    3. The dose of steroids must have been stable for at least 2 weeks prior to enrollment.
    4. The dose of antibiotics must have been stable for at least 2 weeks prior to enrollment.
    5. The dose of immunomodulators (for example, azathioprine, 6-mercaptopurine, or methotrexate) must have been stable for at least 8 weeks prior to enrollment and the subject on therapy for at least three months prior to enrollment
  9. Patient is, in the investigator's opinion, willing and able to comply with the protocol requirements

Exclusion Criteria:

In order to participate in this study, a patient Must Not:

  1. Have a known, serious radiographic contrast allergy (gadolinium in particular)
  2. Have a hematologic abnormality as evidenced by hematocrit < 25%, white blood cell < 2,500/ul or platelet values < 100,000/ul without another explanation.
  3. Have liver dysfunction, as evidenced by enzymes (AST and ALT) greater than three times the Upper limit normal.
  4. Have a coagulopathy (International Normalized ratio (INR) > 1.3) not due to a reversible cause (i.e., Coumadin). Patients on Coumadin will be withdrawn 5 days before the procedure and confirmed to have an INR < 1.3. Patients who cannot be withdrawn from Coumadin will be excluded from enrollment.
  5. Bone marrow dysfunction, as evidenced by a 20% or more deviation from normal hematocrit, white blood cell count or platelet values without another explanation.
  6. Be an organ transplant recipient.
  7. Clinical history of malignancy within 5 years (i.e., patients with prior malignancy must be disease free for 5 years), except curatively-treated basal cell carcinoma, squamous cell carcinoma, or cervical carcinoma.
  8. Non-cardiac condition that limits lifespan to < 1 year.
  9. Patients with a highly active luminal CD, i.e., if they meet any of the following criteria: - Presence of severe proctitis (prominent friability, spontaneous bleeding, multiple erosions, deep ulcers) or very active luminal disease that requires immediate treatment, revealed by colonoscopy.
  10. Have anal dysplasia
  11. Patients that have received radiation to the pelvic/perianal area.
  12. Presence of abscess or other collections not drained (revealed by baseline radiologic study).
  13. Presence of setons unless they are removed before treatment beginning.
  14. Rectal and/ or anal stenosis that cannot be adequately evaluated for dysplasia by Examination under anesthesia or endoscopy.
  15. Need surgery in the perianal region for reasons other than fistulas at inclusion or within 16 weeks after treatment administration.
  16. Had a stable dose of an anti-TNF agent within the past 8 weeks before the cell treatment administration.
  17. Taking tacrolimus or cyclosporine and not on a stable maintenance dose for 2 weeks before the start of scheduled interventions.
  18. Have a history of alcohol or other addictive substances abuse within 6 months before inclusion.
  19. Severe uncontrolled diseases (chronic renal failure, cardiovascular, pulmonary or any systemic disease).
  20. Any type of medical or psychiatric disease which are considered as exclusion criteria, in the investigator's opinion.
  21. Subjects with congenital or acquired immunodeficiency.
  22. Positive serology for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV), Human papillomavirus (HPV) or Herpes Virus.
  23. Had major surgery or serious traumatism within 6 weeks of enrollment.
  24. Impossibility of doing an radiological exploration (reaction to contrast material, pacemakers, claustrophobia, etc.)
  25. Have hypersensitivity to dimethyl sulfoxide (DMSO)
  26. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial.
  27. Be a female who is pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods. Female patients must undergo a blood or urine pregnancy test at screening and within 36 hours prior to injection.

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): NCT02677350


Locations
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United States, Florida
Univeristy of Miami Miller School of Medicine
Miami, Florida, United States, 33136
Sponsors and Collaborators
Joshua M Hare
Investigators
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Principal Investigator: David Kerman, MD ISCI / University of Miami

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Responsible Party: Joshua M Hare, Sponsor, University of Miami
ClinicalTrials.gov Identifier: NCT02677350     History of Changes
Other Study ID Numbers: 20150965
First Posted: February 9, 2016    Key Record Dates
Last Update Posted: June 24, 2019
Last Verified: June 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
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Crohn Disease
Inflammatory Bowel Diseases
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Intestinal Diseases