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Trial record 23 of 56 for:    stem cell arthritis AND bone marrow

Comparing Mesenchymal Stem Cell Counts in Unilateral vs. Bilateral Posterior Superior Iliac Spine Bone Marrow Aspiration

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ClinicalTrials.gov Identifier: NCT03014037
Recruitment Status : Recruiting
First Posted : January 9, 2017
Last Update Posted : February 1, 2019
Sponsor:
Information provided by (Responsible Party):
Kenneth Mautner, Emory University

Brief Summary:
Musculoskeletal conditions are common sources of pain. Specifically, osteoarthritis affects nearly 27 million people in the United States. This disease leads to the breakdown of the cartilage surfaces of the joints, which serve as the connection points between the bones of the body, causing a large amount of pain and disability in patients. Increasing the number of available treatment options for osteoarthritis is becoming increasingly more important as Americans continue to age. Using stem cells taken from bone marrow is one of the non-operative treatments that has been gaining popularity in the recent past. This study aims to clarify how this procedure should best be done by comparing stem cell concentrations and patient outcomes (short and long term) in patients who have stem cells taken from one area vs two (unilateral vs bilateral posterior superior iliac spine (PSIS) aspirations).

Condition or disease Intervention/treatment Phase
Osteoarthritis Procedure: Unilateral Bone Marrow Procurement Procedure: Bilateral Bone Marrow Procurement Not Applicable

Detailed Description:

Musculoskeletal conditions are common sources of pain. Specifically, osteoarthritis affects nearly 27 million people in the United States. This disease leads to the breakdown of the cartilage surfaces of the joints, which serve as the connection points between the bones of the body, causing a large amount of pain and disability in patients. Increasing the number of available treatment options for osteoarthritis is becoming increasingly more important as Americans continue to age. Using stem cells taken from bone marrow is one of the non-operative treatments that has been gaining popularity in the recent past. This study aims to clarify how this procedure should best be done by comparing stem cell concentrations and patient outcomes (short and long term) in patients who have stem cells taken from one area vs two (unilateral vs bilateral posterior superior iliac spine (PSIS) aspirations).

This research study involves the participant being randomly placed into one of two groups; one group will have cells taken from one hip, and the other will have cells taken from both hips. Both of these approaches are performed in clinics currently, and both are considered to be standard of care. All bone marrow collected for the purposes of this study will be obtained by the principal investigator while performing the standard procedure. In obtaining these sample the physicians will abide by the standard of care set forth for the Bone Marrow Aspiration Concentrate procedure.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Comparing Mesenchymal Stem Cell Counts in Unilateral vs. Bilateral Posterior Superior Iliac Spine Bone Marrow Aspiration
Actual Study Start Date : September 7, 2017
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : May 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Osteoarthritis

Arm Intervention/treatment
Unilateral Procurement of Bone Marrow
Participants currently scheduled to undergo a bone marrow aspirate concentration (BMAC) procedure will be randomized to unilateral procurement of bone marrow.
Procedure: Unilateral Bone Marrow Procurement
A total of 61cc of bone marrow will be procured under ultrasound guidance from one posterior superior iliac spine (PSIS) via 3 passes, each at least 1 cm apart, through the bone cortex. In each pass, investigators will obtain 2.3cc of BMA with a 60cc syringes.

Experimental: Bilateral Bone Marrow Procurement
Participants currently scheduled to undergo a bone marrow aspirate concentration (BMAC) procedure will be randomized to bilateral procurement of bone marrow.
Procedure: Bilateral Bone Marrow Procurement
30.5cc of bone marrow will be obtained under ultrasound guidance from each posterior superior iliac spine (PSIS) with 3 passes, at least 1 cm apart, per side (10.17cc per pass) using 60cc syringes. The collection from each PSIS will be combined to yield a total of 61cc.




Primary Outcome Measures :
  1. Change Quality of Life assessed by the Emory Quality of Life (EQOL) Survey Score [ Time Frame: Pre-treatment, Follow Up (Up to One Year) ]
    The EQOL survey measures five dimensions - mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The participant will be asked to answer questions regarding these measures and to indicate their current experience on a scale from 1 to 3; 1 being "no problem" and 3 being "most extreme problem". The answers to these question are put together to create a 5 digit composite score.This composite score can be indexed to a lookup table which produces a single summary score from 0 to 100. The lookup table we use is weighted and normalized to the United Stated general population.

  2. Change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) [ Time Frame: Pre-treatment, Follow Up (Up to One Year) ]
    The KOOS questionnaire is an instrument to assess the patient's opinion about their osteoarthritis and associated problems. It consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and knee related Quality of life (QOL). Standardized answer options are given (5 Likert boxes) and each question is assigned a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. A total lower score indicates more problems.


Secondary Outcome Measures :
  1. Capacity of Isolated Cells to Differentiate Down Cell Lineages [ Time Frame: Post Cell Culture (Up to 21 Days) ]
    Bone marrow aspirate will be placed in 10 mL heparinized tubes and nucleated cells will be isolated with a density gradient and re-suspended in complete culture medium for plating. Isolated adherent cells will be processed for the ability to differentiate down osteogenic-, adipogenic- and chondrogenic-lineage after cell harvest. Specifically, isolated cells are treated with different media to induce their differentiation into 1) osteo-progenitor cells (identified by positive staining with Alzarian red, 2) adipocytes (identified by positive staining with Oil-Red) and 3) chondrocytes (identified by positive staining with Alcian blue). The presence of these phenotypes should be prevalent by 3 weeks; if not, the cells are not considered pluripotent for that lineage and hence would not be classified as mesenchymal stem cells.



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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Currently scheduled for a bone marrow aspirate concentration (BMAC) procedure
  • Cognitively able to give consent and complete the required questionnaires

Exclusion Criteria:

  • History of leukemia or lymphoma
  • History of any autoimmune disorders and disease
  • Currently taking immunosuppressive medications
  • Presence of an active or suspected infection, or an infection of the joint in question within the past 6 months
  • Vulnerable populations (pregnant women and breast-feeding women)
  • Cortisone injection into the affected joint within 6 weeks
  • Used NSAIDs within 1 week of the procedure
  • History of bleeding disorders or inflammatory joint disease
  • Surgical intervention on the affected or contralateral joint within 6 months of BMAC 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): NCT03014037


Contacts
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Contact: Kenneth Mautner, MD 404-778-7142 kmautne@emory.edu

Locations
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United States, Georgia
The Emory Clinic Recruiting
Atlanta, Georgia, United States, 30322
Contact: Kenneth Mautner, MD    404-778-7142    kmautne@emory.edu   
Sponsors and Collaborators
Emory University
Investigators
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Principal Investigator: Kenneth Mautner, MD Emory University

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Responsible Party: Kenneth Mautner, Associate Professor, Emory University
ClinicalTrials.gov Identifier: NCT03014037     History of Changes
Other Study ID Numbers: IRB00093044
First Posted: January 9, 2017    Key Record Dates
Last Update Posted: February 1, 2019
Last Verified: January 2019

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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 Kenneth Mautner, Emory University:
Orthopedics

Additional relevant MeSH terms:
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Osteoarthritis
Arthritis
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases