Evaluation of Safety and Efficiency of Method of Exosome Inhalation in SARS-CoV-2 Associated Pneumonia. (COVID-19EXO)
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|ClinicalTrials.gov Identifier: NCT04491240|
Recruitment Status : Completed
First Posted : July 29, 2020
Results First Posted : November 4, 2020
Last Update Posted : November 4, 2020
Coronavirus is an acute viral disease with prevailing upper respiratory tract infections caused by the RNA-containing virus of the genus Betacoronavirus of the Coronaviridae family. Most patients with severe COVID-19 develop pneumonia in the first week of the disease. As the infection progresses, the infiltration increases, and the affected areas increases. Excessive and uncontrolled immune system response with rapidly developing fatal cytokine storm plays the main role in the pathogenesis of acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection.
According to available data, exosomes can regulate inflammation and regenerative processes due to the change in the concentration of anti-inflammatory cytokines and switch the immune cell to regenerative secretome. Inhalation of exosomes may reduce inflammation and damage to the lung tissue and stimulate the regenerative processes.
This protocol has been developed based on the literature, information about the ongoing tests NCT04276987 (A Pilot Clinical Study on Inhalation of Mesenchymal Stem Cells Exosomes Treating Severe Novel Coronavirus Pneumonia) and NCT04384445 (Organicell Flow for Patients With COVID-19), Patent No 271036826 of 2019. "A method for obtaining and concentrating microRNA-containing exosomal multi-potent mesenchymal-stromal cells for use in cosmetic and pharmaceutical products to stimulate regenerative processes and slow down aging.
|Condition or disease||Intervention/treatment||Phase|
|Covid19 SARS-CoV-2 PNEUMONIA COVID-19||Drug: EXO 1 inhalation Drug: EXO 2 inhalation Drug: Placebo inhalation||Phase 1 Phase 2|
COVID-19 is an infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. COVID-19 is now a pandemic affecting many countries worldwide. Globally, as of 1:09 pm CEST, 27 July 2020, there have been 16 096 741 confirmed cases of COVID-19, including 646 384 deaths, reported to WHO.
The main and rapidly achievable target of SARS-CoV-2 is lung type II alveolar cells (AT2), which determines the development of diffuse alveolar damage. In the pathogenesis of ARDS due to COVID-19, the main role is played by an over-response of the immune system with rapidly developing severe life-threatening cytokine release syndrome (cytokine storm). Cytokine release syndrome threatens the emergence and progression of ARDS. The key components of the pathogenesis of ARDS also include disruption of cell cytotoxicity mechanisms, excessive activation of cytotoxic lymphocytes and macrophages with a massive release of proinflammatory cytokines (FNO-α, IL-1, IL-2, IL-6, IL-8, IL-10), granulocytic colony-stimulating factor, monocytic chemoattractive protein 1), and inflammatory markers (CRP, serum ferritin), infiltration of internal organs and tissues by activated T-lymphocytes and macrophages, resulting in a hyperinflammatory reaction. Such severe lesions can lead to death or severe lung damage, including long rehabilitation after discharge.
Experimental studies have demonstrated that mesenchymal stem cells (MSCs) may significantly reduce lung inflammation and pathological impairment resulting from different types of lung injury. Many researchers connect the anti-inflammatory effect of MSC with their secretome which includes MSC derived exosomes. It is highly likely that MSC exosomes have the same therapeutic effect on inoculation pneumonia as MSCs themselves. Moreover, exosomes show a strong effect of regenerative stimulation on different wounds so the regenerative effect can be extended on patients with COVID-19 pneumonia.
The purpose of this protocol is to explore the safety and efficiency of aerosol inhalation of the exosomes in the treatment of severe patients hospitalized with novel coronavirus pneumonia (NCP).
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||30 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||The trial has three groups, each with 10 subjects (n=30). All eligible study subjects will be randomized, double-blinded, to either the two treatment groups or placebo group.|
|Masking:||Double (Participant, Care Provider)|
|Masking Description:||Two main groups will be provided with exosomes in a specially provided solution, the third group (control) will receive the same solution without exosomes. Due to exosomes are nanoparticles and requires special methods and devices to be detected the hospital staff and patients have no way to check which group receives exosomes.|
|Official Title:||The Protocol of Evaluation of Safety and Efficiency of Method of Exosome Inhalation in SARS-CoV-2 Associated Two-Sided Pneumonia|
|Actual Study Start Date :||July 20, 2020|
|Actual Primary Completion Date :||October 1, 2020|
|Actual Study Completion Date :||October 20, 2020|
Participants (n=10) in this group will receive standard therapy and exosomes of the first type.
Drug: EXO 1 inhalation
Twice a day during 10 days inhalation of 3 ml special solution contained 0.5-2x10^10 of nanoparticles (exosomes) of the first type.
Participants (n=10) in this group will receive standard therapy and exosomes of the second type.
Drug: EXO 2 inhalation
Twice a day during 10 days inhalation of 3 ml special solution contained 0.5-2x10^10 of nanoparticles (exosomes) of the second type.
Placebo Comparator: Placebo
Participants (n=10) in this group will receive standard therapy and inhalation placebo solution.
Drug: Placebo inhalation
Twice a day during 10 days inhalation of 3 ml special solution free of nanoparticles (exosomes).
- Number of Participants With Non-serious and Serious Adverse Events During Trial [ Time Frame: 30 days after clinic discharge ]Safety assessment such as adverse events will be registered. Adverse events will be monitored during all trial
- Number of Participants With Non-serious and Serious Adverse During Inhalation Procedure [ Time Frame: after each inhalation during 10 days ]Safety assessments such as adverse events during the inhalation procedures will be registered.
- Time to Clinical Recovery (TTCR) [ Time Frame: from first inhalation until discharge from the clinic, up to 30 days ]Measure and compare time to clinical recovery compared to placebo. Time to clinical recovery calculated by the number of days the patient has hospitalized.
- SpO2 Concentration [ Time Frame: 10 days during inhalation ]The concentration of SpO2 by Pulse oximetry device during procedures in the groups. The measure was done before and after each inhalation (total 4 measures per day). The intraday SpO2 data of all patients in groups was calculated as Median with Inter-Quartile Range and presented in the table by days.
- C-reactive Protein [ Time Frame: At the begining of inhalation (day 1) and on next day of last inhalation (day 11) ]Blood biochemistry C reactive protein level in serum.
- Lactic Acid Dehydrogenase (LDH) [ Time Frame: At the beginning of inhalation (day 1) and on next day of last inhalation (day 11) ]Lactic Acid Dehydrogenase (LDH) level in serum
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): NCT04491240
|Medical Centre Dinasty|
|Samara, Russian Federation, 443095|