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Safety and Preliminary Efficacy of Adipose Derived Stem Cells and Low Frequency Ultrasound in PAD

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ClinicalTrials.gov Identifier: NCT02756884
Recruitment Status : Completed
First Posted : April 29, 2016
Last Update Posted : June 26, 2019
Sponsor:
Collaborator:
SonaCare Medical
Information provided by (Responsible Party):
Arkansas Heart Hospital

Tracking Information
First Submitted Date  ICMJE April 25, 2016
First Posted Date  ICMJE April 29, 2016
Last Update Posted Date June 26, 2019
Actual Study Start Date  ICMJE June 3, 2015
Actual Primary Completion Date January 31, 2019   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: January 11, 2018)
Safety measured by incidence of adverse events [ Time Frame: 6 months ]
The primary outcome will be the safety/tolerability of treatment with aADSC in patients with PAD as determined by the incidence and severity of adverse events and serious adverse events.
Original Primary Outcome Measures  ICMJE
 (submitted: April 27, 2016)
Frequency of Adverse Events (AE) and Serious Adverse Events (SAE) related to treatment [ Time Frame: Number of AEs and SAEs from Baseline to 6 months ]
Change History Complete list of historical versions of study NCT02756884 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: January 11, 2018)
  • Efficacy of stem cells in improving ABI [ Time Frame: 6 months ]
    Changes in ABI reported as an entire number with two decimals (e.g. 1.00) from baseline
  • Efficacy of stem cells in improving 6MWT [ Time Frame: 6 months ]
    Improvement in six minute walk test (6MWT) in meters when compared to baseline.
  • Efficacy of stem cells in improving the TcPO2 [ Time Frame: 6 months ]
    improvement in Transcutaneous oxygen pressure (TcPO2) in mmHg as compared to baseline
  • Efficacy of stem cells in improving Quality of Life using EQ-5D 5L questionnaire [ Time Frame: 6 months ]
    Improvement in overall quality of life as measured using the EQ-5D 5L questionnaire as compared to baseline.
  • Efficacy of stem cells in improving Quality of Life using the VascuQol questionnaire [ Time Frame: 6 months ]
    Improvement in overall quality of life as measured using the VascuQol questionnaire as compared to baseline.
Original Secondary Outcome Measures  ICMJE
 (submitted: April 27, 2016)
  • ABI of the affected extremity [ Time Frame: Change from Baseline ABI at 6 months ]
    ABI is reported as an entire number with two decimals (e.g. 1.00)
  • 6MWT in meters [ Time Frame: Change from Baseline 6MWT at 6 months ]
    6MWT is reported in meters.
  • TcPO2 in the angiosome affected in mmHg [ Time Frame: Change from Baseline TcPO2 at 6 months ]
    TcPO2 is reported in mmHg
  • Quality of Life Scores for PAD [ Time Frame: Change from Baseline Quality of Life Scores at 6 months ]
    EQ-5D 5L questionnaire score is reported as a numeric value (e.g. 17)
  • Quality of Life Scores for PAD [ Time Frame: Change from Baseline Quality of Life Scores at 6 months ]
    VascuQol questionnaire score is reported as a numeric value (e.g. 10)
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Safety and Preliminary Efficacy of Adipose Derived Stem Cells and Low Frequency Ultrasound in PAD
Official Title  ICMJE Phase I/Phase II Safety and Preliminary Efficacy Study Using Low Frequency Ultrasound in Addition to Adipose Derived Stem Cells (ADSCs) in Patients With Moderate to Severe Lower Extremity Peripheral Arterial Disease (PAD)
Brief Summary

This is a single center, open label, prospective, randomized, controlled study in patients with non- revascularizable moderate or severe lower extremity Peripheral Arterial Disease (PAD) receiving autologous stem cells therapy (minimally manipulated). This study will enroll a maximum of 10 subjects in this study. The patients will be divided into two groups. One group will receive Adipose Derived Stem Cells (ADSCs) alone and the other group will receive low frequency ultrasound before the addition of ADSCs. The randomization will be 1:1. If the results of this pilot study are not clearly different, there will be a need for a phase II study to support the results.

Baseline, 6 week, 3 month and 6 month assessments of 6 min walking distance (6MWT), Ankle Brachial Indexes (ABIs)/Toe Brachial Indexes (TBIs), Transcutaneous Partial Oxygenation (TcPO2) and Rutherford assessments will be performed for the study group. Prior to the stem cell treatment, the ultrasound group patient will receive noninvasive transcutaneous pulsed focused ultrasound around the involved vessel(s) in the affected extremity. All patients will then receive 200 million autologous stromal vascular fraction cells containing adipose derived stem cell therapy: 1/3 of the cells will be delivered intra-venous proximal to the lesion (not retrograde), 1/3 of the cells will be delivered intra- adventitia proximal to the lesion and 1/3 of the cells will be delivered by intra- muscular injection along the vessel path (20-30 injections each separated by1.5 inch). Standard therapy for PAD patients will not be interrupted for the duration of the study. Standard therapy for PAD is defined as cardiovascular general measures like lifestyle changes, smoke cessation, exercise, cardiovascular rehabilitation, etc. All participants have already received maximal non-surgical therapy. Safety will be monitored on an ongoing basis.

Detailed Description

This is a single center, open label, prospective, randomized, controlled study in patients with non- revascularizable moderate or severe lower extremity PAD receiving autologous stem cells therapy. We will enroll a maximum of 10 subjects in this study. The patients will be divided into two groups. One group will receive ADSCs alone and the other group will receive low frequency ultrasound before the addition of ADSCs. The randomization will be 1:1. If the results of this pilot study are not clearly different, there will be a need for a phase II study to support the results.

Baseline, 6 week, 3 month and 6 month assessments of 6 min walking distance, ABIs/TBIs, TcPO2, Rutherford assessments will be performed for the study group. Prior to the stem cell treatment, the ultrasound group patient will receive noninvasive transcutaneous pulsed focused ultrasound around the involved vessel(s) in the affected extremity. All patients will then receive 100 to 200 million autologous adipose derived stem cell therapy: 1/3 of the cells will be delivered intra-venous proximal to the lesion (not retrograde), 1/3 of the cells will be delivered intra- adventitia proximal to the lesion and 1/3 of the cells will be delivered by intra- muscular injection along the vessel path (20-30 injections each separated by 1.5 inch). Standard therapy for PAD patients will not be interrupted for the duration of the study. Standard therapy for PAD is defined as cardiovascular general measures like lifestyle changes, smoke cessation, exercise, cardiovascular rehabilitation, etc. All participants have already received maximal non-surgical therapy. Safety will be monitored on an ongoing basis.

SUBJECT PARTICIPATION A screening evaluation to determine if a potential subject is suitable for participation in this trial will be conducted prior to enrollment and treatment by the Investigator. This includes obtaining written informed consent, collection of a complete medical history, including current and past medications, physical examination and clinical laboratory tests, PAD related testing (ABI/TBI, 6MWT, TcPO2, QoL questionnaires, etc.).

Eligible subjects will be randomized and treated at the Sponsor hospital as approved by the sponsor. Study medical staff will evaluate the patients upon admission according to the scheduled medical assessments to ensure eligibility of the subjects. Ultrasound group will receive LFUS over the affected limb (see page XIV). Intra-venous, intra-adventitia and intramuscular dosing of the autologous ADSC will occur on the morning of Day 0. Conscious sedation (I.V.) may be used during the tissue harvesting and intra-adventitia administration of the cells.. Subjects must remain in the clinic/hospital until they are clinically stable for discharge; subjects that are clinically stable will be discharged into the care of a responsible individual. Follow-up visits will occur at 6 weeks and 3 and 6 months post-treatment, and may occur with the patient's personal physician who will be provided the follow-up assessment forms. If this occurs, the Investigator and/or Sponsor or sponsor's designee may also contact the patient by telephone to collect follow-up safety information. Adverse events, concomitant medications, vital signs, clinical laboratory test results and physical examinations will be collected or conducted at follow-up visits according to the schedule of assessments (Appendix B). All previous medical care, including medications and rehabilitation, for the patient's current medical conditions will be continued as prescribed by the patient's personal physician(s). Use of other investigational agents or treatments is not allowed during this study.

Study Type  ICMJE Interventional
Study Phase  ICMJE Early Phase 1
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Peripheral Arterial Disease
Intervention  ICMJE
  • Biological: LoFU and aADSC
    Administration of low frequency ultrasound prior to administration of autologous adipose derived stem cells.
  • Biological: adipose derived stem cells
    control arm will only received the adipose derived stem cells.
Study Arms  ICMJE
  • Experimental: LoFU and aADSC
    Low Frequency Ultrasound LFUS will be delivered in a non-sterile manner using a custom modified LFUS combined imaging/therapy probe. Adipose derived stem cells from the patient will be harvested through lipoaspiration. This solution will be injected intra-venous, intra-adventitia and intramuscular in the affected vessel and area after the administration of the low frequency ultrasound
    Intervention: Biological: LoFU and aADSC
  • Active Comparator: Adipose Derived Stem Cells
    Adipose derived stem cells from the patient will be harvested through lipoaspiration. This solution will be injected intra-venous, intra-adventitia and intramuscular in the affected vessel and area without the administration of the low frequency ultrasound
    Intervention: Biological: adipose derived stem cells
Publications * Tebebi PA, Burks SR, Kim SJ, Williams RA, Nguyen BA, Venkatesh P, Frenkel V, Frank JA. Cyclooxygenase-2 or tumor necrosis factor-α inhibitors attenuate the mechanotransductive effects of pulsed focused ultrasound to suppress mesenchymal stromal cell homing to healthy and dystrophic muscle. Stem Cells. 2015 Apr;33(4):1173-86. doi: 10.1002/stem.1927.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: April 27, 2016)
10
Original Estimated Enrollment  ICMJE Same as current
Actual Study Completion Date  ICMJE January 31, 2019
Actual Primary Completion Date January 31, 2019   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Males and Females ≥18 years
  2. Patients with a Rutherford classification of 3 or 4.
  3. Non revascularizable lesions by balloon or stent angioplasty of the lower extremity SFA (Superficial femoral artery), Popliteal, AT (anterior tibial), PT (posterior tibial) or peroneal arteries. Non-revascularizable lesions will be determined based on a CT angiogram and/ or angiography.
  4. Life expectancy greater than 6 months.
  5. Ability to understand and provide signed informed consent.
  6. Reasonable expectation that patient will receive standard post-treatment care and attend all scheduled safety follow-up visits
  7. Written informed consent

Exclusion Criteria:

  1. Immunosuppressive agents, including but not limited to, corticosteroids and steroidal anti- inflammatory agents (SAIDS)
  2. Non-steroidal anti- inflammatory agents (NSAIDS)
  3. Patients taking currently P2Y12 inhibitors or calcium channel blockers.
  4. Uncontrolled seizure disorder
  5. Dementia
  6. Evidence or presence of immune deficiency.
  7. Presence of any other clinically-significant medical condition, psychiatric condition, or laboratory abnormality that in the judgment of the Investigator or Sponsor would pose a safety risk to the subject
  8. Participation in another study with an investigational drug or device within one month prior to treatment
  9. Females known to be pregnant, lactating or having a positive pregnancy test (will be tested during screening) or planning to become pregnant during the study
  10. Inability to comply with the conditions of the protocol.
  11. Allergy to sodium citrate or any "caine" type of local anesthetic
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 99 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT02756884
Other Study ID Numbers  ICMJE AHH-2015-10
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Arkansas Heart Hospital
Study Sponsor  ICMJE Arkansas Heart Hospital
Collaborators  ICMJE SonaCare Medical
Investigators  ICMJE
Principal Investigator: Wilson Wong, MD Arkansas Heart Hospital
PRS Account Arkansas Heart Hospital
Verification Date June 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP