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Safety and Efficacy Study of Intrasphincteric Autologous Myoblast Injection to Treat Stress Urinary Incontinence

Primary Purpose

Stress Urinary Incontinence

Status
Completed
Phase
Phase 1
Locations
Slovenia
Study Type
Interventional
Intervention
Transurethral intrasphincteric autologous myoblast implantation
Sponsored by
University Medical Centre Ljubljana
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stress Urinary Incontinence focused on measuring Urinary incontinence, Myoblasts, Muscle derived cells, Stem cells

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Female outpatients, predominant clinical diagnosis of SUI
  • Have discrete episodes of incontinence (that is, are dry between episodes and not continuously leaking urine, synchronous with increased intra-abdominal pressure from coughing, sneezing, exercising, etc.)
  • Have a positive Fixed Bladder Volume Cough Stress Test (CST) result; and post void residual volume of <50 ml
  • Report normal urinary diurnal (≤8/day) and nocturnal (≤2/night) frequency per micturition history
  • Have had symptoms of SUI for a minimum of 3 months prior to study entry
  • Can independently use toilet without difficulty
  • If patients regularly use laxatives, stool softeners, or stool-bulking agents (for example, fibre supplements), the use of these products should remain constant during participation in the study.
  • Competent to comprehend, sign, and date an Ethics Committee approved informed consent form before any study-specific procedure is performed.
  • Are women of non-childbearing potential by reason of hysterectomy, other surgery, or natural menopause, or are women of childbearing potential who test negative for pregnancy at the time of enrolment based on a urine pregnancy test and agree to use a medically accepted means of contraception (for example, intrauterine device [IUD], oral or injectable contraceptives, implant, barrier device, sterilization, abstinence, or sex with a vasectomized male partner) for the duration of the study. Women using oral contraceptives or hormone replacement therapy must have a stable dose and regimen for greater than or equal to 3 months prior to entry into the study.

Exclusion Criteria:

  • Previous diagnosis of any of the following conditions, disorders, or diseases of the urinary tract:

    • Greater than Stage I Anterior (cystocoele), Apical (uteri), or Posterior (rectocoele) Compartment Prolepses as per the POP-Q)
    • Ureteric bladder, urethral or rectal fistula
    • Uncorrected congenital abnormality leading to urinary incontinence
    • Interstitial cystitis
    • Urinary urgency that results in leakage (as a predominant symptom)
    • Adult enuresis
    • Urodynamically proven:
  • detrusor instability
  • sensory urgency defined as first sensation of bladder fill (urge to void) of <100 ml; bladder capacity of <300 ml
  • voiding difficulty
  • Have no sensation at any time during the simple filling cystometry procedure
  • Unstable systemic disease including active infection, uncontrolled hypertension, unstable angina, congestive heart failure, or myocardial infarction within 6 months before enrollment
  • Have a symptomatic urinary tract infection (UTI); or have a history of four or more urinary tract infections in the preceding year.
  • Have prolonged menstruation (>14 days per month).
  • Have history of (or currently have) urogenital cancer.
  • Suffer from severe constipation defined as less than one bowel movement per week
  • Are pregnant, <12 months postpartum or are lactating
  • Have had any major inpatient surgery within 3 months prior to study entry
  • Known infection with human immunodeficiency virus (HIV)
  • Known active infection with Hepatitis B virus, Hepatitis C virus or Lues.
  • Any organic or psychiatric disorder that, in the opinion of the investigator, might prevent the subject from completing the study or interfere with the interpretation of the study results.
  • Have had any anti-incontinence or prolapse surgery, including the following:

    • Anterior Repair
    • Needle Suspension such as Raz; Pereyra; Stamey; Gittes; and Muzsnai procedures
    • Retropubic Procedures: such as Marshall, Marchetti & Krantz; and Burch procedures
    • Sling Procedure
    • Collagen Injections
    • Artificial Sphincter.
  • Use any of the following:

    • Any anti-incontinence device (for example, Reliance, Minigard, or FemAssist) including tampons used to prevent incontinence during participation in the study
    • Vaginal pessaries for prolapse or incontinence
    • Any nonpharmacologic intervention for incontinence or prolapse (for example, electro stimulation, vaginal cones, or any such device) within the 3 months prior to study entry.
  • Current use of any of the following drugs: antidepressants, duloxetine, monoamine oxidase inhibitors or other, clonidine, alpha-methyl-DOPA, beta-blockers, guanethidine, reserpine, pentosan polysulfate, or alpha-receptor antagonists/agonists (chronic use).
  • Current use of any medications for the treatment of urinary incontinence.
  • Are on a medication regimen including estrogens, anti-estrogens, or diuretics where dose and/or frequency has not been stable for at least the past 12 weeks, or is anticipated to change during the course of the study.
  • ≤ 30 days since receiving an investigational medicinal product or device in another clinical trial. Current enrollment in another clinical trial is not permitted.
  • Allergy/ intolerance of at least one of the active ingredients or excipients of the investigational products, e.g. bovine protein, gentamycin
  • Have any abuse disorder within the 5 years prior to study entry; e.g. patients who report regular consumption of >21 alcoholic drinks per week (an average of 3 drinks per day)

Sites / Locations

  • University Medical Center Ljubljana, Dept. of Gynecology

Outcomes

Primary Outcome Measures

Change from baseline in Incontinence episode frequency (IEF)
The median percent change from baseline in IEF using the 3-day bladder diary analysis
Change from baseline in Quality of Life (I-QOL) total score
Mean improvement from baseline for the Incontinence Quality of Life (I-QOL) total score
Change from baseline in the Incontinence score

Secondary Outcome Measures

Time to onset of response
Time to onset of response; time to maximum response; maintenance of response observed through changes in Incontinence episode frequency(IEF), Visual analog scale of the degree of suffering (VAS), Modified patient global impression of improvement(PGI-I*), fixed bladder stress test and I-QOL.
Change from baseline in Fixed bladder stress test outcome
Rate for subsequent incontinence surgery
Change from baseline in Urodynamic evaluation
Cystometry, urethral pressure profile (UPP), 1-hour pad-test.
Safety
Number of adverse events, patholgical lab values, vital signs and weight recordings. Number of immediate and delayed complications of cell injection, including surgical injury, scars, urinary tract infection, inflammation, pelvic pain, prolonged urinary retention, voiding dysfunction, de novo urge incontinence, hematuria, hyperplasia or tumours. Any clinically significant findings based on physical examination, standard haematology, clinical chemistry and urinalysis profiles, Electrocardiogram (ECG), Blood Pressure (BP), pulse rate and adverse events recordings.
Change from baseline in Urinary incontinence semiquantitative (UIS)
Amount of leaked urine measured semiqantitative from a 3-day bladder diary.

Full Information

First Posted
May 12, 2011
Last Updated
May 16, 2011
Sponsor
University Medical Centre Ljubljana
Collaborators
Innovacell Biotechnologie AG
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1. Study Identification

Unique Protocol Identification Number
NCT01355133
Brief Title
Safety and Efficacy Study of Intrasphincteric Autologous Myoblast Injection to Treat Stress Urinary Incontinence
Official Title
Transurethral Ultrasound-directed Injection of Autologous Myoblasts in Combination With Functional Electrical Stimulation in Patients With Intrinsic Urinary Sphincter Deficiency
Study Type
Interventional

2. Study Status

Record Verification Date
May 2011
Overall Recruitment Status
Completed
Study Start Date
August 2009 (undefined)
Primary Completion Date
February 2011 (Actual)
Study Completion Date
February 2011 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
University Medical Centre Ljubljana
Collaborators
Innovacell Biotechnologie AG

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this pilot clinical study is to determine if intrasphincteric autologous myoblast injections in combination with electrical stimulation are safe and effective in treating stress urinary incontinence, confirming the optimal dose and assessing tolerability of the procedure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stress Urinary Incontinence
Keywords
Urinary incontinence, Myoblasts, Muscle derived cells, Stem cells

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
Transurethral intrasphincteric autologous myoblast implantation
Intervention Description
Patients undergo upper arm muscle biopsy to isolate and cultivate autologous myoblasts. Using the ultrasound-directed transurethral medical device, 15-18 aliquots (50 - 100 µl per depot) of the 2 ml myoblasts/media suspension are directly injected into the urethral rhabdosphincter at two different levels. The procedure is a single-dose injection of a cell count in range of 1x106 -5x107 cells, depending of the size/quality of the biopsy and quality of outgrowing cells in order to identify possible dose related effects. To possibly enhance cell integration following implantation, a course of transvaginal electrical stimulation is undertaken.
Primary Outcome Measure Information:
Title
Change from baseline in Incontinence episode frequency (IEF)
Description
The median percent change from baseline in IEF using the 3-day bladder diary analysis
Time Frame
6 months post-implantation
Title
Change from baseline in Quality of Life (I-QOL) total score
Description
Mean improvement from baseline for the Incontinence Quality of Life (I-QOL) total score
Time Frame
6 months post-implantation
Title
Change from baseline in the Incontinence score
Time Frame
6 months post-implantation
Secondary Outcome Measure Information:
Title
Time to onset of response
Description
Time to onset of response; time to maximum response; maintenance of response observed through changes in Incontinence episode frequency(IEF), Visual analog scale of the degree of suffering (VAS), Modified patient global impression of improvement(PGI-I*), fixed bladder stress test and I-QOL.
Time Frame
Up to 6 months post-implantation (based on recordings at baseline, at implantation, at 6 weeks, 3 months and 6 months post-impalntation)
Title
Change from baseline in Fixed bladder stress test outcome
Time Frame
Baseline, 6 months postimplantation.
Title
Rate for subsequent incontinence surgery
Time Frame
6 months post-implantation
Title
Change from baseline in Urodynamic evaluation
Description
Cystometry, urethral pressure profile (UPP), 1-hour pad-test.
Time Frame
6 months post-implantation
Title
Safety
Description
Number of adverse events, patholgical lab values, vital signs and weight recordings. Number of immediate and delayed complications of cell injection, including surgical injury, scars, urinary tract infection, inflammation, pelvic pain, prolonged urinary retention, voiding dysfunction, de novo urge incontinence, hematuria, hyperplasia or tumours. Any clinically significant findings based on physical examination, standard haematology, clinical chemistry and urinalysis profiles, Electrocardiogram (ECG), Blood Pressure (BP), pulse rate and adverse events recordings.
Time Frame
Up to 6 months post-implantation
Title
Change from baseline in Urinary incontinence semiquantitative (UIS)
Description
Amount of leaked urine measured semiqantitative from a 3-day bladder diary.
Time Frame
6 months post-implantation

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female outpatients, predominant clinical diagnosis of SUI Have discrete episodes of incontinence (that is, are dry between episodes and not continuously leaking urine, synchronous with increased intra-abdominal pressure from coughing, sneezing, exercising, etc.) Have a positive Fixed Bladder Volume Cough Stress Test (CST) result; and post void residual volume of <50 ml Report normal urinary diurnal (≤8/day) and nocturnal (≤2/night) frequency per micturition history Have had symptoms of SUI for a minimum of 3 months prior to study entry Can independently use toilet without difficulty If patients regularly use laxatives, stool softeners, or stool-bulking agents (for example, fibre supplements), the use of these products should remain constant during participation in the study. Competent to comprehend, sign, and date an Ethics Committee approved informed consent form before any study-specific procedure is performed. Are women of non-childbearing potential by reason of hysterectomy, other surgery, or natural menopause, or are women of childbearing potential who test negative for pregnancy at the time of enrolment based on a urine pregnancy test and agree to use a medically accepted means of contraception (for example, intrauterine device [IUD], oral or injectable contraceptives, implant, barrier device, sterilization, abstinence, or sex with a vasectomized male partner) for the duration of the study. Women using oral contraceptives or hormone replacement therapy must have a stable dose and regimen for greater than or equal to 3 months prior to entry into the study. Exclusion Criteria: Previous diagnosis of any of the following conditions, disorders, or diseases of the urinary tract: Greater than Stage I Anterior (cystocoele), Apical (uteri), or Posterior (rectocoele) Compartment Prolepses as per the POP-Q) Ureteric bladder, urethral or rectal fistula Uncorrected congenital abnormality leading to urinary incontinence Interstitial cystitis Urinary urgency that results in leakage (as a predominant symptom) Adult enuresis Urodynamically proven: detrusor instability sensory urgency defined as first sensation of bladder fill (urge to void) of <100 ml; bladder capacity of <300 ml voiding difficulty Have no sensation at any time during the simple filling cystometry procedure Unstable systemic disease including active infection, uncontrolled hypertension, unstable angina, congestive heart failure, or myocardial infarction within 6 months before enrollment Have a symptomatic urinary tract infection (UTI); or have a history of four or more urinary tract infections in the preceding year. Have prolonged menstruation (>14 days per month). Have history of (or currently have) urogenital cancer. Suffer from severe constipation defined as less than one bowel movement per week Are pregnant, <12 months postpartum or are lactating Have had any major inpatient surgery within 3 months prior to study entry Known infection with human immunodeficiency virus (HIV) Known active infection with Hepatitis B virus, Hepatitis C virus or Lues. Any organic or psychiatric disorder that, in the opinion of the investigator, might prevent the subject from completing the study or interfere with the interpretation of the study results. Have had any anti-incontinence or prolapse surgery, including the following: Anterior Repair Needle Suspension such as Raz; Pereyra; Stamey; Gittes; and Muzsnai procedures Retropubic Procedures: such as Marshall, Marchetti & Krantz; and Burch procedures Sling Procedure Collagen Injections Artificial Sphincter. Use any of the following: Any anti-incontinence device (for example, Reliance, Minigard, or FemAssist) including tampons used to prevent incontinence during participation in the study Vaginal pessaries for prolapse or incontinence Any nonpharmacologic intervention for incontinence or prolapse (for example, electro stimulation, vaginal cones, or any such device) within the 3 months prior to study entry. Current use of any of the following drugs: antidepressants, duloxetine, monoamine oxidase inhibitors or other, clonidine, alpha-methyl-DOPA, beta-blockers, guanethidine, reserpine, pentosan polysulfate, or alpha-receptor antagonists/agonists (chronic use). Current use of any medications for the treatment of urinary incontinence. Are on a medication regimen including estrogens, anti-estrogens, or diuretics where dose and/or frequency has not been stable for at least the past 12 weeks, or is anticipated to change during the course of the study. ≤ 30 days since receiving an investigational medicinal product or device in another clinical trial. Current enrollment in another clinical trial is not permitted. Allergy/ intolerance of at least one of the active ingredients or excipients of the investigational products, e.g. bovine protein, gentamycin Have any abuse disorder within the 5 years prior to study entry; e.g. patients who report regular consumption of >21 alcoholic drinks per week (an average of 3 drinks per day)
Facility Information:
Facility Name
University Medical Center Ljubljana, Dept. of Gynecology
City
Ljubljana
ZIP/Postal Code
1000
Country
Slovenia

12. IPD Sharing Statement

Citations:
PubMed Identifier
22342057
Citation
Blaganje M, Lukanovic A. Intrasphincteric autologous myoblast injections with electrical stimulation for stress urinary incontinence. Int J Gynaecol Obstet. 2012 May;117(2):164-7. doi: 10.1016/j.ijgo.2011.11.029. Epub 2012 Feb 18.
Results Reference
derived

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Safety and Efficacy Study of Intrasphincteric Autologous Myoblast Injection to Treat Stress Urinary Incontinence

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