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Safety Study of Autologous Umbilical Cord Blood Cells for Treatment of Hypoplastic Left Heart Syndrome

Primary Purpose

Hypoplastic Left Heart Syndrome

Status

Completed

Phase

Phase 1

Locations

United States

Study Type

Interventional

Intervention

autologous cell-based delivery

About this trial

This is an interventional treatment trial for Hypoplastic Left Heart Syndrome focused on measuring Hypoplastic Left Heart Syndrome, HLHS, Congenital Heart Disease, Umbilical cord blood, UCB, Cord blood, Stem cells, Regenerative therapy, Stage II Glenn, Glenn Surgery

Eligibility Criteria

undefined - 18 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria

Individuals with autologous cord blood product that met all cell release criteria (listed on the certificate of analysis from Mayo Clinic Human Cell Therapy Lab) as follows:
1. No aerobic or anaerobic bacterial growth after 14 days
2. Greater than 70% cell viability pre-freeze
3. Total Nucleated Cells (TNC) concentration of 30-42 x 106 cells/mL (pre-freeze)
4. Minimum of one (1) vial of cells
5. Mononuclear cell percentage of greater than 50%
6. Endotoxin result of less than 16 Endotoxin Units (EU)/mL.
Mother's serology test results are negative for HIV, Hepatitis B, and Hepatitis C.
Individuals with HLHS having undergone Stage I surgical palliation and undergoing planned Stage II palliative Glenn surgery.
Ages up to 18 months are eligible if written informed consent can be obtained from both parents (unless one parent is not reasonably available) and/or legal guardians.

Exclusion Criteria

Child who's UCB does not meet the specified cell release criteria in Inclusion Criterion #1.
History of dimethyl sulfoxide (DMSO) reaction for either the child or mother.
Parent(s)/child unwilling to participate.
Child with severe chronic diseases, extensive extra-cardiac syndromic features, or history of cancer.
Child not completing all pre-procedure work-up within 10 days of the Stage II Glenn surgery as listed in section 6 of this protocol AND lack of pre-procedure work-up documented as a safety concern by a site investigator.
Child who's cells have been compromised after meeting cell release criteria (as defined in Inclusion Criterion #1).
Child with the following complications of their congenital heart disease:
1. Any condition requiring urgent, or unplanned procedure within 15 days prior to Stage II surgical repair
2. Severe pulmonary hypertension (reported in the medical record as >70% systemic pressure)
3. Other clinical concerns as documented by a site investigator that would predict (more likely to happen than not to happen) a risk of severe complications or very poor outcome during or after Stage II surgical repair.

Sites / Locations

Children's Hospital Los Angeles
Children's Hospital Colorado
Children's Hospital of Minnesota
Mayo Clinic
Oklahoma University Children's Hospital
Children's Hospital of Philadelphia

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

autologous cell-based delivery

Arm Description

autologous cell-based delivery a target dose of 3 million cells / kg of body weight will be delivered into the right heart muscle at the time of surgery. Cells are derived from autologous (self) umbilical cord blood.

Outcomes

Primary Outcome Measures

Incidence of all-cause mortality

Incidence of new and worsening adverse cardiac events

The adverse cardiac events would include sustained/symptomatic ventricular arrhythmias, heart failure, myocardial infarction, cardiac infections, and unexpected cardiovascular surgery.

Percentage of subjects whose cells meet all cell release criteria

Percentage of subjects enrolled who undergo cell therapy treatment

Secondary Outcome Measures

Change in right ventricular ejection fraction at one month according to cardiac imaging with echocardiography

Change in right ventricular ejection fraction at 3 months according to cardiac imaging with echocardiography

Change in right ventricular ejection fraction at 6 months according to cardiac imaging with echocardiography

Change in right ventricle tricuspid annular plane systolic excursion (TAPSE) at one month according to cardiac imaging with echocardiography

Change in right ventricle TAPSE at 3 months according to cardiac imaging with echocardiography

Change in right ventricle TAPSE at 6 months according to cardiac imaging with echocardiography

Change in right ventricle fractional area change at one month according to cardiac imaging with echocardiography

Change in right ventricle fractional area change at 3 months according to cardiac imaging with echocardiography

Change in right ventricle fractional area change at 6 months according to cardiac imaging with echocardiography

Full Information

NCT ID

NCT01883076

First Posted

June 11, 2013

Last Updated

April 28, 2022

Sponsor

Timothy J Nelson, MD, PhD

Collaborators

University of Oklahoma, Children's Hospital of Philadelphia, Children's Hospitals and Clinics of Minnesota, Children's Hospital Los Angeles, Children's Hospital Colorado, Mayo Clinic

1. Study Identification

Unique Protocol Identification Number

NCT01883076

Brief Title

Safety Study of Autologous Umbilical Cord Blood Cells for Treatment of Hypoplastic Left Heart Syndrome

Official Title

Phase I Safety Study of Autologous Umbilical Cord Blood Derived Mononuclear Cells During Surgical Stage II Palliation of Hypoplastic Left Heart Syndrome

Study Type

Interventional

2. Study Status

Record Verification Date

April 2022

Overall Recruitment Status

Completed

Study Start Date

May 15, 2013 (Actual)

Primary Completion Date

April 28, 2021 (Actual)

Study Completion Date

April 28, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor-Investigator

Name of the Sponsor

Timothy J Nelson, MD, PhD

Collaborators

University of Oklahoma, Children's Hospital of Philadelphia, Children's Hospitals and Clinics of Minnesota, Children's Hospital Los Angeles, Children's Hospital Colorado, Mayo Clinic

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

This is a Phase I study to determine the safety and feasibility of injections of autologous umbilical cord blood (UCB) cells into the right ventricle of Hypoplastic Left Heart Syndrome (HLHS) children undergoing a scheduled Glenn surgical procedure. The investigators are doing this research study to find out if autologous stem cells from the individual's own umbilical cord blood can be used to strengthen the muscle of the right side of their heart. This will help determine the safety and feasibility of using cell-based regenerative therapy as an additional treatment for the management of HLHS.

Detailed Description

This study is a Phase I trial to determine the safety of autologous mononuclear cells (MNC) derived from umbilical cord blood for intramyocardial delivery into the right ventricle during a planned and non-emergent Stage II surgical palliation in subjects with HLHS. This is the first critical step towards applying autologous MNC therapy as an add-on regenerative intervention for congenital heart disease management. The choice of HLHS as the target disease for regenerative therapies in congenital heart disease management is multi-factorial and includes the following considerations: 1) Severity of of this incurable disease, 2) palliative nature and burden of long-term outcomes with a single right ventricular system, 3) three stages of planned surgical procedures that provide time points to adjunctively intervene, and 4) prenatal diagnosis enabling planned collection of UCB. An emerging goal for cardiac regeneration includes the application of cell-based technology to congenital heart disease, which is a favorable substrate due to the lack of fibrotic scaring, and the presence of a microenvironment that is expected to support ongoing cardiac proliferation and growth for functional remuscularization. This Phase I safety study will determine the feasibility of collection, processing, and delivery of autologous cells as used in adult cardiac regenerative protocols in the setting of HLHS surgical management.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Hypoplastic Left Heart Syndrome

Keywords

Hypoplastic Left Heart Syndrome, HLHS, Congenital Heart Disease, Umbilical cord blood, UCB, Cord blood, Stem cells, Regenerative therapy, Stage II Glenn, Glenn Surgery

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 1

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

N/A

Enrollment

30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

autologous cell-based delivery

Arm Type

Experimental

Arm Description

Intervention Type

Biological

Intervention Name(s)

autologous cell-based delivery

Other Intervention Name(s)

umbilical cord blood derived mononuclear cells

Intervention Description

autologous cells (derived from "self")

Primary Outcome Measure Information:

Title

Incidence of all-cause mortality

Time Frame

Within 2 years following cell therapy treatment

Title

Incidence of new and worsening adverse cardiac events

Description

The adverse cardiac events would include sustained/symptomatic ventricular arrhythmias, heart failure, myocardial infarction, cardiac infections, and unexpected cardiovascular surgery.

Time Frame

Within 2 years following cell therapy treatment

Title

Percentage of subjects whose cells meet all cell release criteria

Time Frame

Up to 2 years

Title

Percentage of subjects enrolled who undergo cell therapy treatment

Time Frame

Up to 2 years

Secondary Outcome Measure Information:

Title

Change in right ventricular ejection fraction at one month according to cardiac imaging with echocardiography

Time Frame

baseline, 1 month

Title

Change in right ventricular ejection fraction at 3 months according to cardiac imaging with echocardiography

Time Frame

baseline, 3 months

Title

Change in right ventricular ejection fraction at 6 months according to cardiac imaging with echocardiography

Time Frame

baseline, 6 months

Title

Change in right ventricle tricuspid annular plane systolic excursion (TAPSE) at one month according to cardiac imaging with echocardiography

Time Frame

baseline, 1 month

Title

Change in right ventricle TAPSE at 3 months according to cardiac imaging with echocardiography

Time Frame

baseline, 3 months

Title

Change in right ventricle TAPSE at 6 months according to cardiac imaging with echocardiography

Time Frame

baseline, 6 months

Title

Change in right ventricle fractional area change at one month according to cardiac imaging with echocardiography

Time Frame

baseline, 1 month

Title

Change in right ventricle fractional area change at 3 months according to cardiac imaging with echocardiography

Time Frame

baseline, 3 months

Title

Change in right ventricle fractional area change at 6 months according to cardiac imaging with echocardiography

Time Frame

baseline, 6 months

10. Eligibility

Sex

All

Maximum Age & Unit of Time

18 Months

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria Individuals with autologous cord blood product that met all cell release criteria (listed on the certificate of analysis from Mayo Clinic Human Cell Therapy Lab) as follows: No aerobic or anaerobic bacterial growth after 14 days Greater than 70% cell viability pre-freeze Total Nucleated Cells (TNC) concentration of 30-42 x 106 cells/mL (pre-freeze) Minimum of one (1) vial of cells Mononuclear cell percentage of greater than 50% Endotoxin result of less than 16 Endotoxin Units (EU)/mL. Mother's serology test results are negative for HIV, Hepatitis B, and Hepatitis C. Individuals with HLHS having undergone Stage I surgical palliation and undergoing planned Stage II palliative Glenn surgery. Ages up to 18 months are eligible if written informed consent can be obtained from both parents (unless one parent is not reasonably available) and/or legal guardians. Exclusion Criteria Child who's UCB does not meet the specified cell release criteria in Inclusion Criterion #1. History of dimethyl sulfoxide (DMSO) reaction for either the child or mother. Parent(s)/child unwilling to participate. Child with severe chronic diseases, extensive extra-cardiac syndromic features, or history of cancer. Child not completing all pre-procedure work-up within 10 days of the Stage II Glenn surgery as listed in section 6 of this protocol AND lack of pre-procedure work-up documented as a safety concern by a site investigator. Child who's cells have been compromised after meeting cell release criteria (as defined in Inclusion Criterion #1). Child with the following complications of their congenital heart disease: Any condition requiring urgent, or unplanned procedure within 15 days prior to Stage II surgical repair Severe pulmonary hypertension (reported in the medical record as >70% systemic pressure) Other clinical concerns as documented by a site investigator that would predict (more likely to happen than not to happen) a risk of severe complications or very poor outcome during or after Stage II surgical repair.

Overall Study Officials: