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Allogeneic Human Cells (hMSC)in Patients With Idiopathic Pulmonary Fibrosis Via Intravenous Delivery (AETHER) (AETHER)

Primary Purpose

Idiopathic Pulmonary Fibrosis (IPF)

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs)
matched placebo
Sponsored by
Joshua M Hare
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Idiopathic Pulmonary Fibrosis (IPF) focused on measuring IPF, Pulmonary fibrosis

Eligibility Criteria

40 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Provide written informed consent.
  • Subjects age equal to or greater than 40 and equal to or less than 90 years at the time of signing the Informed Consent Form.
  • Have a clinical diagnosis of Idiopathic Pulmonary Fibrosis (IPF) prior to screening
  • Forced vital capacity (FVC) ≥ 50% predicted and diffusing capacity (DLCO) ≥30% (corrected for hemoglobin but not alveolar volume).
  • RVSP equal to or less than 50 mmHg, as documented by Doppler echo or right heart catheterization.
  • Female subjects must be surgically sterile or post-menopausal (greater than 1 year).

Exclusion Criteria:

  • HRCT and/or surgical lung biopsy results inconsistent with the diagnosis of IPF.
  • Infiltrative lung disease of any type other than Idiopathic Pulmonary Fibrosis (IPF), lungs disease related to fibrogenic agents, toxins, drugs or other exposures, granulomatous lung disease, pulmonary vascular disease, or known connective tissue disease.
  • Inability to perform any of the assessments required for endpoint analysis (report safety or tolerability concerns, perform pulmonary function tests or high resolution CT (HRCT), undergo blood draws, read and respond to questionnaires.
  • Currently receiving (or received within four weeks of screening) any medication, treatment, or experimental agents for the treatment of Idiopathic Pulmonary Fibrosis (IPF), except for patients receiving non drug therapies will include oxygen saturation therapy (oxygen supplementation) and pulmonary rehabilitation.
  • Active listing (or expected future listing) for transplant of any organ.
  • Clinically important abnormal screening laboratory values, including but not limited to: hemoglobin <8 g/dl, white blood cell count <3000/mm3, platelets <80,000/mm3, INR > 1.5, aspartate transaminase, alanine transaminase, or alkaline phosphatase > 3 times upper limit of normal, total bilirubin > 1.5 mg/dl.
  • Serious comorbid illness that, in the opinion of the investigator, may compromise the safety or compliance of the patient or preclude successful completion of the study. Including, but not limited to: HIV, advanced liver or renal failure, class III/IV congestive heart failure, myocardial infarction, unstable angina, or cardiac revascularization within the last six months, or severe obstructive ventilatory defect.
  • Any other condition that, in the opinion of the investigator, may compromise the safety or compliance of the patient or preclude successful completion of the study.
  • Have known allergies to penicillin or streptomycin.
  • Be an organ transplant recipient.
  • Have a clinical history of malignancy within 5 years (i.e., patients with prior malignancy must be disease free for 5 years), except curatively- treated basal cell carcinoma, squamous cell carcinoma, or cervical carcinoma.
  • Have a non-pulmonary condition that limits lifespan to less than 1 year.
  • Have a history of drug or alcohol abuse within the past 24 months.
  • Be serum positive for Human immunodeficiency virus (HIV), hepatitis BsAg or Viremic hepatitis C.
  • Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial.
  • Be a female who is pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods. Female patients must undergo a blood or urine pregnancy test at screening and within 36 hours prior to injection.
  • Female subjects must have a FSH less than 25.8 IU/L
  • Subject with hypersensitivity to dimethyl sulfoxide (DMSO)
  • Saturated oxygen (SpO2 of less than 93% (room air [sea level] at rest). SpO2 of less than 88% (room air [>5,000 feet above sea level (1524 meters) at rest).

Sites / Locations

  • Interdisciplinary Stem Cell Institute / University of Miami

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Placebo Comparator

Experimental

Experimental

Arm Label

20 million hMSCs

Placebo

100 million hMSCs

200 million hMSCs

Arm Description

Patients will receive a single administration of Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs): 2 x10^6 (20 million) cells delivered via peripheral intravenous infusion

Patients will receive a matched placebo delivered via peripheral intravenous infusion

Patients will receive a single administration of Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs): 100 x10^6 (20 million) cells delivered via peripheral intravenous infusion

Patients will receive a single administration of Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs): 200 x10^6 (200 million) cells delivered via peripheral intravenous infusion

Outcomes

Primary Outcome Measures

To determine the safety and tolerability of intravenous allo hMSCs in patients with Idiopathic Pulmonary Fibrosis (IPF).
Safety (Primary): Incidence (one month post infusion) of any treatment-emergent serious adverse events (TE-SAEs), defined as the composite of: death, non-fatal pulmonary embolism, stroke, hospitalization for worsening dyspnea and clinically significant laboratory test abnormalities.

Secondary Outcome Measures

- To explore effects of allo hMSCs on lung function: forced vital capacity (FVC).
- Difference in absolute decline of forced vital capacity (FVC) percent predicted.
To explore effects of allogenic human mesenchymal stem cells on symptom related quality of life.
- Quality of Life endpoint tools to be used include: University of California San Diego-Shortness of breath (UCSD-SOBQ), short form - 36 (SF-36), and St. George's respiratory questionnaire (SGRQ) questionnaires.
Difference in frequency of acute exacerbations of Idiopathic Pulmonary Fibrosis (IPF)
Defined as: New or worsened dyspnea (<30 days). New ground glass opacities on High Resolution CT (HRCT) superimposed on chronic findings. New or worsened hypoxemia in the absence of other identifiable causes.
Death from any cause.
Participants will be followed for the duration of the trial, which is an expected average of 60 weeks.
To explore effects of allogenic human mesenchymal stem cells on lung function: Diffusing Capacity (DLCO)
- Difference in absolute decline of Diffusing capacity (DLCO).

Full Information

First Posted
December 2, 2013
Last Updated
March 5, 2021
Sponsor
Joshua M Hare
Collaborators
The Lester And Sue Smith Foundation, The Emmes Company, LLC
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1. Study Identification

Unique Protocol Identification Number
NCT02013700
Brief Title
Allogeneic Human Cells (hMSC)in Patients With Idiopathic Pulmonary Fibrosis Via Intravenous Delivery (AETHER)
Acronym
AETHER
Official Title
A Phase I, Randomized, Blinded and Placebo-controlled Trial to Evaluate the Safety, Tolerability, and Potential Efficacy of Allogeneic Human Mesenchymal Stem Cell Infusion in Patients With Idiopathic Pulmonary Fibrosis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2021
Overall Recruitment Status
Terminated
Why Stopped
Study completed
Study Start Date
November 13, 2013 (Actual)
Primary Completion Date
December 11, 2015 (Actual)
Study Completion Date
November 24, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Joshua M Hare
Collaborators
The Lester And Sue Smith Foundation, The Emmes Company, LLC

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase I, randomized, blinded, placebo-controlled 9 subjects pilot safety run-in followed by an additional 16 randomized subjects for a total of 25 subjects. In the pilot phase subjects will be randomized into three treatment groups of allogenic mesenchymal stem cells and in the randomized phase subjects will receive either allogenic mesenchymal stem cells or matched placebo.
Detailed Description
Idiopathic Pulmonary Fibrosis (IPF) is a progressive and debilitating lung disease characterized by interstitial fibrosis with decreasing lung volumes and pulmonary insufficiency eventually resulting in death. Patients with Idiopathic Pulmonary Fibrosis (IPF) typically present with complaints of sub acutely progressive dyspnea and non-productive cough, often accompanied by digital clubbing. Due to the insidious onset of symptoms, however, most patients are diagnosed at late stages of the disease after significant fibrosis has occurred. Physical exam is characterized by hypoxemia, "dry" inspiratory crackles on auscultation, and occasional digital clubbing (6). Pulmonary function tests (PFTs) usually reveal restrictive lung physiology with progressive decline of forced vital capacity (FVC), diffusion capacity (DLCO) and six-minute walk distances. Diagnosis is established by the pathologic finding of usual interstitial pneumonia (with sub epithelial fibroblastic foci) by open lung biopsy (7), and/or by high resolution CT (HRCT) demonstrating the characteristic findings of peripheral/basal sub pleural reticulonodular changes with fibrosis, honeycombing, and traction bronchiectasis (8, 9). The prognosis for patients with Idiopathic Pulmonary Fibrosis (IPF) is uniformly poor. The natural history of the disease is characterized by inexorable progressive decline interspersed with "exacerbations" or periods of accelerated disease which are often fatal (5). There are no FDA approved treatment options for patients with Idiopathic Pulmonary Fibrosis (IPF) and thus no standard of care. In cases of patients under the age of 60 with limited comorbid disease, lung transplant may be offered. Patients with Idiopathic Pulmonary Fibrosis (IPF) receive empiric treatment, supportive care alone, and more recently, are offered enrollment in clinical trials. The pathogenesis of Idiopathic Pulmonary Fibrosis (IPF) is characterized by epithelial cell injury and activation with interstitial inflammation, fibroblast proliferation with extracellular matrix collagen deposition, and eventual loss of function. Because mesenchymal stem cells are known to home to sites of injury, inhibit inflammation, and contribute to epithelial tissue repair, their use has been suggested as a novel therapy for the treatment of Idiopathic Pulmonary Fibrosis (IPF).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Idiopathic Pulmonary Fibrosis (IPF)
Keywords
IPF, Pulmonary fibrosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
20 million hMSCs
Arm Type
Experimental
Arm Description
Patients will receive a single administration of Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs): 2 x10^6 (20 million) cells delivered via peripheral intravenous infusion
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients will receive a matched placebo delivered via peripheral intravenous infusion
Arm Title
100 million hMSCs
Arm Type
Experimental
Arm Description
Patients will receive a single administration of Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs): 100 x10^6 (20 million) cells delivered via peripheral intravenous infusion
Arm Title
200 million hMSCs
Arm Type
Experimental
Arm Description
Patients will receive a single administration of Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs): 200 x10^6 (200 million) cells delivered via peripheral intravenous infusion
Intervention Type
Biological
Intervention Name(s)
Allogeneic Adult Human Mesenchymal Stem Cells (hMSCs)
Intervention Type
Biological
Intervention Name(s)
matched placebo
Intervention Description
The placebo will be 25 ml of Plasma-Lyte A with 1% HSA in a Cryostore bag.
Primary Outcome Measure Information:
Title
To determine the safety and tolerability of intravenous allo hMSCs in patients with Idiopathic Pulmonary Fibrosis (IPF).
Description
Safety (Primary): Incidence (one month post infusion) of any treatment-emergent serious adverse events (TE-SAEs), defined as the composite of: death, non-fatal pulmonary embolism, stroke, hospitalization for worsening dyspnea and clinically significant laboratory test abnormalities.
Time Frame
One month post infusion
Secondary Outcome Measure Information:
Title
- To explore effects of allo hMSCs on lung function: forced vital capacity (FVC).
Description
- Difference in absolute decline of forced vital capacity (FVC) percent predicted.
Time Frame
Participants will be followed from 12 weeks to an expected average of 60 weeks following infusion.
Title
To explore effects of allogenic human mesenchymal stem cells on symptom related quality of life.
Description
- Quality of Life endpoint tools to be used include: University of California San Diego-Shortness of breath (UCSD-SOBQ), short form - 36 (SF-36), and St. George's respiratory questionnaire (SGRQ) questionnaires.
Time Frame
Participants will be followed from 4 weeks to an expected average of 60 weeks following infusion.
Title
Difference in frequency of acute exacerbations of Idiopathic Pulmonary Fibrosis (IPF)
Description
Defined as: New or worsened dyspnea (<30 days). New ground glass opacities on High Resolution CT (HRCT) superimposed on chronic findings. New or worsened hypoxemia in the absence of other identifiable causes.
Time Frame
4 weeks following infusion
Title
Death from any cause.
Description
Participants will be followed for the duration of the trial, which is an expected average of 60 weeks.
Time Frame
60 weeks.
Title
To explore effects of allogenic human mesenchymal stem cells on lung function: Diffusing Capacity (DLCO)
Description
- Difference in absolute decline of Diffusing capacity (DLCO).
Time Frame
Participants will be followed from 12 weeks to an expected average of 60 weeks following infusion.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Provide written informed consent. Subjects age equal to or greater than 40 and equal to or less than 90 years at the time of signing the Informed Consent Form. Have a clinical diagnosis of Idiopathic Pulmonary Fibrosis (IPF) prior to screening Forced vital capacity (FVC) ≥ 50% predicted and diffusing capacity (DLCO) ≥30% (corrected for hemoglobin but not alveolar volume). RVSP equal to or less than 50 mmHg, as documented by Doppler echo or right heart catheterization. Female subjects must be surgically sterile or post-menopausal (greater than 1 year). Exclusion Criteria: HRCT and/or surgical lung biopsy results inconsistent with the diagnosis of IPF. Infiltrative lung disease of any type other than Idiopathic Pulmonary Fibrosis (IPF), lungs disease related to fibrogenic agents, toxins, drugs or other exposures, granulomatous lung disease, pulmonary vascular disease, or known connective tissue disease. Inability to perform any of the assessments required for endpoint analysis (report safety or tolerability concerns, perform pulmonary function tests or high resolution CT (HRCT), undergo blood draws, read and respond to questionnaires. Currently receiving (or received within four weeks of screening) any medication, treatment, or experimental agents for the treatment of Idiopathic Pulmonary Fibrosis (IPF), except for patients receiving non drug therapies will include oxygen saturation therapy (oxygen supplementation) and pulmonary rehabilitation. Active listing (or expected future listing) for transplant of any organ. Clinically important abnormal screening laboratory values, including but not limited to: hemoglobin <8 g/dl, white blood cell count <3000/mm3, platelets <80,000/mm3, INR > 1.5, aspartate transaminase, alanine transaminase, or alkaline phosphatase > 3 times upper limit of normal, total bilirubin > 1.5 mg/dl. Serious comorbid illness that, in the opinion of the investigator, may compromise the safety or compliance of the patient or preclude successful completion of the study. Including, but not limited to: HIV, advanced liver or renal failure, class III/IV congestive heart failure, myocardial infarction, unstable angina, or cardiac revascularization within the last six months, or severe obstructive ventilatory defect. Any other condition that, in the opinion of the investigator, may compromise the safety or compliance of the patient or preclude successful completion of the study. Have known allergies to penicillin or streptomycin. Be an organ transplant recipient. Have a clinical history of malignancy within 5 years (i.e., patients with prior malignancy must be disease free for 5 years), except curatively- treated basal cell carcinoma, squamous cell carcinoma, or cervical carcinoma. Have a non-pulmonary condition that limits lifespan to less than 1 year. Have a history of drug or alcohol abuse within the past 24 months. Be serum positive for Human immunodeficiency virus (HIV), hepatitis BsAg or Viremic hepatitis C. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial. Be a female who is pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods. Female patients must undergo a blood or urine pregnancy test at screening and within 36 hours prior to injection. Female subjects must have a FSH less than 25.8 IU/L Subject with hypersensitivity to dimethyl sulfoxide (DMSO) Saturated oxygen (SpO2 of less than 93% (room air [sea level] at rest). SpO2 of less than 88% (room air [>5,000 feet above sea level (1524 meters) at rest).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marilyn K. Glassberg, MD
Organizational Affiliation
University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
Interdisciplinary Stem Cell Institute / University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
27890713
Citation
Glassberg MK, Minkiewicz J, Toonkel RL, Simonet ES, Rubio GA, DiFede D, Shafazand S, Khan A, Pujol MV, LaRussa VF, Lancaster LH, Rosen GD, Fishman J, Mageto YN, Mendizabal A, Hare JM. Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER): A Phase I Safety Clinical Trial. Chest. 2017 May;151(5):971-981. doi: 10.1016/j.chest.2016.10.061. Epub 2016 Nov 24.
Results Reference
background
Links:
URL
http://isci.med.miami.edu/
Description
Interdisciplinary Stem Cell Institute University of Miami

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Allogeneic Human Cells (hMSC)in Patients With Idiopathic Pulmonary Fibrosis Via Intravenous Delivery (AETHER)

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