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Evaluation of Mesenchymal Stem Cells to Treat Avascular Necrosis of the Hip (ORTHO-2)

Primary Purpose

Avascular Necrosis of the Femoral Head

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Cultured autologous Mesenchymal Cells
Sponsored by
Universidad Autonoma de Madrid
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Avascular Necrosis of the Femoral Head focused on measuring avascular necrosis of femoral head, cell therapy, Mesenchymal stem cells

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Age 18 to 65, both sexes

  • Early avascular necrosis of the fem oral head (MRI diagnosis): Ficat and Arlet 0, 1, or 2 (Steinberg stages 0, I, IIA, IIB, or IIC)
  • Sym ptom atic osteonecrosis with less than 6 months of evolution
  • Able to provide informed consent, and signed informed consent
  • Medical health care coverage

Exclusion Criteria:

  • Pregnancy, breast feeding women and women who are of childbearing age and not practicing adequate birth control.
  • Participation in another therapeutic trial in the previous 3 m onths
  • Stages 3 or m ore (Ficat and Arlet) or III or m ore (Steinberg) of severe fem oral head osteonecrosis,primarily based on diagnosis by im aging (X-Rays, MRI).
  • Flattening or collapse of the fem oral head (Steinberg stage IV) or articular cartilage collapse at the time of core decompression surgery.
  • Septic arthritis.
  • Stress fracture.
  • Non-osteonecrosis metabolic bone diseases (particularly Paget's disease of bone, osteogenesis imperfecta, primary hyperparathyroidism , fibrous dysplasia monostotic, polyostotic McCune-Albright syndrome] and osteopetrosis).
  • Any active bisphosphonate treatment or any history of intravenous (IV) treatment.
  • History of prior or concurrent diagnosis of HIV-, Hepatitis-B- or Hepatitis-C-infection
  • Active hepatitis B or hepatitis C infection at the time of screening.
  • Known allergies to products involved in the production process of MSC.
  • History of neoplasia or current neoplasia in any organ.
  • Corticoid or immunosuppressive therapy more than one week in the two months prior to study inclusion
  • Patients who will require continuous, systemic, high dose corticosteroid therapy (more than 7.5 m g/day) within 6 months after surgery.
  • Patients who are in active treatment for cancer or blood dyscrasia, or have received chemotherapy, radiotherapy or immunotherapy in the past 2 years.
  • History of regular alcohol consumption exceeding 2 drinks/day within 6 months of screening and/or history of illicit drug use.
  • Serum AST (SGO T)/ALT (SGPT) > 2.5 X (institutional standard range).
  • MRI-incompatible internal devices (pacemakers, aneurysm clips, etc).
  • Body mass index (BMI) of 40 kg/m ² or greater.
  • Patients unable to tolerate general anesthesia defined as an American Society of Anesthesiologists (ASA) criteria of > 2.
  • Insulin dependent diabetes
  • Patients with poorly controlled diabetes mellitus (HbA1C > 8%), or with peripheral neuropathy, or known concomitant vascular problems.
  • Patients receiving treatment with hematopoietic growth factors or anti-vasculogenesis or antiangiogenesis treatment.
  • Traumatic osteonecrosis.
  • Adult in the care of a guardian (Subject legally protected)
  • Im possibility to meet at the appointments for the clinical follow up.

Sites / Locations

  • Department of Orthopaedic Surgery, Hôpital Henri Mondor
  • Department of Orthopaedic Surgery, CHU Tours
  • University Children's Hospital
  • Department of Orthopaedic Trauma, University of Ulm
  • Istituto Ortopedico Rizzoli
  • Servicio de Cirugía Ortopédica y Traumatología "A", Hospital La Paz

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cultured autologous Mesenchymal Cells

Arm Description

Cultured Mesenchymal Cells from bone marrow isolation, expanded under GMP protocol in associated facilities and introduced at the end of the appropriate forage up to the femoral head under fluoroscopic control. 20x106 cells per cc in a single administration of 7cc

Outcomes

Primary Outcome Measures

Complication rate
Includes early local complication rate plus global complication rate, as the percentage of patients with local or general complications at 52 weeks.

Secondary Outcome Measures

complication rate
Local and general complication rate
Progression of disease to the next stage
Amount of necrotic bone in the femoral head in MRI
Pain (VAS)
serum levels of bone turnover markers

Full Information

First Posted
February 12, 2014
Last Updated
October 5, 2021
Sponsor
Universidad Autonoma de Madrid
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1. Study Identification

Unique Protocol Identification Number
NCT02065167
Brief Title
Evaluation of Mesenchymal Stem Cells to Treat Avascular Necrosis of the Hip
Acronym
ORTHO-2
Official Title
Evaluation of Safety and Feasibility of Bone Marrow Derived Autologous MSCs to Enhance Bone Healing in Patients With Avascular Necrosis of the Femoral Head
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Completed
Study Start Date
February 2014 (Actual)
Primary Completion Date
June 2016 (Actual)
Study Completion Date
December 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Universidad Autonoma de Madrid

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose is to assess the safety and feasibility of cellular therapy derived from bone marrow, to help bone healing in patients with avascular necrosis of the hip.
Detailed Description
To assess the safety and feasibility of an in situ single injection of a high dose of autologous bone marrow-derived, in vitro expanded Mesenchymal stem cells, and its contribution to the resolution of the early stages of avascular osteonecrosis of the femoral head.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Avascular Necrosis of the Femoral Head
Keywords
avascular necrosis of femoral head, cell therapy, Mesenchymal stem cells

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Cultured autologous Mesenchymal Cells
Arm Type
Experimental
Arm Description
Cultured Mesenchymal Cells from bone marrow isolation, expanded under GMP protocol in associated facilities and introduced at the end of the appropriate forage up to the femoral head under fluoroscopic control. 20x106 cells per cc in a single administration of 7cc
Intervention Type
Biological
Intervention Name(s)
Cultured autologous Mesenchymal Cells
Intervention Description
Cultured Mesenchymal Cells from bone marrow isolation, expanded under GMP protocol in associated facilities and introduced at the end of the appropriate forage up to the femoral head under fluoroscopic control.
Primary Outcome Measure Information:
Title
Complication rate
Description
Includes early local complication rate plus global complication rate, as the percentage of patients with local or general complications at 52 weeks.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
complication rate
Description
Local and general complication rate
Time Frame
6,12,24,104 weeks
Title
Progression of disease to the next stage
Time Frame
12 months
Title
Amount of necrotic bone in the femoral head in MRI
Time Frame
12 weeks and 52 weeks
Title
Pain (VAS)
Time Frame
6,12,24,52,104 weeks
Title
serum levels of bone turnover markers
Time Frame
12 and 24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 to 65, both sexes Early avascular necrosis of the fem oral head (MRI diagnosis): Ficat and Arlet 0, 1, or 2 (Steinberg stages 0, I, IIA, IIB, or IIC) Sym ptom atic osteonecrosis with less than 6 months of evolution Able to provide informed consent, and signed informed consent Medical health care coverage Exclusion Criteria: Pregnancy, breast feeding women and women who are of childbearing age and not practicing adequate birth control. Participation in another therapeutic trial in the previous 3 m onths Stages 3 or m ore (Ficat and Arlet) or III or m ore (Steinberg) of severe fem oral head osteonecrosis,primarily based on diagnosis by im aging (X-Rays, MRI). Flattening or collapse of the fem oral head (Steinberg stage IV) or articular cartilage collapse at the time of core decompression surgery. Septic arthritis. Stress fracture. Non-osteonecrosis metabolic bone diseases (particularly Paget's disease of bone, osteogenesis imperfecta, primary hyperparathyroidism , fibrous dysplasia monostotic, polyostotic McCune-Albright syndrome] and osteopetrosis). Any active bisphosphonate treatment or any history of intravenous (IV) treatment. History of prior or concurrent diagnosis of HIV-, Hepatitis-B- or Hepatitis-C-infection Active hepatitis B or hepatitis C infection at the time of screening. Known allergies to products involved in the production process of MSC. History of neoplasia or current neoplasia in any organ. Corticoid or immunosuppressive therapy more than one week in the two months prior to study inclusion Patients who will require continuous, systemic, high dose corticosteroid therapy (more than 7.5 m g/day) within 6 months after surgery. Patients who are in active treatment for cancer or blood dyscrasia, or have received chemotherapy, radiotherapy or immunotherapy in the past 2 years. History of regular alcohol consumption exceeding 2 drinks/day within 6 months of screening and/or history of illicit drug use. Serum AST (SGO T)/ALT (SGPT) > 2.5 X (institutional standard range). MRI-incompatible internal devices (pacemakers, aneurysm clips, etc). Body mass index (BMI) of 40 kg/m ² or greater. Patients unable to tolerate general anesthesia defined as an American Society of Anesthesiologists (ASA) criteria of > 2. Insulin dependent diabetes Patients with poorly controlled diabetes mellitus (HbA1C > 8%), or with peripheral neuropathy, or known concomitant vascular problems. Patients receiving treatment with hematopoietic growth factors or anti-vasculogenesis or antiangiogenesis treatment. Traumatic osteonecrosis. Adult in the care of a guardian (Subject legally protected) Im possibility to meet at the appointments for the clinical follow up.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Enrique Gomez-Barrena, Prof
Organizational Affiliation
Universidad Autonoma de Madrid, Hospital la Paz
Official's Role
Study Chair
Facility Information:
Facility Name
Department of Orthopaedic Surgery, Hôpital Henri Mondor
City
Créteil
ZIP/Postal Code
94000
Country
France
Facility Name
Department of Orthopaedic Surgery, CHU Tours
City
Tours
ZIP/Postal Code
37044
Country
France
Facility Name
University Children's Hospital
City
Tübingen
ZIP/Postal Code
72076
Country
Germany
Facility Name
Department of Orthopaedic Trauma, University of Ulm
City
Ulm
ZIP/Postal Code
8907581
Country
Germany
Facility Name
Istituto Ortopedico Rizzoli
City
Bologna
ZIP/Postal Code
40136
Country
Italy
Facility Name
Servicio de Cirugía Ortopédica y Traumatología "A", Hospital La Paz
City
Madrid
ZIP/Postal Code
28046
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
33535589
Citation
Gomez-Barrena E, Padilla-Eguiluz NG, Rosset P, Hernigou P, Baldini N, Ciapetti G, Gonzalo-Daganzo RM, Avendano-Sola C, Rouard H, Giordano R, Dominici M, Schrezenmeier H, Layrolle P, On Behalf Of The Reborne Consortium. Osteonecrosis of the Femoral Head Safely Healed with Autologous, Expanded, Bone Marrow-Derived Mesenchymal Stromal Cells in a Multicentric Trial with Minimum 5 Years Follow-Up. J Clin Med. 2021 Feb 1;10(3):508. doi: 10.3390/jcm10030508.
Results Reference
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Evaluation of Mesenchymal Stem Cells to Treat Avascular Necrosis of the Hip

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