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Stem Cell Spinal Cord Injury Exoskeleton and Virtual Reality Treatment Study (SciExVR)

Primary Purpose

Spinal Cord Injuries, Spinal Cord Compression, Spinal Cord Ischemia

Status
Enrolling by invitation
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Paraspinal
Paraspinal EX
Paraspinal VR
Sponsored by
MD Stem Cells
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Cord Injuries focused on measuring spinal cord injury, spinal cord compression, spinal cord ischemia, spinal cord diseases, spinal paralysis, paraplegia, paraparesis, SCI

Eligibility Criteria

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

Inclusion Criteria:

  • Have documented functional damage to the spinal cord unlikely to improve with present standard of care.
  • If under current medical therapy (pharmacologic or surgical treatment) for the condition be considered stable on that treatment and unlikely to have reversal of the associated spinal cord damage as a result of the ongoing pharmacologic or surgical treatment.
  • In the estimation of Dr. Weiss and Dr. Silberfarb have the potential for improvement with BMSC treatment and be at minimal risk of any potential harm from the procedure.
  • Be over the age of 18 and capable of providing informed consent.
  • Be medically stable and able to be medically cleared by their primary care physician or a licensed primary care practitioner for the procedure. Medical clearance means that in the estimation of the primary care practitioner, the patient can reasonably be expected to undergo the procedure without significant medical risk to health.

Exclusion Criteria:

  • All patients must be capable of an adequate neurologic examination and evaluation to document the pathology. This will include the ability to cooperate with the exam.
  • Patients must be capable and willing to undergo follow up neurologic exams as outlined in the protocol.
  • Patients must be capable of providing informed consent.
  • In the estimation of Dr. Weiss and Dr. Silberfarb the BMSC collection and treatment will not present a significant risk of harm to the patient's general health or to their neurologic function. .
  • Patients who are not medically stable or who may be at significant risk to their health undergoing the procedure will not be eligible.
  • Women of childbearing age must not be pregnant at the time of treatment and should refrain from becoming pregnant for 3 months post treatment.

Sites / Locations

  • MD Stem Cells

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Paraspinal

Paraspinal EX

Paraspinal VR

Arm Description

Bilateral paraspinal injection of bone marrow derived stem cells (BMSC) at spinal cord injury level, superior to injury level and inferior to injury level. Following paraspinal injection remaining BMSC provided intravenous and intranasal.

Bilateral paraspinal injection of bone marrow derived stem cells (BMSC) at spinal cord injury level, superior to injury level and inferior to injury level. Following paraspinal injection remaining BMSC provided intravenous and intranasal. Exoskeleton or equivalent stimulation following this treatment.

Bilateral paraspinal injection of bone marrow derived stem cells (BMSC) at spinal cord injury level, superior to injury level and inferior to injury level. Following paraspinal injection remaining BMSC provided intravenous and intranasal. Virtual Reality or equivalent visualization following this treatment.

Outcomes

Primary Outcome Measures

American Spinal Injury Association (ASIA) Impairment Scale (AIS)
AIS is based on the Frankel scale which is used to classify the degree or completeness of spinal cord injury (SCI) by assessing motor and sensory function. Patients will have AIS assessment prior to procedure and post-procedure for comparison and identification of any improvements in motor or sensory function.

Secondary Outcome Measures

Autonomic Nervous System (ANS) Function
The autonomic nervous system (ANS) through the sympathetic and parasympathetic divisions is responsible for many functions of the body including bladder and bowel control and sweating. Patients will self-report changes in ANS function and their abilities to perform ANS functions following the procedure.
General Well-Being
General Well-Being is a term that may encompass mood, sense of well-being, family relationships, ability to do daily tasks and other practical or emotional practices that vary from person to person. Patients will self-report changes in their Quality of Life

Full Information

First Posted
July 17, 2017
Last Updated
October 17, 2023
Sponsor
MD Stem Cells
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1. Study Identification

Unique Protocol Identification Number
NCT03225625
Brief Title
Stem Cell Spinal Cord Injury Exoskeleton and Virtual Reality Treatment Study
Acronym
SciExVR
Official Title
Stem Cell Spinal Cord Injury Exoskeleton and Virtual Reality Treatment Study
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Enrolling by invitation
Study Start Date
July 1, 2017 (Actual)
Primary Completion Date
July 2024 (Anticipated)
Study Completion Date
July 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
MD Stem Cells

4. Oversight

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

5. Study Description

Brief Summary
The SciExVR study will evaluate the potential benefit of autologous bone marrow derived stem cells (BMSC) in the treatment of spinal cord injury with evidence of impaired motor or sensory function. The treatment consists of bilateral paraspinal injections of the BMSC at the level of the injury as well as superior and inferior to that spinal segment followed by an intravenous injection and intranasal placement. Patients undergoing BMSC treatment may also be assigned to use of exoskeletal movement (or equivalent) or virtual reality visualization (or equivalent) to augment upper motor neuron firing and/or receptivity of the sensory neurons. http://mdstemcells.com/sciexvr/
Detailed Description
The Stem Cell Spinal Cord Injury Exoskeleton and Virtual Reality (SciExVR) study is based on the progress that researchers have made treating spinal cord injury (SCI) with bone marrow derived stem cells (BMSC). While major improvements have remained elusive with other approaches, modest benefits have been achieved. The use of subarachnoid BMSC provided via intrathecal injection has resulted in improvements for certain sensory and bladder functions. Exoskeleton treatment has shown certain benefits in sensory, bowel and bladder function. Intravenous (IV) BMSC have benefited stroke and other central nervous system damage. In the sponsor's concomitant Neurologic Stem Cell Treatment (NEST) study for general neurologic disease, benefit has been shown by combining IV with intranasal BMSC. The SciExVR study uses paraspinal injections- meaning the BMSC are placed adjacent to the spinal nerves which enter the spinal canal through the intervertebral foramen of the vertebral bodies. The BMSC will be placed at the level of the injury on both sides of the spine as well as approximately two segments above and two segments below. The investigators believe this will allow entry into the spinal tissue at the injury site as well as to the injured upper motor neuron pathways; lower motor neurons which may be injured; sensory pathways; dorsal root ganglia at and below the site and autonomic ganglia. Placement in the paraspinal tissue may extend the time that BMSC have to proliferate at, above and below the vicinity of the spinal cord injury and interact with damaged cells in the spinal cord, spinal roots, spinal nerves and paravertebral ganglion. Potential benefits of these interactions include BMSC mitochondrial transfer to target cells, secretion of mRNA increasing target cell activity, secretion of nerve growth factor and other neurotrophic factors beneficial to nerve regrowth. Increased proliferation and contact time may increase neuronal transdifferentiation of BMSC to neurons and/or neuroglia. Following paraspinal injections the patient receives the remaining BMSC intravenously (IV) and also topically intranasally. BMSC given IV may enter the central nervous system through the paraventricular organs in the brain to potentially reach the ascending and descending pathways, thalamus, sensory cortex, motor cortex and circulate through the cerebral spinal fluid (CSF). Intranasal provides access through the axons of the Trigeminal (V) cranial nerves and entry into the brain at the level of the pons with similar opportunity to move through the tissues. BMSC are separated from bone marrow obtained from the posterior iliac crest with a single aspiration on each side. The procedure is performed under general or MAC anesthesia at the fully licensed surgical center so there is no discomfort in performing the procedure. The BMSC are separated from the aspirate using an FDA cleared class II device. After BMSC treatment patients who are in Arm 1 simply follow up with their own neurologists at 1,3,6 and 12 months. Those in Arm 2 require similar follow up and pursue treatment at centers that can provide exoskeletal stimulation or physical therapy equivalent. Exoskeleton devices move the limbs of the patient to provide stimulation to the muscles in a self directed fashion but similar to physical therapy that is often performed for SCI. The investigators believe that Arm 2 may provide stimulation of the upper and lower motor neurons and sensory receptors such as exteroceptors and proprioceptors which may, in the presence of BMSC, assist in regeneration or reactivation of the spinal cord pathways. Patients in Arm 3 require similar follow up and may use Virtual Reality headsets or equivalent to increase visualization of movement of the lower extremities and/or sensory feedback. This may also help stimulate the upper and lower motor neurons and sensory receptors.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Cord Injuries, Spinal Cord Compression, Spinal Cord Ischemia, Spinal Cord Diseases, Spinal Paralysis, Paraplegia, Paraplegia, Spinal, Paraplegia/Paraparesis, Paraplegia; Traumatic, SCI - Spinal Cord Injury
Keywords
spinal cord injury, spinal cord compression, spinal cord ischemia, spinal cord diseases, spinal paralysis, paraplegia, paraparesis, SCI

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
There will be 3 Arms: Arm 1: BMSC Paraspinal, IV, Intranasal . Arm 2: BMSC Paraspinal,IV,Intranasal + exoskeleton or equivalent . Arm 3: BMSC Paraspinal, IV, Intranasal + virtual reality or equivalent .
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Paraspinal
Arm Type
Experimental
Arm Description
Bilateral paraspinal injection of bone marrow derived stem cells (BMSC) at spinal cord injury level, superior to injury level and inferior to injury level. Following paraspinal injection remaining BMSC provided intravenous and intranasal.
Arm Title
Paraspinal EX
Arm Type
Experimental
Arm Description
Bilateral paraspinal injection of bone marrow derived stem cells (BMSC) at spinal cord injury level, superior to injury level and inferior to injury level. Following paraspinal injection remaining BMSC provided intravenous and intranasal. Exoskeleton or equivalent stimulation following this treatment.
Arm Title
Paraspinal VR
Arm Type
Experimental
Arm Description
Bilateral paraspinal injection of bone marrow derived stem cells (BMSC) at spinal cord injury level, superior to injury level and inferior to injury level. Following paraspinal injection remaining BMSC provided intravenous and intranasal. Virtual Reality or equivalent visualization following this treatment.
Intervention Type
Procedure
Intervention Name(s)
Paraspinal
Other Intervention Name(s)
Arm 1
Intervention Description
BMSC provided by paraspinal injection, intravenous and intranasal
Intervention Type
Procedure
Intervention Name(s)
Paraspinal EX
Other Intervention Name(s)
Arm 2
Intervention Description
BMSC provided by paraspinal injections, intravenous and intranasal followed by exoskeleton or equivalent stimulation
Intervention Type
Procedure
Intervention Name(s)
Paraspinal VR
Other Intervention Name(s)
Arm 3
Intervention Description
BMSC provided by paraspinal injections, intravenous and intranasal followed by virtual reality or equivalent visualization
Primary Outcome Measure Information:
Title
American Spinal Injury Association (ASIA) Impairment Scale (AIS)
Description
AIS is based on the Frankel scale which is used to classify the degree or completeness of spinal cord injury (SCI) by assessing motor and sensory function. Patients will have AIS assessment prior to procedure and post-procedure for comparison and identification of any improvements in motor or sensory function.
Time Frame
Pre-procedure, 1,3,6 and 12 months post-procedure
Secondary Outcome Measure Information:
Title
Autonomic Nervous System (ANS) Function
Description
The autonomic nervous system (ANS) through the sympathetic and parasympathetic divisions is responsible for many functions of the body including bladder and bowel control and sweating. Patients will self-report changes in ANS function and their abilities to perform ANS functions following the procedure.
Time Frame
1,3,6 and 12 months post-procedure
Title
General Well-Being
Description
General Well-Being is a term that may encompass mood, sense of well-being, family relationships, ability to do daily tasks and other practical or emotional practices that vary from person to person. Patients will self-report changes in their Quality of Life
Time Frame
1,3,6,12 months post-procedure

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have documented functional damage to the spinal cord unlikely to improve with present standard of care. If under current medical therapy (pharmacologic or surgical treatment) for the condition be considered stable on that treatment and unlikely to have reversal of the associated spinal cord damage as a result of the ongoing pharmacologic or surgical treatment. In the estimation of Dr. Weiss and Dr. Silberfarb have the potential for improvement with BMSC treatment and be at minimal risk of any potential harm from the procedure. Be over the age of 18 and capable of providing informed consent. Be medically stable and able to be medically cleared by their primary care physician or a licensed primary care practitioner for the procedure. Medical clearance means that in the estimation of the primary care practitioner, the patient can reasonably be expected to undergo the procedure without significant medical risk to health. Exclusion Criteria: All patients must be capable of an adequate neurologic examination and evaluation to document the pathology. This will include the ability to cooperate with the exam. Patients must be capable and willing to undergo follow up neurologic exams as outlined in the protocol. Patients must be capable of providing informed consent. In the estimation of Dr. Weiss and Dr. Silberfarb the BMSC collection and treatment will not present a significant risk of harm to the patient's general health or to their neurologic function. . Patients who are not medically stable or who may be at significant risk to their health undergoing the procedure will not be eligible. Women of childbearing age must not be pregnant at the time of treatment and should refrain from becoming pregnant for 3 months post treatment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven Levy, MD
Organizational Affiliation
MD Stem Cells
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Jeffrey Weiss, MD
Organizational Affiliation
Coral Springs
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Steven Silberfarb, DO
Organizational Affiliation
Florida Orthopaedics and Spine Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
MD Stem Cells
City
Coral Springs
State/Province
Florida
ZIP/Postal Code
33063
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://mdstemcells.com/sciexvr/
Description
Study Description

Learn more about this trial

Stem Cell Spinal Cord Injury Exoskeleton and Virtual Reality Treatment Study

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