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The Use of Exosomes for the Treatment of Acute Respiratory Distress Syndrome or Novel Coronavirus Pneumonia Caused by COVID-19 (ARDOXSO)

Primary Purpose

Covid19, Novel Coronavirus Pneumonia, Acute Respiratory Distress Syndrome

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
MSC-exosomes delivered intravenously every other day on an escalating dose: (2:4:8)
MSC-exosomes delivered intravenously every other day on an escalating dose (8:4:8)
MSC-exosomes delivered intravenously every other day (8:8:8)
Sponsored by
AVEM HealthCare
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Covid19 focused on measuring Novel Corona Virus Pneumonia, Exosomes, MSC, Acute Respiratory Distress Syndrome

Eligibility Criteria

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

Inclusion Criteria:

  • Informed Consent given
  • Male and female patients age 18 years or older
  • Patients with coronavirus (SARS-CoV-2) infection confirmed prior to enrollment by any test with local regulatory approval
  • Patients who require intensive care as determined by the following objective criteria:

    • Respiratory rate>25/minute
    • Oxygen saturation <93% on room air; or the
    • Use of high flow oxygen by nasal cannula at a rate ≥ 4L/minute.
  • Patients with lung imaging demonstrating bilateral or diffuse pulmonary infiltrates on chest X-ray or CT scan.
  • Patients with moderate to severe ARDS as defined by Berlin Criteria
  • Patients who require invasive mechanical ventilation (IMV)

Exclusion Criteria:

  • Patients will be excluded from the study if ONE of the following applies:

    • History of hypersensitivity to any drugs of similar classes to exosomes
    • Suspected active uncontrolled bacterial, fungal, or viral (besides SARS-CoV-2) infection
    • Currently receiving ECMO, nitric oxide therapy, or high-frequency oscillatory ventilation
    • In the option of the investigator, the patient is unlikely to survive for more than 24 hours post-enrollment
    • Patients who are on long-term use of select oral or injectable anti-rejection or immunomodulatory drugs
    • Pregnant or nursing (lacking) women

Sites / Locations

  • Mission Community Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Escalating Dose First Cohort

Escalating Dose Second Cohort

Escalating Dose Third Cohort

Treatment Dose Fourth Cohort Randomized control ratio 1:3

Arm Description

First Cohort: Five patients will receive an escalating dose every other day for a period of 5 days, with a minimum of 24 hours between doses recorded. Dose escalation will begin at 2 x 10^9 exosomes

Second Cohort: Five patients will receive an escalating dose every other day for a period of 5 days, with a minimum of 24 hours between doses recorded. Dose escalation will begin at 4 x 10^9 exosomes.

Five patients will receive a treatment dose of 8 X 10^9 exosomes every other day for a period of 5 days, with a minimum of 24 hours between doses recorded.

Fourth Cohort: Randomized Cohort Up to 40 patients may be enrolled in this phase of the trial. For those receiving the placebo (~25%), 3 doses will be given over the 5 day period, dispensed from identical vials with physician and patient blinded. The full dose of 8 X 10^9 exosomes will be given to 75% of the patients in 3 doses over the course of 5 days, with one dose occurring every other day.

Outcomes

Primary Outcome Measures

Measure and report the number of participants with treatment-related-adverse events as assessed by CTCAE v4.0; for patients receiving ARDOXSO™, perinatal MSC-derived exosome therapy.
Quantify safety of ARDOXSO™, an interventional exosome therapy in COVID-19 in participants confirmed with SARS-CoV-2 infection who receive ARDOXSO™ as an intervention.
Tabulate and report the number of IMV days for patients receiving ARDOXSO™ perinatal MSC-derived exosome therapy.
Quantify efficacy of ARDOXSO™, an interventional exosome therapy in COVID-19 in participants confirmed with SARS-CoV-2 infection who receive ARDOXSO™ as an intervention.

Secondary Outcome Measures

Analyze and report organ failure, associated with ICU mortality in participants confirmed with SARS-CoV2 infection, receiving ARDOXSO™ as an interventional exosome therapy.
Correlate and analyze the Sequential Organ Failure Assessment (SOFA) score in participants confirmed with SARS-CoV2 infection, receiving ARDOXSO™, an interventional exosome therapy in COVID-19 patients. An increased SOFA score is predictive of increased mortality.
Record and analyze respiratory measures (Berlin Score/PEEP) following treatment regime.
Berlin Score is a validated measure of Acute Respiratory Distress Syndrome diagnosis, which is common in COVID-19 patients, before and after receiving the interventional exosome therapy, ARDOXSO™.

Full Information

First Posted
March 12, 2021
Last Updated
March 10, 2022
Sponsor
AVEM HealthCare
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1. Study Identification

Unique Protocol Identification Number
NCT04798716
Brief Title
The Use of Exosomes for the Treatment of Acute Respiratory Distress Syndrome or Novel Coronavirus Pneumonia Caused by COVID-19
Acronym
ARDOXSO
Official Title
Mesenchymal Stem Cell Exosomes for the Treatment of COVID-19 Positive Patients With Acute Respiratory Distress Syndrome and/or Novel Coronavirus Pneumonia
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Not yet recruiting
Study Start Date
September 2023 (Anticipated)
Primary Completion Date
September 2024 (Anticipated)
Study Completion Date
December 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
AVEM HealthCare

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
Novel coronavirus pneumonia (NCP) and acute respiratory distress syndrome (ARDS) are both associated with the prevailing upper respiratory tract infections caused by the RNA-containing SARS-CoV2 virus of the genius Betacoronavirus of the Coronaviridae family. As both the viral infiltration and infection progress, the host immune system response can be one of a rapidly developing fatal cytokine storm. In the ARDS or NCP ensuing progression, the patient often succumbs to the effects of the hyper pro-inflammatory response, hence contributing to the associated increased mortality as a result of the cytokine storm and associated pathogenesis.
Detailed Description
In December of 2019, in Wuhan, China, a novel coronavirus outbreak began. Globally this disease referred to as COVID-19, is the result of a novel SARS-CoV2 virus which predominantly targets Type II lung alveolar cells (AT2). The hyper response of the host immune system can rapidly evolve into a life-threatening cytokine-release syndrome or cytokine storm. The cytokine storm can predispose the patient to ARDS and/or NCP., or both. Left unchecked, the ARDS pathogenesis rapidly culminates in disruption of cell cytotoxicity mechanisms, excessive activation of cytotoxic lymphocytes, and a predominance of type I (M1) macrophage; resulting in the massive release of a host of proinflammatory cytokines (FNO-α, IL-1, IL-2, IL-6, IL-8, IL-10), granulocytic colony-stimulating factor, monocytic chemoattractive protein 1. The result systemically is a rise in surrogate inflammatory markers (C Reactive Protein, serum ferritin), with a corresponding infiltration of internal organs and tissues by activated macrophage, T-lymphocytes and a predominance of cellular apoptosis. The resulting hyperinflammatory pathogenic reaction may result in severe aveolar lesions leading to death, scarring, or severe lung damage, persisting well after discharge. Experimental studies have demonstrated that mesenchymal stem cells (MSCs) and MSC-culutre media (MSC-CM) may significantly reduce the pro-inflammatory bias and associated pathologic impairment resulting. The MSC-CM, known to contain exosomes, has been shown to have an anti-inflammatory effect. Further exosomes associated with the amniotic membrane, long used in the treatment of burn and wounds, have been show to have a regenerative effect. The purpose of this protocol is to explore the safety and efficacy of an intravenous injection of MSC derived exosomes in the treatment of severe patients (moderate to severe Berlin score) with ARDS or NCP.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Covid19, Novel Coronavirus Pneumonia, Acute Respiratory Distress Syndrome
Keywords
Novel Corona Virus Pneumonia, Exosomes, MSC, Acute Respiratory Distress Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Nested Cohort with Escalating Dose. The trial has three cohorts of 5 patients each. The subsequent cohort will receive an escalating dose of exosomes via intravenous infusion. The final group of 40 participants will be randomized 1:3 (placebo:intervention).
Masking
ParticipantCare Provider
Masking Description
Open-label for the first 15 patients treated in dose escalation. The final 40 participants are included in RCT. Double; participant and physician are masked.
Allocation
Randomized
Enrollment
55 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Escalating Dose First Cohort
Arm Type
Experimental
Arm Description
First Cohort: Five patients will receive an escalating dose every other day for a period of 5 days, with a minimum of 24 hours between doses recorded. Dose escalation will begin at 2 x 10^9 exosomes
Arm Title
Escalating Dose Second Cohort
Arm Type
Experimental
Arm Description
Second Cohort: Five patients will receive an escalating dose every other day for a period of 5 days, with a minimum of 24 hours between doses recorded. Dose escalation will begin at 4 x 10^9 exosomes.
Arm Title
Escalating Dose Third Cohort
Arm Type
Experimental
Arm Description
Five patients will receive a treatment dose of 8 X 10^9 exosomes every other day for a period of 5 days, with a minimum of 24 hours between doses recorded.
Arm Title
Treatment Dose Fourth Cohort Randomized control ratio 1:3
Arm Type
Placebo Comparator
Arm Description
Fourth Cohort: Randomized Cohort Up to 40 patients may be enrolled in this phase of the trial. For those receiving the placebo (~25%), 3 doses will be given over the 5 day period, dispensed from identical vials with physician and patient blinded. The full dose of 8 X 10^9 exosomes will be given to 75% of the patients in 3 doses over the course of 5 days, with one dose occurring every other day.
Intervention Type
Drug
Intervention Name(s)
MSC-exosomes delivered intravenously every other day on an escalating dose: (2:4:8)
Other Intervention Name(s)
Ardoxso
Intervention Description
Escalating dose 2 X 10^9, 4 X 10^9, 8 X 10^9/mL
Intervention Type
Drug
Intervention Name(s)
MSC-exosomes delivered intravenously every other day on an escalating dose (8:4:8)
Other Intervention Name(s)
Ardoxso
Intervention Description
Escalating dose 8 X 10^9, 4 X 10^9, 8 X 10^9 mL
Intervention Type
Drug
Intervention Name(s)
MSC-exosomes delivered intravenously every other day (8:8:8)
Other Intervention Name(s)
Ardoxso
Intervention Description
Dosed 8 X 10^9, 8 X 10^9, 8 X 10^9 mL
Primary Outcome Measure Information:
Title
Measure and report the number of participants with treatment-related-adverse events as assessed by CTCAE v4.0; for patients receiving ARDOXSO™, perinatal MSC-derived exosome therapy.
Description
Quantify safety of ARDOXSO™, an interventional exosome therapy in COVID-19 in participants confirmed with SARS-CoV-2 infection who receive ARDOXSO™ as an intervention.
Time Frame
90 Days
Title
Tabulate and report the number of IMV days for patients receiving ARDOXSO™ perinatal MSC-derived exosome therapy.
Description
Quantify efficacy of ARDOXSO™, an interventional exosome therapy in COVID-19 in participants confirmed with SARS-CoV-2 infection who receive ARDOXSO™ as an intervention.
Time Frame
90 Days
Secondary Outcome Measure Information:
Title
Analyze and report organ failure, associated with ICU mortality in participants confirmed with SARS-CoV2 infection, receiving ARDOXSO™ as an interventional exosome therapy.
Description
Correlate and analyze the Sequential Organ Failure Assessment (SOFA) score in participants confirmed with SARS-CoV2 infection, receiving ARDOXSO™, an interventional exosome therapy in COVID-19 patients. An increased SOFA score is predictive of increased mortality.
Time Frame
90 Days from last dose
Title
Record and analyze respiratory measures (Berlin Score/PEEP) following treatment regime.
Description
Berlin Score is a validated measure of Acute Respiratory Distress Syndrome diagnosis, which is common in COVID-19 patients, before and after receiving the interventional exosome therapy, ARDOXSO™.
Time Frame
90 Days from last dose

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed Consent given Male and female patients age 18 years or older Patients with coronavirus (SARS-CoV-2) infection confirmed prior to enrollment by any test with local regulatory approval Patients who require intensive care as determined by the following objective criteria: Respiratory rate>25/minute Oxygen saturation <93% on room air; or the Use of high flow oxygen by nasal cannula at a rate ≥ 4L/minute. Patients with lung imaging demonstrating bilateral or diffuse pulmonary infiltrates on chest X-ray or CT scan. Patients with moderate to severe ARDS as defined by Berlin Criteria Patients who require invasive mechanical ventilation (IMV) Exclusion Criteria: Patients will be excluded from the study if ONE of the following applies: History of hypersensitivity to any drugs of similar classes to exosomes Suspected active uncontrolled bacterial, fungal, or viral (besides SARS-CoV-2) infection Currently receiving ECMO, nitric oxide therapy, or high-frequency oscillatory ventilation In the option of the investigator, the patient is unlikely to survive for more than 24 hours post-enrollment Patients who are on long-term use of select oral or injectable anti-rejection or immunomodulatory drugs Pregnant or nursing (lacking) women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tammy C Luttrell, PhD
Phone
833-957-0079
Email
tammy.luttrell@avemhealthcare.com
First Name & Middle Initial & Last Name or Official Title & Degree
Sant P Chawla, MD
Email
santchawla@gmail.com
Facility Information:
Facility Name
Mission Community Hospital
City
Panorama City
State/Province
California
ZIP/Postal Code
91402
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sant P Chawla, MD

12. IPD Sharing Statement

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The Use of Exosomes for the Treatment of Acute Respiratory Distress Syndrome or Novel Coronavirus Pneumonia Caused by COVID-19

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