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Allogeneic Human Mesenchymal Stem Cell Injection in PAtieNts With FaceTogenic Back Pain (VALIANT)

Primary Purpose

Facetogenic Back Pain, Back Pain

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Withdrawn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

About this trial

This is an interventional treatment trial for Facetogenic Back Pain focused on measuring stem cells, back pain

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

In order to participate in this study, a subject must:

  1. Provide written informed consent.
  2. Subjects age >18 and <75 years at the time of signing the Informed Consent Form.
  3. Facetogenic back pain diagnosed using the following diagnostic criteria:

    • The facet joint may be affected by systemic disease, as rheumatoid arthritis and ankylosing spondylitis, or be site of micro traumatic fractures, osteoarthritis, meniscoid entrapment, synovial impingement, joint subluxation, synovial inflammation, loss of cartilage, and mechanical injury.
    • Pain onset at dorsal extension and release at flexion is often considered suggestive for facet pain, even if non-specific, such as maximal tenderness upon deep palpation of posterior elements
    • History of temporary improvement with a medial branch block anesthetic injection of the targeted joints
    • Axial lumbar pain without radicular symptoms
    • Pain on hyperextension, rotation, and lateral bending with physical exam
  4. Chronic facetogenic pain (≥ 6 months) in patients that have failed conservative management. (This includes but is not limited to a trial of oral medications, 6 weeks of physical therapy, intra-articular injection of the facet joints, and/or facet joint medial branch neurotomy.)
  5. Diagnosis of lumbar facet joint pain confirmed by analgesic injections.
  6. Have spinal level L3-4, L4-5 and L5-S1 bilaterally for bilateral pain and same side only for unilateral pain.

Exclusion Criteria:

In order to participate in this study, a subject must not:

  1. Previous surgical intervention for back pain
  2. Previous mesenchymal stem cell (MSC) injection(s) in to facet joints
  3. Use of anticoagulation or NSAIDs within 5 days of the injection
  4. MRI finding of severe high grade lumbar stenosis
  5. Leg pain exceeding back pain
  6. Pain worse with flexion maneuvers
  7. Fracture of lumbar vertebrae
  8. Be a female who is pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods. Female subjects must undergo a blood or urine pregnancy test at screening and within 36 hours prior to injection.
  9. Inability to perform any of the assessments required for endpoint analysis.
  10. Clinically abnormal screening laboratory values.
  11. Serious comorbid illness or any other condition that, in the opinion of the investigator, may compromise the safety or compliance of the subject or preclude successful completion of the study.
  12. Hypersensitivity to dimethyl sulfoxide (DMSO).
  13. Be an organ transplant recipient.
  14. Have a clinical history of malignancy within 5 years (i.e., subjects with prior malignancy must be disease free for 5 years), except curatively-treated basal cell carcinoma, squamous cell carcinoma, melanoma in situ or cervical carcinoma, if recurrence occurs.
  15. Have a non-pulmonary condition that limits lifespan to < 1 year.
  16. Have a history of drug or alcohol abuse within the past 24 months.
  17. Be serum positive for HIV, hepatitis BsAg or Viremic hepatitis C.
  18. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial.

Sites / Locations

  • ISCI / University of Miami Miller School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Placebo Comparator

Experimental

Experimental

Placebo Comparator

Arm Label

Group 1 - Placebo

Group 2 - Allogeneic Human Mesenchymal Stem Cells (hMSCs)

Group A - Allogeneic Human Mesenchymal Stem Cells (hMSCs)

Group B - Placebo

Arm Description

Group 1 - Five (5) subjects will be treated with a single administration of 1 cc of 1% lidocaine with 1 cc of 2% Ropivicaine and 0.5 cc of betamethasone soluspan (celestone) solution delivered via intra-facet injection. These subjects will be part of the control (Standard care) group.

Group 2 - Five (5) subjects will be treated with a single administration of 20 million allogeneic mesenchymal stem cell delivered intra-facet via 6 injections of 1.5 mL per injection, total of 9 to 12ml. These subjects will be part of the experimental group.

Group A will consist of 15 subjects that will receive 20 million Allogeneic hMSCs delivered via lumbar level injection based on pain originator.

Group B will consist of 15 subjects who will receive 2% Ropivicaine and 0.5 cc of betamethasone soluspan (celestone) solution via lumbar level injection based on pain originator.

Outcomes

Primary Outcome Measures

Incidence of any treatment-emergent serious adverse events
Incidence (at one-month post injection) of any treatment-emergent serious adverse events.

Secondary Outcome Measures

Difference in subject quality of life assessment - SF-12
Difference in subject quality of life assessment - SF-12 to assess if there is improvement in health via this health survey.
Difference in subject quality of life assessment - Oswestry Low Back Pain
Difference in subject quality of life assessment - Oswestry Low Back Pain where the scores are defined by percentage with 0 to 20% showing minimal disability and 81-100% showing severe disabling symptoms.
Death from any cause.
Death from any cause.
Change in pain using the Numeric rating scale
Change between baseline and 6 months in pain using the Numeric Rating Scale (NRS) scale. This is assessed on a scale from 0 to 10 with 0 being no pain and 10 being the worst pain.

Full Information

First Posted
March 13, 2018
Last Updated
October 16, 2020
Sponsor
Joshua M Hare
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1. Study Identification

Unique Protocol Identification Number
NCT03487731
Brief Title
Allogeneic Human Mesenchymal Stem Cell Injection in PAtieNts With FaceTogenic Back Pain
Acronym
VALIANT
Official Title
A Phase I/II, Randomized, Blinded and Placebo-controlled Trial to EValuate the Safety and Potential Efficacy of Allogeneic Human Mesenchymal Stem Cell Injection in PAtieNts With FaceTogenic Back Pain
Study Type
Interventional

2. Study Status

Record Verification Date
October 2020
Overall Recruitment Status
Withdrawn
Why Stopped
PI decided to not proceed with study
Study Start Date
December 1, 2020 (Anticipated)
Primary Completion Date
December 1, 2025 (Anticipated)
Study Completion Date
December 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Joshua M Hare

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
The study is a phase I/II trial where allogeneic human mesenchymal stem cells (hMSCs) are injected intracfect into the lumbar facet joints. Forty (40) subjects are scheduled to undergo injection after meeting all inclusion/exclusion criteria will be evaluate at baseline.
Detailed Description
There are 40 subjects that will be randomized into the trial into one of 4 groups. In the pilot phase 5 subjects will be enrolled into Group 1, and another 5 subjects will be enrolled into Group 2. Subjects in group 1 will receive placebo but will be eligible for a cross over phase where they will receive a injection of the study investigational product. In the pilot phase, the first three (3) subjects in each treatment group will not be treated less than 10 days apart. Following the pilot study, thirty (30) subjects will be scheduled to undergo CT guided facet injection of the lumbar facet joints using a posterior approach after meeting all inclusion/exclusion criteria and baseline evaluation. Eligible participants will be randomized to either Group A or Group B.Group A will consist of 15 subjects that will receive 20 million Allogeneic hMSCs. Group B will receive placebo.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Facetogenic Back Pain, Back Pain
Keywords
stem cells, back pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1 - Placebo
Arm Type
Placebo Comparator
Arm Description
Group 1 - Five (5) subjects will be treated with a single administration of 1 cc of 1% lidocaine with 1 cc of 2% Ropivicaine and 0.5 cc of betamethasone soluspan (celestone) solution delivered via intra-facet injection. These subjects will be part of the control (Standard care) group.
Arm Title
Group 2 - Allogeneic Human Mesenchymal Stem Cells (hMSCs)
Arm Type
Experimental
Arm Description
Group 2 - Five (5) subjects will be treated with a single administration of 20 million allogeneic mesenchymal stem cell delivered intra-facet via 6 injections of 1.5 mL per injection, total of 9 to 12ml. These subjects will be part of the experimental group.
Arm Title
Group A - Allogeneic Human Mesenchymal Stem Cells (hMSCs)
Arm Type
Experimental
Arm Description
Group A will consist of 15 subjects that will receive 20 million Allogeneic hMSCs delivered via lumbar level injection based on pain originator.
Arm Title
Group B - Placebo
Arm Type
Placebo Comparator
Arm Description
Group B will consist of 15 subjects who will receive 2% Ropivicaine and 0.5 cc of betamethasone soluspan (celestone) solution via lumbar level injection based on pain originator.
Intervention Type
Biological
Intervention Name(s)
Allogeneic Human Mesenchymal Stem Cells (hMSCs)
Other Intervention Name(s)
allo-hMSCs, stem cells
Intervention Description
A single administration of 20 million allogeneic mesenchymal stem cell delivered intra-facet via 6 injections of 1.5 mL per injection, total of 9 to 12ml.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
A single administration of 1 cc of 1% lidocaine with 1 cc of 2% Ropivicaine and 0.5 cc of betamethasone soluspan (celestone) solution delivered via intra-facet injection.
Primary Outcome Measure Information:
Title
Incidence of any treatment-emergent serious adverse events
Description
Incidence (at one-month post injection) of any treatment-emergent serious adverse events.
Time Frame
at one-month post injection
Secondary Outcome Measure Information:
Title
Difference in subject quality of life assessment - SF-12
Description
Difference in subject quality of life assessment - SF-12 to assess if there is improvement in health via this health survey.
Time Frame
Baseline, Month 3, and Month 6
Title
Difference in subject quality of life assessment - Oswestry Low Back Pain
Description
Difference in subject quality of life assessment - Oswestry Low Back Pain where the scores are defined by percentage with 0 to 20% showing minimal disability and 81-100% showing severe disabling symptoms.
Time Frame
Baseline, Month 3, and Month 6
Title
Death from any cause.
Description
Death from any cause.
Time Frame
Baseline, Month 3, and Month 6
Title
Change in pain using the Numeric rating scale
Description
Change between baseline and 6 months in pain using the Numeric Rating Scale (NRS) scale. This is assessed on a scale from 0 to 10 with 0 being no pain and 10 being the worst pain.
Time Frame
Baseline and Month 6

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: In order to participate in this study, a subject must: Provide written informed consent. Subjects age >18 and <75 years at the time of signing the Informed Consent Form. Facetogenic back pain diagnosed using the following diagnostic criteria: The facet joint may be affected by systemic disease, as rheumatoid arthritis and ankylosing spondylitis, or be site of micro traumatic fractures, osteoarthritis, meniscoid entrapment, synovial impingement, joint subluxation, synovial inflammation, loss of cartilage, and mechanical injury. Pain onset at dorsal extension and release at flexion is often considered suggestive for facet pain, even if non-specific, such as maximal tenderness upon deep palpation of posterior elements History of temporary improvement with a medial branch block anesthetic injection of the targeted joints Axial lumbar pain without radicular symptoms Pain on hyperextension, rotation, and lateral bending with physical exam Chronic facetogenic pain (≥ 6 months) in patients that have failed conservative management. (This includes but is not limited to a trial of oral medications, 6 weeks of physical therapy, intra-articular injection of the facet joints, and/or facet joint medial branch neurotomy.) Diagnosis of lumbar facet joint pain confirmed by analgesic injections. Have spinal level L3-4, L4-5 and L5-S1 bilaterally for bilateral pain and same side only for unilateral pain. Exclusion Criteria: In order to participate in this study, a subject must not: Previous surgical intervention for back pain Previous mesenchymal stem cell (MSC) injection(s) in to facet joints Use of anticoagulation or NSAIDs within 5 days of the injection MRI finding of severe high grade lumbar stenosis Leg pain exceeding back pain Pain worse with flexion maneuvers Fracture of lumbar vertebrae Be a female who is pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods. Female subjects must undergo a blood or urine pregnancy test at screening and within 36 hours prior to injection. Inability to perform any of the assessments required for endpoint analysis. Clinically abnormal screening laboratory values. Serious comorbid illness or any other condition that, in the opinion of the investigator, may compromise the safety or compliance of the subject or preclude successful completion of the study. Hypersensitivity to dimethyl sulfoxide (DMSO). Be an organ transplant recipient. Have a clinical history of malignancy within 5 years (i.e., subjects with prior malignancy must be disease free for 5 years), except curatively-treated basal cell carcinoma, squamous cell carcinoma, melanoma in situ or cervical carcinoma, if recurrence occurs. Have a non-pulmonary condition that limits lifespan to < 1 year. Have a history of drug or alcohol abuse within the past 24 months. Be serum positive for HIV, hepatitis BsAg or Viremic hepatitis C. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew Sherman, MD
Organizational Affiliation
University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
ISCI / University of Miami Miller School of Medicine
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Links:
URL
http://ISCI.med.miami.edu
Description
Interdisciplinary Stem Cell Institute website

Learn more about this trial

Allogeneic Human Mesenchymal Stem Cell Injection in PAtieNts With FaceTogenic Back Pain

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