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Autologous Adipose-Derived Adult Stem Cell Implantation for Corneal Diseases (ADASCs-CT-CD) (ADASCs-CT-CD)

Primary Purpose

Ophthalmological Disorder, Corneal Dystrophy, Treatment

Status
Completed
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Implantation
Lipoaspiration
Sponsored by
Vissum, Instituto Oftalmológico de Alicante
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ophthalmological Disorder focused on measuring Regenerative medicine, Corneal bioengineering, Stem cell therapy, Keratoconus, Adipose-derived adult stem cells (ADASCs), Keratocytes, Corneal confocal microscopy, Advanced corneal therapy

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients affected by corneal stromal dystrophies of any type, but particularly keratoconus, showing clear evidence in the ophthalmic examination of the presence and clear expression of the disease and loss of vision as a result of it
  • Patients with best-corrected visual acuity less than 0.6
  • Absence of chronic or recurrent inflammation in the anterior segment and on the ocular surface.
  • Patient suitable to undergo corneal graft surgery under local anesthesia, from a medical point of view.
  • Pre-surgical analysis of serum biochemistry and normal hematology.
  • Serology for Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) negative.
  • No history of malignancy.
  • Normal chest x-ray (Rx).
  • Normal urinalysis.
  • Normal thyroid exam

Exclusion Criteria:

  • Dense and extensive corneal stromal scars with severe involvement of the visual axis and located in the pupillary area, causing a decrease in the best corrected vision to levels of 0.1 or less.
  • Distance corrected vision with glasses of 0.7 or greater.
  • Extreme corneal thinning with risk of perforation.
  • Infection.
  • Previous corneal surgeries.
  • Moderate or severe dry eye.
  • Moderate or severe chronic inflammatory pathology of the ocular surface.
  • Previous eye surgery other than cataract.
  • Presence of cataract or other severe opacity of the transparent media of the eye that could prevent adequate examination of the fundus.
  • Other ophthalmic comorbidity such as glaucoma or uveitis or any that requires the chronic use of topical ocular medication.
  • Known and severe coagulation abnormalities.
  • Any medical condition that may interfere with causing serious adverse effects during the study.
  • Presence of active or inactive corneal neovascularization (CNV) in the eye to be treated
  • Any immunodeficiency or systemic autoimmune disease
  • Any current or intermittent immunosuppressive therapy or low-dose corticosteroids.
  • Renal insufficiency, defined by creatine value> 1.3 mg / dL.
  • Serological evidence of hepatitis B, hepatitis C, or HIV infection.
  • Pregnant or lactating woman.
  • Corrected visual acuity in the eye contralateral to the experimental eye less than 20/40 (0.5)

Sites / Locations

  • Jorge L. Alio

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

ADASCs Group

Acellular laminas group

ADASCs recellularized laminas group

Arm Description

5 patients, who will receive adipose tissue mesenchymal stem cells in a single dose as study treatment

5 patients, who will receive decellularized corneal laminas as treatment medication

5 patients, who will receive adipose tissue mesenchymal cells combined with decellularized corneal laminas as study treatment in a single intervention

Outcomes

Primary Outcome Measures

Improvement in best-corrected distance visual acuity (BCDVA).
Best-corrected visual acuity (BCDVA) will be studied in Snellen charts by Logmar and the corresponding equivalent in decimal scale.

Secondary Outcome Measures

Increase in corneal thickness.
Corneal thickness will be evaluated by ultrasonic and optical pachymetry (Scheimpflug corneal topography).
Refractive changes
Refraction will be studied by refractive subjection performed by a certified good clinical practice technician.
Improvement in anterior corneal surface regularity
Anterior corneal surface regularity will be evaluated by corneal topography map and analysed by the changes in the Zernike polynomials (third order and fourth order spherical aberration).

Full Information

First Posted
December 17, 2021
Last Updated
May 4, 2023
Sponsor
Vissum, Instituto Oftalmológico de Alicante
Collaborators
Universidad Miguel Hernandez de Elche, Instituto de Salud Carlos III
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1. Study Identification

Unique Protocol Identification Number
NCT05279157
Brief Title
Autologous Adipose-Derived Adult Stem Cell Implantation for Corneal Diseases (ADASCs-CT-CD)
Acronym
ADASCs-CT-CD
Official Title
Implantation of Autologous Mesenchymal Stem Cells of Adipose Origin for the Treatment of Corneal Diseases
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
April 19, 2022 (Actual)
Primary Completion Date
February 5, 2023 (Actual)
Study Completion Date
February 5, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Vissum, Instituto Oftalmológico de Alicante
Collaborators
Universidad Miguel Hernandez de Elche, Instituto de Salud Carlos III

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Cellular therapy of the corneal stroma with implantation of mesenchymal stem cells derived from autologous adipose tissue with or without a carrier (scaffold) composed by decellularized human donor corneal stroma is used in patients with corneal diseases such as corneal dystrophies, and keratoconus. For this purpose, the study planned to assess the enhancement of visual acuity, pachymetric, and aberrometric parameters with implantation of autologous mesenchymal adipose tissue-derived adult stem cells (ADASCs) alone, 120 µm thickness of decellularized or recellularized laminas with ADASCs. Three groups will be included in the study: (1) Implantation of a single dose of ADASCs alone without scaffold. (2) Implantation of decellularized human corneal lamina without ADASCs. (3) Implantation of the recellularized human corneal lamina with ADASCs.
Detailed Description
Different types of stem cells have been used in various ways in several research projects to find the optimal procedure to regenerate the human corneal stroma. It included several approaches which can be classified as intrastromal implantation of stem cells (1) alone, (2) together with a biodegradable scaffold, (3) with a non-biodegradable scaffold, or (4) with a decellularized corneal stromal scaffold. The complex structure of the corneal stroma has not been yet replicated, and there are well-known drawbacks to the use of synthetic scaffold-based designs. Recently, several corneal decellularization techniques have been described, which provide an acellular corneal extracellular matrix (ECM). These scaffolds have gained attention in the last few years. The scaffold provides a more natural environment for the growth and differentiation of cells when compared with synthetic scaffolds. In addition, components of the ECM are generally conserved among species and are tolerated well even by xenogeneic recipients. Keratocytes are essential for remodeling the corneal stroma and for normal epithelial physiology. This highlights the importance of transplanting a cellular substitute together with the structural support (acellular ECM) to undertake these critical functions in corneal homeostasis. To the best of the investigators' knowledge, all attempts to repopulate decellularized corneal scaffolds have used corneal cells, but these cells have major drawbacks that preclude their autologous use in clinical practice (damage of the donor tissue, lack of cells, and inefficient cell subcultures), thus the efforts to find an extraocular source of autologous cells. A recent study by the investigators has shown a perfect bio integration of human decellularized corneal stromal laminas (100 µm thickness) with and without h-ADASCs colonization inside the rabbit cornea in vivo, without observing any rejection response despite the graft being xenogeneic. The investigators also demonstrated the differentiation of h-ADASCs into functional keratocytes inside these implants in vivo, which then achieved their proper biofunctionalization. According to the investigator's opinion, the transplant of stem cells together with decellularized corneal ECM would be the best technique to effectively restore the thickness of a diseased human cornea, like in keratoconus. Through this technique, and using extraocular mesenchymal stem cells from patients, it is possible to transform allergenic grafts into functional autologous grafts, theoretically avoiding the risk of rejection. The process flow is defined as following: (1) the file study: which start by receiving the file of the patient, the file will be forwarded to appointed physicians coordinators for review and submission of medical report, then the medical report will be evaluated within the cell therapy committee and the patient will be asked for clinical examination, and after consultation a reply to the patient with medical decision will follow with an approval or not to be recruited and if yes, a brief report about the procedure will be submitted and explained in details to the patient, a consent form must be signed if the patient agree to be included in the study, (2) the patient admission: which may start by completion of the procedure forms and doing the pre-op evaluation (initial work up defined as a clinical and biological assessment upon C.A.S which may include unaided and best spectacle corrected visual acuity, refraction, slit lamp examination, intraocular pressure, fundoscopy, corneal topography, aberrometry, endothelial cell count (specular microscopy), corneal confocal microscopy, as well as blood tests), all this tests should be effectuated by an specialist and reviewed by an ophthalmologist. Then, a lipoaspiration of the subcutaneous adipose tissue to be performed by a plastic surgeon, sample processing at a cGMP facility for isolation and characterization of the stromal vascular fraction enriched with ADASCs as well as laminas preparing (the quality control assessment will be realized before and after all the steps of the procedure starting from the ADASCs collection to implantation including cell culture, cell quiescence, decellularization of human corneal lamina, recellularization of the laminas with ADASCs, and implantation; the assessment will include cell viability, cell number, cell apoptosis, immunophenotyping, infection, inflammation by analyzing the secreted cytokines from ADASCs, lamina cutting, lamina thickness, immunostaining, confocal microscopy, etc.); (3) the delivery (implantation) which starts by a peribulbar or retrobulbar anesthesia where the patient is placed under operating microscope, followed by a femtosecond laser-assisted mid-stromal lamellar dissection, then the autologous ADASCs or laminas or recellularized laminas will be placed within the pocket, and finally closed by a superior incision closure. The patient will be put under antibiotic/steroids for a defined period and followed by the team at 1 week, 2 weeks, 1 month, 3 months, 6 months. This protocol of cell therapy will be applied exclusively at VISSUM (Alicante-Spain), Barraquer Ophthalmology Center (Barcelona-Spain), Ramon y Cajal Hospital (Madrid-Spain), Asturias Prince Hospital (Madrid-Spain), and Murcia Hospital (Murcia-Spain), in affiliation with Miguel Hernandez of Elche University (Elche-Spain). The patient's recruitment will take place: for the lipoaspiration, processing, preparing the cellularized laminas and quality control assessments in VISSUM (Alicante-Spain), Barraquer Ophthalmology Center (Barcelona-Spain), Ramon y Cajal Hospital (Madrid-Spain), and Murcia Hospital (Murcia-Spain). All these steps are managed by VISSUM (Prof. J. ALIO).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ophthalmological Disorder, Corneal Dystrophy, Treatment, Therapy, Keratoconus
Keywords
Regenerative medicine, Corneal bioengineering, Stem cell therapy, Keratoconus, Adipose-derived adult stem cells (ADASCs), Keratocytes, Corneal confocal microscopy, Advanced corneal therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
In this study, 15 evaluable patients affected by corneal stromal dystrophies of any type (particularly keratoconus) will be included in 3 different groups. Ten patients will be included in the two experimental groups and five in the control group with cell-free treatment (5 patients per group and a total of 3 groups)
Masking
ParticipantCare ProviderInvestigator
Masking Description
Patients who agree to participate in the study and sign the informed consent will be randomized to enter one of the three groups in a 1: 1: 1 ratio. For this, a randomization scheme will be used that will be unknown to the patient, the center staff, and the promoter staff who intervene directly in the study.
Allocation
Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ADASCs Group
Arm Type
Experimental
Arm Description
5 patients, who will receive adipose tissue mesenchymal stem cells in a single dose as study treatment
Arm Title
Acellular laminas group
Arm Type
Experimental
Arm Description
5 patients, who will receive decellularized corneal laminas as treatment medication
Arm Title
ADASCs recellularized laminas group
Arm Type
Experimental
Arm Description
5 patients, who will receive adipose tissue mesenchymal cells combined with decellularized corneal laminas as study treatment in a single intervention
Intervention Type
Procedure
Intervention Name(s)
Implantation
Other Intervention Name(s)
corneal implantation
Intervention Description
Procedure: Implantation The ophthalmologist will carry out the implantation of the ADASCs cells with or without scaffold in the intrastromal cornea of the patient
Intervention Type
Procedure
Intervention Name(s)
Lipoaspiration
Other Intervention Name(s)
corneal implantation
Intervention Description
Procedure: Lipoaspiration The patient will have a liposuction surgery from which the autologous ADASCs implant in the cornea will be obtained. Procedure: Implantation The ophthalmologist will carry out the implantation of the ADASCs with or without scaffold in the intrastromal cornea of the patient
Primary Outcome Measure Information:
Title
Improvement in best-corrected distance visual acuity (BCDVA).
Description
Best-corrected visual acuity (BCDVA) will be studied in Snellen charts by Logmar and the corresponding equivalent in decimal scale.
Time Frame
at 12 months
Secondary Outcome Measure Information:
Title
Increase in corneal thickness.
Description
Corneal thickness will be evaluated by ultrasonic and optical pachymetry (Scheimpflug corneal topography).
Time Frame
at 12 months
Title
Refractive changes
Description
Refraction will be studied by refractive subjection performed by a certified good clinical practice technician.
Time Frame
at 12 months
Title
Improvement in anterior corneal surface regularity
Description
Anterior corneal surface regularity will be evaluated by corneal topography map and analysed by the changes in the Zernike polynomials (third order and fourth order spherical aberration).
Time Frame
at 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients affected by corneal stromal dystrophies of any type, but particularly keratoconus, showing clear evidence in the ophthalmic examination of the presence and clear expression of the disease and loss of vision as a result of it Patients with best-corrected visual acuity less than 0.6 Absence of chronic or recurrent inflammation in the anterior segment and on the ocular surface. Patient suitable to undergo corneal graft surgery under local anesthesia, from a medical point of view. Pre-surgical analysis of serum biochemistry and normal hematology. Serology for Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) negative. No history of malignancy. Normal chest x-ray (Rx). Normal urinalysis. Normal thyroid exam Exclusion Criteria: Dense and extensive corneal stromal scars with severe involvement of the visual axis and located in the pupillary area, causing a decrease in the best corrected vision to levels of 0.1 or less. Distance corrected vision with glasses of 0.7 or greater. Extreme corneal thinning with risk of perforation. Infection. Previous corneal surgeries. Moderate or severe dry eye. Moderate or severe chronic inflammatory pathology of the ocular surface. Previous eye surgery other than cataract. Presence of cataract or other severe opacity of the transparent media of the eye that could prevent adequate examination of the fundus. Other ophthalmic comorbidity such as glaucoma or uveitis or any that requires the chronic use of topical ocular medication. Known and severe coagulation abnormalities. Any medical condition that may interfere with causing serious adverse effects during the study. Presence of active or inactive corneal neovascularization (CNV) in the eye to be treated Any immunodeficiency or systemic autoimmune disease Any current or intermittent immunosuppressive therapy or low-dose corticosteroids. Renal insufficiency, defined by creatine value> 1.3 mg / dL. Serological evidence of hepatitis B, hepatitis C, or HIV infection. Pregnant or lactating woman. Corrected visual acuity in the eye contralateral to the experimental eye less than 20/40 (0.5)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jorge L Alio, MD, PhD
Organizational Affiliation
Universidad Miguel Hernandez, Elche, Spain
Official's Role
Principal Investigator
Facility Information:
Facility Name
Jorge L. Alio
City
Alicante
ZIP/Postal Code
03016
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
28486314
Citation
Alio Del Barrio JL, El Zarif M, de Miguel MP, Azaar A, Makdissy N, Harb W, El Achkar I, Arnalich-Montiel F, Alio JL. Cellular Therapy With Human Autologous Adipose-Derived Adult Stem Cells for Advanced Keratoconus. Cornea. 2017 Aug;36(8):952-960. doi: 10.1097/ICO.0000000000001228.
Results Reference
result
PubMed Identifier
29103962
Citation
Alio Del Barrio JL, El Zarif M, Azaar A, Makdissy N, Khalil C, Harb W, El Achkar I, Jawad ZA, de Miguel MP, Alio JL. Corneal Stroma Enhancement With Decellularized Stromal Laminas With or Without Stem Cell Recellularization for Advanced Keratoconus. Am J Ophthalmol. 2018 Feb;186:47-58. doi: 10.1016/j.ajo.2017.10.026. Epub 2017 Dec 13.
Results Reference
result
PubMed Identifier
33164825
Citation
Alio Del Barrio JL, Arnalich-Montiel F, De Miguel MP, El Zarif M, Alio JL. Corneal stroma regeneration: Preclinical studies. Exp Eye Res. 2021 Jan;202:108314. doi: 10.1016/j.exer.2020.108314. Epub 2020 Oct 24.
Results Reference
result
PubMed Identifier
30772348
Citation
Alio JL, Alio Del Barrio JL, El Zarif M, Azaar A, Makdissy N, Khalil C, Harb W, El Achkar I, Jawad ZA, De Miguel MP. Regenerative Surgery of the Corneal Stroma for Advanced Keratoconus: 1-Year Outcomes. Am J Ophthalmol. 2019 Jul;203:53-68. doi: 10.1016/j.ajo.2019.02.009. Epub 2019 Feb 15.
Results Reference
result
PubMed Identifier
33591032
Citation
El Zarif M, Alio JL, Alio Del Barrio JL, Abdul Jawad K, Palazon-Bru A, Abdul Jawad Z, De Miguel MP, Makdissy N. Corneal Stromal Regeneration Therapy for Advanced Keratoconus: Long-term Outcomes at 3 Years. Cornea. 2021 Jun 1;40(6):741-754. doi: 10.1097/ICO.0000000000002646.
Results Reference
result
PubMed Identifier
32301973
Citation
El Zarif M, A Jawad K, Alio Del Barrio JL, A Jawad Z, Palazon-Bru A, de Miguel MP, Saba P, Makdissy N, Alio JL. Corneal Stroma Cell Density Evolution in Keratoconus Corneas Following the Implantation of Adipose Mesenchymal Stem Cells and Corneal Laminas: An In Vivo Confocal Microscopy Study. Invest Ophthalmol Vis Sci. 2020 Apr 9;61(4):22. doi: 10.1167/iovs.61.4.22.
Results Reference
result
PubMed Identifier
33181549
Citation
El Zarif M, Alio Del Barrio JL, Arnalich-Montiel F, De Miguel MP, Makdissy N, Alio JL. Corneal Stroma Regeneration: New Approach for the Treatment of Cornea Disease. Asia Pac J Ophthalmol (Phila). 2020 Dec;9(6):571-579. doi: 10.1097/APO.0000000000000337.
Results Reference
result
PubMed Identifier
33708786
Citation
El Zarif M, Alio JL, Alio Del Barrio JL, De Miguel MP, Abdul Jawad K, Makdissy N. Corneal Stromal Regeneration: A Review of Human Clinical Studies in Keratoconus Treatment. Front Med (Lausanne). 2021 Feb 23;8:650724. doi: 10.3389/fmed.2021.650724. eCollection 2021.
Results Reference
result

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Autologous Adipose-Derived Adult Stem Cell Implantation for Corneal Diseases (ADASCs-CT-CD)

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