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Autologous Umbilical Cord Blood Infusion for Children With Autism Spectrum Disorder (ASD)

Primary Purpose

Autism Spectrum Disorder

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Autologous Umbilical Cord Blood
Sponsored by
Duke University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Autism Spectrum Disorder focused on measuring Autism Spectrum Disorder, ASD, Umbilical cord blood, Autologous cord blood, cord blood

Eligibility Criteria

24 Months - 72 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age ≥ 24 months to ≤72months at the time of visit 1
  2. Confirmed clinical DSM-5 diagnosis of Autism Spectrum Disorder using all three of the following measures:

    • Autism Diagnostic Observation Schedule - Toddler or Generic (ADOS)
    • Autism Diagnostic Interview-Revised (ADI-R)
    • DSM-5 checklist
  3. IQ ≥ 35 on Stanford Binet Intelligence Scale or similar standardized test
  4. Autologous umbilical cord blood available from a cord blood bank with a minimum total nucleated cell dose of ≥ 1 x 107 cells/kilogram of subject weight that meets acceptance criteria outlined in section 6.0 with confirmed HLA matching
  5. Stable on current medications for at least 2 months prior to infusion of cord blood
  6. Ability to travel to Duke University three times (0, 6, 12 mo.), parent/guardian able to participate in electronic communication tracking two times in the study and interim phone surveys every 3 months
  7. Parental consent
  8. Subject and parent/guardian must be English speaking

Exclusion Criteria:

  1. Unwilling to commit to follow up for a year
  2. History of prior cell therapy
  3. Use of IVIG or other anti-inflammatory medications with the exception of NSAIDs
  4. Medical records indicate that child has genetic or other syndromes such as fragile X, neurofibromatosis, Rett syndrome, tuberous sclerosis, PTEN mutation, cerebral palsy, cystic fibrosis, muscular dystrophy, Crohn's disease, or rheumatoid disease
  5. Co-morbid condition that would influence child's performance on assessments.
  6. Central Nervous System (CNS) infection
  7. History of unstable epilepsy or uncontrolled seizure disorder, infantile spasms, Lennox Gastaut syndrome, Dravet syndrome
  8. Known pathogenic copy number variation (CNV) (e.g. 16p11.2, 15q13.2, 2q13.3)
  9. Significant sensory (i.e., deafness, blind) or motor impairment (CP) (if using Language Environment Analysis (LENA), no uncorrected hearing impairment)
  10. Presence of obvious physical dysmorphology
  11. Review of medical records indicates ASD diagnosis not likely or other serious complicating genetic or medical condition present
  12. Impaired renal or liver function as determined by serum creatinine >1.5mg/dL and/or total bilirubin>1.3mg/dL
  13. Clinically significant abnormalities in Complete Blood Count (CBC): Hemoglobin < 10.0 g/dL, White Blood Count (WBC) < 3.8 x 10e9, Platelets < 150x 10e9.
  14. Known metabolic disorder, mitochondrial dysfunction
  15. Uncontrolled infection, presence of or infection with HIV
  16. Active malignancy
  17. Macroencephaly or microencephaly ( >2 standard deviations in the relevant direction between head circumference and height)
  18. Change in current stable use of psychoactive medications; as per parent report.

Sites / Locations

  • Duke University Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Autologous Umbilical Cord Blood (UCB)

Arm Description

All participants will receive a single intravenous (into the vein) infusion of autologous umbilical cord blood cells.

Outcomes

Primary Outcome Measures

Number of participants with non-serious and serious adverse events.

Secondary Outcome Measures

The primary efficacy measure will be change in the Vineland Adaptive Behavior Scale- II

Full Information

First Posted
June 16, 2014
Last Updated
December 2, 2019
Sponsor
Duke University
Collaborators
The Marcus Foundation, PerkinElmer, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02176317
Brief Title
Autologous Umbilical Cord Blood Infusion for Children With Autism Spectrum Disorder (ASD)
Official Title
Autologous Umbilical Cord Blood Infusion for Children With Autism Spectrum Disorder (ASD)
Study Type
Interventional

2. Study Status

Record Verification Date
December 2019
Overall Recruitment Status
Completed
Study Start Date
June 2014 (undefined)
Primary Completion Date
December 2015 (Actual)
Study Completion Date
December 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Duke University
Collaborators
The Marcus Foundation, PerkinElmer, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is a prospective phase 1 single-center trial designed to determine the safety of a single intravenous infusion of autologous umbilical cord blood in children with Autism Spectrum Disorder (ASD) and assess the feasibility of various outcome measures to determine which measure(s) can be used as primary and secondary endpoints for a future randomized phase 2 clinical trial. All subjects will receive infusion of cord blood cells at baseline with follow up assessments at 6 and 12 months.
Detailed Description
Autism Spectrum Disorder (ASD) is a neurodevelopment disorder with early onset in life. Currently, available treatments for patients with ASD are supportive, but not curative. Umbilical cord blood (UCB) has been shown to lessen the clinical and radiographic impact of hypoxic brain injury and stroke in animal models and in infants with hypoxic ischemic encephalopathy. UCB also engrafts and differentiates in the brain, facilitating neural cell repair in animal models and human patients with inborn errors of metabolism undergoing allogeneic, unrelated donor UCB transplantation. Infusion of autologous UCB does not require immunosuppression and has been shown to be safe in young children with brain injuries such as cerebral palsy and stroke. In this study, the investigators hypothesize that infusion of a patient's own umbilical cord blood cells (UCB) can offer neural protection/repair in the brain and reduction of inflammation associated with this disorder.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Autism Spectrum Disorder
Keywords
Autism Spectrum Disorder, ASD, Umbilical cord blood, Autologous cord blood, cord blood

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Autologous Umbilical Cord Blood (UCB)
Arm Type
Experimental
Arm Description
All participants will receive a single intravenous (into the vein) infusion of autologous umbilical cord blood cells.
Intervention Type
Biological
Intervention Name(s)
Autologous Umbilical Cord Blood
Intervention Description
All participants will receive autologous umbilical cord blood cells with a pre-cryopreservation cell dose of 1-5 x 10^7 Total Nucleated Cells (TNC)/kilogram of subject body weight. The cells will be administered as a single intravenous (into the vein) infusion over 2 to 25 minutes
Primary Outcome Measure Information:
Title
Number of participants with non-serious and serious adverse events.
Time Frame
up to 12 months
Secondary Outcome Measure Information:
Title
The primary efficacy measure will be change in the Vineland Adaptive Behavior Scale- II
Time Frame
up to 12 months
Other Pre-specified Outcome Measures:
Title
Change in Pervasive Developmental Disorder- Behavior Inventory
Time Frame
up to 12 months
Title
Change in Repetitive Behavior Scal
Time Frame
up to 12 months
Title
Change in Sensory Experience Questionnaire
Time Frame
up to 12 months
Title
Change in Behavior Assessment of Children
Time Frame
up to 12 months
Title
Change in Autism Diagnostic Observation Scale
Time Frame
up to 12 months
Title
Change in Clinical Global Impression- Severity and Improvement Scales
Time Frame
up to 12 months
Title
Change in Stanford Binet Intelligence Scale or other standardized IQ test
Time Frame
up to 12 months
Title
Change in frequency of child vocalization/ conversational turns
Time Frame
up to 12 months
Title
Change in Expressive One-Word Picture Vocabulary Test
Time Frame
up to 12 months
Title
Change in Preschool Age Psychiatric Assessment
Time Frame
up to 12 months
Title
Change in Aberrant Behavior Checklist
Time Frame
up to 12 months
Title
Prevalent and incident of GI symptoms
Time Frame
up to 12 months
Title
Change in Parenting Stress Index
Time Frame
up to 12 months
Title
Change in attention to social stimuli assessed via eye-tracking and electroencephalography (EEG)
Time Frame
up to 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
24 Months
Maximum Age & Unit of Time
72 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 24 months to ≤72months at the time of visit 1 Confirmed clinical DSM-5 diagnosis of Autism Spectrum Disorder using all three of the following measures: Autism Diagnostic Observation Schedule - Toddler or Generic (ADOS) Autism Diagnostic Interview-Revised (ADI-R) DSM-5 checklist IQ ≥ 35 on Stanford Binet Intelligence Scale or similar standardized test Autologous umbilical cord blood available from a cord blood bank with a minimum total nucleated cell dose of ≥ 1 x 107 cells/kilogram of subject weight that meets acceptance criteria outlined in section 6.0 with confirmed HLA matching Stable on current medications for at least 2 months prior to infusion of cord blood Ability to travel to Duke University three times (0, 6, 12 mo.), parent/guardian able to participate in electronic communication tracking two times in the study and interim phone surveys every 3 months Parental consent Subject and parent/guardian must be English speaking Exclusion Criteria: Unwilling to commit to follow up for a year History of prior cell therapy Use of IVIG or other anti-inflammatory medications with the exception of NSAIDs Medical records indicate that child has genetic or other syndromes such as fragile X, neurofibromatosis, Rett syndrome, tuberous sclerosis, PTEN mutation, cerebral palsy, cystic fibrosis, muscular dystrophy, Crohn's disease, or rheumatoid disease Co-morbid condition that would influence child's performance on assessments. Central Nervous System (CNS) infection History of unstable epilepsy or uncontrolled seizure disorder, infantile spasms, Lennox Gastaut syndrome, Dravet syndrome Known pathogenic copy number variation (CNV) (e.g. 16p11.2, 15q13.2, 2q13.3) Significant sensory (i.e., deafness, blind) or motor impairment (CP) (if using Language Environment Analysis (LENA), no uncorrected hearing impairment) Presence of obvious physical dysmorphology Review of medical records indicates ASD diagnosis not likely or other serious complicating genetic or medical condition present Impaired renal or liver function as determined by serum creatinine >1.5mg/dL and/or total bilirubin>1.3mg/dL Clinically significant abnormalities in Complete Blood Count (CBC): Hemoglobin < 10.0 g/dL, White Blood Count (WBC) < 3.8 x 10e9, Platelets < 150x 10e9. Known metabolic disorder, mitochondrial dysfunction Uncontrolled infection, presence of or infection with HIV Active malignancy Macroencephaly or microencephaly ( >2 standard deviations in the relevant direction between head circumference and height) Change in current stable use of psychoactive medications; as per parent report.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joanne Kurtzberg, MD
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32616759
Citation
Simhal AK, Carpenter KLH, Nadeem S, Kurtzberg J, Song A, Tannenbaum A, Sapiro G, Dawson G. Measuring robustness of brain networks in autism spectrum disorder with Ricci curvature. Sci Rep. 2020 Jul 2;10(1):10819. doi: 10.1038/s41598-020-67474-9.
Results Reference
derived

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Autologous Umbilical Cord Blood Infusion for Children With Autism Spectrum Disorder (ASD)

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