Intrathecal Autologous Adipose-derived Mesenchymal Stromal Cells for Amyotrophic Lateral Sclerosis (ALS)
Primary Purpose
ALS, Amyotrophic Lateral Sclerosis
Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Autologous Adipose-derived Mesenchymal Stromal Cells
Sponsored by
About this trial
This is an interventional treatment trial for ALS
Eligibility Criteria
Inclusion Criteria:
- All patients will have ALS diagnosed as possible, laboratory-supported probable, probable, or definite as defined by the World Federation of Neurology criteria for the diagnosis of ALS.
- Examination and neurophysiological testing confirm a pure motor syndrome compatible with the diagnosis of ALS. All other possible causes of weakness have been excluded by extensive investigations.
- Age greater than 18 years, if female, must be post-menopausal, had a hysterectomy, or agree to two forms of birth control.
- Permanent resident or citizen of the United States.
- Geographic accessibility to the study site and willingness and ability to comply with follow-up.
- History of a chronic onset of a progressive motor weakness of less than two years duration.
- Subjects must be taking a stable dose of riluzole for at least 30 days prior to enrolment or not be on riluzole, and not have been on it for at least 30 days prior to enrolment (riluzole-naïve subjects are permitted in the study).
- Able to comply with protocol requirements, including MRI testing.
- Can provide written informed consent.
Exclusion Criteria:
- Use of Radicava® (edaravone) within 30 days of screening or intent to use Radicava® at any time during the course of the study including the follow up period.
- Any clinically significant medical condition (e.g., within six months of baseline, had myocardial infarction, angina pectoris, and/or congestive heart failure) that, in the opinion of the investigator, would compromise the safety of patient.
- Pulmonary Slow Vital Capacity (SVC) less than 65% of predicted for age, gender, and body type.
- Autoimmunity, including Crohn's disease or rheumatoid arthritis
- Current use of immunosuppressant medication or use of such medication within 4 weeks of Screening visit (Visit 1).
- Malignancy 5 years prior to enrollment, including melanoma,with the exception of localized skin cancers (with no evidence of metastasis, significant invasion, or re-occurrence within three years of baseline).
- Active systemic or local infection near the lumbar puncture site.
- Inability to lie flat for the duration of intrathecal cell transplantation, or inability to tolerate study procedures for any other reason.
- Other active systemic disease as defined by laboratory abnormalities delineated in Appendix IV.
- Use of herbal medications, nutritional supplements or other unapproved drugs or investigational medicinal products being used or studied for the treatment of ALS.
- Unwilling to forgo initiating the use of any new supplements during participation in the study.
- Enrolled in an investigational drug trial within 30 days of baseline visit
- Prior stem cell therapy for a neurological disease
- Kokmen Short Test of Mental Status score <32
- Presence of a tracheostomy
- Ventilator dependent
- Pregnancy
- Men or women of childbearing potential who are unwilling to employ adequate contraception
- Chronic low back pain requiring invasive procedures (i.e. epidural injections or lumbar spine surgery)
Sites / Locations
- Mayo Clinic
- Mayo Clinic
- Mayo Clinic in Rochester
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Mesenchymal Stromal Cells
Arm Description
Autologous Adipose-derived Mesenchymal Stromal Cells (aaMSCs) will be administered intrathecally at a single dose in a volume of 5-10 mL, all patients will receive 5 x 10^7 intrathecal aaMSCs at the first injection (Visit 4). Subsequent doses may be reduced to 1 x 10^7 or increased to 1 x 10^8, based on Dose Modification Rules.
Outcomes
Primary Outcome Measures
Number of Adverse Events
Number of adverse events will be recorded from the time of enrollment until the end of the follow-up period or, in the case of early withdrawal, to the time of study withdrawal.
Secondary Outcome Measures
Change in slope of ALS Functional Rating Scale - Revised (ALSFRS-R)
The ALSFRS-R includes 12 questions. Each task is rated on a five-point scale from 0 = can't do, to 4 = normal ability. Individual item scores are summed to produce a reported score of between 0=worst and 48=best.
Full Information
NCT ID
NCT03268603
First Posted
August 30, 2017
Last Updated
February 2, 2023
Sponsor
Mayo Clinic
Collaborators
State of Minnesota Regenerative Medicine Minnesota
1. Study Identification
Unique Protocol Identification Number
NCT03268603
Brief Title
Intrathecal Autologous Adipose-derived Mesenchymal Stromal Cells for Amyotrophic Lateral Sclerosis (ALS)
Official Title
A Phase II Study of Intrathecal Autologous Adipose-derived Mesenchymal Stromal Cells for Amyotrophic Lateral Sclerosis
Study Type
Interventional
2. Study Status
Record Verification Date
February 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
October 10, 2017 (Actual)
Primary Completion Date
November 2023 (Anticipated)
Study Completion Date
November 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Mayo Clinic
Collaborators
State of Minnesota Regenerative Medicine Minnesota
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this study is to determine the safety and efficacy of intrathecal treatment delivered to the cerebrospinal fluid (CSF) of mesenchymal stem cells in ALS patients every 3 months for a total of 4 injections over 12 months.
Mesenchymal stem cells (MSCs) are a type of stem cell that can be grown into a number of different kinds of cells. In this study, MSCs will be taken from the subject's body fat and grown. CSF is the fluid surrounding the spine.
The use of mesenchymal stem cells is considered investigational, which means it has not been approved by the Food and Drug Administration (FDA) for routine clinical use. However, the FDA has allowed the use of mesenchymal stem cells in this research study.
Detailed Description
The Goal of the Proposed Study is to perform an open label, 60 subject, Phase II multi-site clinical trial to investigate the safety and efficacy of intrathecal treatment of aaMSCs in ALS. Patients will be treated with 10-100 million aaMSCs every 3 months for a total of 4 intrathecal injections over 12 months. Reduced dose treatments will be allowed based on specific adverse events. Multiple biomarkers will be tracked throughout the clinical trial and correlated with response to treatment. This study was initially performed at Mayo Clinic in Rochester and subsequently expanded to the two other Mayo Clinic sites in Arizona and Florida. All biopsies and stem cell injections take place at Mayo Clinic Rochester, regardless of where the subject initially enrolls into the study.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
ALS, Amyotrophic Lateral Sclerosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
75 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Mesenchymal Stromal Cells
Arm Type
Experimental
Arm Description
Autologous Adipose-derived Mesenchymal Stromal Cells (aaMSCs) will be administered intrathecally at a single dose in a volume of 5-10 mL, all patients will receive 5 x 10^7 intrathecal aaMSCs at the first injection (Visit 4). Subsequent doses may be reduced to 1 x 10^7 or increased to 1 x 10^8, based on Dose Modification Rules.
Intervention Type
Drug
Intervention Name(s)
Autologous Adipose-derived Mesenchymal Stromal Cells
Intervention Description
The investigational product consists of autologous adipose-derived Mesenchymal Stromal Cells (MSCs), suspended in 5-10 mL Lactated Ringer's. The MSC are provided in a sterile syringe labelled with appropriate patient and product identifiers ready for intrathecal injection.
Primary Outcome Measure Information:
Title
Number of Adverse Events
Description
Number of adverse events will be recorded from the time of enrollment until the end of the follow-up period or, in the case of early withdrawal, to the time of study withdrawal.
Time Frame
approximately 2 years
Secondary Outcome Measure Information:
Title
Change in slope of ALS Functional Rating Scale - Revised (ALSFRS-R)
Description
The ALSFRS-R includes 12 questions. Each task is rated on a five-point scale from 0 = can't do, to 4 = normal ability. Individual item scores are summed to produce a reported score of between 0=worst and 48=best.
Time Frame
baseline, approximately 1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
All patients will have ALS diagnosed as possible, laboratory-supported probable, probable, or definite as defined by the World Federation of Neurology criteria for the diagnosis of ALS.
Examination and neurophysiological testing confirm a pure motor syndrome compatible with the diagnosis of ALS. All other possible causes of weakness have been excluded by extensive investigations.
Age greater than 18 years, if female, must be post-menopausal, had a hysterectomy, or agree to two forms of birth control.
Permanent resident or citizen of the United States.
Geographic accessibility to the study site and willingness and ability to comply with follow-up.
History of a chronic onset of a progressive motor weakness of less than two years duration.
Subjects must be taking a stable dose of riluzole for at least 30 days prior to enrolment or not be on riluzole, and not have been on it for at least 30 days prior to enrolment (riluzole-naïve subjects are permitted in the study).
Able to comply with protocol requirements, including MRI testing.
Can provide written informed consent.
Exclusion Criteria:
Use of Radicava® (edaravone) within 30 days of screening or intent to use Radicava® at any time during the course of the study including the follow up period.
Any clinically significant medical condition (e.g., within six months of baseline, had myocardial infarction, angina pectoris, and/or congestive heart failure) that, in the opinion of the investigator, would compromise the safety of patient.
Pulmonary Slow Vital Capacity (SVC) less than 65% of predicted for age, gender, and body type.
Autoimmunity, including Crohn's disease or rheumatoid arthritis
Current use of immunosuppressant medication or use of such medication within 4 weeks of Screening visit (Visit 1).
Malignancy 5 years prior to enrollment, including melanoma,with the exception of localized skin cancers (with no evidence of metastasis, significant invasion, or re-occurrence within three years of baseline).
Active systemic or local infection near the lumbar puncture site.
Inability to lie flat for the duration of intrathecal cell transplantation, or inability to tolerate study procedures for any other reason.
Other active systemic disease as defined by laboratory abnormalities delineated in Appendix IV.
Use of herbal medications, nutritional supplements or other unapproved drugs or investigational medicinal products being used or studied for the treatment of ALS.
Unwilling to forgo initiating the use of any new supplements during participation in the study.
Enrolled in an investigational drug trial within 30 days of baseline visit
Prior stem cell therapy for a neurological disease
Kokmen Short Test of Mental Status score <32
Presence of a tracheostomy
Ventilator dependent
Pregnancy
Men or women of childbearing potential who are unwilling to employ adequate contraception
Chronic low back pain requiring invasive procedures (i.e. epidural injections or lumbar spine surgery)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nathan P Staff, MD, PhD
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Anthony J Windebank, MD
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic
City
Scottsdale
State/Province
Arizona
ZIP/Postal Code
85259
Country
United States
Facility Name
Mayo Clinic
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Facility Name
Mayo Clinic in Rochester
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Links:
URL
https://www.mayo.edu/research/clinical-trials
Description
Mayo Clinic Clinical Trials
Learn more about this trial
Intrathecal Autologous Adipose-derived Mesenchymal Stromal Cells for Amyotrophic Lateral Sclerosis (ALS)
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