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Mechanisms of Interferon Gamma-primed Mesenchymal Stromal Cells (MSCs) for Moderate-to-severe Persistent Asthma

Primary Purpose

Asthma

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Albuterol Sulfate
Interferon gamma-primed mesenchymal stromal cells (MSCs)
Prednisone
Sponsored by
Emory University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Asthma focused on measuring Asthma

Eligibility Criteria

18 Years - 30 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age 18 through 30 years at the screening visit
  • Physician diagnosis of asthma
  • Onset of asthma during childhood
  • Evidence of atopy, evidenced by allergic rhinitis, aeroallergen sensitization, elevated total immunoglobulin E (IgE) level based on age-dependent reference values, or blood eosinophil counts > or = 150 cells/microliter
  • Moderate-to-severe persistent asthma as defined by the National Asthma Education and Prevention Program Expert Panel Report-4

Exclusion criteria at the screening visit include any of the following (*may be re-enrolled):

  • A Panel Reactive Antibodies (PRA) test is positive for human leukocyte antigens (HLA) antibodies against the γMSC product
  • Oral or injectable corticosteroid use within the two-week period prior to the screening visit.* Nasal corticosteroids may be used at any time during this trial at the discretion of the study's Medical Principal Investigator.
  • Use of medications known to significantly interact with corticosteroid disposition within the two-week period prior to the screening visit, including but not limited to carbamazepine, erythromycin or other macrolide antibiotics, phenobarbital, phenytoin, rifampin, and ketoconazole*
  • Presence of chronic or active lung disease other than asthma, including disorders of the airways or chest wall
  • Current smoking or vaping
  • History of premature birth before 35 weeks gestation
  • Significant medical illness other than asthma, including thyroid disease, diabetes mellitus, sickle cell disease, Cushing's disease, Addison's disease, hepatic disease, immune deficiency, or concurrent medical problems that could require oral corticosteroids during the study or that would place the subject at increased risk of participating in the study
  • A history of cataracts, glaucoma, or any other medical disorder associated with an adverse effect to corticosteroids
  • History of adverse reactions to corticosteroids or short-acting bronchodilators or any of their ingredients
  • Receiving allergen immunotherapy other than an established maintenance regimen (continuous regimen for ≥ 3 months)*
  • Pregnancy or lactation
  • If the participant is a female, failure to practice abstinence or use of an acceptable birth control method
  • Inability to perform study procedures
  • Current participation in another investigational drug trial
  • Evidence that the participant may be unreliable or nonadherent, or may move from the clinical center area before trial completion

Exclusion criteria at the randomization/infusion visit include any of the following:

  • Clinically significant deterioration in the level of asthma control, evidenced by:

    • Decrease in post-bronchodilator forced expiratory volume in one second (FEV1) of 15% (absolute change) compared to the post-bronchodilator FEV1 value obtained at the baseline visit, or
    • An asthma exacerbation
  • Clinically significant thrombocytopenia, anemia, neutropenia or elevations in the white blood cell count, assessed at the screening visit
  • Positive pregnancy test

The investigators will also ask participants to refrain from receiving new asthma therapies such as biologics until the final safety determination is made 7 days after the γMSC infusion (at study Day 14). They will also ask participants to refrain from participating in other interventional drug studies for the duration of their participation.

Sites / Locations

  • Children's Healthcare of AtlantaRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Infusion of γMSCs

Arm Description

Escalating doses Dose escalation design with two dose levels. The low dose level involves a single intravenous infusion of γMSCs at 2x106 cells/kg. The high dose level involves a single intravenous infusion of γMSCs at 5x106 cells/kg.

Outcomes

Primary Outcome Measures

Change in number of adverse events and severe adverse events post-intervention
This outcome will measure safety of allogeneic cord tissue derived MSCs and allogeneic interferon-γ primed bone marrow derived MSCs. Assessments will be made by physical examination and further investigation as indicated. Events will be classified according to the NIH Clinical Toxicity Criteria for Adverse Events (CTCAE), version 5. All recorded adverse events and serious adverse events will be documented and recorded. Their attribution to the γMSC product will be determined. Adverse events that may be attributable to the study product include dyspnea, cough, wheezing, respiratory failure, allergic reaction, anaphylaxis, and infusion-related reaction.
Number of grade ≥3 adverse reaction attributable to the γMSC product
This outcome will measure toxicity. Toxicity is defined as any grade ≥3 adverse reaction and attributable to the γMSC product (attribution listed as at least probable), occurring from MSC infusion (at study day 7) through 7 days post-infusion (study day 14). Toxicity is considered unacceptable.

Secondary Outcome Measures

Change in lung function test
Change in lung function test and asthma characterization will determine the clinical impact of MSC therapy
In- vivo trafficking of MSCs after intravenous infusion
In vivo trafficking of MSCs after intravenous infusion
Upper airway inflammation of MSC treatment
Upper airway inflammation will be determined by analysis of small molecule inflammatory constituents in exhaled breath condensate.
Circulating inflammatory cells of MSC treatment
Circulating cell inflammation will be determined by flow cytometric analysis of peripheral blood cells and AbSeq analysis of peripheral blood cells.
Biophysical characteristics of the cell products and correlation with clinical outcome
Characteristics of the γMSCs will be determined by comprehensive analysis at the Marcus Center for Therapeutic Cell Characterization and Manufacturing (MC3M)

Full Information

First Posted
September 3, 2021
Last Updated
August 23, 2023
Sponsor
Emory University
Collaborators
The Marcus Foundation, Ossium Health, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05035862
Brief Title
Mechanisms of Interferon Gamma-primed Mesenchymal Stromal Cells (MSCs) for Moderate-to-severe Persistent Asthma
Official Title
A Phase 1 Study to Evaluate Safety, Toxicity, and Potential Mechanisms of Interferon Gamma-primed Mesenchymal Stromal Cells (MSCs) for Moderate-to-severe Persistent Asthma
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 16, 2022 (Actual)
Primary Completion Date
July 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Emory University
Collaborators
The Marcus Foundation, Ossium Health, Inc.

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
This study is a two strata, dose escalation Phase I clinical trial designed to assess the safety and determine the maximal tolerated dose (MTD) of allogenic cord tissue derived MSCs (cMSCs, stratum 1) and allogeneic, interferon-γ primed bone marrow MSCs (γMSCs, stratum 2). Each stratum is designed to independently accrue 3 children at a dose level 1 of 2x106 cells/kg and 6 children at dose level 2 of 10x106 cells/kg, resulting in 9 children in each stratum. The primary objectives are to determine the safety and toxicity of allogeneic cord tissue derived MSCs and allogeneic interferon-γ primed bone marrow derived MSCs.
Detailed Description
Asthma affects one out of every 10 patients in the United States. Many of these patients have poor asthma symptom control. For example, patients with moderate-to-severe persistent asthma have ongoing symptoms and airway inflammation despite aggressive treatment with asthma medications. These patients are at increased risk for medication-related side effects and potentially life-threatening exacerbations. Novel therapies are critically needed for this population. Mesenchymal stem cells (MSCs) are cells that reside in the bone marrow. MSCs are anti-inflammatory and also promote body tissue repair. This study will determine whether one form of MSCs called "interferon gamma-primed MSCs or γMSCs" are safe for patients with moderate-to-severe asthma. Patients will receive a single intravenous infusion of γMSCs at either 2x10^6 cells/kg or 5x10^6 cells/kg. Up to 12 young adults will be enrolled. The total sample size will not exceed 24 participants. The study will take place at Children's Healthcare of Atlanta (for patient activities) and at Emory University (for laboratory research activities). Participants will be identified from the asthma clinics at Children's Healthcare of Atlanta. Participants will complete up to 12 visits over 1 year and will be compensated for their time and travel. At the completion of the study, any samples remaining after experimentation will be de-identified and made available for future research. While some study participants may receive no direct benefit from participating in this study, others may benefit from the close monitoring of their respiratory health, specialized asthma education, and general evaluation of their condition, including lung function tests. Some participants also achieve psychological benefit from participating in an important research study and from interaction with the study staff. It is also possible that the knowledge obtained from this study, such as identification of biomarkers, may assist in the creation of novel asthma therapies in the future.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Asthma
Keywords
Asthma

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Infusion of γMSCs
Arm Type
Experimental
Arm Description
Escalating doses Dose escalation design with two dose levels. The low dose level involves a single intravenous infusion of γMSCs at 2x106 cells/kg. The high dose level involves a single intravenous infusion of γMSCs at 5x106 cells/kg.
Intervention Type
Drug
Intervention Name(s)
Albuterol Sulfate
Intervention Description
Participants who experience symptoms of cough, dyspnea, chest tightness or wheezing will initiate use of albuterol (2 inhalations, 90 mcg/actuation) by metered dose inhaler (MDI) every 20 minutes for up to 1 hour and then every 4 hours if necessary.
Intervention Type
Drug
Intervention Name(s)
Interferon gamma-primed mesenchymal stromal cells (MSCs)
Other Intervention Name(s)
Interferon gamma (IFNγ)-primed human bone marrow-derived mesenchymal stromal cells
Intervention Description
IFNγ-primed bone marrow MSCs at a dose level of 2x106 cells/kg and a dose level of 5x106 cells/kg
Intervention Type
Drug
Intervention Name(s)
Prednisone
Intervention Description
Prednisone is recommended if the participant uses more than 12 inhalations of albuterol in 24 hours (excluding preventive use before exercise), or if the patient has ongoing symptoms for 48 hours or longer. The recommended prednisone dose for acute exacerbations is 2 mg/kg/day (maximum 60 mg) as a single dose for two days followed by 1 mg/kg/day (maximum 30 mg) as a single dose for two days. All administered doses will be rounded down to the nearest 10 mg.
Primary Outcome Measure Information:
Title
Change in number of adverse events and severe adverse events post-intervention
Description
This outcome will measure safety of allogeneic cord tissue derived MSCs and allogeneic interferon-γ primed bone marrow derived MSCs. Assessments will be made by physical examination and further investigation as indicated. Events will be classified according to the NIH Clinical Toxicity Criteria for Adverse Events (CTCAE), version 5. All recorded adverse events and serious adverse events will be documented and recorded. Their attribution to the γMSC product will be determined. Adverse events that may be attributable to the study product include dyspnea, cough, wheezing, respiratory failure, allergic reaction, anaphylaxis, and infusion-related reaction.
Time Frame
During the infusion, during the observation interval after the infusion (2 hours postinfusion), one day after the infusion, and at 7 to 30 days after the infusion (study day 14 to 37)
Title
Number of grade ≥3 adverse reaction attributable to the γMSC product
Description
This outcome will measure toxicity. Toxicity is defined as any grade ≥3 adverse reaction and attributable to the γMSC product (attribution listed as at least probable), occurring from MSC infusion (at study day 7) through 7 days post-infusion (study day 14). Toxicity is considered unacceptable.
Time Frame
7 to 30 days post-infusion (study day 14 to 37)
Secondary Outcome Measure Information:
Title
Change in lung function test
Description
Change in lung function test and asthma characterization will determine the clinical impact of MSC therapy
Time Frame
Baseline, 7 to 30 days post-infusion (study day 14 to 37)
Title
In- vivo trafficking of MSCs after intravenous infusion
Description
In vivo trafficking of MSCs after intravenous infusion
Time Frame
7 to 30 days post-infusion (study day 14 to 37)
Title
Upper airway inflammation of MSC treatment
Description
Upper airway inflammation will be determined by analysis of small molecule inflammatory constituents in exhaled breath condensate.
Time Frame
7 to 30 days post-infusion (study day 14 to 37)
Title
Circulating inflammatory cells of MSC treatment
Description
Circulating cell inflammation will be determined by flow cytometric analysis of peripheral blood cells and AbSeq analysis of peripheral blood cells.
Time Frame
7 to 30 days post-infusion (study day 14 to 37)
Title
Biophysical characteristics of the cell products and correlation with clinical outcome
Description
Characteristics of the γMSCs will be determined by comprehensive analysis at the Marcus Center for Therapeutic Cell Characterization and Manufacturing (MC3M)
Time Frame
7 to 30 days post-infusion (study day 14 to 37)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 through 30 years at the screening visit Physician diagnosis of asthma Onset of asthma during childhood Evidence of atopy, evidenced by allergic rhinitis, aeroallergen sensitization, elevated total immunoglobulin E (IgE) level based on age-dependent reference values, or blood eosinophil counts > or = 150 cells/microliter Moderate-to-severe persistent asthma as defined by the National Asthma Education and Prevention Program Expert Panel Report-4 Exclusion criteria at the screening visit include any of the following (*may be re-enrolled): A Panel Reactive Antibodies (PRA) test is positive for human leukocyte antigens (HLA) antibodies against the γMSC product Oral or injectable corticosteroid use within the two-week period prior to the screening visit.* Nasal corticosteroids may be used at any time during this trial at the discretion of the study's Medical Principal Investigator. Use of medications known to significantly interact with corticosteroid disposition within the two-week period prior to the screening visit, including but not limited to carbamazepine, erythromycin or other macrolide antibiotics, phenobarbital, phenytoin, rifampin, and ketoconazole* Presence of chronic or active lung disease other than asthma, including disorders of the airways or chest wall Current smoking or vaping History of premature birth before 35 weeks gestation Significant medical illness other than asthma, including thyroid disease, diabetes mellitus, sickle cell disease, Cushing's disease, Addison's disease, hepatic disease, immune deficiency, or concurrent medical problems that could require oral corticosteroids during the study or that would place the subject at increased risk of participating in the study A history of cataracts, glaucoma, or any other medical disorder associated with an adverse effect to corticosteroids History of adverse reactions to corticosteroids or short-acting bronchodilators or any of their ingredients Receiving allergen immunotherapy other than an established maintenance regimen (continuous regimen for ≥ 3 months)* Pregnancy or lactation If the participant is a female, failure to practice abstinence or use of an acceptable birth control method Inability to perform study procedures Current participation in another investigational drug trial Evidence that the participant may be unreliable or nonadherent, or may move from the clinical center area before trial completion Exclusion criteria at the randomization/infusion visit include any of the following: Clinically significant deterioration in the level of asthma control, evidenced by: Decrease in post-bronchodilator forced expiratory volume in one second (FEV1) of 15% (absolute change) compared to the post-bronchodilator FEV1 value obtained at the baseline visit, or An asthma exacerbation Clinically significant thrombocytopenia, anemia, neutropenia or elevations in the white blood cell count, assessed at the screening visit Positive pregnancy test The investigators will also ask participants to refrain from receiving new asthma therapies such as biologics until the final safety determination is made 7 days after the γMSC infusion (at study Day 14). They will also ask participants to refrain from participating in other interventional drug studies for the duration of their participation.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Anne Fitzpatrick, PhD
Phone
404-727-9112
Email
anne.fitzpatrick@emory.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Edwin Horwitz, MD
Organizational Affiliation
Emory University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Healthcare of Atlanta
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Anne Fitzpatrick, PhD
Phone
404-727-9112
Email
anne.fitzpatrick@emory.edu

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Individual de-identified participant data will be shared and will be made available
IPD Sharing Time Frame
12 months after publication of the primary outcome manuscript.
IPD Sharing Access Criteria
Access will be limited to scientific investigators who wish to perform a secondary analysis of the data. These investigators must provide a written request and data analysis protocol for review by the Principal Investigator.

Learn more about this trial

Mechanisms of Interferon Gamma-primed Mesenchymal Stromal Cells (MSCs) for Moderate-to-severe Persistent Asthma

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