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Mesenchymal Stromal Cells to Treat Type 1 Diabetes in Children and Adolescents

Primary Purpose

Type1diabetes

Status
Recruiting
Phase
Phase 1
Locations
Sweden
Study Type
Interventional
Intervention
the ATMP Protrans
Sponsored by
Uppsala University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type1diabetes

Eligibility Criteria

7 Years - 21 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Written informed consent for participation of the study (for subjects below 18 years of age also from both caregivers), given before undergoing any study-specific procedures
  2. Clinical history compatible with type 1 diabetes diagnosed less than 6 months before enrolment
  3. In the first part of the study, six subjects, three between 7-11 and three between 12-18 years of age (both groups inclusive at both ends), will be included. The sixty subjects in the second part of the study are stratified by age (12-21 and 7-11 years, respectively) and randomized to one of two treatment arms (active or placebo), with a 6-month safety delay for the younger stratum.
  4. Mentally stable and, in the opinion of the investigator, able to comply with the procedures of the study protocol.
  5. Fasting plasma C-peptide concentration >0.12 nmol/L.
  6. Subjects of child-bearing potential must agree to using adequate contraception until one year after the administration of WJMSC/Placebo. Adequate contraception is as follows:

    1. oral (except low-dose gestagen (lynestrenol and noretisteron), injectable or implanted hormonal contraceptives.
    2. intrauterine device
    3. intrauterine system (for example progestin-releasing coil)
    4. vasectomized male (with appropriate postvasectomy documentation of the absence of sperm in the ejaculate)

Exclusion Criteria:

  1. Subjects with body weight >100 kg
  2. Subjects with unstable cardiovascular status incl. NYHA class III/IV or symptoms of angina pectoris.
  3. Subjects with uncontrolled hypertension (≥160/105 mmHg).
  4. Subjects with active on-going infections.
  5. Subjects with latent or previous as well as on-going therapy against tuberculosis, or exposed to tuberculosis or has traveled in areas with a high risk of tuberculosis or mycosis within the last 3 months.
  6. Subjects with serological evidence of infection with HIV, Treponema pallidum, hepatitis B antigen (subjects with serology consistent with previous vaccination and a history of vaccination are acceptable), or hepatitis C.
  7. Subjects with any systemic immune suppressive treatment
  8. Subjects with a known demyelinating disease or with symptoms or physical examination findings consistent with possible demyelinating disease.
  9. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test.
  10. Subjects with known, or previous, malignancy.
  11. Taking oral anti-diabetic therapies or any other concomitant medication which may interfere with glucose regulation other than insulin.
  12. Subjects with GFR <60 ml/min/1.73 m2 body surface.
  13. Subject with any condition or any circumstance that, in the opinion of the investigator, would make it unsafe to undergo treatment with MSC.
  14. Known hypersensitivity against any excipients, i.e., dimethyl sulfoxide (DMSO).

Sites / Locations

  • Uppsala University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Wharton's jelly derived mesenchymal stromal cells (Protrans)

Placebo

Arm Description

Cells are dissolved in saline and given intravenously over a period of 20-40 min. 100 million cells to subjects < 50 kg and 200 million cells to subjects 50-100 kg (>100 kg is an exclusion criterion).

Placebo (saline) is given intravenously over a period of 20-40 min.

Outcomes

Primary Outcome Measures

Safety at one year evaluated as adverse events
Safety parameters will be evaluated at each study visit and recorded as adverse events.
Safety at five years evaluated as adverse events
Safety parameters will be evaluated at each study visit and recorded as adverse events.
Efficacy measured as change in C-peptide Area under the curve to a mixed mealtolerance test.
Change in C-peptide Area under the curve (AUC) (0-120 min) for mixed meal tolerance test (MMTT) at 12 months following Protrans/Placebo infusion when compared to test performed before the start of treatment (baseline).

Secondary Outcome Measures

Insulin independency
The proportion of study participants independent of insulin at 6 months
Insulin independency
The proportion of study participants independent of insulin at 12 months
Low insulin needs
The proportion of study participants with daily insulin needs <0.25 U/kg at 6 months
Low insulin needs
The proportion of study participants with daily insulin needs <0.25 U/kg at 12 months
Insulin needs
Insulin requirement/kg body weigh at 6 months
Insulin needs
Insulin requirement/kg body weigh at 12 months
HbA1c
HbA1c at 6 months
HbA1c
HbA1c at 12 months
Time in target
Time in target (4-8 mmol/l) as measured by flash glucose monitoring for 14 days at 6 months
Time in target
Time in target (4-8 mmol/l) as measured by flash glucose monitoring for 14 days at 12 months
Time in range
Time in target (3.9-10 mmol/l) as measured by flash glucose monitoring for 14 days at 6 months
Time in range
Time in target (3.9-10 mmol/l) as measured by flash glucose monitoring for 14 days at 12 months
C-peptide
Change in C-peptide Area under the curve (AUC) (0-120 min) for mixed meal tolerance test (MMTT) at 6 months following Protrans/Placebo infusion when compared to test performed before the start of treatment (baseline).
Change in peak C-peptide
Change in peak C-peptide concentration during the first 6 months
Change in peak C-peptide
Change in peak C-peptide concentration during the first 12 months

Full Information

First Posted
September 20, 2021
Last Updated
May 16, 2022
Sponsor
Uppsala University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05061030
Brief Title
Mesenchymal Stromal Cells to Treat Type 1 Diabetes in Children and Adolescents
Official Title
A Double-blinded, Randomized, Parallel, Placebo-controlled Trial of Wharton's Jelly-derived Allogeneic Mesenchymal Stromal Cells to Treat Type 1 Diabetes in Children and Adolescents
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
January 14, 2022 (Actual)
Primary Completion Date
September 2028 (Anticipated)
Study Completion Date
December 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Uppsala University Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a combined phase 1 and 2 study in 66 subjects, male or female, between 7-21 years of age that have recently (< 6 months) been diagnosed with type 1 diabetes. The first phase 1 part of the study includes six subjects openly receiving allogeneic Wharton's jelly derived mesenchymal stromal cells as the Advanced Therapy Medicinal Product (ATMP) Protrans, three each in the age ranges 7-11 and 12-18.The second part is a randomized, double-blinded placebo-controlled phase 2 study in parallel design comparing allogeneic Wharton's jelly derived mesenchymal stromal cells treatment (as Protrans) to placebo in children and adolescent subjects (7-21 years of age) diagnosed with type 1 diabetes, The primary objectives of this study will be to investigate the safety, tolerance and efficacy after an allogieneic infusion of Wharton's jelly derived mesenchymal stromal cells.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type1diabetes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
66 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Wharton's jelly derived mesenchymal stromal cells (Protrans)
Arm Type
Active Comparator
Arm Description
Cells are dissolved in saline and given intravenously over a period of 20-40 min. 100 million cells to subjects < 50 kg and 200 million cells to subjects 50-100 kg (>100 kg is an exclusion criterion).
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo (saline) is given intravenously over a period of 20-40 min.
Intervention Type
Biological
Intervention Name(s)
the ATMP Protrans
Intervention Description
Protrans consists of Wharton's jelly derived mesenchymal stromal cells
Primary Outcome Measure Information:
Title
Safety at one year evaluated as adverse events
Description
Safety parameters will be evaluated at each study visit and recorded as adverse events.
Time Frame
One year
Title
Safety at five years evaluated as adverse events
Description
Safety parameters will be evaluated at each study visit and recorded as adverse events.
Time Frame
Five years
Title
Efficacy measured as change in C-peptide Area under the curve to a mixed mealtolerance test.
Description
Change in C-peptide Area under the curve (AUC) (0-120 min) for mixed meal tolerance test (MMTT) at 12 months following Protrans/Placebo infusion when compared to test performed before the start of treatment (baseline).
Time Frame
One year
Secondary Outcome Measure Information:
Title
Insulin independency
Description
The proportion of study participants independent of insulin at 6 months
Time Frame
One year
Title
Insulin independency
Description
The proportion of study participants independent of insulin at 12 months
Time Frame
One year
Title
Low insulin needs
Description
The proportion of study participants with daily insulin needs <0.25 U/kg at 6 months
Time Frame
6 months
Title
Low insulin needs
Description
The proportion of study participants with daily insulin needs <0.25 U/kg at 12 months
Time Frame
12 months
Title
Insulin needs
Description
Insulin requirement/kg body weigh at 6 months
Time Frame
6 months
Title
Insulin needs
Description
Insulin requirement/kg body weigh at 12 months
Time Frame
12 months
Title
HbA1c
Description
HbA1c at 6 months
Time Frame
6 months
Title
HbA1c
Description
HbA1c at 12 months
Time Frame
12 months
Title
Time in target
Description
Time in target (4-8 mmol/l) as measured by flash glucose monitoring for 14 days at 6 months
Time Frame
6 months
Title
Time in target
Description
Time in target (4-8 mmol/l) as measured by flash glucose monitoring for 14 days at 12 months
Time Frame
12 months
Title
Time in range
Description
Time in target (3.9-10 mmol/l) as measured by flash glucose monitoring for 14 days at 6 months
Time Frame
6 months
Title
Time in range
Description
Time in target (3.9-10 mmol/l) as measured by flash glucose monitoring for 14 days at 12 months
Time Frame
12 months
Title
C-peptide
Description
Change in C-peptide Area under the curve (AUC) (0-120 min) for mixed meal tolerance test (MMTT) at 6 months following Protrans/Placebo infusion when compared to test performed before the start of treatment (baseline).
Time Frame
6 months
Title
Change in peak C-peptide
Description
Change in peak C-peptide concentration during the first 6 months
Time Frame
6 months
Title
Change in peak C-peptide
Description
Change in peak C-peptide concentration during the first 12 months
Time Frame
12 months
Other Pre-specified Outcome Measures:
Title
Gender differences
Description
Differences in parameters of primary and secondary endpoints between genders
Time Frame
6 months
Title
Gender differences
Description
Differences in parameters of primary and secondary endpoints between genders
Time Frame
12 months
Title
HLA class 1 genotypes
Description
Differences in parameters of primary and secondary endpoints between HLA class 1 genotypes
Time Frame
6 months
Title
HLA class 1 genotypes
Description
Differences in parameters of primary and secondary endpoints between HLA class 1 genotypes
Time Frame
12 months
Title
age
Description
Differences in parameters of primary and secondary endpoints between ages 7-11 and 12-21
Time Frame
6 months
Title
age
Description
Differences in parameters of primary and secondary endpoints between ages 7-11 and 12-21
Time Frame
12 months
Title
Autoantibodies
Description
Change of levels of diabetes-related autoantibodies when compared to test before the start of treatment (baseline)
Time Frame
6 months
Title
Autoantibodies
Description
Change of levels of diabetes-related autoantibodies when compared to test before the start of treatment (baseline)
Time Frame
12 months
Title
Peripheral blood mononuclear cells
Description
Change in reactivity and cytokine production of peripheral blood mononuclear cells when compared to test before the start of treatment (baseline)
Time Frame
6 months
Title
Peripheral blood mononuclear cells
Description
Change in reactivity and cytokine production of peripheral blood mononuclear cells when compared to test before the start of treatment (baseline)
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
7 Years
Maximum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent for participation of the study (for subjects below 18 years of age also from both caregivers), given before undergoing any study-specific procedures Clinical history compatible with type 1 diabetes diagnosed less than 6 months before enrolment In the first part of the study, six subjects, three between 7-11 and three between 12-18 years of age (both groups inclusive at both ends), will be included. The sixty subjects in the second part of the study are stratified by age (12-21 and 7-11 years, respectively) and randomized to one of two treatment arms (active or placebo), with a 6-month safety delay for the younger stratum. Mentally stable and, in the opinion of the investigator, able to comply with the procedures of the study protocol. Fasting plasma C-peptide concentration >0.12 nmol/L. Subjects of child-bearing potential must agree to using adequate contraception until one year after the administration of WJMSC/Placebo. Adequate contraception is as follows: oral (except low-dose gestagen (lynestrenol and noretisteron), injectable or implanted hormonal contraceptives. intrauterine device intrauterine system (for example progestin-releasing coil) vasectomized male (with appropriate postvasectomy documentation of the absence of sperm in the ejaculate) Exclusion Criteria: Subjects with body weight >100 kg Subjects with unstable cardiovascular status incl. NYHA class III/IV or symptoms of angina pectoris. Subjects with uncontrolled hypertension (≥160/105 mmHg). Subjects with active on-going infections. Subjects with latent or previous as well as on-going therapy against tuberculosis, or exposed to tuberculosis or has traveled in areas with a high risk of tuberculosis or mycosis within the last 3 months. Subjects with serological evidence of infection with HIV, Treponema pallidum, hepatitis B antigen (subjects with serology consistent with previous vaccination and a history of vaccination are acceptable), or hepatitis C. Subjects with any systemic immune suppressive treatment Subjects with a known demyelinating disease or with symptoms or physical examination findings consistent with possible demyelinating disease. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test. Subjects with known, or previous, malignancy. Taking oral anti-diabetic therapies or any other concomitant medication which may interfere with glucose regulation other than insulin. Subjects with GFR <60 ml/min/1.73 m2 body surface. Subject with any condition or any circumstance that, in the opinion of the investigator, would make it unsafe to undergo treatment with MSC. Known hypersensitivity against any excipients, i.e., dimethyl sulfoxide (DMSO).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Per-Ola Carlsson, MD, PhD
Phone
+46186110000
Email
per-ola.carlsson@mcb.uu.se
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Per-Ola Carlsson, MD, PhD
Organizational Affiliation
Uppsala University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Uppsala University Hospital
City
Uppsala
ZIP/Postal Code
75185
Country
Sweden
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Per-Ola Carlsson, MD, PhD
Phone
+46186110000
Email
per-ola.carlsson@mcb.uu.se

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Mesenchymal Stromal Cells to Treat Type 1 Diabetes in Children and Adolescents

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