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Safety and Efficacy of Adipose Derived Stem Cells in Refractory Rheumatoid Arthritis, Systemic Lupus Erythematosus or Sharp's Syndrome

Primary Purpose

Systemic Lupus Erythematosus, Rheumatoid Arthritis, Sharp's Syndrome

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Intravenous injection of Stromal Vascular Fraction Cells (SVF) containing ADSCs
Lipoaspiration
Sponsored by
Arkansas Heart Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Systemic Lupus Erythematosus focused on measuring Type III hypersensitivity autoimmune disease

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Males and Females ≥18 years
  2. Cognitive competitiveness.
  3. Diagnosis of refractory RA (patient's poor response of 3 months of DMARDs determined and documented by a rheumatologist) ,diagnosis of relapsing SLE (more than 2 episodes in a year during optimal medical SLE therapy) or diagnosis of Sharp syndrome (Alarcon-Segovia's criteria: patients with U1 Ribonucleic protein (RNP) ≥ 1:1600, and three of the following: Swollen hands, Synovitis, Myositis, Raynauld's phenomenon, Acrosclerosis)
  4. Life expectancy greater than 8 months
  5. Ability to understand and provide signed informed consent, or have a designated legal guardian or spouse legally able and willing to make such decisions on the subject's behalf
  6. Reasonable expectation that patient will receive standard post-treatment care and attend all scheduled safety follow-up visits
  7. No changes in active pulmonary medications for heart failure during the two weeks prior enrollment.
  8. Written informed consent

Exclusion Criteria:

  1. Currently on systemic steroids (if chronic steroid therapy cannot be stopped, the patient will qualify if he/she is on a minimum maintenance dose per SLE, RA or SS guidelines of only one systemic steroid and constituting a bioequivalent to normal endogenous levels of that hormone).
  2. Dementia.
  3. Presence of immune deficiency.
  4. Currently on NSAIDs, TNFa inhibitors, Calcium channel blockers or P2Y12 inhibitors
  5. Complicated type 2 diabetes mellitus (presence of diabetic foot, advanced kidney disease or retinopathy).
  6. History of cancer within the past 5 years.
  7. Presence of any other clinically-significant medical condition, psychiatric condition, or laboratory abnormality, that in the judgment of the Investigator or Sponsor for which participation in the study would pose a safety risk to the subject
  8. Participation in another study with an investigational drug or device within 3 weeks prior to treatment
  9. History within the past year of drug or alcohol abuse.
  10. Females known to be pregnant, lactating or having a positive pregnancy test (will be tested during screening) or planning to become pregnant during the study.
  11. Inability to comply with the conditions of the protocol.
  12. Porphyria.
  13. Allergy to sodium citrate or any "caine" type of local anesthetic.
  14. Patient scheduled for hospice care.

Sites / Locations

  • Arkansas Heart Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ADSC arm

Arm Description

Single intravenous administration of Stromal Vacsular Fraction (SVF) cells soinating Adipose Derived Stem Cells (ADSC) 6 week baseline data prior to the injection of ADSC will be collected. 6 week, 3 months and 6 months follow up data will be compared against baseline.

Outcomes

Primary Outcome Measures

Frequency of Adverse Events (AE) and Serious Adverse Events (SAE) during a 6 month follow up period.

Secondary Outcome Measures

Quality of Life Questionnaires for SLE/ RA
SLEQoL score
Quality of Life Questionnaires for RA
DAS-28 score
Blood Flow Cytometry for CD4+CD25+Foxp3+ regulatory T cells
CD4+CD25+Foxp3+ regulatory T cells,
Blood Flow Cytometry for CD3+CD8-IL17A+TH17 cells
CD3+CD8-IL17A+TH17 cells
Serum C- reactive protein (CRP)
C- reactive protein (CRP)
Erythrocyte Sedimentation Rate (ESR)
Erythrocyte Sedimentation Rate (ESR)
Serum Tumor Necrosis Factor- alpha (TNFa)
Tumor Necrosis Factor- alpha (TNFa)
Serum Transforming Growth Factor- beta (TGFb)
Transforming Growth Factor- beta (TGFb)
Serum Interleukin- 6 (IL-6)
Interleukin- 6 (IL-6)
Serum Interleukin- 17 (IL-17)
Interleukin- 17 (IL-17)

Full Information

First Posted
April 6, 2016
Last Updated
March 2, 2017
Sponsor
Arkansas Heart Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02741362
Brief Title
Safety and Efficacy of Adipose Derived Stem Cells in Refractory Rheumatoid Arthritis, Systemic Lupus Erythematosus or Sharp's Syndrome
Official Title
A Phase I-II Open- Label Study to Assess the Safety, Tolerability, and Preliminary Efficacy of a Single Intravenous Dose of Autologous Adipose Stem Cell (Adult Human) to Subjects With Refractory Rheumatoid Arthritis, Relapsing Systemic Lupus Erythematosus or Sharp's Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Terminated
Why Stopped
Primary Investigator no longer with institution
Study Start Date
December 2015 (undefined)
Primary Completion Date
December 31, 2016 (Actual)
Study Completion Date
December 31, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Arkansas Heart Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a Phase I-II open- label single-dose study in subjects with significant refractory Rheumatoid Arthritis (RA), relapsing Systemic Lupus Erythematosus (SLE) or Sharp's Syndrome (SS). This study will enroll a minimum of 20 subjects for RA, 20 subjects for SLE and 20 patients for SS. 6 week data of serum Tumor Necrosis Factor- alpha (TNFa), Interleukin- 6 (IL-6), C- Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Cluster of Differentiation (CD)4 +CD25 + Forkhead box P3(Foxp3) + regulatory T cells, Disease Activity Score for 28 joints (DAS-28) score and pain score will be collected in all patients who are enrolled in the study for the RA group (Baseline and 6 weeks after). For the SLE group, Transforming Growth Factor- beta (TGF-β), TNFa, IL-6, Interleukin- 17 (IL-17), CD3+CD8-IL17A+ T helper-17 (Th17) cells, CD4+CD25+Foxp3+ regulatory T cells and the Systemic Lupus Erythematosus Quality of Life Questionnaire (SLEQoL) score will be collected in all the subjects of this group. SS group will undergo the assessments of RA and SLE. Prior to the stem cell treatment, the patient will be assessed for 6 weeks by all the previously mentioned markers. Then, patients will receive the infusion of stromal vascular fraction cells containing the adult adipose derived stem cells 'aADSC' (single intravenous dose). The disease- modifying anti-rheumatic drugs (DMARDs) or the standard SLE treatment will not be interrupted with the exception of systemic steroids (excluding minimal maintenance dose of one steroid) during the duration of the study. Follow up visits will take place at 6 weeks, 3 Months and 6 Months after the cell infusion. Safety will be monitored on an ongoing basis, and an interim safety review will be conducted by the Investigator(s) and Sponsor after the first 10 patients have been enrolled and treated in each group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Systemic Lupus Erythematosus, Rheumatoid Arthritis, Sharp's Syndrome
Keywords
Type III hypersensitivity autoimmune disease

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
ADSC arm
Arm Type
Experimental
Arm Description
Single intravenous administration of Stromal Vacsular Fraction (SVF) cells soinating Adipose Derived Stem Cells (ADSC) 6 week baseline data prior to the injection of ADSC will be collected. 6 week, 3 months and 6 months follow up data will be compared against baseline.
Intervention Type
Other
Intervention Name(s)
Intravenous injection of Stromal Vascular Fraction Cells (SVF) containing ADSCs
Other Intervention Name(s)
Tissue transplant
Intervention Type
Other
Intervention Name(s)
Lipoaspiration
Primary Outcome Measure Information:
Title
Frequency of Adverse Events (AE) and Serious Adverse Events (SAE) during a 6 month follow up period.
Time Frame
6 Months
Secondary Outcome Measure Information:
Title
Quality of Life Questionnaires for SLE/ RA
Description
SLEQoL score
Time Frame
6 Months
Title
Quality of Life Questionnaires for RA
Description
DAS-28 score
Time Frame
6 Months
Title
Blood Flow Cytometry for CD4+CD25+Foxp3+ regulatory T cells
Description
CD4+CD25+Foxp3+ regulatory T cells,
Time Frame
6 Months
Title
Blood Flow Cytometry for CD3+CD8-IL17A+TH17 cells
Description
CD3+CD8-IL17A+TH17 cells
Time Frame
6 Months
Title
Serum C- reactive protein (CRP)
Description
C- reactive protein (CRP)
Time Frame
6 Months
Title
Erythrocyte Sedimentation Rate (ESR)
Description
Erythrocyte Sedimentation Rate (ESR)
Time Frame
6 Months
Title
Serum Tumor Necrosis Factor- alpha (TNFa)
Description
Tumor Necrosis Factor- alpha (TNFa)
Time Frame
6 Months
Title
Serum Transforming Growth Factor- beta (TGFb)
Description
Transforming Growth Factor- beta (TGFb)
Time Frame
6 Months
Title
Serum Interleukin- 6 (IL-6)
Description
Interleukin- 6 (IL-6)
Time Frame
6 Months
Title
Serum Interleukin- 17 (IL-17)
Description
Interleukin- 17 (IL-17)
Time Frame
6 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and Females ≥18 years Cognitive competitiveness. Diagnosis of refractory RA (patient's poor response of 3 months of DMARDs determined and documented by a rheumatologist) ,diagnosis of relapsing SLE (more than 2 episodes in a year during optimal medical SLE therapy) or diagnosis of Sharp syndrome (Alarcon-Segovia's criteria: patients with U1 Ribonucleic protein (RNP) ≥ 1:1600, and three of the following: Swollen hands, Synovitis, Myositis, Raynauld's phenomenon, Acrosclerosis) Life expectancy greater than 8 months Ability to understand and provide signed informed consent, or have a designated legal guardian or spouse legally able and willing to make such decisions on the subject's behalf Reasonable expectation that patient will receive standard post-treatment care and attend all scheduled safety follow-up visits No changes in active pulmonary medications for heart failure during the two weeks prior enrollment. Written informed consent Exclusion Criteria: Currently on systemic steroids (if chronic steroid therapy cannot be stopped, the patient will qualify if he/she is on a minimum maintenance dose per SLE, RA or SS guidelines of only one systemic steroid and constituting a bioequivalent to normal endogenous levels of that hormone). Dementia. Presence of immune deficiency. Currently on NSAIDs, TNFa inhibitors, Calcium channel blockers or P2Y12 inhibitors Complicated type 2 diabetes mellitus (presence of diabetic foot, advanced kidney disease or retinopathy). History of cancer within the past 5 years. Presence of any other clinically-significant medical condition, psychiatric condition, or laboratory abnormality, that in the judgment of the Investigator or Sponsor for which participation in the study would pose a safety risk to the subject Participation in another study with an investigational drug or device within 3 weeks prior to treatment History within the past year of drug or alcohol abuse. Females known to be pregnant, lactating or having a positive pregnancy test (will be tested during screening) or planning to become pregnant during the study. Inability to comply with the conditions of the protocol. Porphyria. Allergy to sodium citrate or any "caine" type of local anesthetic. Patient scheduled for hospice care.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gerardo Rodriguez, MD PhD
Organizational Affiliation
Arkansas Heart Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Arkansas Heart Hospital
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
26435067
Citation
Wang D, Huang S, Yuan X, Liang J, Xu R, Yao G, Feng X, Sun L. The regulation of the Treg/Th17 balance by mesenchymal stem cells in human systemic lupus erythematosus. Cell Mol Immunol. 2017 May;14(5):423-431. doi: 10.1038/cmi.2015.89. Epub 2015 Oct 5.
Results Reference
background
PubMed Identifier
4621694
Citation
Sharp GC, Irvin WS, Tan EM, Gould RG, Holman HR. Mixed connective tissue disease--an apparently distinct rheumatic disease syndrome associated with a specific antibody to an extractable nuclear antigen (ENA). Am J Med. 1972 Feb;52(2):148-59. doi: 10.1016/0002-9343(72)90064-2. No abstract available.
Results Reference
background
PubMed Identifier
26209923
Citation
Deng W, Chen W, Zhang Z, Huang S, Kong W, Sun Y, Tang X, Yao G, Feng X, Chen W, Sun L. Mesenchymal stem cells promote CD206 expression and phagocytic activity of macrophages through IL-6 in systemic lupus erythematosus. Clin Immunol. 2015 Dec;161(2):209-16. doi: 10.1016/j.clim.2015.07.011. Epub 2015 Jul 22.
Results Reference
background
PubMed Identifier
26538398
Citation
Garimella MG, Kour S, Piprode V, Mittal M, Kumar A, Rani L, Pote ST, Mishra GC, Chattopadhyay N, Wani MR. Adipose-Derived Mesenchymal Stem Cells Prevent Systemic Bone Loss in Collagen-Induced Arthritis. J Immunol. 2015 Dec 1;195(11):5136-48. doi: 10.4049/jimmunol.1500332. Epub 2015 Nov 4.
Results Reference
background
PubMed Identifier
21169196
Citation
Kamata Y, Iwamoto M, Muroi K, Minota S. Repeated local implantation of autologous peripheral blood mononuclear cells for the treatment of ischaemic digits in patients with connective tissue diseases. Rheumatology (Oxford). 2011 May;50(5):906-10. doi: 10.1093/rheumatology/keq389. Epub 2010 Dec 15.
Results Reference
background

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Safety and Efficacy of Adipose Derived Stem Cells in Refractory Rheumatoid Arthritis, Systemic Lupus Erythematosus or Sharp's Syndrome

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