search
Back to results

Safety and Feasibility Study of Autologous Engineered Urethral Constructs for the Treatment of Strictures

Primary Purpose

Urologic Diseases, Male Urogenital Diseases, Urethral Stricture

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Autologous Engineered Urethral Construct
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Urologic Diseases focused on measuring Urethral Stricture

Eligibility Criteria

21 Years - 75 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Stricture of the anterior urethra meeting the following criteria:

    1. History of at least one previously failed attempt at conservative management, at least 6 months prior to study.
    2. Urethral stricture of 10-60 mm in length, as determined by urethrography.
    3. Contains at least 1 strictured segment through which a 16 Fr flexible cystoscope cannot be atraumatically passed.
  2. Patients must be available for all follow-up visits.
  3. Ability to speak English.

Exclusion Criteria:

Any of the following is regarded as a criterion for excluding a subject from the study:

  1. Strictures of the meatus or prostatic urethra; any urethral stricture associated with or suspected to be urethral carcinoma, or strictures due to pelvic distraction injuries. Strictures <10 mm or >60 mm, as determined by urethrography, and criteria for bulbar urethral strictures excluding those with strictures <20 mm and >60 mm, as described by urethrography.
  2. Presence of untreated urinary tract infection.
  3. Presence or prior history of lichen sclerosus et atrophicus (previously termed 'balanitis xerotica obliterans').
  4. Uncontrolled bleeding disorder or patients with a platelet count less than 50,000, hemophilia or patients routinely receiving blood products for bleeding disorders.
  5. Any urological condition that would be likely to require additional urethral instrumentation during the period of investigation, including, but not limited to benign prostatic hyperplasia requiring treatment, use of alpha blockers, active prostate cancer, an unevaluated elevated prostate surface antigen (PSA), bladder cancer, or any recurrent urinary stone formation. Patients with evidence or diagnosis of any coagulation disorder (including concomitant anti-coagulation therapy at enrollment).
  6. Serum creatinine > 2.0 mg/dl or evidence of progressive renal disease.
  7. Patients with abnormal urologic conditions, including vesicoureteral reflux, bladder stones, bladder tumors and renal impairment.
  8. Subjects with an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value >3 times the upper limit of normal.
  9. Subjects with an albumin value <3.0 g/dL.
  10. Subjects with uncontrolled diabetes, unstable cardiac and/or pulmonary disorders.
  11. Subjects with active tuberculosis (TB) requiring treatment in the past 3 years. Subjects with a current positive (≥5 mm induration for high-risk subjects; otherwise ≥10 mm of induration) purified protein derivative (PPD) test are excluded unless they have completed a full course of treatment for latent TB and have a negative chest x-ray film at enrollment.
  12. Subjects known to be colonized with either methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE), or gentamicin-resistant organisms.
  13. Immunocompromised subjects or subjects receiving immunosuppressive agents (inhaled corticosteroids and chronic low-dose corticosteroids [≤0.25 mg/kg prednisone or equivalent per day] are permitted).
  14. Any history of alcohol and/or drug abuse.
  15. Current smoker.
  16. Documented history of, or positive result of HIV, Hepatitis B or C, or any infectious disease. External signs, sequelae, or positive serology of sexually transmitted disease (including HPV). Patients with a history of systemic conditions, including but not limited to HIV, diabetes and chronic liver disease (including Hepatitis B or C), that the Investigator believes may jeopardize the safety of the patient to participate in the study.
  17. Concurrent participation in any other clinical investigation during the period of this investigation. Patients who have been treated with any other investigational drug or participated in any investigational study within 30 days prior to enrollment in this study.
  18. Any current illness that might confound the results of this investigation, including but not limited to bladder atonia, neuropathic/neurogenic bladder, bladder outlet obstruction (other than urethral stricture), sphincteric dysfunction, or spinal cord injury.
  19. Any circumstance in which the investigator deems participation in the study is not in the subject's best interest.
  20. Inability to participate in all necessary study activities due to physical or mental limitations.
  21. Inability or unwillingness to return for all required follow-up visits.
  22. Inability or unwillingness to sign informed consent.
  23. Patients requiring concomitant use of or treatment with immunosuppressive agents.
  24. Patients with neurological disorders (e.g., multiple sclerosis, Parkinson's disease).

Sites / Locations

  • University of California San Francisco
  • Wake Forest Institute for Regenerative Medicine (WFIRM)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Autologous Engineered Urethral Construct

Arm Description

All subjects enrolled will undergo a full-thickness bladder biopsy as an out-patient surgical procedure. Urothelial and Smooth Muscle Cells recovered from the biopsy will be isolated and expanded over the next 4-6 weeks, and then seeded onto a tubular scaffold to create the autologous engineered urethral construct. Subjects will undergo a second surgical procedure to excise the urethral stricture and implant the urethral construct. All subjects will be followed for 3 years for safety and efficacy.

Outcomes

Primary Outcome Measures

Incidence of product-related, biopsy procedure-related, and injection procedure-related adverse events
Rate of adverse events reported for each patient

Secondary Outcome Measures

Effectiveness of urethral construct in repairing urethral stricture
Improvement in peak urinary flow rate defined as Qmax improvement from baseline

Full Information

First Posted
August 3, 2017
Last Updated
September 27, 2023
Sponsor
Wake Forest University Health Sciences
Collaborators
United States Department of Defense
search

1. Study Identification

Unique Protocol Identification Number
NCT03258658
Brief Title
Safety and Feasibility Study of Autologous Engineered Urethral Constructs for the Treatment of Strictures
Official Title
A Phase 1 Pilot Safety and Feasibility Study of Autologous Engineered Urethral
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
November 2023 (Anticipated)
Primary Completion Date
February 2024 (Anticipated)
Study Completion Date
May 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences
Collaborators
United States Department of Defense

4. Oversight

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

5. Study Description

Brief Summary
This is a Phase I clinical study to determine the safety and efficacy of using autologous, engineered urethral constructs for the treatment of urethral strictures in adult males. The proposed study design is a prospective non-randomized and uncontrolled single-center investigation. Autologous urothelial cells (UCs) and smooth muscle cells (SMCs), obtained from enrolled male subjects' bladder tissue samples, will be culture expanded in vitro and used to seed tubular PGA scaffolds to create autologous urethral constructs for the repair of urethral strictures.
Detailed Description
This is a Phase I clinical study to determine the safety and efficacy of using autologous, engineered urethral constructs for the treatment of urethral strictures in adult males. The proposed study design is a prospective non-randomized and uncontrolled single-center investigation. Autologous urothelial cells (UCs) and smooth muscle cells (SMCs), obtained from enrolled male subjects' bladder tissue samples, will be culture expanded in vitro and used to seed tubular Polyglycolic Acid (PGA) scaffolds to create autologous urethral constructs for the repair of urethral strictures. Male patients, aged 21-65 years old, seen in the Wake Forest Baptist Health urology clinic, referred to or self-referred to the study team, with recurrent urethral stricture, previously treated with dilation, internal urethrotomy, or urethroplasty, will be approached and offered consent to participate in in the trial. Up to 20 men may undergo screening procedures to identify 10 eligible subjects meeting all inclusion and exclusion criteria. All eligible subjects will undergo full thickness bladder tissue biopsies at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina to obtain UCs and SMCs, which will be cultured and expanded and then seeded on tubular PGA scaffolds. Approximately 6 weeks after biopsy, the subjects will return to undergo surgical removal of the stricture and implant of the urethral construct. Subjects will be followed through 36 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Urologic Diseases, Male Urogenital Diseases, Urethral Stricture, Urethral Injury
Keywords
Urethral Stricture

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Autologous Engineered Urethral Construct
Arm Type
Experimental
Arm Description
All subjects enrolled will undergo a full-thickness bladder biopsy as an out-patient surgical procedure. Urothelial and Smooth Muscle Cells recovered from the biopsy will be isolated and expanded over the next 4-6 weeks, and then seeded onto a tubular scaffold to create the autologous engineered urethral construct. Subjects will undergo a second surgical procedure to excise the urethral stricture and implant the urethral construct. All subjects will be followed for 3 years for safety and efficacy.
Intervention Type
Biological
Intervention Name(s)
Autologous Engineered Urethral Construct
Intervention Description
urethral construct
Primary Outcome Measure Information:
Title
Incidence of product-related, biopsy procedure-related, and injection procedure-related adverse events
Description
Rate of adverse events reported for each patient
Time Frame
monitored through 36 months post treatment
Secondary Outcome Measure Information:
Title
Effectiveness of urethral construct in repairing urethral stricture
Description
Improvement in peak urinary flow rate defined as Qmax improvement from baseline
Time Frame
monitored through 36 months post construct implant

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Stricture of the anterior urethra meeting the following criteria: History of at least one previously failed attempt at conservative management, at least 6 months prior to study. Urethral stricture of 10-60 mm in length, as determined by urethrography. Contains at least 1 strictured segment through which a 16 Fr flexible cystoscope cannot be atraumatically passed. Patients must be available for all follow-up visits. Ability to speak English. Exclusion Criteria: Strictures of the meatus or prostatic urethra; any urethral stricture associated with or suspected to be urethral carcinoma, or strictures due to pelvic distraction injuries. Strictures <10 mm or >60 mm, as determined by urethrography, and criteria for bulbar urethral strictures excluding those with strictures <20 mm and >60 mm, as described by urethrography. Presence of untreated urinary tract infection. Presence or prior history of lichen sclerosus et atrophicus (previously termed 'balanitis xerotica obliterans'). Uncontrolled bleeding disorder or patients with a platelet count less than 50,000, hemophilia or patients routinely receiving blood products for bleeding disorders. Any urological condition that would be likely to require additional urethral instrumentation during the period of investigation, including, but not limited to benign prostatic hyperplasia requiring treatment, use of alpha blockers, active prostate cancer, an unevaluated elevated prostate surface antigen (PSA), bladder cancer, or any recurrent urinary stone formation. Patients with evidence or diagnosis of any coagulation disorder (including concomitant anti-coagulation therapy at enrollment). Serum creatinine > 2.0 mg/dl or evidence of progressive renal disease. Patients with abnormal urologic conditions, including vesicoureteral reflux, bladder stones, bladder tumors and renal impairment. Subjects with an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value >3 times the upper limit of normal. Subjects with an albumin value <3.0 g/dL. Subjects with uncontrolled diabetes, unstable cardiac and/or pulmonary disorders. Subjects with active tuberculosis (TB) requiring treatment in the past 3 years. Subjects with a current positive (≥5 mm induration for high-risk subjects; otherwise ≥10 mm of induration) purified protein derivative (PPD) test are excluded unless they have completed a full course of treatment for latent TB and have a negative chest x-ray film at enrollment. Subjects known to be colonized with either methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE), or gentamicin-resistant organisms. Immunocompromised subjects or subjects receiving immunosuppressive agents (inhaled corticosteroids and chronic low-dose corticosteroids [≤0.25 mg/kg prednisone or equivalent per day] are permitted). Any history of alcohol and/or drug abuse. Current smoker. Documented history of, or positive result of HIV, Hepatitis B or C, or any infectious disease. External signs, sequelae, or positive serology of sexually transmitted disease (including HPV). Patients with a history of systemic conditions, including but not limited to HIV, diabetes and chronic liver disease (including Hepatitis B or C), that the Investigator believes may jeopardize the safety of the patient to participate in the study. Concurrent participation in any other clinical investigation during the period of this investigation. Patients who have been treated with any other investigational drug or participated in any investigational study within 30 days prior to enrollment in this study. Any current illness that might confound the results of this investigation, including but not limited to bladder atonia, neuropathic/neurogenic bladder, bladder outlet obstruction (other than urethral stricture), sphincteric dysfunction, or spinal cord injury. Any circumstance in which the investigator deems participation in the study is not in the subject's best interest. Inability to participate in all necessary study activities due to physical or mental limitations. Inability or unwillingness to return for all required follow-up visits. inability or unwillingness to sign informed consent. Patients requiring concomitant use of or treatment with immunosuppressive agents. Patients with neurological disorders (e.g., multiple sclerosis, Parkinson's disease).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Mary-Clare Day, RN, BSN
Phone
336-713-1343
Email
mday@wakehealth.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Yoo, MD
Organizational Affiliation
Wake Forest Institute for Regenerative Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94110
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Natalie Rios
Phone
415-723-1456
Email
Natalie.Rios@ucsf.edu
First Name & Middle Initial & Last Name & Degree
Benjamin Breyer, MD
Facility Name
Wake Forest Institute for Regenerative Medicine (WFIRM)
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Safety and Feasibility Study of Autologous Engineered Urethral Constructs for the Treatment of Strictures

We'll reach out to this number within 24 hrs