Umbilical Cord Blood Stem Cell Injection for Critical Limb Ischemia
Overview
- Phase
- Phase 1
- Intervention
- Not specified
- Conditions
- Critical Limb Ischemia
- Sponsor
- Richard Burt, MD
- Enrollment
- 1
- Locations
- 1
- Primary Endpoint
- Ankle brachial index (ABI), a 15% increase will be considered improvement
- Status
- Terminated
- Last Updated
- 12 years ago
Overview
Brief Summary
The purpose of this study is to determine whether treatment with umbilical cord blood stem cells will improve blood flow to the most severely affected leg of a participant with medically refractory and non-surgical peripheral vascular disease of the lower extremity.
Detailed Description
Umbilical cord blood is a safe alternative source of stem cells used for decades in hematopoietic stem cell transplants for malignancies. There is also a reported decreased incidence of acute GVHD compared to matched unrelated donor transplants.A cord blood registry will be searched for suitable units with compatibility in the ABO and HLA systems. The minimum total nucleated cell dose required which would be 1.0 x 107/kg, and one unit of cells will be procured to meet this requirement. Although it is likely that the transplanted cord blood cells will be rejected over time, we hypothesize that while they remain in the host's tissue these cells will be producing and releasing cytokines, growth factors and other humoral factors that might promote vasculogenesis by stimulating endogenous stem cells and endothelial cells. Since there is no need to collect the patient's own stem cells, the patient's cardiovascular system will not be subjected to any stress due to the leukapheresis procedure itself. No injections of exogenous growth factors, which have been associated with thrombosis, would be required to mobilize the patient's own stem cells. The procedure could conceivably even be performed in its entirety on an outpatient basis. A total of 25 patients will be enrolled in the study. Patients will be followed for 24 months after the procedure with evaluation visits one day after the transplant and then at one month, six, twelve and twenty four months post-treatment. The visit one day after the transplant will involve a history and physical with a leg exam, a CBC and a chemistry panel to evaluate for possible infection, or other adverse event.
Investigators
Richard Burt, MD
MD
Northwestern University
Eligibility Criteria
Inclusion Criteria
- •Atherosclerotic ischemic peripheral vascular disease or Thromboangiitis Obliterans with Critical Limb Ischemia (Fontaine stages III and IV)
- •Participant must match either a or b
- •Ankle brachial index (ABI) ≤ 0.7
- •Doppler waveforms at posterior tibial artery and dorsalis pedis artery are monophasic with toe pressure \< 30 mmHg.
- •A non-surgical candidate for revascularization e.g. prior vascular reconstruction, inability to locate a suitable vein for grafting, diffuse multi- segment disease, or extensive infra-popliteal disease not amenable to a vascular graft.
- •Age \> 18 years old.
- •The non-index leg may be treated only in the event and it full fills the same eligibility criteria and exclusion criteria used in this protocol for the treatment leg.
- •Patients must be on maximal tolerated medical therapy for PVD including A) Cessation of smoking B) Referral to endocrinologist for control of HgA1c to \< 7.0 mg/dl, control of hyperlipidemia with statins or other anti-hyperlipidemic drugs as indicated, control of hypertension as indicated C) Antiplatelet therapy with aspirin and / or cilostazol (unless medically contraindicated, e.g. bleeding or allergy)
Exclusion Criteria
- •Popliteal vascular entrapment syndrome
- •Lower extremity infection or infected ulcer
- •Hypercoagulable state
- •HIV positive
- •HBsAg positive
- •Uncontrolled arrhythmia, that is, persistence of an arrhythmia despite medical therapy
- •Unstable angina
- •Thrombocytopenia \< 50,000/ul
- •Leukemia or myelodysplasia
- •Allergy to E coli or its products
Outcomes
Primary Outcomes
Ankle brachial index (ABI), a 15% increase will be considered improvement
Time Frame: Pre-transplant, 1, 6, 12 and 24 months after
Healing of ischemic ulcers
Time Frame: Pre-transplant, 1, 6, 12 and 24 months after
Decreased pain level as reported by the patient
Time Frame: Pre-transplant, 1, 6, 12 and 24 months after
Secondary Outcomes
- Increase in pain free ambulation time on treadmill by more than 25%(Pre-transplant, 1, 6 , 12, and 24 months after HSC transplant)
- SF-36 quality of life (QOL)(Pre-transplant, 1, 6 , 12, and 24 months after HSC transplant)
- Walking Impairment Questionnaire(Pre-transplant, 1, 6 , 12, and 24 months after HSC transplant)
- Increase in four meter walk or six minute walk by more than 25%(Pre-transplant, 1, 6 , 12, and 24 months after HSC transplant)