To Study and Demonstrate the Safety and Efficacy of RES-Q Prepared Bone Marrow Mononuclear Cells Injected Into Ischemic Tissue of Patients With Non-Reconstructable Critical Limb Ischemia (CLI).
Overview
- Phase
- Phase 1
- Intervention
- Not specified
- Conditions
- Critical Limb Ischemia
- Sponsor
- TotipotentSC Scientific Product Pvt. Ltd.
- Enrollment
- 17
- Locations
- 1
- Primary Endpoint
- Number of Participants With Adverse Events as a Measure of Safety and Major Limb Amputation Free Survival Post BMMNC Administration
- Status
- Completed
- Last Updated
- 10 years ago
Overview
Brief Summary
The purpose of this study is to evaluate the safety and efficacy of the concentrated autologous bone marrow derived stem cells for the treatment of Critical Limb Ischemia patients.
Detailed Description
A total of 15 patients suffering from end stage IV and V Rutherford /CLI in whom all previous therapeutic strategies failed (e.g. surgical revascularization) will be selected and undergo local transplantation of autologous BMMNCs. Conventional treatments include angioplasty and /or bypass to remove blood vessel blockage for restoring blood supply, along with prescribed medicines that aid in ulcer recovery and wound healing and debridement of damaged/infected tissue. Amputation is inevitable in many cases because some blood capillaries cannot be corrected and restenosis of vessels is very common. Cell therapies with mononuclear cells from patients own bone marrow is promising because these stem cells are capable of stimulating and regenerating capillaries and blood vessels (neovascularization). This is a Phase Ib (feasibility study), prospective, non randomized and open labeled study aimed to find out the safety and efficacy of intramuscular autologous bone marrow mononuclear cells implantation in patients with chronic critical limb ischemia. The efficacy/safety of this therapy will be assessed by using several endpoints such as (a) prevention of amputation, (b) wound healing and (c) degree of angiogenesis. In order to assess the limb ischemia, the measurements will be performed at pre- and post transplantation at a variety of time intervals. The measurements include: ABI-ankle brachial index, Transcutaneous partial pressure of Oxygen (TcPO2), 6 min walk test, Rest pain and intermittent Claudication assessment, Healing of ulcers/ wounds and angiography of the affected limb.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Atherosclerotic ischemic peripheral vascular disease (PVD) or Thromboangiitis Obliterans with severe Critical Limb Ischemia (Rutherford Category 4 and 5: ischemic pain at rest and minor tissue loss and Fontaine Class 4: Ischemic ulcers or gangrene, whivh may be dry or humid).
- •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.
- •Major amputation recommended patients due to severe life threatening PAD.
- •Subjects must be on maximal tolerated medical therapy for peripheral vascular disease including A) Cessation of smoking B) Referral to endocrinologist for control of HgA1c to \< 8% mg/dl, C) control of hyperlipidemia with statins or other anti-hyperlipidemic drugs as indicated, D) control of hypertension as indicated E) Antiplatelet therapy with aspirin and / or cilostazol (unless medically contraindicated, e.g. bleeding or allergy).
- •Ankle Brachial Pressure Index (ABI) ≤ 0.6 or ankle systolic pressure ≤ 60 mm Hg or TcPO2 ≤ 35 mmHg in the foot.
- •Subjects who are able to understand the requirements of the study, and willing to provide voluntary written informed consent, which abide by the study requirements, and agree to return for required follow-up visits.
Exclusion Criteria
- •Subjects with CLI suitable for surgical or percutaneous revascularization and Subjects with acute and chronic inflammatory condition.
- •CLI patient requiring amputation proximal to trans-metatarsal level
- •Subjects with spreading (wet) gangrene
- •Subjects with gait disturbance for reasons other than CLI.
- •Subjects with poorly controlled diabetes mellitus.
- •Subjects diagnosed with Thromboangiitis Obliterans (Buerger's Disease) who are smokers and are unwilling or unable to quit smoking or the physician feels the smoking cessation is doubtful.
- •Subjects having moderate to severe COPD with GOLD Classification IIb or III.
- •Uncontrolled congestive heart failure or Subjects with left ventricular ejection fraction \< 25% or AHA Stage C or D heart failure or NYHA Class IV CHF
- •Stroke or myocardial infarction within last 3 months.
- •Subjects who are contraindicated for CT Angiogram.
Outcomes
Primary Outcomes
Number of Participants With Adverse Events as a Measure of Safety and Major Limb Amputation Free Survival Post BMMNC Administration
Time Frame: 1, 3, 6 and 12 Months
The Primary objective of this study was to determine the safety of intramuscular administration of concentrated autologous BMMNCs harvested, and processed using the Res-Q 60 technology (a point-of-care system). Safety measurements included close vigilance for major limb amputation free survival at 1, 3, 6 and 12 months post BMMNCs administration and stringent reporting of AEs and SAEs.
Secondary Outcomes
- Degree of Angiogenesis Measured by the Number of Collateral Blood Vessels Formed at 12 Months(Baseline and 12 month)
- Measurement of Mean Change in Ankle Brachial Index From Baseline to 12 Months(Baseline, 1, 3, 6 and 12 months)
- Clinical Evaluation for the Presence of Ulcer and/or Gangrene in the Affected Limb From Baseline to 12 Months(Baseline, 1, 3, 6 and 12 months)
- Number of Participants Able to Walk From Baseline to 12 Months as Measured by 6-Minute Walk Test(Baseline, 1, 3, 6 and 12 months)
- Measurement of Change in Transcutaneous Oxygen Pressure (TcPO2) From Baseline to 12 Months(Baseline, 1, 3, 6 and 12 months)
- Change in Rest Pain and Intermittent Claudication Assessment From Baseline to 12 Months(Baseline, 1, 3, 6 and 12 months)