Multicenter Phase II, Randomized Open Clinical Trial on the Therapeutic Use of Intra-arterial Infusion of Autologous Bone Marrow Mononuclear Cells in Non-diabetic Patients With Critical Chronic Ischemia of Lower Limbs (CLI).
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 38
- 试验地点
- 10
- 主要终点
- Adverse events
研究概览
简要总结
Phase II Clinical Trial, a prospective, multicenter, open, randomized, parallel-group controlled with three levels of dose.
The hypothesis of the test we propose is that the mononuclear cells of bone marrow provide progenitor cells with regenerative capacity and besides secrete several angiogenic factors, and their implantation into ischemic tissues with both elements should contribute to angiogenesis and tissue regeneration with recovery of the circulation in the affected limb.
详细描述
The study population will consist of a total of 44 non-diabetic patients with chronic critical ischemia in at least one of their lower limbs (CLI) and without possibility of revascularization. In the experimental group will be included a total of 33 patients divided into three levels of dose, 11 patients in each level (increasing dose of mononuclear cells from autologous bone marrow) and other 11 patients in control group.
- 11 patients in group 1 will not receive cell therapy, and they will only receive conventional treatment, acting as a control group.
- 11 patients in group 2 will receive 1x108 autologous bone marrow mononuclear cells.
- 11 patients in group 3 will receive 5x108 autologous bone marrow mononuclear cells.
- 11 patients in group 4 will receive 1x109 autologous bone marrow mononuclear cells.
The cell therapy drug will be administered intra-arterially in all cases. Patients will be evaluated by clinical, radiological and angiological methods (ankle / brachial pressure index, transcutaneous oxygen pressure, perimeter calf muscle, presence of ulcers, oximetry and digital arteriography).
Patients will receive concomitant drug treatment established by the good clinical practice, so undoubtedly it could be possible that some improvement occurs due to drug treatment.
It is estimated that the inclusion period is approximately 42 months, and the follow-up of each patient of six months. Therefore the total duration of the study will be about forty eight months from the entry of the first patient to the end of the follow-up period of the last patient included.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 89 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients of both sexes aged ≥ 18 and ≤ 89 years.
- •Non-diabetic.
- •Infrapopliteal atherosclerotic vascular disease with severe to severe claudication or Rutherford-Becker grade I-3, II, III, in at least one lower limb. The chronic critical ischemia of the lower limb is defined as persistent / recurring pain requiring analgesia and / or non-healing ulcers present> 4 weeks, with no evidence of improvement with conventional therapies and / or walking test (stress test) between 1-6 minutes two exercise tests separated by at least 2 weeks and / or ankle-brachial index at rest <0.
- •Inability to endovascular or surgical revascularization as recommended by the TransAtlantic Inter-Society Consensus (TASC).
- •Failure of the revascularization surgical performed at least 30 days before, either persistently or entry in critical ischemia phase.
- •Life expectancy> 2 years.
- •Not expected major amputation in the limb to treat in the next 6 months after inclusion.
- •Normal laboratory parameters, defined by:
- •Leukocytes ≥ 3000
- •Neutrophils ≥ 1500
- •Platelets ≥ 100,000
- •Aspartate aminotransferase AST) / Alanine aminotransferase (ALT) ≤ 2.5 standard range institution.
- •Creatinine ≤ 2.5 mg / dl
- •Patients should give their written informed consent to participate in the study.
- •Women of childbearing potential must have negative results on a pregnancy test following standard procedures for each hospital performed at the time of inclusion in the study and agree to use a medically approved method of contraception through the duration of the study.
排除标准
- •History of malignancy or hematologic disease (myeloproliferative disease, myelodysplastic syndrome or leukemia)
- •Patients with uncontrolled hypertension (defined as blood pressure> 180/110 on more than one occasion).
- •Severe heart failure (New York Heart Association IV).
- •Patients with malignant ventricular arrhythmias or unstable angina.
- •Diagnosis of deep vein thrombosis in the previous 3 months.
- •Active infection or gangrene wet day infusion of mononuclear bone marrow cells.
- •Corporal mass index (BMI)> 40 kg/m
- •Patients with a diagnosis of alcoholism at the time of inclusion.
- •Proliferative retinopathy.
结局指标
主要结局
Adverse events
时间窗: 6 months
次要结局
- Ankle-brachial index(1 month, 3 months, 6 months)
- Transcutaneous oxygen pressure (TcO2)(1 month, 3 months, 6 months)
- Greater ulcer size(1 month, 3 months, 6 months)
- Degree of Rutherford-Becker(1 month, 3 months, 6 months)
- Perimeter calf muscle(1 month, 3 months, 6 months)
- Presence of faster opacity in infrapopliteal vessels at 6 months compared with the basal situation of the patient.(1 month, 3 month, 6 month)