Autologous Cultured Mesenchymal Bone Marrow Stromal Cells Secreting Neurotrophic Factors (MSC-NTF), in ALS Patients.

Phase 1

Completed

Interventions: Biological: MSC-NTF cells transplantation (IM)
Biological: MSC-NTF cells transplantation (IT)

Brief Summary: The study will evaluate the safety, tolerability and therapeutic effects (preliminary efficacy) of injection of autologous cultured mesenchymal bone marrow stromal cells secreting neurotrophic factors (MSC-NTF), as a possible treatment for patients with Amyotrophic Lateral Sclerosis (ALS) at the early and progressive disease stages.

Detailed Description: This study is a single center trial to be conducted at the Department of Neurology \& Laboratory of Neuroimmunology, at the Hadassah Hebrew University Medical Center, Jerusalem in Israel. All patients enrolled will have a documented history of ALS disease prior to study enrolment. Patients diagnosed as early stage ALS disease with duration of less than 6 months and patients diagnosed with progressive stage ALS disease with duration of 6-12 months. Overall, 24 patients will be recruited and allocated based on their ALS disease severity to 2 treatment groups: Group A - 12 patients of early ALS disease stage and Group B - 12 patients of progressive ALS disease.

Eligible patients will be enrolled into the study and will be observed for every 2 weeks during a "run in period" of 3 months for determination of the progression rate of the disease. During the "run in period" after about 6 weeks following enrollment, patients of both study groups will undergo a Bone Marrow Aspiration procedure and MSC-NTF cells will be produced from the bone marrow aspirate based on Brainstorm Cell Therapeutics Ltd proprietary method. On the last "run in period" visit, patients of both study groups will undergo the treatment and MSC-NTF will be transplanted by IM or IT injection to the early and progressive ALS patients respectively.

After the MSC-NTF transplantation patients will be observed on a monthly basis for a post treatment follow up period of 6 months.

Recruitment & Eligibility

Inclusion Criteria

El Escorial criteria for definite or probable ALS
Either men or non pregnant women between 20-75 years of age.
Patient is mentally intact and psychologically stable
For early stage ALS- Patients will be with ALS-FRS-R scale of at least 30 and disease duration of less than 2 years.Or, for progressive stage ALS- Patients will be with an ALS-FRS-R scale of 15-30 and disease duration of less than 2 years
For early stage ALS- Patient has sufficiently bulky muscles. Or, for progressive stage ALS- Patient with at least 60% FVC
Participant understands the nature of the procedure and provides written informed consent prior to any study procedure.

Exclusion Criteria

Positive test for HBV, HCV, HIV and Mycoplasma.
High protein in the CSF.
Lymphocytosis in the CSF.
Positive for anti-GM1 antibodies.
Patient has significant conduction blocks or slow nerve conduction velocities (a reduction of more than 30%) confirmed by nerve conduction velocity - EMG studies.
The patient is a respiratory dependent.
Renal failure, impaired hepatic function
Patients suffering from significant cardiac disease, malignant diseases or any other disease that may risk the patient or interfere with the ability to interpret the results
Active infections.
Participation in another clinical trial within 1 month prior to start of this study.
Subject unwilling or unable to comply with the requirements of the protocol.
Patient has not been treated previously with any cellular therapy.

Arm && Interventions

Group	Intervention	Description
MSC-NTF cells IM	MSC-NTF cells transplantation (IM)	Intramuscular administration in early stage patients
MSC-NTF cells IT	MSC-NTF cells transplantation (IT)	Intrathecal administration in progressive stage patients

Primary Outcome Measures

Name	Time	Method
Safety evaluation and tolerability of a single treatment administration of autologous cultured mesenchymal bone marrow stromal cells secreting neurotrophic factors (MSC-NTF)	6 months	Safety evaluation and tolerability of a single treatment administration of autologous cultured mesenchymal bone marrow stromal cells secreting neurotrophic factors (MSC-NTF) by multiple intramuscular injections (IM) at 24 separate sites on the biceps and triceps muscles to patients with ALS at the early disease stage
Safety evaluation and tolerability of single intrathecal injection (IT) into the cerebrospinal fluid (CSF) of autologous cultured mesenchymal bone marrow stromal cells secreting neurotrophic factors (MSC-NTF)	6 months	Safety evaluation and tolerability of single intrathecal injection (IT) into the cerebrospinal fluid (CSF) of autologous cultured mesenchymal bone marrow stromal cells secreting neurotrophic factors (MSC-NTF),to patients with ALS at the progressive disease stage.

Secondary Outcome Measures

Name	Time	Method
Changes in the progression rate of the disease as evidenced by changes in the ALS functional rating scale (ALS-FRS)	6 months
Changes in muscle strength grading (MVIC) by muscle chart	6 months
Changes in forced vital capacity (FVC %) (In the progressive disease stage group only).	6 months
Changes in muscle bulk estimated by MRI of the upper and lower extremities	6 months
Changes in upper and lower extremities circumference (cm)	6 months
Changes in EMG parameters	6 months
Need and time to tracheotomy or permanent assisted ventilation	6 months
Overall survival, calculating time to death	6 months