Safety and Efficacy of Repeated Administrations of NurOwn® in ALS Patients

Phase 3

Completed

• Conditions: Amyotrophic Lateral Sclerosis (ALS)
• Interventions: Biological: NurOwn® (MSC-NTF cells); Other: Placebo; Other: Bone Marrow aspiration

• Registration Number: NCT03280056
• Lead Sponsor: Brainstorm-Cell Therapeutics

Brief Summary

This study will evaluate the safety and efficacy of repeated administration of NurOwn® (MSC-NTF cells) therapy, which is based on transplantation of autologous bone marrow derived mesenchymal stromal cells (MSC), which are enriched from the patient's own bone marrow, propagated ex vivo and induced to secrete Neurotrophic factors (NTFs).

The autologous NurOwn® (MSC-NTF cells) are back-transplanted into the patient intrathecally by standard lumbar puncture where neurons and glial cells are expected to take up the neurotrophic factors secreted by the transplanted cells

Detailed Description

Neurotrophic factors (NTFs) are potent survival factors for embryonic, neonatal, and adult neurons and are considered potential therapeutic candidates for ALS. Delivery of multiple NTFs to the immediate environment of afflicted neurons in ALS patients is expected to improve their survival and thus slow down disease progression and alleviate symptoms. NTF-secreting mesenchymal stromal cells (MSC-NTF cells) are a novel cell-therapeutic approach aimed at effectively delivering NTFs directly to the site of damage in ALS patients.

Participants meeting the inclusion and exclusion criteria will be randomized and will undergo bone-marrow aspiration. MSC of the participants randomized to the treatment group will be induced into MSC-NTF cells. Participants will undergo a total of three intrathecal (IT) transplantations with NurOwn® (MSC-NTF cells) or matching placebo at three bi-monthly intervals

Study Timeline

• Study Start: 2017-08-28
• Study First Submitted: 2017-08-29
• Study First Submitted QC: 2017-09-10
• Study First Posted: 2017-09-12
• Primary Completion: 2020-09-29
• Study Completion: 2020-09-29
• Disposition First Submitted: 2021-10-03
• Results First Submitted: 2023-12-01
• Status Verified: 2024-02
• Results First Submitted QC: 2024-02-05
• Last Update Submitted: 2024-02-05
• Results First Posted: 2024-02-29
• Disposition First Posted: 2024-02-29
• Last Update Posted: 2024-02-29

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 196

Inclusion Criteria

• ALS diagnosed as possible, laboratory-supported probable, probable, or definite as defined by revised El Escorial criteria.
• Having onset of ALS disease symptoms, including limb weakness within 24 months at the Screening Visit.
• ALSFRS-R ≥ 25 at the screening Visit.
• Upright slow vital capacity (SVC) measure ≥ 65% of predicted for gender, height, and age at the screening Visit.
• Rapid progressors
• Participants taking a stable dose of Riluzole are permitted in the study
• Citizen or permanent resident of the United States or Canadian citizen able to travel to a US site for all follow-up study visits

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Exclusion Criteria

• Prior stem cell therapy of any kind
• History of autoimmune or other serious disease (including malignancy and immune deficiency) that may confound study results
• Current use of immunosuppressant medication or anticoagulants (per Investigator discretion)
• Exposure to any other experimental agent or participation in an ALS clinical trial within 30 days prior to Screening Visit
• Use of RADICAVA (edaravone injection) within 30 days of screening or intent to use edaravone at any time during the course of the study including the follow up period
• Use of non-invasive ventilation (BIPAP), diaphragm pacing system or invasive ventilation (tracheostomy)
• Feeding tube
• Pregnant women or women currently breastfeeding

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
NurOwn® (MSC-NTF cells)	Bone Marrow aspiration	Three Intrathecal administrations of NurOwn® (MSC-NTF cells) at bi-monthly intervals
NurOwn® (MSC-NTF cells)	NurOwn® (MSC-NTF cells)	Three Intrathecal administrations of NurOwn® (MSC-NTF cells) at bi-monthly intervals
Placebo	Bone Marrow aspiration	Three Intrathecal administrations of Placebo at bi-monthly intervals
Placebo	Placebo	Three Intrathecal administrations of Placebo at bi-monthly intervals

Primary Outcome Measures

Name	Time	Method
The Proportion of NurOwn® Treated Participants With a ≥1.25 Points/Month Improvement in Post-treatment Slope vs. Pre-treatment Slope in ALSFRS-R Score at 28 Weeks Following the First Treatment as Compared to Placebo	28 weeks following the first intrathecal injection	The ALSFRS-R is a quickly administered (10 minutes) ordinal, validated rating scale (ratings 0-4) used to determine participants' assessment of their capability and independence in 12 functional activities. All 12 activities are relevant in ALS. Initial validity was established by documenting that in ALS patients, change in ALSFRS-R scores correlated with change in strength over time, as measured by quantitative neuromuscular strength testing, and with quality of life measures, and predicted survival. The total score of ALSFRS-R ranges from 0-48, with higher score being better.

Secondary Outcome Measures

Name	Time	Method
NurOwn® (MSC-NTF Cells) Treated Patients vs. Placebo Treated Patients as Measured by the Combined Assessment of Function and Survival at 28 Weeks	28 weeks following the first intrathecal injection	The combined Assessment of Function and Survival (CAFS) is a composite endpoint based on (1) the change from baseline in ALS Functional Rating Scale-Revised (ALSFRS-R) score and (2) time to death.; On the ALSFRS-R, 12 functions are rated on 5-point ordinal rating scales (from 0 to 4) with a total score range (minimum and maximum score) of 0-48 (sum of all 12 items). The higher the score the better functioning. For the survival endpoint, the longer time the better outcome.; A patient's CAFS score represents a patient's rank in the study based on comparing the patient's outcome for both the change in ALSFRS-R and the time to death to all other patients in the study in a pairwise fashion. The ranked scores range from 001 to 189 (the number of subjects in the mITT population) with larger rank score numbers associated with a better outcome. The reported values are the mean rank scores in each group for the composite endpoint.
Number of Participants Whose Disease Progression is Halted or Improved as Measured by a 100% or Greater Improvement in Post-treatment Slope vs. Pre-treatment Slope in ALSFRS-R Score of NurOwn® Treatment vs. Placebo	28 weeks following the first intrathecal injection	The ALSFRS-R is a quickly administered (10 minutes) ordinal, validated rating scale (ratings 0-4) used to determine participants' assessment of their capability and independence in 12 functional activities. All 12 activities are relevant in ALS. Initial validity was established by documenting that in ALS patients, change in ALSFRS-R scores correlated with change in strength over time, as measured by quantitative neuromuscular strength testing, and with quality of life measures, and predicted survival. The total score of ALSFRS-R ranges from 0-48, with higher score being better.
Score of NurOwn® (MSC-NTF Cells) Treated Patients vs. Placebo Treated Patients as Measured by Change From Baseline in ALSFRS-R Score at Week 28	28 weeks following the first intrathecal injection	The ALSFRS-R is a quickly administered (10 minutes) ordinal, validated rating scale (ratings 0-4) used to determine participants' assessment of their capability and independence in 12 functional activities. All 12 activities are relevant in ALS. Initial validity was established by documenting that in ALS patients, change in ALSFRS-R scores correlated with change in strength over time, as measured by quantitative neuromuscular strength testing, and with quality of life measures, and predicted survival. The total score of ALSFRS-R ranges from 0-48, with higher score being better.

Trial Locations

Locations (6)

University of California Irvine Alpha Stem Cell Clinic; 🇺🇸 Irvine, California, United States

Cedars-Sinai Medical Center; 🇺🇸 Los Angeles, California, United States

Massachusetts General Hospital; 🇺🇸 Boston, Massachusetts, United States

California Pacific Medical Center; 🇺🇸 San Francisco, California, United States

University of Massachusetts Medical School; 🇺🇸 Worcester, Massachusetts, United States

Mayo Clinic; 🇺🇸 Rochester, Minnesota, United States