Autologous Muscle Fiber Fragment Injections

Not Applicable

Recruiting

• Conditions: Fecal Incontinence
• Interventions: Procedure: Muscle Fiber Fragment (MFF) Injections

• Registration Number: NCT05396456
• Lead Sponsor: Wake Forest University Health Sciences

Brief Summary

To regenerate functional anal sphincter muscle using muscle fiber fragments that contain muscle precursor cells (MPCs)

Detailed Description

The Study hypothesizes that efficient re-assembly of injected fragments within host muscle tissue along the fiber direction of native muscle will be induced. It is anticipated that these fiber fragments would integrate into the host vascular and neural network.

Study Timeline

• Study First Submitted: 2022-05-25
• Study First Submitted QC: 2022-05-25
• Study First Posted: 2022-05-31
• Study Start: 2023-01-12
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-26
• Last Update Posted: 2025-03-27
• Primary Completion: 2026-12
• Study Completion: 2026-12

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 10

Inclusion Criteria

• 18 years of age
• participants must experience 4 or more Fecal Incontinence (FI) episodes per 2 week period
• participants must score >10 on Cleveland Clinic Fecal Incontinence Severity Scoring System (CCIS)
• participants must have had symptoms for at least 12 months
• participants who have failed standard medical and surgical treatments for FI
• participant will undergo anorectal manometry (ARM) testing
• participants will undergo endoscopic anal ultrasound and demonstrate an anatomic defect of the anal sphincter complex of at least 30 degrees
• women of childbearing potential must use acceptable contraceptives during this study

Exclusion Criteria

• participants with symptomatic anorectal disease including symptomatic hemorrhoid disease, anal fissure or fistula causing symptoms such as bleeding, swelling, pain, or drainage
• participants with pre-existing ano-rectal pain of any cause
• participants with incontinence of flatus only
• chronic watery diarrhea which is the primary cause for fecal incontinence
• acute or chronic anorectal infections (including proctitis, recurrent abscesses, fistulae)
• presence of anorectal tumors
• active proctitis or inflammatory bowel disease
• previous injection of internal anal sphincter (IAS) with bulking agents
• participants requiring immunosuppression or who have any malignant disease within 3 years of enrollment
• participants with a defined bleeding disorder diagnosed and treated by a hematologist
• other exclusions include history of pelvic radiation, rectal prolapse, anorectal malformations, anorectal surgery within the previous 12 months, or treatments using injection or infrared coagulation for treatment of hemorrhoids
• participants with neurologic disease characterized by significant peripheral neuropathy or spinal cord dysfunction
• women who are pregnant, breastfeeding, or have had a child within the last year
• participants with a history of unstable cardiac function (New York Heart Association Functional Classification III or IV) or unstable pulmonary function requiring home oxygen, or abnormal kidney function (Cr >1.5 mg/dl or on dialysis) or uncontrolled diabetes (Hemoglobin A1C > 8 mg/dl)
• participants with anemia (hemoglobin <10g, increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >2 times normal) or increased bilirubin >1.5mg/dl
• participants with Hepatitis B or C, or human immunodeficiency virus (HIV)-1 or 2
• rectal prolapse
• vaginal prolapse beyond the hymen
• unable to understand informed consent information even with provision of a medical translator

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Muscle Fiber Fragment (MFF) injections	Muscle Fiber Fragment (MFF) Injections	autologous muscle fiber fragment injections, harvested in an autologous fashion from the quadriceps muscle, for the treatment of Fecal Incontinence (FI) symptoms in men and women with a demonstrated anal sphincter defect and who have failed conservative treatments

Primary Outcome Measures

Name	Time	Method
Cleveland Clinic Fecal Incontinence Severity Scoring System (CCIS) scores (also termed the Wexner score)	Month 12	fecal incontinence score from 0-20; where 0 is perfect continence and 20 is complete incontinence

Secondary Outcome Measures

Name	Time	Method
Rectal Anal Inhibitory Reflex (RAIR) Pressure scores	baseline, Months 3 and 12	Low resting pressure is defined as \<50 mmHg during the anorectal motility exam performed with high-resolution catheter (Given, Atlanta, GA). Normal resting pressures range from 50 to 100 mmHg.; A flexible catheter with solid-state pressure transducers is placed in the anal canal and rectum to obtain Rectal Anal Inhibitory Reflex (RAIR)
Internal Anal sphincter (IAS) Pressure scores	baseline, Months 3 and 12	Typical resting pressure in a healthy volunteer is 40 to 60 mmHg
Change in Fecal Incontinence Quality of Life (FI-QOL) scores	baseline, Months 3 and 12	The Fecal Incontinence Quality of Life Scale is composed of a total of 29 items; these items form four scales: Lifestyle (10 items), Coping/Behavior (9 items), Depression/Self-Perception (7 items), and Embarrassment (3 items).
Anorectal Manometry (ARM) Pressure scores	baseline, Months 3 and 12	Low resting pressure is defined as \<50 mmHg during the anorectal motility exam performed with high-resolution catheter (Given, Atlanta, GA). Normal resting pressures range from 50 to 100 mmHg.; A flexible catheter with solid-state pressure transducers is placed in the anal canal and rectum to obtain standard pressure measurements
Fecal Incontinence Severity Index (FISI) scores	baseline, Months 3 and 12	Participants who score closer to 61 are likely to have their quality of life severely impacted by the fecal incontinence they suffer from.

Trial Locations

Locations (1)

Wake Forest University Health Sciences; 🇺🇸 Winston-Salem, North Carolina, United States