A Phase 1/2 Study to Examine the Safety and Preliminary Efficacy of Mesenchymal Stromal Cells on Linear Growth and Bone Health Parameters in Children With Type 3 Osteogenesis Imperfecta (OI)
试验速览
- 阶段
- 1 期
- 状态
- 尚未招募
- 入组人数
- 12
- 主要终点
- Recruitment rate of participants
研究概览
简要总结
This is a Phase 1/2 study to determine the safety and efficacy of allogeneic (third party), bone-marrow derived mesenchymal stromal cells (MSCs) for the treatment of Osteogenesis Imperfecta (OI) Type 3. It will evaluate this by looking at whether there are treatment related infusion reactions, and assessing linear growth rates and bone health, both of which are impaired in patients ages 3-10 with Osteogenesis Imperfecta Type 3. This is a single-site non-randomized clinical trial, that will take place at Children's Healthcare of Atlanta (CHOA) at Egleston and Emory Children's Center.
详细描述
This is a Phase 1/2 study to determine the safety and efficacy of allogeneic (third party), bone-marrow derived mesenchymal stromal cells (MSCs) for the treatment of Osteogenesis Imperfecta (OI) Type 3. It will evaluate this by looking at whether there are treatment related infusion reactions, and assessing linear growth rates and bone health, both of which are impaired in patients ages 3-10 with Osteogenesis Imperfecta Type 3. This is a single-site non-randomized clinical trial, that will take place at Children's Healthcare of Atlanta (CHOA) at Egleston and Emory Children's Center.
MSCs will be infused through IV every 4 months for 6 total infusions. There will be a baseline visit before MSC therapy is initiated, and there will be a follow up visits every 4 months for 1 year after the final MSC infusion. These infusions will take place in between pamidronate infusions (i.e. 2 months after the last pamidronate infusion, and 2 months before the next one). Pamidronate aids in treatment of bone pain and bone mineral density but does not correct the underlying defect nor does it show substantial improvements in linear growth.
After the MSC infusions, patients will be provided an overnight at Ronald McDonald House, or a hospital affiliated hotel so they can be near to the hospital in case of any unanticipated effects, and for a follow up visit the next morning.
Labs will be collected during every visit to look at bone metabolism. Limb and bone age x-rays, pQCT scans, and dual-energy x-ray absorptiometry (DXA) scans will be completed annually, while spine films will be completed every 18 months. These images will directly examine bone health. Body measurements will be taken every visit as well to assess linear growth. The patients' parents will complete events diaries and submit them each infusion day to evaluate fractures that occurred between visits. Patients and their parents will also complete quality of life surveys once a year.
There will be financial compensation for each study visit. Subjects will also be provided a free lunch on days when radiology visits occur and will be reimbursed for parking.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 3 Years 至 10 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •1. Parent/legal guardian must be willing to sign consent forms to participate in this trial
- •Participants must be >3 years of age and <10 years of age at time of enrollment
- •Must carry mutation in either COL1A1 or COL1A2 genes and based on clinical assessment have severe Type 3 OI*
- •Must be pre-pubertal to minimize potential influence of hormonal effects on growth velocity and BMD; for children who may be entering puberty at or near upper end of this age bracket, puberty assessment will be based on clinical and laboratory findings
- •Must have received IV pamidronate therapy for at least one year prior to study initiation.
- •Type 3 OI will be confirmed with an Invitae Skeletal Dysplasia test, and clinical assessment including:
- •Blue/grey sclerae
- •Presence of prenatal fractures (on ultrasound when available)
- •Deformities present at birth (confirming prenatal fractures)
- •Severity of fractures and progressive deformities although no absolute 'number' of fractures is available
排除标准
- •Lacking confirmation of mutation in either COLA1A1 or COL1A2 genes
- •Other pathological types of OI
- •Any concurrent medical issue(s) known to decrease BMD (e.g., malabsorption conditions, glucocorticoid use)
- •Participation in other clinical trial
- •Vitamin D deficiency (<20 ng/dL) despite treatment
- •Clinically significant thrombocytopenia as defined by a platelet count of < 150,000x103/microliter ; anemia as defined by hemoglobin < 5th percentile for age (<11.5g/dL); neutropenia as defined by absolute neutrophil count < 1.5 x103/microliter; or elevations in the white blood cell count as defined by 3-6 year old-WBC > 15.5WBC x 103/microliter; 6-9 year old WBC >13.5 x103/microliter (Flerlage 2015)
- •8. PRA screening positive for anti-HLA antibodies
- •Elevated LFT's greater than 2 times the upper limit of normal
- •Other genetic disorders
- •Other skeletal dysplasia disorders
- •Other primary or secondary bone disorders
- •History of acute or chronic infections
- •History of cancer
- •History of thrombosis or prothrombotic disorders
- •History of heart disease
- •History of diabetes
- •History of strokes
- •History of vascular conditions
- •History of lung disease
研究组 & 干预措施
Children with OI receiving Bone marrow-derived MSCs infusion
Intravenously-infused allogeneic, bone marrow-derived mesenchymal stromal cells (MSCs) in children with Osteogenesis Imperfecta Type III that will be infused at 0 months, 4 months, 8 months, 12 months, 16 months, and 20 months, after enrollment.
干预措施: Bone marrow-derived mesenchymal stromal cells (MSCs) (Drug)
结局指标
主要结局
Recruitment rate of participants
时间窗: Up to 24 months post-intervention
Number of participants consented at the end of the trial
Number of participants with correctly collected data for the study outcomes
时间窗: Up to 24 months post-intervention
Number of participants with data correctly collected for the study outcomes
Total number of visits with protocol deviation
时间窗: Up to 24 months post-intervention
Total number of visits with protocol deviations at the end of the trial
Patient retention rate
时间窗: Up to 1 year post last infusion intervention
Percentage of patients that complete the study intervention and all follow up study visits
Number of participants with changes in laboratory panels from baseline (CBC, CMP)
时间窗: Baseline, every 4 months post-intervention
Number of patients with changes in CBC or CMP values from baseline CBC or CMP values. Any evidence of thrombocytopenia, anemia, neutropenia, or elevations in white blood counts will require consideration of stopping or pausing infusions by the PI. Slight changes in the ALT, AST, and calcium values are expected due to standard medication uses and will be monitored by PI.
Change in number of participants with changes in radiological parameters
时间窗: Baseline, 8, 20 and 32 months post-intervention
Number of participants with changes in radiological parameters (xrays and DXA scan) from baseline will be monitored during the study follow up time. DXA scans and x-rays used to assess for any semi-triggers that may require considerations of stopping or pausing infusions.
Change in annualized linear growth velocity
时间窗: Baseline, every 4 months until 1 year after last infusion intervention
This study will assess the annualized linear growth velocity at baseline and during cell therapy protocol in children with Type 3 OI (3-10 years of age and pre-pubertal at time of enrollment). Growth charts will be generated using growth measurements obtained every 4 months. Growth charts will be referenced against sex- and age-specific Centers for Disease Control and Prevention (CDC) childhood OI growth reference charts.
Visit attendance by participants
时间窗: Up to 1 year post last infusion intervention
Percentage of visits completed by participants
Patient Primary Clinical Outcome Retention Rate
时间窗: Up to 1 year post last infusion intervention
Percentage of participants that completed the primary clinical outcome measurements
Change in acceptability from baseline
时间窗: Baseline, Up to 36 months post-intervention
Acceptability will be evaluated with an end of study structured, verbal interview. This interview will consist of a mix of closed ended (scaled questions from 1\[worst\]-5 \[best\]) and open-ended questions giving subjective measurements. Open-ended questions will address overall experience during the study and prompt expression of thoughts or perspectives after completing the study. The total possible score range is 18 to 90. Higher score correlates with better outcome.
Number of participants with change in vital signs from baseline
时间窗: Baseline, 10 minutes pre-intervention, 15 minutes post-intervention, 30 minutes post-intervention, 1 hour post-intervention, 1 hour post completion of the infusion
Number of participants with blood pressure, oxygen saturation, heart rate, respiratory rate, and temperature below or above each participants accepted mean reference range.
Number of unexpected adverse events
时间窗: Up to 1 year post last infusion intervention
Unexpected adverse events that occur from first study intervention to one year after last infusion.
Change in fracture rate from baseline
时间窗: Baseline, every 4 months post-intervention until 1 year after last infusion intervention
Overt and covert fracture rate will be measured in each child at baseline and at regular intervals during MSC therapy by using a caretaker events diary, limb films, and spine films to tally more objectively new and healing fractures.
Change in bone mineral density from baseline
时间窗: Baseline, yearly until 1 year after last infusion intervention
Bone mineral density will be determined by DXA (dual-energy absorptiometry) analysis for TBLH (total body less head), spine and distal radius sites.
Change in bone age
时间窗: Baseline, yearly until 1 year after last infusion intervention
A bone age assessment is done using left hand radiograph. Bone age will be followed yearly in children of 8 years of age and older at time of enrollment in conjunction with exam and laboratory assessments to determine potential effects of puberty on bone density.
Change in Vertebral Compression Fractures (VCFs)
时间窗: Baseline, every 18 months until one year after last infusion intervention
Due to abnormal collagen and the associated decrease in BMD, VCFs are common in Type 3 OI. These can be 'silent' and/or associated with back pain. PA TL film and LAT TL film will be obtained to assess VCF's that cannot be assessed by DXA in children. Spine radiographs are within standard of care for treatment of OI.
次要结局
- Change in Limb Deformity Modified EOS Questionnaire (LD-EOSQ-22) from baseline(Baseline, annually until 1 year after last infusion)
- Number of participants with changes in bone metabolism markers(Baseline, every 12 months post-intervention, and at the conclusion of the study (up to 36 months post-intervention))
- Change in BAMF (Brief Assessment of Motor Function) from baseline(Baseline, annually until 1 year after last infusion)
- Change in Pediatric Orthopedic Data Collection Instrument (PODCI) from baseline(Baseline, annually until 1 year after last intervention)
研究者
Doris Fadoju
Assistant Professor
Emory University