Efficacy and Safety Study of Autologous Hematopoietic Stem Cell Transplantation to Treat New Onset Type 1 Diabetes
- Conditions
- Type 1 Diabetes
- Interventions
- Procedure: immunosuppression and stem cell transplantation
- Registration Number
- NCT01341899
- Lead Sponsor
- The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
- Brief Summary
Type 1 diabetes is an autoimmune disease and results from T cell autoimmunity mediated destruction of the majority of insulin-producing pancreatic β-cells. Hence,the development of new therapies to control T cell autoimmunity, and to preserve the remaining β-cell function will be of great significance in managing patients with type 1 diabetes
Autologous nonmyeloablative hematopoietic stem cell transplantation (AHST) has been tested for the treatment of patients with new onset of type 1 diabetes. This therapeutic strategy can result in exogenous insulin independence by destroying pathogenic memory T cells and preserving the remaining β-cell function.
However, little is known about the efficacy of AHST in the dynamics of immunocompetent cell reconstitution and how the reconstituted immune system regulates β-cell specific antibody response. Furthermore, many Chinese patients at diagnosis of type 1 diabetes have progressed to develop diabetic ketoacidosis (DKA). Whether treatment with AHST could still achieve adequate glycemic control and preserve the β-cell function and what the factors are associated with the therapeutic efficacy have not been explored.
This is a phase Ⅱ clinical trial in patients who have been diagnosed with type 1 diabetes within the previous 12 months.This study is to determine:
* The effects of autologous hematopoietic stem cell transplantation on the reconstitution of immune system
* β-cell preservation following stem cell transplantation
* The potential factors affecting efficacy of stem cell transplantation
* Whether this new therapy is safe.
- Detailed Description
Patients diagnosed with type 1 diabetes within the previous 12 months will be recruited into this study.Hematopoietic stem cells were mobilized with cyclophosphamide (CY, 2.0g/m2) and granulocyte colony stimulating factor (10 μg/kg per day) and then collected from peripheral blood by leukapheresis and cryopreserved. The cells were infused after conditioning with CY (200 mg/kg) and rabbit antithymocyte globulin (4.5 mg/kg). All the included patients undergoing AHST complied with blood glucose self-monitoring and scheduled medical appointments.Their blood samples were obtained for measuring the frequency of lymphocytes and the levels of plasma hemoglobin A1c (HbA1c), serum C-peptide, islet antibodies, and cytokines longitudinally.
Ages Eligible for Study: no more than 35 years
Genders Eligible for Study: both
Islet Autoantibodies Eligible for Study: positive for glutamic acid decarboxylase antibody (GADA), protein tyrosine phosphatase antibody (IA-2A), islet cell antibody (ICA) and/or insulin autoantibody (IAAs)
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 50
- diagnosis of diabetes according to the guidelines of the World Health Organization 1999
- the duration of diabetes is no more than 12 months
- positive for for glutamic acid decarboxylase antibody (GADA), protein tyrosine phosphatase antibody (IA-2A), islet cell antibody (ICA) and/or insulin autoantibody (IAAs)
- pregnancy
- mental disorders
- blood diseases
- the presence of any other severe diseases that could potentially influence the transplantation outcomes
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description stem cell transplantation immunosuppression and stem cell transplantation -
- Primary Outcome Measures
Name Time Method Changes in C-peptide levels during standard-meal tolerance test from baseline to different time points after transplantation 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years
- Secondary Outcome Measures
Name Time Method Temporal changes of exogenous insulin requirement from baseline to different time points after transplantation 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years Dynamic changes in lymphocyte immunophenotyping and cytokine profiles from baseline to different time points after transplantation 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years mortality and dysfunction of other endocrine glands up to 10 years Changes in serum levels of HbA1c from baseline to different time points after transplantation 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years Dynamic changes in islet antibody status from baseline to different time points after transplantation 3 months, 6 months, 12 months, then yearly after transplantation, up to 10 years
Trial Locations
- Locations (1)
at Division of Endocrinology, the Affiliated Drum Tower Hospital of Nanjing University
🇨🇳Nanjing, Jiangsu, China