Allogenic Mesenchymal Stem Cells in Hemophilia: a Pilot Study
试验速览
- 阶段
- 1 期
- 入组人数
- 20
- 试验地点
- 2
- 主要终点
- Assessment of Safety / Efficacy
研究概览
简要总结
Hemophilia is caused by a single-gene defect resulting in familial bleeding disorder. Small increase in gene products could transform a severe form of hemophilia into a mild one. Stem cells from extrahepatic sources are being considered for clinical applications in liver cell therapy as they possess high in vitro culture potential and could be used in transplant procedures. We studied the differentiation of bone marrow hematopoietic stem cells (BM-HSCs) from hemophilia patients' relatives into factor 8 (FVIII)-producing hepatocyte-like cells aiming to expand patients' donor options for partial replacement of mutant liver cells by healthy cells in hemophilia A patients which could manage the severity of the bleeding disorder.
BM-HSCs from hemophilic families will be cultured in short-liquid hepatic induction medium. Appearance of hepatic phenotype will be evaluated by alpha-fetoprotein expression using immunocytochemistry. Functional evaluation of transdifferentiation will be done through detection of albumin synthesis using microalbumin assay kit, factor VIII activity by one-stage clotting assay and expression of FVIII messenger RNA( mRNA) by reverse transcription ( RT-PCR).
Inducing the differentiation of BM-HSCs by in-vitro manipulation may become a valuable tool to provide a cell source for hepatocyte transplant procedures for treatment of hemophilia patients.
详细描述
Hemophilia A is an X-linked bleeding disorder caused by a deficiency or abnormality of factor VIII. It is the most common inherited coagulation protein deficiency with an incidence of approximately 1 in 10,000 males. More than 75% of hemophilic patients suffer the severe type of the disease.
Hemophilia treatments are readily available in developed countries; however, it is estimated that 70% of people with this disease worldwide are undiagnosed or undertreated. Moreover, about 20% of hemophilia A patients develop inhibitors to treatment and consequently are difficult to treat.
Exogenous factor 8 replacement for hemophilia patients presents a great financial and medical challenge. The optimum therapeutic option for these patients is to provide endogenous secretion of the factor. This was proposed through liver transplantation. Liver transplantation in human and canine hemophilia A results in an increase in factor VIII levels to normal and thus cures the bleeding diathesis. Given the problems of donor availability, major operative procedure and the need for lifelong immunosuppression, cell-based therapy using isolated hepatocytes has been proposed as a promising option to treat clotting disorders. The therapeutic effectiveness of human hepatocytes transplanted under the kidney capsules of mice has been demonstrated. Transplantation of wild-type rats with deficient bilirubin conjugation after ischemia/reperfusion damage resulted in 30% decrease in serum bilirubin, the appearance of bilirubin conjugates in bile and the expression of normal glucuronyltransferase enzyme denoting that transplantation of a small number of hepatocytes can result in partial correction of functional defects.
Although cellular transplantation of hepatocytes solves the operative risk, it has the disadvantage of difficult propagation of hepatocytes in vitro.
An alternative to hepatocyte transplantation is the use of in-vitro transdifferentiated bone marrow derived stem cells.
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
- 6 Years 至 40 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Laboratory diagnosis of factor 8 deficiency
- •Dependent on exogenous factor 8 therapy
排除标准
- •Liver disease
- •History of allergy to factor therapy
- •Abnormal spleen by sonography
结局指标
主要结局
Assessment of Safety / Efficacy
时间窗: 2 years
Assessment of vitality, life style and bleeding times of the Patients.
次要结局
- Assessment of Coagulation Profile(2 years)