Phase II Efficacy Study of Intramuscular Autologous Bone Marrow Mononuclear Cells Plus Mesenchymal Stem Cell Implantation Versus Autologous Bone Marrow Mononuclear Cells Implantation Only in Patients With Chronic Critical Limb Ischemia
试验速览
- 阶段
- 2 期
- 发起方
- 入组人数
- 50
- 试验地点
- 2
- 主要终点
- Change in angiogenesis
研究概览
简要总结
This is a randomized and single blinded study aimed to compare the efficacy between intramuscular autologous bone marrow mononuclear cells plus mesenchymal stem cell implantation and intramuscular autologous bone marrow mononuclear cells implantation only in patients with chronic critical limb ischemia. Patients will be randomized into two groups of equal number; patients in one group will be implanted with mononuclear cells and mesenchymal stem cells, and the other implanted with mononuclear cells only in the area of affected limb.
详细描述
When the long blood vessels supplying blood to the arms and legs become blocked (ischemic), patient will experience painful sensations in their calves when they walked which slowly become excruciating painful at rest. When the condition worsens, the patients will not be able to feel any pain from their legs and they will not know if there are any small ulcers or cuts on their legs. As a result, a small ulcer which goes unnoticed becomes bigger and can sometimes become infected. In the worst situations, infection might lead towards gangrene and septicaemia. Severe rest pain and/or ulcerations of ischemic limbs are defined as the state of chronic critical limb ischemia and at this point, amputation of the affected limb is suggested.
Conventional treatments include angioplasty/bypass operation to remove blood vessel blockage to restore blood supply, the use of prescribed medicines to aid in ulcer recovery and clear infection and debridement of damaged/infected tissue. Some procedures have to be performed multiple times. Amputation is inevitable in many cases because some blood capillaries cannot be corrected and restenosis of vessels is very common. Cell therapy with mononuclear cells and mesenchymal stem cells from bone marrow is promising because these stem cells are capable of stimulating and regenerating capillaries and blood vessels.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 20 Years 至 —(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinical diagnosis of critical limb ischemia leading to ischemic ulcers in which amputation is indicated
- •Not suitable for, or remain symptomatic despite angioplasty, bypass operation or collateralization
排除标准
- •Contraindication to epidural anesthesia and bone marrow aspiration
- •Contraindication to contrast angiography
- •Evidence of neoplasia and bone marrow diseases
- •Any acute or chronic communicable diseases including Hepatitis B, Hepatitis C and HIV
- •Patients with a limited life expectancy (< 1 year)
- •Patients with myocardial infarction or stroke within 6 months
- •Patients with coronary intervention within 6 months
- •Renal impairment indicated by serum creatinine greater than two times upper limit of the normal range
- •Liver impairment indicated by serum aspartate transaminase and alanine transaminase greater than two times upper limit of normal
- •Any other co-morbidity which the physician deems as a contraindication to stem cell transplantation
结局指标
主要结局
Change in angiogenesis
时间窗: 1 month, 3 months, 6 months, 9 months, 12 months
Measurement of angiogenesis by presence of peripheral pulses, capillary refill and transcutaneous oxygen saturation (TCOS).
次要结局
- Visual Analog Score(1 month, 3 months, 6 months, 9 months, 12 months)
- Change in ulcer size(1 month, 3 months, 6 months, 9 months, 12 months)
- Exercise Treadmill Test(1 month, 3 months, 6 months, 9 months, 12 months)
- Improvement in vascularity and blood supply(1 month, 3 months, 6 months, 9 months and 12 months)
研究者
Dr Hanafiah Harunarashid
Senior Consultant Vascular Surgeon
National University of Malaysia
