The Effect of Intralesian Injection of Umbilical Cord Mesenchymal Stem Cells, Its Conditioned Medium, and Triamcinolone Acetonide on Type 1:3 Collagen Ratio and Interleukin-10 Levels in Keloid: A Randomised Controlled Trial

July 1, 2023 updated by: Rumah Sakit Pusat Angkatan Darat Gatot Soebroto
The objective of this study is to observe the potency of umbilical cord-derived mesenchymal stem cells (UC-MSC) and umbilical cord-derived conditioned medium (UC-CM), or triamcinolone acetonide (TA) in keloid therapy, measured by the decrease in the type 1:3 collagen ratio and the increase of IL-10 levels carried out using CONSORT statement.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Screening of patients were done by measuring keloid dimensions using a ruler. Patients meeting the inclusion criteria were then randomly divided into 3 groups. The same injection volume (1 ml) in every cm3 keloid volume was given using a 1 mL syringe and 27G needle to the subjects. Ultrasound guidance was used to administer the injection using an in-plane technique into the center of the lesion, with inclinations of 30-45 degrees, ensuring uniform pressure in every subject. Group 1 was given UC-MSC 2 million cells/mL/cm3, group 2 receives UC-CM 1mL/cm3 while group 3 was administered TA 40 mg/mL/cm3. In order to obtain UC-MSC and UC-CM, 10 cm of umbilical cord tissue was collected in 50 mL transport medium containing the following substances: amphotericin B (Final concentration 7500 ng/ml [JR Scientific 50701]), alpha minimal essential medium (MEM [GIBCO 12000-022 1]), penicillin/streptomycin (final concentration 300 U/ml [Gibco 15140-122]). Samples were then processed within 8 hours of collection. The umbilical cord was then dissected, briefly washed in 0.5% povidone-iodine (betadine ©) with phosphate buffered saline of pH 7.4 (PBS [Sigma P3813]), and then washed in PBS to remove betadine and blood. The umbilical vessels were excised before the umbilical cord was minced into a complete medium. UC-CM was created using Alpha-MEM and Dulbecco's modified Eagles medium (DMEM [GIBCO 31600-034]). The finalized complete medium contains 1% L-glutamine (Lonza 17-605C), 10% TC (Indonesian Red Cross), amphotericin B (final concentration 2500 ng/ml), and penicillin/streptomycin (final concentration 100 U/ml). Supplementation of culture with 10% autologous or allogeneic cord blood serum and 10% human AB serum (Gibco 34005-100) was done to create MEM. Each well of a 12-well plate (growth are 3.8 cm2 [Biolite]) was filled with three explants (diameter 2-5 mm) and Wharton's Jelly, followed by addition of several drops of complete medium. Triplication of culture was done to each medium. The plate was incubated at 37°C and 5% CO2 and observed daily for contamination or cellular growth, in which the contaminated wells were removed. After the explants was attached, addition of 200-500 µL of appropriate medium was done. Medium changes, involving removal of half of the medium and addition of half of each medium, were performed every 2-3 days. Growth of the cells beyond the explants with 90% confluence marks viability for harvesting using TrypLE Select (GIBCO 12563-011). Dye exclusion method was used to count the viable/non-viable cell yield. After each harvest, with the explant still attached to the plate, new appropriate medium was added with the plate being re-incubated at 37°C and 5% CO2. Similar treatment was repeated for the second and subsequent cultures, enabling multiple harvests from a single explant. Biopsies of the keloid tissues were then conducted twice, in the first meeting and 17 weeks after. Parameters to be evaluated in anatomic pathology examination are Sirius red staining to evaluate collagen structure under a polarizing lens, as well as In Vitro quantitative examination using the ELISA method to examine IL-10. Calculation of changes in the ratio of type 1 to type 3 collagen levels was carried out by dividing the ratio of collagen before treatment from the ratio of collagen after each treatment. When visualized under a polarizing lens, type-3 collagen will appear green-birefringence and type-1 collagen will appear yellow-birefringence. The collagen ratio was obtained by dividing the composition of collagen type 1 to collagen type 3 in Sirius red staining under polarizing lenses.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
24

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Indonesia
    • DKI Jakarta
      • Jakarta Pusat, DKI Jakarta, Indonesia, 10410
        • RSPAD Gatot Soebroto

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • The patient has keloids with a length of 2-10 cm and a thickness of 3-5 mm located on the chest, back, abdomen and extremities
  • Patients aged 18 - 55 years
  • Post-surgery patients more than 3 months that cause keloids
  • The patient is willing to fill in the informed consent form

Exclusion Criteria:

  • Patients with hypertrophic scars
  • History of kidney failure
  • Hypertension
  • Pregnant and breastfeeding
  • History of blood disorders
  • History of tumor or malignancy
  • Get other keloid therapy outside of the research procedure

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: umbilical cord-derived mesenchymal stem cells (UC-MSC)

UC-MSC was collected in 50 mL of transport medium, which contained alpha minimal essential medium (αMEM [GIBCO 12000-0221]), penicillin/streptomycin (final concentration 300u/mL [GIBCO 15140-122]) and amphotericin B (final concentration 7500ng /mL [JR Scientific 50701]), and processed in less than 8 hours after collection.

Group 1 was given UC-MSC 2 million cells/mL/cm3
Biological: umbilical cord-derived mesenchymal stem cells (UC-MSC)
Group 1 was injected UC-MSC 2 million cells/mL/cm3, given the same injection volume (1 mL) in every cm3 keloid volume using a 1 mL syringe and 27G needle. The injections were ultrasound-guided into the center of the lesion with a 30-45-degree angle using an in-plane technique, therefore the same pressure.
Experimental: umbilical cord-derived mesenchymal stem cells conditioned medium (UC-CM)
group 2 was given UC-CM 1 mL/cm3
Biological: umbilical cord-derived mesenchymal stem cells conditioned medium (UC-CM)
Group 2 was injected UC-CM 1 mL/cm3, given the same injection volume (1 mL) in every cm3 keloid volume using a 1 mL syringe and 27G needle. The injections were ultrasound-guided into the center of the lesion with a 30-45-degree angle using an in-plane technique, therefore the same pressure.
Active Comparator: triamcinolone acetonide
group 3 was given TA 40 mg/mL/cm3
Drug: Triamcinolone Acetonide (TA)
Group 3 was injected TA 40 mg/mL/cm3, given the same injection volume (1 mL) in every cm3 keloid volume using a 1 mL syringe and 27G needle. The injections were ultrasound-guided into the center of the lesion with a 30-45-degree angle using an in-plane technique, therefore the same pressure.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Type 1:3 collagen ratio reduction
Time Frame: 17 weeks
Biopsies of the keloid tissues were then conducted twice, in the first meeting and 17 weeks after. Parameters to be evaluated in anatomic pathology examination are Sirius red staining to evaluate collagen structure under a polarizing lens. Calculation of changes in the ratio of type 1 to type 3 collagen levels was carried out by dividing the ratio of collagen before treatment from the ratio of collagen after each treatment. When visualized under a polarizing lens, type-3 collagen will appear green-birefringence and type-1 collagen will appear yellow-birefringence. The collagen ratio was obtained by dividing the composition of collagen type 1 to collagen type 3 in Sirius red staining under polarizing lenses.
17 weeks
IL-10 levels increase
Time Frame: 17 weeks
Biopsies of the keloid tissues were then conducted twice, in the first meeting and 17 weeks after. Parameters to be evaluated in anatomic pathology examination is In Vitro quantitative examination using the ELISA method to examine IL-10.
17 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Rumah Sakit Pusat Angkatan Darat Gatot Soebroto

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Indonesia University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 1, 2021

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 9, 2022

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 9, 2022

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 1, 2023

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 1, 2023

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 11, 2023

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
July 11, 2023

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 1, 2023

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • KET-1206/UN2.F1

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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