- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01619189
Cell Therapy in Failure Syndromes in Limbal Stem Cells (TC181)
August 29, 2019 updated by: Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts
Thérapie Cellulaire au Cours Des Syndromes d'Insuffisance en Cellules Souches Limbiques
Transplantation of allogeneic or autologous limbal epithelial stem cells cultured on human amniotic membrane with no feeders in eyes with total limbal deficiency.
Prospective non-comparative monocentric study.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
The limbal stem cell deficiency syndrome is characterized by invasion of the corneal surface by an epithelium with a conjunctival differentiation, and, clinically, by opacification and vascularization of the corneal epithelium with impaired corneal epithelial cicatrisation and corneal ulcers that may lead to corneal perforation.
When total, the limbal deficiency syndrome is the cause of major disability.
Vision decreases largely under the legal threshold of blindness.
Overall, the most frequent etiology is by far the complete loss of limbal stem cells induced by severe ocular burns.
Until a rather recent date, no treatment was possible in this pathology.
Progress in the comprehension of the physiology of the corneal epithelium renewal made it possible to introduce a therapeutic approach, i.e., transplantation of cultured limbal stem cells retrieved from the healthy contralateral eye (autograft, unilateral diseases) or from a cadaveric donor eye (allograft, bilateral diseases or unique eye).
Techniques of cell therapy were first described in Italy, Asia and in the USA with positive clinical results.
They have all different processes for preparing the cell product to be transplanted and none answers the safety criteria required by the French legislation.
The investigators developed a process for preparing a cell therapy product which was accepted by the French regulation agency (AFSSaPS) for a clinical trial (TC181) which began in 2007.
The aims of the study are (1) evaluation of the clinical results of this technique in terms of improvement of visual function, reduction in the handicap, improvement of the anatomical condition of the ocular surface and restitution of the physiological function of the limbal epithelium and (2) evaluation of its possible side effects.
It is a biphasic monocentric non-comparative prospective study including, according to the clinical responses observed during the first phase (plane of Gehan, ß = 10%), from 15 to 50 voluntary patients with unilateral or bilateral total limbal deficiency.
Patient follow-up is 3 years.
The expected minimal success rate is 20% for allografts and 40% for the autografts.
Monitoring is ensured by URC-Est.
The grafts are prepared by culture of autologous or allogeneic limbal epithelial cells from limbal explants on human amniotic membrane.
The medical safety requirements relating to transplantation of tissues and cells are reached and the cell therapy products are secured at each stage of their preparation by conventional bacteriological and fungal tests and viral and bacterial PCR.
The graft quality is controlled before transplantation.
The main outcome measure is survival of the grafted epithelium (Kaplan-Meier method) defined by absence of recurrence of the clinical signs of limbal deficiency (opacification of the corneal epithelium, irregularity of the corneal epithelium, surface corneal vascularization) in the central cornea.
The expected repercussions are (1) restitution of a limbal epithelial function allowing a clear corneal epithelium to be obtained, with no superficial vascularization nor chronic epithelial defects, (2) improvement of vision in blind patients, and (3) obtaining a vision higher than the legal threshold of blindness after cell therapy or after subsequent corneal transplantation.
If the clinical trial makes it possible to show the effectiveness of this cell therapy technique, a request for authorization of process will be made at AFSSaPS for routine use.
Study Type
Interventional
Enrollment (Actual)
14
Phase
- Phase 2
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
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Paris, France, 75012
- CHNO des Quinze-Vingts
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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
Ages Eligible for Study
18 years to 70 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patient age between 18 and 70 years
- Informed consent.
- Unilateral or bilateral limbal deficiency with diffuse opacification of the corneal epithelium, and superficial (or superficial and deep) corneal vascularization, and irregular corneal epithelial surface at slit-lamp examination with fluorescein, either associated with chronic epithelial defects
- Visual acuity of the eye to be treated < 20/20.
- Absence de kératinization of the ocular surface.
- Schirmer test > 0 at 3 minutes.
- For autografts : sérology HIV -, HCV -, HBs
Exclusion Criteria:
- Age < 18 y or > 70 y.
- Absence of informed consent or imformed consent not possible.
- Partial limbal deficiency (healthy corneal epithelium persistant in at least one zone).
- Previous treatment of limbal deficiency by limbal transplantation or amniotic membrane transplantation during the last 12 months.
- Conjunctival stem cell deficiency (xerophtalmia, keratinization of the ocular surface).
- Local anesthesia impossible.
- Immune keratitis not controlled by medical treatment.
- Ocular burn during the last 2 weeks.
- Corneal anesthesia.
- Pregnancy, breast-feeding.
- Allergy to steroid eyedrops.
- Active fungal keratitis.
- For autografts : risk factor for rabbies or Creutzfeldt-Jacob disease, serology HIV +, VHC +, HBs+.
- Follow-up not possible
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: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Tranplantation of cultured LSC in stage 3 limbal deficiency
Transplantation of Allogeneic or Autologous Limbal Epithelial Stem Cells Cultured on Human Amniotic Membrane with no Feeders in stage 3 unilateral or bilateral limbal stem cell deficiency.
|
transplantation of allogeneic or autologous limbal epithelial stem cells cultured on human amniotic membrane with no feeders
transplantation of allogeneic or autologous limbal epithelial stem cells cultured on human amniotic membrane with no feeders
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
survival of the transplanted epithelium
Time Frame: 3 years
|
survival of the transplanted epithelium defined by absence of recurrence of the clinical signs of limbal deficiency (opacification of the corneal epithelium, irregularity of the corneal epithelium, surface corneal vascularization) in the central cornea.
|
3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
visual acuity
Time Frame: 3 years
|
far best spectacle-corrected LogMAR visual acuity
|
3 years
|
re-epithelialization time after keratoplasty
Time Frame: 3 years
|
The healing time of corneal epithelium will be collectively assed by investigators form the CRF and the pictures taken during the study.
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3 years
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Symptoms
Time Frame: 3 years
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Symptoms recorded at each visit:
Grading of symptoms : sum of all symptoms (0-6) |
3 years
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morphometric analysis of the ocular surface
Time Frame: 3 years
|
the morphometric analysis of the corneal epithelial ulcerations will be assed by the CRA from the pictures of the corneal surface.
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3 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Vincent M Borderie, MD, PhD, CHNO des 15-20
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
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)
June 1, 2007
Primary Completion (ACTUAL)
March 6, 2017
Study Completion (ACTUAL)
March 6, 2017
Study Registration Dates
First Submitted
May 23, 2012
First Submitted That Met QC Criteria
June 12, 2012
First Posted (ESTIMATE)
June 14, 2012
Study Record Updates
Last Update Posted (ACTUAL)
September 3, 2019
Last Update Submitted That Met QC Criteria
August 29, 2019
Last Verified
August 1, 2019
More Information
Terms related to this study
Other Study ID Numbers
- PHRC 2001 (Other Grant/Funding Number: Ministry of Health)
- AOM01086 (OTHER: AFSSAPS)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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