Allogeneic UCB Therapy With EPO in Children With CP

Safety and Efficacy of Allogeneic Umbilical Cord Blood Therapy Combined With Erythropoietin in Children With Cerebral Palsy: a Double-blind, Randomized, Placebo-controlled Clinical Trial

This randomized controlled study aims to evaluate the efficacy and safety of allogeneic umbilical cord blood therapy combined with erythropoietin for children with cerebral palsy.

Study Overview

• Status: Completed
• Conditions: Cerebral Palsy
• Intervention / Treatment: Procedure: Umbilical Cord Blood therapy; Biological: Erythropoietin alfa; Other: Rehabilitation; Biological: Placebo EPO; Procedure: Placebo UCB

Detailed Description

Cerebral palsy (CP) is a group of neurodevelopmental conditions with abnormal movement and posture resulted from a non-progressive cerebral disturbance. It is the most common cause of motor disability in childhood. Most therapies are palliative rather than restorative. Umbilical cord blood (UCB) and erythropoetin (EPO) may be used as restorative approach for children with CP.

Many experimental animal studies have revealed that UCB is beneficial to improve and repair neurological injuries. EPO is also known to have neuroprotective effects.

Based on animal studies and some clinical trials, UCB is suggested as a potential therapy for children with CP. EPO is combined to add synergistic effects to UCB therapy.

• Study Type: Interventional
• Enrollment (Actual): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Korea, Republic of
  • Gyeonggi-do
    • Seongnam-si, Gyeonggi-do, Korea, Republic of, 463-712
      • CHA Bundang Medical Center, CHA University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 months to 6 years (CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosed with cerebral palsy
• Age of ≥10 months and ≤6 years
• Mismatch in HLA-A, B, and DR ≤2, and total nucleated cell count ≥3x107/kg. If the cell count is less than given values, more than 1 unit could be used.
• Hemoglobin ≤13.6 g/dL
• Decision of participation in the study by and acquisition of informed consent from the subject's representative
• Willingness and ability to be hospitalized according to the schedule specified in the protocol and continue the study for 12 months after study entry

Exclusion Criteria:

• Current aspiration pneumonia
• Known genetic disease
• History of hypersensitivity reaction to any study drugs pertinent to the study
• History of participation in any other study with stem cell
• Prior treatment with EPO within 3 months prior to study entry
• Known coagulopathy with family history of thrombosis or medical history of recurrent thrombosis
• Patient with severe seizure disease who has clinical convulsion despite combination therapy with 3 or more agents
• Uncontrolled hypertension defined as systolic blood pressure >115 mmHg and/or diastolic blood pressure >70 mmHg
• Hepatic impairment defined as asparate aminotransferase (AST) >55 IU/L and/or alanine aminotransferase (ALT) >45 IU/L
• Renal impairment defined as creatinine (Cr) ≥1.2 mg/dL
• Absolute neutrophil count ≤500/dL
• Presence of diagnosed or suspected malignant tumor and/or hematologic malignancy
• Non-compliance with study visits specified in the protocol or unwillingness of care-giver due to lack of understanding of the patient

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: QUADRUPLE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: UCB and EPO; UCB + EPO + Rehabilitation	Procedure: Umbilical Cord Blood therapy; HLA (Human Leukocyte Antigen) typing; Biological: Erythropoietin alfa; Other Names: Espogen (LG Life Science Ltd.); Other: Rehabilitation; Active rehabilitation
ACTIVE_COMPARATOR: UCB and placebo EPO; UCB + placebo EPO + Rehabilitation	Procedure: Umbilical Cord Blood therapy; HLA (Human Leukocyte Antigen) typing; Other: Rehabilitation; Active rehabilitation; Biological: Placebo EPO
ACTIVE_COMPARATOR: placebo UCB and EPO; placebo UCB + EPO + Rehabilitation	Biological: Erythropoietin alfa; Other Names: Espogen (LG Life Science Ltd.); Other: Rehabilitation; Active rehabilitation; Procedure: Placebo UCB
PLACEBO_COMPARATOR: placebo UCB and placebo EPO; placebo UCB + placebo EPO + Rehabilitation	Other: Rehabilitation; Active rehabilitation; Biological: Placebo EPO; Procedure: Placebo UCB

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Standardized Gross Motor Function	GMFM (Gross Motor Function Measure) is a standardized measurement tool for assessing gross motor function consisting of sub-scales; lying & rolling, sitting, crawling & kneeling, standing, walking, running & jumping (range: 0~100, higher value means better gross motor function).	Baseline - 1 month - 3 months - 6 months - 12months
Changes in Motor Performance	GMPM (Gross Motor Performance Measure) is a standardized measurement tool for assessing quality of movement regarding 3 properties of 5 ones; alignment, coordination, dissociated movement, stability, and weight shift (range: 0~100, higher value means better motor quality).	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Cognitive Neurodevelopmental Outcome	Korean version of Bayley Scale of Infant Development-II (K-BSID-II) Mental Scale (range: 0~178; worst: 0, best: 178)	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Motor Neurodevelopmental Outcome	Korean version of Bayley Scale of Infant Development-II (K-BSID-II) Motor Scale (range: 0~112; worst: 0, best: 112)	Baseline - 1 month - 3 months - 6 months - 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Gross Motor Function Classification System	GMFCS (Gross Motor Function Classification System) is a five-level classification system based on self-initiated movement, with emphasis on sitting, transfers, and mobility (level I: walks without limitations, ll: walks with limitations, III: walks using a hand-held mobility device, IV: self-mobility with limitations, V: transported in a manual wheelchair).	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Functional Independence in Daily Activities	WeeFIM (Functional Independence Measure for Children) measures functional independence in daily activities. WeeFIM contains 18 items and each item is ranked from complete dependence (scored as 1) to complete independence (scored as 7). The range is from 18 to 126 and higher score means more independent performance in daily activities.	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Functional Performance in Daily Activities	Pediatric Evaluation of Disability Inventory (PEDI) is used to assess functional performance in daily activities in children (All values are adjusted and higher value means better functional performance, 0 - worst, 100 - best). PEDI consists of 2 scales such as Functional Skill Scale (FSS) and a Caregiver Assistance Scale (CAS) and each scale is composed of 3 domains including self care, mobility, and social function.	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Upper Extremity Function	QUEST (Quality of Upper Extremity Skills Test) is a standardized measurement tool for assessing upper extremity function consisting of sub-scales; dissociated movement, grasps, weight bearing, and protective extension. QUEST ranges from 0 (or below 0 in grasp section) to 100 and higher values mean better upper extremity function.	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Visual Perception Test	Visual perception function will be assessed with one of 3 tools such as DTVP (Developmental Test of Visual Perception), MVPT (Motor-free Visual Perception Test), and VMI (Visual-Motor Integration, Visual Perception and Motor Coordination). Higher value means better visual perception ability.	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Selective Movement of Lower Extremity	SCALE (Selective Control Assessment of Lower Extremity) is a measurement tool of selective movement of hip, knee, ankle, subtalar joint and toes. Selective voluntary motor control is graded at each joint as normal (2 points), impaired (1 point) or unable (0 point).	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Spasticity	Muscle spasticity of biceps, hip adductors, hamstrings and heel cords is graded according to modified Ashworth scale (MAS).	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Dynamic Component of Spasticity	Dynamic component of spasticity in bilateral hamstrings is graded using modified Tardieu scale (MTS).	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Muscle Strength	Muscle strength is measured using summated scores of manual muscle test (zero=0, trace=1, poor=2, fair=3, good=4, normal=5) for flexors, extensors, abductors, and adductors of bilateral shoulder and hip joints; flexors and extensors of bilateral elbow, wrist, and knee; dorsiflexors and plantar flexors of the ankles (range: 0 ~ 160). Higher score means stronger muscle power.	Baseline - 1 month - 3 months - 6 months - 12 months
Changes in Brain MRI	Diffusion Tensor Image (DTI) of brain MRI (magnetic resonance imaging) provides quantitative information about the microscopic integrity of white matter. White matter normally possesses a high degree of diffusion anisotropy than gray matter. Fractional anisotropy (FA) will be measured and it ranges from 0 to 1. Higher FA value means more integrity of white matter.	Baseline - 12 months
Changes in Brain 18F-FDG PET	18F-FDG PET (Positron emission tomography with fluorine-18-fluorodeoxyglucose) imaging will be performed twice prior to and 12 months after UCB therapy.	Baseline - 12 months
Changes in EEG	Electroencephalography (EEG) will be performed twice prior to and 12 months after UCB therapy.	Baseline - 12 months
Changes in EP	Median, tibial somatosensory evoked potential (SEP), visual evoked potential (VEP), auditory evoked potential (AEP) will be performed twice prior to and 12 months after UCB therapy.	Baseline - 12 months
Number of adverse events and participants with those adverse events	The numbers of adverse events and subjects with those serious adverse events within each group; A serious adverse event is any untoward medical occurrence that at any dose: results in death or is life-threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, or causes a congenital anomaly/birth defect.	12 months

Collaborators and Investigators

• Sponsor: MinYoung Kim, MD, PhD
• Collaborators: LG Life Sciences; Chong Kun Dang Pharmaceutical; CHA University; Ministry of Health & Welfare, Korea

Publications and helpful links

General Publications

• Min K, Suh MR, Cho KH, Park W, Kang MS, Jang SJ, Kim SH, Rhie S, Choi JI, Kim HJ, Cha KY, Kim M. Potentiation of cord blood cell therapy with erythropoietin for children with CP: a 2 x 2 factorial randomized placebo-controlled trial. Stem Cell Res Ther. 2020 Nov 27;11(1):509. doi: 10.1186/s13287-020-02020-y.

Study record dates

Study Major Dates

• Study Start (ACTUAL): November 26, 2013
• Primary Completion (ACTUAL): June 24, 2017
• Study Completion (ACTUAL): June 24, 2017

Study Registration Dates

• First Submitted: November 17, 2013
• First Submitted That Met QC Criteria: November 17, 2013
• First Posted (ESTIMATE): November 25, 2013

Study Record Updates

• Last Update Posted (ACTUAL): January 18, 2020
• Last Update Submitted That Met QC Criteria: January 15, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Keywords: Rehabilitation; Cerebral Palsy; Erythropoietin; Umbilical Cord Blood
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Damage, Chronic; Cerebral Palsy; Hematinics; Epoetin Alfa
• Other Study ID Numbers: UCBnEPOinCP