Allogenic Bone Marrow Derived Mesenchymal Stem Cell Therapy in Cases of Hemophilia

April 5, 2014 updated by: Hala Gabr, Cairo University

Allogenic Mesenchymal Stem Cells in Hemophilia: a Pilot Study

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.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

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.

In the past few years, a novel option to regenerate damaged liver from bone marrow-derived cells has been proposed by many investigators. Studies showed that bone marrow cells not only differentiated into hepatic and liver sinusoidal endothelial cells but they also expressed the intact gene of the FVIII A3 domain.

Mesenchymal stem cells have many advantages as candidates for cellular therapy. They can be propagated in-vitro, do not evoke immune reaction as they express only human leukocyte antigen (HLA)-G, and have been proven to adopt hepatocyte phenotype in vitro.

In hemophilia A patients, the mother is a carrier, the father is completely normal, and the female siblings have a 50% chance of being normal or carrier. Thus, the possibility of finding an HLA-matched donor with normal FVIII activity in the family is present. The use of mesenchymal stem cells (BM-MSCs) have the following advantaged over BM-HSCs:

  1. MSCs can differentiate into both hepatic and endothelial phenotypes
  2. MSCs do not express HLA antigens except HLA-G which caused immunosuppression, thus matching for MSC transplantation can be easier.

The hypothesis of the present study is to use allogenic bone marrow derived mesenchymal stem cells induced to adopt hepatocyte phenotype in vitro as a cellular therapy product in hemophilia patients.

Donors will be subjected to:

  1. Bone marrow aspiration under local or short general anaesthesia, 40-60ml BM will be collected on heparinized syringes.
  2. Mononuclear cell fraction will be separated using SEPAX machine (Biosafe)
  3. MSCs will be isolated using plastic adherence and subjected to hepatic induction using sequential fibroblast growth factor and hepatocyte growth factor addition under GMP conditions.
  4. Verification of hepatic induction will be done using morphological, molecular and proteomic screening.
  5. Cells will then be harvested using 0.25% trypsin, washed and suspended in sterile saline in a dose of 2 million cells per kg body weight in a final volume of 5ml and injected into the hepatic parenchyma under sonographic monitoring.

Study Type

Interventional

Enrollment (Anticipated)

20

Phase

  • Phase 1

Contacts and Locations

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

Study Contact

Study Locations

  • Egypt
      • Cairo, Egypt, 11451
        • Military Medical Academy
        • Principal Investigator:
          • wael Abou El-kheir, M.D.

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

6 years to 40 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Laboratory diagnosis of factor 8 deficiency
  • Dependent on exogenous factor 8 therapy

Exclusion Criteria:

  • Liver disease
  • History of allergy to factor therapy
  • Abnormal spleen by sonography

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: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Cellular therapy
Cellular therapy : injection of mesenchymal stem cells subjected to hepatogenic induction
Biological: Cellular therapy
bone marrow derived mesenchymal stem cells for normal subjects will be separated and induced to adopt the hepatocyte phenotype then injected through the portal vein to hemophilia patients

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessment of Safety / Efficacy
Time Frame: 2 years
Assessment of vitality, life style and bleeding times of the Patients.
2 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessment of Coagulation Profile
Time Frame: 2 years

All Participants Subjected to :

  1. APPT (activated partial thromboplastin time) weekly
  2. Factor 8 assay will be done weekly.
2 years

Collaborators and Investigators

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

Sponsor

Cairo University

Collaborators

Affiliated Hospital to Academy of Military Medical Sciences

Investigators

  • Principal Investigator: hala Gabr, M.D., Cairo University
  • Study Chair: Wael Abou El-Kheir, M.D., Military Medical Academy

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.

General Publications

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

August 1, 2014

Primary Completion (Anticipated)

August 1, 2015

Study Completion (Anticipated)

February 1, 2016

Study Registration Dates

First Submitted

February 15, 2014

First Submitted That Met QC Criteria

April 5, 2014

First Posted (Estimate)

April 9, 2014

Study Record Updates

Last Update Posted (Estimate)

April 9, 2014

Last Update Submitted That Met QC Criteria

April 5, 2014

Last Verified

April 1, 2014

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SC-HEM

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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