A Comparative Study of 2 Doses of BM Autologous H-MSC+Biomaterial vs Iliac Crest AutoGraft for Bone Healing in Non-Union (ORTHOUNION)

A Multi-centre, Open-label, Randomized, Comparative Clinical Trial of Two Doses of Bone Marrow Autologous MSC+ Biomaterial vs Iliac Crest Autologous Graft, for Bone Healing in Non-union After Long Bone Fractures

ORTHOUNION is a multi-centre, open, comparative, randomized, clinical trial with three parallel arms that aims to compare the efficacy of three treatments to enhance bone healing in patients with long bone non-union.

Study Overview

• Status: Completed
• Conditions: Non Union Fracture
• Intervention / Treatment: Biological: Cultured Mesenchymal Stem Cells; Procedure: Autologous iliac crest graft

Detailed Description

Bone injuries represent an important world medical problem producing significant healthcare and societal expenditure. While most bone injuries are not severe and are capable of healing through bone regeneration by natural callus formation with standard treatments, severe bone injuries may not heal, becoming an important unmet clinical need.

Non-unions, or pseudarthrosis, may occur in 5% to 20% of long-bone fractures that fail to heal properly after more than 6 months, with morbidity, prolonged hospitalization, and increased expenses. The most commonly accepted standard augmentation to procure fracture and non-union healing consists of autologous bone grafting, obtained from the same patient in a different surgical site and transplanted to the reconstruction site. However, autologous bone grafting has some drawbacks (such as persistent pain, scar, late recovery, limited amount of bone, etc) and a limited regeneration efficacy (success rate of about 74%) and high societal cost. Culture-expanded autologous MSCs combined with biphasic calcium phosphate (BCP) biomaterial granules have been claimed as a solid regenerative medicine alternative to autologous bone grafting in non-unions, although current data are limited. In this context, the ORTHOUNION initiative focuses on the opportunity to test the hypothesis of superiority of MSC, the investigational ATMP, versus the currently accepted standard therapy, iliac crest bone autograft to biologically augment surgical treatment of long-bone non-unions.

• Study Type: Interventional
• Enrollment (Actual): 46
• Phase: Phase 3

Contacts and Locations

Study Locations

• France
  • Clermont-Ferrand, France
    • CHU Clermont-Ferrand
  • Créteil, France
    • Department of Orthopaedic Surgery, Hospital Henri Mondor
  • Nantes, France
    • Department of Orthopaedic Surgery, CHU Nantes
  • Toulouse, France
    • Department of Orthopaedic Surgery Toulouse University Hospital
  • Tours, France, 37044
    • Department of Orthopaedic Surgery, CHU Tours
• Germany
  • Frankfurt, Germany
    • Universitätsklinikum Frankfurt, Department of Trauma, Hand and Reconstructive Surgery
  • Freiburg, Germany
    • Universitätsklinikum Freiburg, Klinik für Orthopädie und Unfallchirurgie
  • Munich, Germany
    • Universitätsklinikum München
  • Ulm, Germany, 8907581
    • Department of Orthopaedic Trauma, University of Ulm
• Italy
  • Bologna, Italy, 40136
    • Istituto Ortopedico Rizzoli, SSD Fisiopatologia Ortopedica e Medicina Rigenerativa
  • Brescia, Italy
    • Arienda Spedali Civili di Brescia II Ortopedia e Traumatologia
  • Milano, Italy
    • Istituto Ortopedico Galeazzi, Chirugia dell´Anca l
• Spain
  • Madrid, Spain
    • Hospital Universitario Ramon y Cajal
  • Madrid, Spain
    • Hospital Clínica San Carlos, Servicio de Cirugía Ortopédica y Traumatología
  • Madrid, Spain
    • Hospital U. 12 de Octubre, Servicio de Cirugía Ortopédica y Traumatología
  • Madrid, Spain
    • Hospital U. Gregorio Marañon, Servicio de Cirugía Ortopédica y Traumatología
  • Madrid, Spain
    • Hospital U. La Princesa, Servicio de CirugíaOrtopédica y Traumatología
  • Madrid, Spain
    • Servicio de Cirugía Ortopédica y Traumatología "A", Hospital La Paz
  • Madrid
    • Majadahonda, Madrid, Spain
      • Hospital U. Puerta de Hierro-Majadahonda, Servicio de Cirugía Ortopédica y Traumatología

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age 18 years and older, both sexes
2. Traumatic isolated closed or open Gustilo I and II, IIIA and IIIB humerus, tibial or femur diaphyseal or metaphysodiaphyseal fracture with a status of atrophic, oligotrophic or normotrophic non-union.
3. Able to understand, accept and sign informed consent
4. Medical health coverage
5. Able to understand and accept the study constraints

Exclusion Criteria:

1. Hypertrophic non-unions
2. Segmental bone loss requiring specific therapy (bone transport, vascularized graft, large structural allograft, megaprosthesis, etc)
3. Unrecovered vascular or neural injury
4. Other fractures causing interference with weight bearing
5. Visceral injuries or diseases interfering with callus formation (severe cranioencephalic trauma, etc.)
6. Active infection of any location and aetiology
7. Surgical contraindication of any cause
8. Pregnancy, breast feeding women and women who are of childbearing age and not practicing adequate birth control.
9. Malignant tumour (past history or concurrent disease)(except carcinoma in situ or basalioma in remission)
10. History of bone harvesting on iliac crest contraindicating new iliac crest bone graft harvesting or bone marrow collection
11. Insulin dependent diabetes
12. Any evidence (confirmed by PCR) of active infection with HIV, Hepatitis B or Hepatitis C infection
13. Any evidence of Syphilis
14. Known allergies to products involved in the production process of MSC
15. Corticoid or immunosuppressive therapy more than one week in the three months prior to study inclusion
16. Autoimmune inflammatory disease
17. Current treatment by biphosphonates not stopped three months prior to study inclusion
18. Impossibility to meet at the appointments for the follow up
19. Participation in another therapeutic trial in the previous 3 months
20. Second non-union in case of bilateral or multiple non-unions (only one non-union per patient will be included in the trial)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: hBM-MSCs-Low Dose; Autologous Cultured Mesenchymal Stem Cells +Biomaterial (Low Dose): 100x106 cells	Biological: Cultured Mesenchymal Stem Cells; Cultured Mesenchymal Stem Cells obtained from expanded bone marrow
Experimental: hBM-MSCs-High Dose; Autologous Cultured Mesenchymal Stem Cells+Biomaterial (High Dose): 200x106 cells	Biological: Cultured Mesenchymal Stem Cells; Cultured Mesenchymal Stem Cells obtained from expanded bone marrow
Active Comparator: Autologous iliac crest graft; Autologous Iliac Crest Grafting	Procedure: Autologous iliac crest graft; Autologous iliac crest grafting

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bone consolidation	The percentage of bone consolidation in the comparator treatment arm ( iliac crest autograft) and experimental treatment arm (mesenchymal cells).	12 months after treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bone consolidation	To compare bone consolidation between the experimental arms and the comparator	6 and 24 months
Radiological Bone consolidation	To compare bone consolidation, using the REBORNE scale, between the experimental arms and the comparator. The REBORNE scale is an ad-hoc and validated scale, developed by Gomez-Barrena et al. (article currently under preparation) as a modification of the RUST score (Whelan, 2010; Journal of Trauma). In the REBORNE scale, the presence/absence of radiological consolidation is evaluated on a total of 4 cortices. Score range from 0 (no bone callus visible) to 4 (callus present with same density as cortical). The total score will be recorded.	6, 12 and 24 months
Level of Pain	To compare level of pain (by Numeric Rating Scale [NRS]) between the experimental arms and the comparator. The NRS is a scale that rates the patient´s pain from 0-10 (0= no pain, 10= worst pain), at the time of the visit.	6, 12 and 24 months
Complications	To compare the rate of complications between the experimental arms and the comparator	6, 12 and 24 months
Health status	To compare the health status (by using the Short Form-36 Health Questionnaire) between treatment arms. The SF-36 questionnaire is a validated, widely used patient-reported health survey which measures their physical and mental health status. It consists of 36 questions organized in 8 dimensions. The total score will be recorded.	6, 12 and 24 months

Collaborators and Investigators

• Sponsor: Universidad Autonoma de Madrid
• Investigators: Principal Investigator: Enrique Gomez-Barrena, Prof, Universidad Autonoma de Madrid

Publications and helpful links

General Publications

• Gomez-Barrena E, Padilla-Eguiluz NG, Avendano-Sola C, Payares-Herrera C, Velasco-Iglesias A, Torres F, Rosset P, Gebhard F, Baldini N, Rubio-Suarez JC, Garcia-Rey E, Cordero-Ampuero J, Vaquero-Martin J, Chana F, Marco F, Garcia-Coiradas J, Caba-Dessoux P, de la Cuadra P, Hernigou P, Flouzat-Lachaniette CH, Gouin F, Mainard D, Laffosse JM, Kalbitz M, Marzi I, Sudkamp N, Stockle U, Ciapetti G, Donati DM, Zagra L, Pazzaglia U, Zarattini G, Capanna R, Catani F. A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol. Stem Cells Int. 2018 Feb 22;2018:6025918. doi: 10.1155/2018/6025918. eCollection 2018.

Helpful Links

• Webpage of the Orthounion Study

Study record dates

Study Major Dates

• Study Start (Actual): September 5, 2017
• Primary Completion (Actual): October 17, 2022
• Study Completion (Actual): December 15, 2023

Study Registration Dates

• First Submitted: October 25, 2017
• First Submitted That Met QC Criteria: October 25, 2017
• First Posted (Actual): October 30, 2017

Study Record Updates

• Last Update Posted (Actual): December 4, 2024
• Last Update Submitted That Met QC Criteria: December 2, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: Mesenchymal stem cells; Non-union; Advanced therapies; Long bone
• Additional Relevant MeSH Terms: Wounds and Injuries; Fractures, Bone; Fractures, Ununited
• Other Study ID Numbers: ORTHOUNION; 2015-000431-32 (EudraCT Number); EUCTR2015-000431-32-ES (Registry Identifier: International Clinical Trials Registry Plataform)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No