- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03818854
Mesenchymal Stromal Cells For Acute Respiratory Distress Syndrome (STAT)
A Phase 2b, Randomized, Double-blind, Placebo-controlled, Multi-center Clinical Trial of Allogeneic Bone Marrow-derived Human Mesenchymal Stromal Cells (hMSCs) for the Treatment of Acute Respiratory Distress Syndrome
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This clinical study design is a randomized, double-blinded, placebo-controlled Phase 2b clinical trial using a 10 million cell/kg dose of human Mesenchymal Stromal Cells (hMSCs). Subjects will be randomized in a 1:1 randomization scheme to receive hMSCs or cell reconstitution media (1:1 mix of 5% human serum albumin and 10% Dextran 40) as the placebo; the study will enroll 120 patients who achieve a stable clinical baseline and receive study product (either hMSCs or the placebo).
The Data and Safety Monitoring Board (DSMB) will review adverse outcomes and protocol compliance. A pre-specified interim review will occur after 60 subjects have been enrolled and received study product; enrollment will continue during the DSMB review. All pre-specified clinically important events and unexpected serious adverse events including death during hospitalization up to 60 days will be reported to the DSMB on an ongoing basis; the study will be stopped for a safety evaluation by the DSMB if they have any concerns or if three subjects have pre-specified clinically important events or unexpected serious adverse events except death since death will be common in this critically ill population due the nature of the underlying illness (e.g., ARDS).
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Michael Matthay, MD
- Phone Number: 415-353-1206
- Email: michael.matthay@ucsf.edu
Study Contact Backup
- Name: Hanjing Zhuo, MPH
- Phone Number: 415-502-7434
- Email: hanjing.zhuo@ucsf.edu
Study Locations
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California
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Sacramento, California, United States, 95817
- University of California Davis Medical Center
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San Francisco, California, United States, 94143
- University of California San Francisco
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San Francisco, California, United States, 94110
- Zuckerberg San Francisco General Hospital and Trauma Center
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Oregon
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Portland, Oregon, United States, 97239
- Oregon Health & Science University
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Tennessee
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Nashville, Tennessee, United States, 37232
- Vanderbilt University Medical Center
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Texas
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Houston, Texas, United States, 77030
- Memorial Hermann Hospital - Texas Medical Center
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Washington
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Seattle, Washington, United States, 98112
- Harborview Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Patients will be eligible for inclusion if they meet all of the below criteria within 14 days of initial ICU admission. Criteria 1-3 must all be present within a 24-hour time period and at the time of enrollment:
Acute onset (defined below) of:
- A need for positive pressure ventilation by an endotracheal or tracheal tube with a PaO2/FiO2 ratio <250 mmHg and ≥5 cm H2O positive end-expiratory airway pressure (PEEP), as per the Berlin Criteria.
- Bilateral infiltrates consistent with pulmonary edema (defined below) on the frontal chest radiograph, or bilateral ground glass opacities on a chest CT scan.
- No clinical evidence of left atrial hypertension as a primary explanation for the bilateral pulmonary infiltrates.
If the cause of ARDS is trauma, additional inclusion criteria will include ONE of the following relevant risk factors for developing ARDS:
- Hypotension (systolic blood pressure[SBP] < 90 mmHg) in the field or in the first 24 h after injury, or
- Transfusion of 3 units of blood products in the first 24 hours following injury, or
- Meets the new Critical Administration Threshold (CAT) criteria with at least 3 units of blood in one hour, or
- Blunt or penetrating torso trauma, or
- Long bone fractures, or
- The highest level of institutional trauma activation
Exclusion Criteria:
- Age less than 18 years
- Greater than 72 hours since first meeting ARDS criteria per the Berlin definition of ARDS
- Greater than 14 days since initial ICU admission
- Inability to administer study product within 14 days of ICU admission
- PaO2/FiO2 ≥ 250 mmHg after consent obtained and before study product is administered
- Unable to obtain informed consent/no surrogate available
- Pregnant or lactating
- In custody of law enforcement officials
- Burns > 20% of total body surface area
- WHO Class III or IV pulmonary hypertension
- History of cancer treatment in the last 2 years except for non-melanotic skin cancers
- Underlying medical condition for which 6-month mortality is estimated to be > 50%
- Moribund patient not expected to survive 24 hours
- Advanced chronic liver disease (Child-Pugh Score > 12)
- Severe chronic respiratory disease with the use of home oxygen
Severe traumatic brain injury - defined as:
- A patient who has undergone intracranial neurosurgical intervention for monitoring or therapy (intracranial pressure monitoring, external ventricular drain, craniotomy), or
- Intracranial injury by head CT (does not include patients with minimal subarachnoid injury and/or minor skull fracture), or
- Post-resuscitation Glasgow Coma Score (GCS) < 9 assessed after sedation interruption, or
- Non-survivable head injury as assessed by neurosurgery
- Evidence of anoxic brain injury
- History of stroke within the last 3 years
- No intent/unwillingness to follow lung protective ventilation strategy
- Currently receiving extracorporeal life support (ECLS) or high-frequency oscillatory ventilation (HFOV)
- Anticipated extubation within 24 hours of enrollment
- Clinical evidence of left atrial hypertension as measured by a pulmonary arterial wedge pressure > 18mmHg or left ventricular failure measured by an echocardiogram with a left ventricular ejection fraction less than 40%. Clinical judgement will determine if either of these measurements needs to be carried out.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Human Mesenchymal Stromal Cells
A single dose of 10 million cells/kg predicted body weight (PBW) Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells will administered intravenously over approximately 60-80 minutes.
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Immediately prior to administration, the study product will be thawed and diluted 1:1 with reconstitution media (1:1 mix of 5% human serum albumin and 10% Dextran 40).
Additional reconstitution media is added to a final product volume of 300 mL.
Other Names:
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Experimental: Cell Reconstitution Media
A single dose of cell reconstitution media (1:1 mix of 5% human serum albumin and 10% Dextran 40) will administered intravenously over approximately 60-80 minutes.
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300 mL of reconstitution media (1:1 mix of 5% human serum albumin and 10% Dextran 40)
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in oxygenation index (OI)
Time Frame: 36 hours
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Change in OI from baseline over the 36 hours following the infusion of study product
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36 hours
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acute Lung Injury Score (LIS)
Time Frame: 7 days
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LIS over 7 days, or on the last day of positive pressure ventilation prior to day 7.
The LIS is a composite 4-point scoring system including the PaO2/FiO2, PEEP, lung compliance, and the extent of infiltrates on the chest X-ray.
Each of the four components is categorized from 0 to 4, where a higher number is worse.
The total Lung Injury Score is obtained by dividing the aggregate sum by the number of components used.
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7 days
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Pulmonary Dead Space Fraction
Time Frame: 7 days
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Pulmonary Dead Space at day 1, 2, 3 and 7.
The dead-space fraction is calculated as: (PaCO2 - PeCO2) ÷ PaCO2
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7 days
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Chest radiograph assessment of pulmonary edema (RALE score)
Time Frame: 7 days
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RALE score at day 1, 2, 3 and 7. To calculate RALE, each radiographic quadrant is scored for extent of consolidation (0-4) and density of opacification (1-3).
The product of the consolidation and density scores for each of the four quadrants is summed.
The RALE score ranges from 0 (best) to 48 (worst).
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7 days
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Ventilator free-days
Time Frame: 28 days
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Ventilator free-days over 7, 14 and 28 days
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28 days
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Duration of assisted ventilation over 28 days
Time Frame: 28 days
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Duration of assisted ventilation over 28 days in the survivors
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28 days
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Percentage of patients achieving pressure support ventilation for 2 hours
Time Frame: 28 days
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Percentage of patients achieving pressure support ventilation equal to 5 cm H2O with positive end-expiratory pressure (PEEP) equal to 5 cm H2O for 2 hours
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28 days
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Occurrence of Infection
Time Frame: 14 days
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Superficial incisional/wound infections, deep incisional wound infections, and organ/space infections, and ventilator associated pneumonia (all during the 14 days after enrollment)
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14 days
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Sequential Organ Failure Assessment (SOFA) over 7 days
Time Frame: 7 days
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SOFA score at 3 and 7 days.
The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems which are added up.
Each score ranges from 0 to 4. SOFA score ranges from 0 (best) to 24 (worst).
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7 days
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All-cause hospital mortality
Time Frame: 60 days
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All-cause hospital mortality at 14, 28 and 60 days
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60 days
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Glasgow Outcome Score (GCS)
Time Frame: 60 days
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Glasgow Outcome Score at hospital discharge.
The GCS is a scale to evaluate level of consciousness in patients with acute brain injury.
The scale assesses 3 functions: Eye Opening, Verbal Response, and Motor Response.
GCS scores range from 15 (best) to 3 (worst)
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60 days
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Percentage of patients occurred any thromboembolic events
Time Frame: 60 days
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Thromboembolic events are measured by ultrasound of the deep venous system or CT-angiography of the chest ordered for clinical purposes/by treating clinicians
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60 days
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Plasma angiopoietin-2
Time Frame: 72 hours
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Change in levels of plasma angiopoietin-2 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma Receptor for Advanced Glycation Endproducts (RAGE)
Time Frame: 72 hours
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Change in levels of plasma RAGE from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma interleukin-6
Time Frame: 72 hours
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Change in levels of plasma interleukin-6 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma interleukin-8
Time Frame: 72 hours
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Change in levels of plasma interleukin-8 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma Soluble tumor necrosis factor 1 (sTNF-1)
Time Frame: 72 hours
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Change in levels of plasma sTNF-1 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma protein C
Time Frame: 72 hours
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Change in levels of plasma protein C from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma lipoxin A4
Time Frame: 72 hours
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Change in levels of plasma lipoxin A4 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma Resolvin D1
Time Frame: 72 hours
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Change in levels of plasma Resolvin D1 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma angiopoietin-1
Time Frame: 72 hours
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Change in levels of plasma angiopoietin-1 from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Plasma keratinocyte growth factor (KGF)
Time Frame: 72 hours
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Change in levels of plasma KGF from baseline compared to 6, 24, 48 and 72 hours
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72 hours
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Urine microalbumin
Time Frame: 48 hours
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Change in levels of urine microalbumin from baseline compared to 24 and 48 hours
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48 hours
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Total protein in min-bronchoalveolar lavage (mBAL)
Time Frame: 2 days
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Change in total protein levels in from baseline to day 2
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2 days
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Tolerability of the hMSCs - incidence of pre-specified infusion-associated events and unexpected severe adverse events
Time Frame: 24 hours
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Tolerability of the hMSCs, defined as the incidence of pre-specified infusion-associated events and unexpected severe adverse events in ARDS patients treated with human MSCs
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24 hours
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Michael Matthay, MD, University of California, San Francisco
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- UCSF-hMSC-ARDS-P1P2-12
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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