Use of UC-MSCs for COVID-19 Patients

Umbilical Cord-derived Mesenchymal Stem Cells for COVID-19 Patients With Acute Respiratory Distress Syndrome (ARDS)

The purpose of this research study is to learn about the safety and efficacy of human umbilical cord derived Mesenchymal Stem Cells (UC-MSC) for treatment of COVID-19 Patients with Severe Complications of Acute Lung Injury/Acute Respiratory Distress Syndrome (ALI/ARDS).

Study Overview

• Status: Completed
• Conditions: COVID-19; Acute Respiratory Distress Syndrome; Corona Virus Infection; ARDS; ARDS, Human
• Intervention / Treatment: Biological: Umbilical Cord Mesenchymal Stem Cells + Heparin along with best supportive care.; Other: Vehicle + Heparin along with best supportive care

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • Florida
    • Miami, Florida, United States, 33136
      • Diabetes Research Institute, University of Miami Miller School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Patients >/= 18 years old diagnosed with COVID-19 (as evaluated by PCR test confirming infection with SARS-CoV-2) will be eligible for inclusion if they meet all of the below criteria. Inclusion criteria must all be present within a 24-hour time period at the time of enrollment:

1. Patient currently hospitalized
2. Aged ≥ 18 years
3. Willing and able to provide written informed consent, or with a legal representative who can provide informed consent
4. Peripheral capillary oxygen saturation (SpO2) ≤ 94% at room air, or requiring supplemental oxygen at screening
5. PaO2/FiO2 ratio < 300 mmHg
6. Bilateral infiltrates on frontal chest radiograph or bilateral ground glass opacities on a chest CT scan
7. Hypoxemia requiring an increase in the fraction of inspired oxygen (FiO2) of ≥ 20% AND an increase in positive end-expiratory airway pressure (PEEP) level of 5 cm H2O or more to maintain transcutaneous oxygen saturations in the target range of 88-95%, or requirement for escalation from oxygen therapy to invasive mechanical ventilation

Exclusion Criteria:

1. PaO2/FiO2 ≥ 300 at the time of enrollment
2. A previous MSC infusion not related to this trial
3. History of Pulmonary Hypertension (WHO Class III/IV)
4. History of left atrial hypertension or decompensated left heart failure.
5. Pregnant or lactating patient
6. Unstable arrhythmia
7. Patients with previous lung transplant
8. Patients currently receiving chronic dialysis
9. Patients currently receiving Extracorporeal Membrane Oxygenation (ECMO)
10. Presence of any active malignancy (except non-melanoma skin cancer)
11. Any other irreversible disease or condition for which 6-month mortality is estimated to be greater than 50%
12. Moderate to severe liver disease (AST and ALT >5 X ULN)
13. Severe chronic respiratory disease with a PaCO2 > 50 mm Hg or the use of home oxygen
14. Baseline QT prolongation
15. Moribund patient not expected to survive > 24 hours

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: UC-MSCs Group; Participants in this group will be treated with two infusions of UC-MCSs along with heparin (blood thinner) in addition to standard of care treatment. The first infusion will be administered within 24 hours of study enrollment and the second infusion will be administered within 72 hours of study enrollment.	Biological: Umbilical Cord Mesenchymal Stem Cells + Heparin along with best supportive care.; UC-MSC will be administered at 100x10^6 cells/infusion administered intravenously in addition to the standard of care treatment.
PLACEBO_COMPARATOR: Control Group; Participants in this group will be treated with two infusions of vehicle along with heparin (blood thinner) in addition to standard of care treatment. The first infusion will be administered within 24 hours of study enrollment and the second infusion will be administered within 72 hours of study enrollment.	Other: Vehicle + Heparin along with best supportive care; Best supportive care treatment per the treating hospital protocol.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Pre-Specified Infusion Associated Adverse Events	Safety as defined by the number of pre-specified infusion associated adverse events as assessed by treating physician. Any of the following occurring within 6 h post each infusion: An increase in vasopressor dose greater than or equal to the following:Norepinephrine: 10 μg/minPhenylephrine: 100 μg/minDopamine: 10 μg/kg/minEpinephrine: 10 μg/min; In patients receiving mechanical ventilation: worsening hypoxemia, as assessed by a requirement for an increase of PEEP by 5 cm H2O over baseline, or requirement to increase FiO2 of >20%.; In patients receiving high flow oxygen therapy: worsening hypoxemia, as indicated by requirement of intubation and mechanical ventilation.; New cardiac arrhythmia requiring cardioversion; New ventricular tachycardia, ventricular fibrillation, or asystole; A clinical scenario consistent with transfusion incompatibility or transfusion-related infection; Cardiac arrest or death within 24h post infusion	6 and 24 hours
Number of Subjects With Serious Adverse Events by 31 Days After First Infusion	The number of subjects experiencing serious adverse events by 31 days after the first infusion (corresponding to 28 days after the last infusion).	31 days
Percentage of Participants Experiencing Serious Adverse Events (SAEs) Through Study Day 90	Safety will be reported as the percentage of participants experiencing serious adverse events through Day 90 as assessed by treating physician.	90 days
Number of Adverse Events (AEs) and Serious Adverse Events (SAEs)	Total number of adverse events and serious adverse events as assessed by treating physician	90 days
Number of Adverse Events (AEs) and Serious Adverse Events (SAEs) by Severity	Total number of adverse events plus serious adverse events categorized by severity.	90 days
Subjects With Adverse Events and Serious Adverse Events by Severity	Total number of subjects with adverse events and serious adverse events categorized by severity.	90 days
Number of Adverse Events and Serious Adverse Events by Relatedness to Treatment	Total number of adverse events and serious adverse events categorized by relatedness to treatment defined by a medical professional.	90 days
Subjects With Adverse Events by Relatedness to Treatment	Total number of subjects with adverse events categorized by relatedness to treatment by a medical professional	90 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Survival at 31 Days Post First Infusion	Number of participants that are alive at 31 days post first infusion follow up corresponding to 28 day post second infusion.	31 Days
Survival at 60 Days Post First Infusion	Number of participants alive at 60 days post first infusion follow up.	60 days
Time to Recovery	Time to discharge or, if the subject was hospitalized, no longer requiring supplemental oxygen and no longer requiring COVID-19-related medical care by 31 days. The numbers represent days at which 25%, 50%, 75% subjects within the treatment group had recovered.	31 days
Ventilator-Free Days Throughout 28 Days Post Second Infusion	Number of days participants were off ventilators during 28 days post second infusion.	28 days post second infusion
Ventilator-Free Days Throughout 90 Days	Number of days participants were off ventilators within up to 90 days of hospitalization.	90 days or hospital discharge, whichever is earlier
Respiratory Rate and Oxygenation Index (ROX Index)	Respiratory Rate-Oxygenation (ROX) index is defined as the ratio of oxygen saturation as measured by pulse oximetry (SpO2)/ Fraction of inspired oxygen (FiO2) to respiratory rate. This index can be used in the assessment of disease progression and the risk of intubation in COVID-19 patients with pneumonia.	day 6
Oxygenation Index (OI)	Measure of the fraction of inspired oxygen (FiO2) and its usage within the body during intensive care, measured using fNIRS (Functional Near Infrared Spectroscopy). The calculation for Oxygenation index is ((FIO2 * Mean airway pressure)/partial pressure of oxygen).	day 6
Positive End-Expiratory Pressure (PEEP) and Plateau Pressure (Pplat)	Measuring the respiratory mechanics; positive end-expiratory pressure (PEEP) and plateau pressure (Pplat) in ventilated patients visit 8 (day 6)	day 6
Sequential Organ Failure Assessment (SOFA) Scores	Sequential Organ Failure Assessment (SOFA) Scores is used to track a person's risk status during stay in the Intensive Care Unit (ICU). The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal, and neurological systems. Each organ system is assigned a point value from a minimum of 0 (normal) to a maximum of 4 (high degree of dysfunction/failure). The total score corresponds to the sum of the six different scores of the organ systems. In total, the minimum SOFA score is 0 (normal) and the maximum SOFA score is 24 (highest degree dysfunction/failure).	Day 6
Smell Identification Test (SIT) Scores	SIT measures the participant's sense of smell. SIT has a total score ranging from 0 to 40 with the higher the score indicating a more normal sense of smell	90 days
White Blood Cell Count (WBC)	As assessed via serum blood samples.	day 6
Platelets Count	As assessed via serum blood samples.	day 6
Hemogoblin	Measures the total amount of the oxygen-carrying protein in the blood as assessed via serum blood samples.	day 6
Hematocrit	The percentage by volume of red cells in your blood as assessed via serum blood samples.	day 6
Neutrophils	the amount of immune cells (that is one of the first cell types to travel to the site of an infection) as assessed via serum blood samples	day 6
Lymphocytes	Lymphocyte count as assessed via serum blood samples	day 6
Glomerular Filtration Rate	Glomerular filtration rate (GFR) as assessed via serum blood samples to check how well the kidneys are working. It estimates how much blood passes through the glomeruli each minute.	day 6
Total Protein	Total protein as assessed via serum blood samples as a part of the comprehensive metabolic panel (CMP). It is a measurement of the sum of albumin and globulins.	Day 6
Sodium	Sodium levels as assessed by serum blood samples.	day 6
Potassium	Potassium levels as assessed via serum blood samples.	day 6
Creatinine	Creatinine levels as assessed via serum blood samples	day 6
Glucose	Glucose levels as assessed via serum blood samples	day 6
Albumin	Albumin levels as assessed via serum blood samples	day 6
Alkaline Phosphatase	Alkaline phosphatase levels as assessed via serum blood samples for the Comprehensive Metabolic Panel.	day 6
Alanine Aminotransferase or Serum Glutamate-pyruvate Transaminase (ALT or SGPT)	The alanine aminotransferase or serum glutamate-pyruvate transaminase (ALT or SGPT) test as assessed via serum blood samples	day 6
Aspartate Aminotransferase or Serum Glutamic Oxaloacetic Transaminase (AST or SGOT)	The aspartate aminotransferase or serum glutamic oxaloacetic transaminase (AST or SGOT) test as assessed via serum blood samples	day 6
Total Bilirubin	Bilirubin levels as assessed via serum blood samples for the comprehensive metabolic panel.	day 6
Blood Urea Nitrogen (BUN)	Blood urea nitrogen (BUN) levels as assessed via serum blood samples for the comprehensive metabolic panel.	day 6
Calcium	Calcium levels as assessed via serum blood samples for the comprehensive metabolic panel.	day 6
Chloride	Chloride levels as assessed via serum blood samples for the comprehensive metabolic panel.	day 6
Carbon Dioxide (CO2)	Carbon Dioxide (CO2) levels as assessed via serum blood samples for the comprehensive metabolic panel.	day 6
C-Reactive Protein Levels	As assessed via serum blood samples.	day 6
Arachidonic Acid/Eicosapentaenoic Acid (AA/EPA) Ratio	As assessed via serum blood samples on day 6 (visit 8).	day 6
D-dimer Levels	As assessed via serum blood samples.	day 6
25-Hydroxy Vitamin D Levels	As assessed via serum blood samples.	day 6
Tumor Necrosis Factor-alpha (TNFα)	Analysis of TNFα in peripheral blood plasma	day 6
Tumor Necrosis Factor-beta (TNFβ)	Analysis of TNFβ in peripheral blood plasma	day 6
Soluble Tumor Necrosis Factor Receptor 2 (sTNFR2)	Analysis of soluble tumor necrosis factor receptor 2 (sTNFR2) in peripheral blood plasma	day 6
Viral Load by SARS-CoV-2 RT-PCR	Viral load as assessed in blood plasma for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) via Reverse Transcriptase Polymerase Chain Reaction (RT-PCR).	day 6
Number of Participants Reporting Panel Reactive Antibody (PRA) Positivity at Day 3 Post First Infusion	Number of participants reporting panel reactive antibody (PRA) positivity at Day 3 post first infusion for class I and class II as assessed via serum blood samples. These antibodies can develop following a transplant. Recipients can become sensitized to certain molecules (Human Leukocyte Antigen Class I or Class II), which can affect immune responses to and rejection of potential future transplants.	day 3 post first infusion
Number of Participants Reporting Panel Reactive Antibody (PRA) Positivity at Day 6 Post First Infusion	Number of participants reporting panel reactive antibody (PRA) positivity at Day 6 post first infusion for class I and class II as assessed via serum blood samples. These antibodies can develop following a transplant. Recipients can become sensitized to certain molecules (Human Leukocyte Antigen Class I or Class II), which can affect immune responses to and rejection of potential future transplants.	day 6
Number of Participants Reporting Panel Reactive Antibody (PRA) Positivity at Day 14 Post First Infusion	Number of participants reporting panel reactive antibody (PRA) positivity at Day 14 post first infusion for class I and class II as assessed via serum blood samples. These antibodies can develop following a transplant. Recipients can become sensitized to certain molecules (Human Leukocyte Antigen Class I or Class II), which can affect immune responses to and rejection of potential future transplants.	day 14
Number of Participants With Positive, Negative, or Borderline Serology Testing for SARS-CoV-2 IgM/IgG	Number of participants with positive, negative, or borderline SARS-CoV-2 Immunoglobulin M (IgM)/Immunoglobulin G (IgG) serology from serum blood samples.	day 14 post first infusion

Collaborators and Investigators

• Sponsor: Camillo Ricordi

Study record dates

Study Major Dates

• Study Start (ACTUAL): April 25, 2020
• Primary Completion (ACTUAL): October 31, 2020
• Study Completion (ACTUAL): October 31, 2020

Study Registration Dates

• First Submitted: April 13, 2020
• First Submitted That Met QC Criteria: April 17, 2020
• First Posted (ACTUAL): April 21, 2020

Study Record Updates

• Last Update Posted (ACTUAL): December 6, 2021
• Last Update Submitted That Met QC Criteria: December 1, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Keywords: COVID-19
• Additional Relevant MeSH Terms: Pathologic Processes; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Respiration Disorders; Pneumonia, Viral; Pneumonia; Lung Diseases; Disease; Infant, Newborn, Diseases; Lung Injury; Infant, Premature, Diseases; COVID-19; Coronavirus Infections; Syndrome; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Acute Lung Injury; Molecular Mechanisms of Pharmacological Action; Fibrinolytic Agents; Fibrin Modulating Agents; Anticoagulants; Heparin; Calcium heparin
• Other Study ID Numbers: 20200671; 20200370 (OTHER: Secondary Protocol ID)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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