Safety and Efficacy of Intravenous Wharton's Jelly Derived Mesenchymal Stem Cells in Acute Respiratory Distress Syndrome Due to COVID 19

January 13, 2021 updated by: BioXcellerator

Safety and Efficacy of Intravenous Infusion of Wharton's Jelly Derived Mesenchymal Stem Cell Plus Standard Therapy for the Treatment of Patients With Acute Respiratory Distress Syndrome Diagnosis Due to COVID 19: A Randomized Controlled Trial

Recent COVID 19 pandemic has overwhelmed health services all around the world, and humanity has yet to find a cure or a vaccine for the treatment of patients, mainly the severe ones, who pose a therapeutic challenge to healthcare professionals given the paucity of information we have regarding SARS-CoV-2 pathogenesis.

Recently, reports mainly from China from patients treated with mesenchymal stem cells have shown promise in accelerating recovery, even in the critically ill and the therapy has sustained an increase in research because of it's powerful immunomodulatory effects, making it and interesting alternative in patients with lung and systemic inflammation.

These effects could help treat a lot of patients and improve their outcomes, reason why phase I/II studies are needed to show their safety and experimental efficacy.

Study Overview

Detailed Description

SARS-CoV-2, virus culprit of the COVID 19 that emerged in China, has become now a worldwide problem, with more than three million cases al around the world as reported by the World Health Organization. This situation has put health systems under extreme pressure, being overwhelmed be the amount of patients requiring attention.

Around 5% of patients will require ICU internation, due to severe lung inflammation giving rise to Acute Respiratory Distress Syndrome (ARDS) and a cytokine storm that ultimately affects other organs. In this group, mortality can be as high as 40%.

Mesenchymal stem cells (MSC) have shown great immunomodulatory effects, and are used in other inflammatory conditions as autoimmune diseases, being safe and preliminary effective in improving patients health status. They exert their effect via paracrine and autocrine pathways and have been shown to reduce IL-1, IL-6, Tumor necrosis factor alpha and increase IL-10 in COVID 19 patients. One of the greater advantages of the MSC is that they express no Major Histocompatibility Complex, reducing the risk of host immune reaction.

Given their immunomodulatory effects, research in this topic showing their safety and experimental efficacy are needed, as therapies for severe patients are lacking. Patients, researchers and data analysts will be blinded, and ARDS patients will be randomly allocated in standard therapy plus MSC arm or standard therapy alone to answer these questions.

Study Type

Interventional

Enrollment (Anticipated)

40

Phase

  • Phase 2
  • 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 Contact Backup

Study Locations

    • Antioquia
      • Rionegro, Antioquia, Colombia
        • Recruiting
        • Clinical Somer
        • Contact:
          • Alfredo Hernandez-Ruiz, MSc
          • Phone Number: +574442630
    • Antioquia-CO
      • Medellin, Antioquia-CO, Colombia, 050022
        • Not yet recruiting
        • BioXcellerator
        • Contact:
          • Karolynn Halpert, Dr.
          • Phone Number: 6041815

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

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • SARS-CoV-2 positive Real Time - Polymerase Chain Reaction
  • Moderate to severe Acute respiratory distress syndrome according to Murray classification.
  • PaO2/FiO2 less than 200 mmHg.
  • Within 36 hours of orotracheal intubation.
  • Absence of response with previous standard therapy.
  • Willing to participate in the study expressed by patient or responsible caregiver.
  • Not being in other clinical trial.

Exclusion Criteria:

  • Current pregnancy.
  • Cardiac rhythm abnormalities with instability.
  • Acute congestive heart failure/cardiogenic shock.
  • Severe comorbidities affecting mortality as defined by research group.
  • Cancer history in the past 5 years.
  • HIV, syphilis, hepatitis B or C.
  • Concomitant use of immunosuppressive therapy with contraindication to MSC.
  • Fivefold elevation of liver enzymes (ALT, AST).
  • Chronic kidney disease with glomerular filtration rate below 30ml/min or dialytic needs.

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: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Mesenchymal stem cell
WJ MSC 50*10e6, two doses plus standard treatment with hydroxychloroquine + Lopinavir/Ritonavir or Azithromycin and ventilation support.
IV Wharton's jelly derived Mesenchymal stem cells, two doses
Active Comparator: Control group
Hydroxychloroquine, lopinavir/ritonavir and ventilation support plus placebo
Standard therapy as per hospital protocol, hydroxychloroquine 400mg + Lopinavir/Ritonavir 400/100 or azithromycin 500mg and Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Intergroup mortality difference with treatment
Time Frame: 28 days.
Evaluation of efficacy of WJ-MSC defined by mortality at 28 days of application.
28 days.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of patients with treatment related adverse events
Time Frame: 6 months.
Safety evaluation of WJ-MSC describing and comparing incidence, type and severity of adverse events in both groups.
6 months.
Difference in days of mechanical ventilation between groups
Time Frame: From ICU admission to 180 days.
Evaluation of the effect of WJ-MSC in the time of mechanical ventilation compared between the two groups, as prolonged mechanical ventilation days are associated with higher complication risks as pneumonia, tracheostomy and death.
From ICU admission to 180 days.
Median reduction of days of hospitalization
Time Frame: From hospital admission to 180 days.
Evaluation of the effect of WJ-MSC in the time of hospitalization between the two groups as a measure of efficacy.
From hospital admission to 180 days.
Median reduction of days of oxygen needs
Time Frame: From hospital admission to 180 days.
Evaluation of the effect of WJ-MSC in the time of oxygen needs compared between the two groups as a measure of efficacy.
From hospital admission to 180 days.
Difference between "Sequential Organ Failure Assessment" score between groups
Time Frame: Baseline to 7 days
"Sequential Organ Failure Assessment" (SOFA) score is a tool used to determine the beginning and evolution of multiorgan failure, ranging from 0 to 24, being 24 the worst scenario. It has been proven useful as an outcome predictor of mortality and ICU stay. The result is the addition of the evaluation of each organ or system. Effect of WJ-MSC in the SOFA score will be compared between the two groups.
Baseline to 7 days
Difference between median Murray score between groups
Time Frame: Baseline and 7 days

Murray score is a tool used to classify lung injury. 0 = no lung injury, 0.1-2.5, mild to moderate lund injury, >2.5 Acute respiratory distress syndrome.

The effect of WJ-MSC in the Murray score will be compared between the two groups.

Baseline and 7 days
Difference in APACHE II score between groups
Time Frame: Baseline and 7 days

APACHE II is a prognostic score based on 12 different items obtained in the first 24 hours of ICU admission. Its mainly used as a single measure, but some authors have used and described prediction usefulness with repeated measures. It ranges from 0 to 71 points. Higher scores are related to higher ICU mortality.

The effect of WJ-MSC in the APACHE II score will compared between the two groups.

Baseline and 7 days
Difference in lymphocyte count between groups
Time Frame: baseline and 21 days or discharge

Evaluation of the effect of WJ-MSC in lymphocyte count measured in absolute number/mm3.

These laboratory measures have been associated with COVID 19 severity.

baseline and 21 days or discharge
Changes in C reactive protein concentration between groups
Time Frame: baseline and 21 days or discharge

Evaluation of the effect of WJ-MSC in C reactive protein concentration between the two groups, measured in mg/dl.

Highest levels have been associated with COVID 19 severity and inflammation.

baseline and 21 days or discharge
Changes in D dimer concentration
Time Frame: baseline and 21 days or discharge
Evaluation of the effect of WJ-MSC in D dimer between the two groups, measured in micrograms Highest levels have been associated with COVID 19 severity and thromboembolic complications.
baseline and 21 days or discharge
Changes in ferritin concentration
Time Frame: baseline and 21 days or discharge

Evaluation of the effect of WJ-MSC in ferritin compared between the two groups, measured in nanograms/ml.

These laboratory measures have been associated with COVID 19 infection and severity.

baseline and 21 days or discharge
Changes in lactate dehydrogenase concentration
Time Frame: baseline and 21 days or discharge

Evaluation of the effect of WJ-MSC in LDH compared between the two groups, measured in units/liter.

These laboratory measures have been associated with COVID 19 infection and severity.

baseline and 21 days or discharge
Impact on interleukin 6 concentrations between groups.
Time Frame: Baseline and 7 days
Cytokines are biomarkers of inflammation or inflammatory activity in the human body. Changes in this profile give information about underlying process of inflammation.The effect of WJ-MSC in IL-6 will be compared between the two groups. It will be measured in picograms/ml.
Baseline and 7 days
Impact on interleukin 8 concentrations between groups.
Time Frame: Baseline and 7 days
Cytokines are biomarkers of inflammation or inflammatory activity in the human body. Changes in this profile give information about underlying process of inflammation. The effect of WJ-MSC in IL 8 will be compared between the two groups. It will be measured in picograms/ml.
Baseline and 7 days
Impact on interleukin 10 concentrations between groups.
Time Frame: Baseline and 7 days
Cytokines are biomarkers of inflammation or inflammatory activity in the human body. Changes in this profile give information about underlying process of inflammation. The effect of WJ-MSC in IL 10 will be compared between the two groups. It will be measured in picograms/ml.
Baseline and 7 days
Impact on tumor necrosis factor alpha concentrations between groups.
Time Frame: Baseline to 7 days.
Cytokines are biomarkers of inflammation or inflammatory activity in the human body. Changes in this profile give information about underlying process of inflammation. The effect of WJ-MSC in TNF alpha will be compared between the two groups. It will be measured in nanograms/ml.
Baseline to 7 days.

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in 6 minute walk between groups
Time Frame: 6 months

Evaluation of the effect of WJ-MSC in pulmonary function measured with 6 minute walk.

6 minute walk is a test that gives information about pulmonary, cardiovascular and musculoskeletal functions. It measures the distance walked in 6 minutes in meters.

6 months
Changes in Pulmonary Computed Tomography Scan between groups
Time Frame: 6 months
Evaluation of the effect of WJ-MSC in pulmonary function with thoracic CT scan. CT scan gives information about lung parenchyma, showing acute and chronic changes related to the underlying condition. Radiologic findings will be compared mainly comparing percentage of patients with pulmonary fibrosis.
6 months
Changes in Spirometry between groups
Time Frame: 6 months

Evaluation of the effect of WJ-MSC in pulmonary function measured with spirometry, compared between the two groups. Spirometry gives information about lung volume and mobilization of air.

Main parameters to be measured in spirometry are Forced Vital Capacity, Forced Expiratory Volume in 1 second and relation between these two to define if there is obstruction or restriction of airflow.

6 months
Changes in health related quality of life between groups
Time Frame: 6 months

Evaluation of the effect of WJ-MSC in health related quality of life assessed by 36 Item Short Survey (SF-36).

SF 36 is a patient reported tool. Each question is rated from 0 to 100, being 100 the best score possible. The scores are then compared to a population defined median score.

Differences in global and specific scoring will be measured between groups.

6 months

Collaborators and Investigators

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

Sponsor

Collaborators

Investigators

  • Principal Investigator: Alfredo Hernandez-Ruiz, MSc, Clinica SOMER

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 (Actual)

January 13, 2020

Primary Completion (Anticipated)

December 1, 2021

Study Completion (Anticipated)

April 1, 2022

Study Registration Dates

First Submitted

May 12, 2020

First Submitted That Met QC Criteria

May 14, 2020

First Posted (Actual)

May 15, 2020

Study Record Updates

Last Update Posted (Actual)

January 15, 2021

Last Update Submitted That Met QC Criteria

January 13, 2021

Last Verified

January 1, 2021

More Information

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.

Clinical Trials on Acute Respiratory Distress Syndrome

Clinical Trials on Wharton's jelly derived Mesenchymal stem cells.

3
Subscribe