Safety and Efficiency of Method of Exosome Inhalation in COVID-19 Associated Pneumonia (COVID-19EXO2)

The Extended Protocol of Evaluation of Safety and Efficiency of Method of Exosome Inhalation in COVID-19 Associated Two-Sided Pneumonia

Coronavirus is an acute viral disease with prevailing upper respiratory tract infections caused by the RNA-containing virus of the genus Betacoronavirus of the Coronaviridae family. Most patients with severe COVID-19 develop pneumonia in the first week of the disease. As the infection progresses, the infiltration increases, and the affected areas increases. Excessive and uncontrolled immune system response with rapidly developing fatal cytokine storm plays the main role in the pathogenesis of acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection.

According to available data, exosomes can regulate inflammation and regenerative processes due to the change in the concentration of anti-inflammatory cytokines and switch the immune cell to regenerative secretome. Inhalation of exosomes may reduce inflammation and damage to the lung tissue and stimulate the regenerative processes.

This protocol has been developed based on the literature, information about the ongoing tests NCT04276987 (A Pilot Clinical Study on Inhalation of Mesenchymal Stem Cells Exosomes Treating Severe Novel Coronavirus Pneumonia) and NCT04384445 (Organicell Flow for Patients With COVID-19), Patent No 271036826 of 2019. "A method for obtaining and concentrating microRNA-containing exosomal multi-potent mesenchymal-stromal cells for use in cosmetic and pharmaceutical products to stimulate regenerative processes and slow down aging.

Study Overview

• Status: Unknown
• Conditions: COVID-19; Covid19; SARS-CoV-2 PNEUMONIA
• Intervention / Treatment: Drug: EXO 1 inhalation; Drug: EXO 2 inhalation; Drug: Placebo inhalation

Detailed Description

COVID-19 is an infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. COVID-19 is now a pandemic affecting many countries worldwide. Globally, as of 1:09 pm CEST, 27 July 2020, there have been 16 096 741 confirmed cases of COVID-19, including 646 384 deaths, reported to WHO.

The main and rapidly achievable target of SARS-CoV-2 is lung type II alveolar cells (AT2), which determines the development of diffuse alveolar damage. In the pathogenesis of ARDS due to COVID-19, the main role is played by an over-response of the immune system with rapidly developing severe life-threatening cytokine release syndrome (cytokine storm). Cytokine release syndrome threatens the emergence and progression of ARDS. The key components of the pathogenesis of ARDS also include disruption of cell cytotoxicity mechanisms, excessive activation of cytotoxic lymphocytes and macrophages with a massive release of proinflammatory cytokines (FNO-α, IL-1, IL-2, IL-6, IL-8, IL-10), granulocytic colony-stimulating factor, monocytic chemoattractive protein 1), and inflammatory markers (CRP, serum ferritin), infiltration of internal organs and tissues by activated T-lymphocytes and macrophages, resulting in a hyperinflammatory reaction. Such severe lesions can lead to death or severe lung damage, including long rehabilitation after discharge.

Experimental studies have demonstrated that mesenchymal stem cells (MSCs) may significantly reduce lung inflammation and pathological impairment resulting from different types of lung injury. Many researchers connect the anti-inflammatory effect of MSC with their secretome which includes MSC derived exosomes. It is highly likely that MSC exosomes have the same therapeutic effect on inoculation pneumonia as MSCs themselves. Moreover, exosomes show a strong effect of regenerative stimulation on different wounds so the regenerative effect can be extended on patients with COVID-19 pneumonia.

The purpose of this protocol is to explore the safety and efficiency of aerosol inhalation of the exosomes in the treatment of severe patients hospitalized with novel coronavirus pneumonia (NCP).

• Study Type: Interventional
• Enrollment (Anticipated): 90
• Phase: Phase 2

Contacts and Locations

Study Locations

• Russian Federation
  • Samara, Russian Federation, 443095
    • Medical Centre Dinasty

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Ability to understand the study objectives and risks and provide signed and dated informed consent;
• COVID-19 infection (by PCR or antibody test or high probability of COVID-19 by CT);
• Pneumonia requiring hospitalization, and oxygen saturation of <93%, need for noninvasive ventilation. The confirmed volume of lung damage by CT;
• ability to proceed with inhalation by self;

Exclusion Criteria:

• Severe respiratory failure at the time of screening due to COVID-19 pneumonia;
• Known to undergo medical resuscitation for 14 days before randomization;
• Any serious medical condition or deviation of the clinical laboratory parameter that, in the opinion of the researcher, prevents safe participation and completion of the study by the participant Confirmed uncontrolled active bacterial, fungal, viral or other infection (other than SARS-CoV-2).
• According to the researcher, the progression to death is inevitable and will occur within the next 24 hours, regardless of the therapy.
• The life expectancy of fewer than 28 days, taking into account a medical condition already existing that cannot be corrected, e.g. participants with the following conditions or suspicions: polyorganic insufficiency, poorly controlled neoplasms, terminal stage heart disease, cardiopulmonary cardiac arrest that required cardiopulmonary resuscitation, or electrical activity not accompanied by a pulse, or asystole within the last 30 days, terminal stage liver disease, terminal stage liver disease, or liver disease;
• Pregnancy or breastfeeding;
• Liver function failure (Class C for Child-Pugh), detected within 24 hours at screening (local laboratory);
• Absolute neutrophil count (ANC) <500 cells/µL at screening (local laboratory);
• Platelet count <50000 cells/µL at screening (based on laboratory data);
• Creatinine level ≥ 1.5 from the upper limit;
• Uncontrolled or untreated arrhythmia with clinical manifestations, myocardial infarction within the last 6 weeks or congestive heart failure (NYHA Degrees 3 or 4);
• Respiratory failure in the last 6 months or home use of oxygen in severe chronic respiratory disease (COPD);
• Quadriplegia;
• Primary immunodeficiency, tuberculosis, progressive multifocal leukoencephalopathy, aspergillosis or other invasive mold/fungal infection in anamnesis, or internal or bone marrow transplantation for 6 months before randomization;
• Known infection with hepatitis B or C viruses requiring therapy;

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: EXO-1; Participants (n=30) in this group will receive standard therapy and exosomes of the first type.	Drug: EXO 1 inhalation; Twice a day during 10 days inhalation of 3 ml special solution contained 0.5-2x10^10 of nanoparticles (exosomes) of the first type.
Experimental: EXO-2; Participants (n=30) in this group will receive standard therapy and exosomes of the second type.	Drug: EXO 2 inhalation; Twice a day during 10 days inhalation of 3 ml special solution contained 0.5-2x10^10 of nanoparticles (exosomes) of the second type.
Placebo Comparator: Placebo; Participants (n=30) in this group will receive standard therapy and inhalation placebo solution.	Drug: Placebo inhalation; Twice a day during 10 days inhalation of 3 ml special solution free of nanoparticles (exosomes).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants with non-serious and serious adverse events during trial	Safety assessment such as adverse events will be registered. Adverse events will be monitored during all trial	through study, an average of 2 months
Number of participants with non-serious and serious adverse during inhalation procedure	Safety assessments such as adverse events during the inhalation procedures will be registered.	10 days during inhalation procedures

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to clinical recovery (TTCR)	Measure and compare time to clinical recovery and clinical discharge compare to placebo.	up to 2 months
SpO2 concentration changes	Concentration of SpO2 by Pulse oximetry device during procedures and compare to placebo.	up to 2 months
Chest Imaging Changes	Chest imaging changes for 30 days compared to placebo. Information on the percent of damaged lungs will be analyzed and reported.	Three times. At diagnosis, 10-14 days after treatment and 30 days after clinic discharge
Blood biochemistry (CRP)	C-reactive protein (CRP, mg/L) concentration in the plasma will be measured. The result will be analyzed and compared in time.	Baseline, day 5, 10, 20
Procalcitonin concentration	Procalcitonin concentration in plasma (ng/mL) will be measured. The result will be analyzed and compared in time.	Baseline, day 5, 10, 20
Ferritin concentration	Ferritin concentration in plasma (ng/mL) will be measured. The result will be analyzed and compared in time.	Baseline, day 5, 10, 20
Creatinine concentration	Creatinine concentration (umol/L) in plasma will be measured. The result will be analyzed and compared in time.	Baseline, day 5, 10, 20
Urea concentration	Urea concentration (mmol/L) in plasma will be measured. The result will be analyzed and compared in time.	Baseline, day 5, 10, 20

Collaborators and Investigators

• Sponsor: Olga Tyumina
• Collaborators: Clinics of the Federal State Budgetary Educational Institution SSMU; Samara Regional Clinical Hospital V.D. Seredavin

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2020
• Primary Completion (Anticipated): August 1, 2021
• Study Completion (Anticipated): December 30, 2021

Study Registration Dates

• First Submitted: October 21, 2020
• First Submitted That Met QC Criteria: October 23, 2020
• First Posted (Actual): October 26, 2020

Study Record Updates

• Last Update Posted (Actual): October 26, 2020
• Last Update Submitted That Met QC Criteria: October 23, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: SARS-CoV-2; Covid-19; MSC; exosomes
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Lung Diseases; COVID-19; Pneumonia
• Other Study ID Numbers: COVID-19 EXO Extended

Drug and device information, study documents

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