A Randomized Placebo-controlled Multicenter Trial to Evaluate the Efficacy and Safety of JTR-161, Allogeneic Human Dental Pulp Stem Cell, in Patients With Acute Ischemic stRoke (J-REPAIR) (J-REPAIR)

An Exploratory, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate Safety and Efficacy of JTR-161 in Patients With Acute Ischemic Stroke

The objective of this study is to evaluate the safety and efficacy of a single intravenous administration of JTR-161 (allogeneic stem cell product derived from the dental pulp of healthy adult humans) to patients with acute ischemic stroke.

This study is comprised of 3 cohorts and conducted in the order of Cohort 1, Cohort 2 and Cohort 3.

Cohort 1 Arm-1: JTR-161, 1 × 10^8 cells/subject, 6 subjects Arm-2: Placebo, 2 subjects

The Data and Safety Monitoring Board (DSMB) and the Sponsor will decide whether Cohort 2 can be initiated or not.

Cohort 2 Arm-1: JTR-161, 3 × 10^8 cells/subject, 6 subjects Arm-2: Placebo, 2 subjects

DSMB and the Sponsor will decide whether Cohort 3 can be initiated or not and the dose of JTR-161 in Cohort 3.

Cohort 3 Arm-1: JTR-161, 1 × 10^8 cells/subject or 3 × 10^8 cells/subject, 30 subjects Arm-2: Placebo, 30 subjects

Study Overview

• Status: Completed
• Conditions: Acute Ischemic Stroke
• Intervention / Treatment: Biological: JTR-161; Biological: Placebo

• Study Type: Interventional
• Enrollment (Actual): 79
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• Japan
  • Tokyo
    • Bunkyo-ku, Tokyo, Japan, 113-8602
      • Nippon Medical School Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients who have ischemic strokes in the anterior circulation
• Patients whose mRS is 0 or 1 prior to the onset of ischemic stroke
• Patients whose NIHSS score of ≥5 to ≤20 at screening
• Patients who can be administered dosing solutions within 48 h of stroke onset

Exclusion Criteria:

• Patients who have new ischemic lesion in the cerebellum or brainstem
• Patients whose consciousness level drops severely
• Patients whose infarct area is widespread
• Patients who have a clinically significant hemorrhagic transformation
• Patients who had seizures after onset of ischemic stroke
• Patients who have medical history of a neurological event such as stroke or clinically significant head trauma within 180 days prior to giving informed consent
• Patients who have poor blood pressure control
• Patients who have poor glycaemic control

• Patients who have one of the following complications

  1. Severe liver dysfunction
  2. Severe kidney dysfunction
  3. Severe heart failure
  4. Severe pulmonary dysfunction
• Patients who have severe infections
• Patients who have any neurological disorder affecting informed consent or study assessments
• Patients who have the malignant tumor, or medical history of malignant tumor within 2 years prior to the onset of ischemic stroke
• Patients who have a contraindication for MRI
• Patients who have thrombocytopenia
• Patients who have medical history of allergy to products derived from human tissues, bovine or porcine
• Patients who have medical history of allergy to streptomycin
• Patients who have undergone splenectomy in the past
• Patients who have a possibility of transient ischemic attack
• Patients who are scheduled to undergo revascularization (carotid endarterectomy, stent placement etc.)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Biological: Placebo; Placebo will be suspended and administered in an intravenously infusion.
Experimental: JTR-161	Biological: JTR-161; JTR-161 (1 or 3 × 10^8 cells/subject) will be suspended and administered in an intravenously infusion.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The percentage of patients who achieved Excellent outcome (modified Rankin Scale [mRS] ≤1 and National Institutes of Health Stroke Scale [NIHSS] ≤1 and Barthel Index [BI] ≥95) on Day 91 in Cohort 3.	91 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of patients who achieved mRS ≤ 1 or mRS ≤ 2		366 days
Percentage of patients who achieved BI ≥ 95		366 days
Percentage of patients who achieved NIHSS ≤ 1, who achieved improvement of ≥ 75%, and who achieved improvement of ≥ 10 points		91 days
Changes in EQ-5D-5L scores	The EuroQOL 5 dimension 5-level (EQ-5D-5L) consists of 2 parts: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1="no problems", 2="slight problems", 3="moderate problems", 4="severe problems" and 5="extreme problems". The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine'.	366 days
Percentage of patients who achieved excellent outcome (mRS ≤ 1, NIHSS ≤ 1, and BI ≥ 95)		91 days
Percentage of patients who showed overall improvement (mRS ≤ 2, NIHSS improvement of ≥ 75%, and BI ≥ 95)		91 days
Incidence of Adverse events (signs and symptoms)		366 days
Changes in Laboratory tests (hematology, blood chemistry, blood coagulation test, urinalysis)	Number of participants with clinical laboratory abnormalities for each parameter; hematology Red blood cell count, Hemoglobin, Hematocrit, Platelet count, Leukocyte count, Leukocyte formula (neutrophils, lymphocytes, monocytes, eosinophils, basophils); blood chemistry Total protein, Albumin, Total bilirubin, Aspartate aminotransferase , Alanine aminotransferase, Alkaline phosphatase , Lactate dehydrogenase , γ-Glutamyltransferase, Blood urea nitrogen , Creatinine, Uric acid, Sodium, Potassium, Calcium, Chloride, Creatine kinase , C-reactive protein; blood coagulation Prothrombin time (International normalized ratio) , Activated partial thromboplastin time; urinalysis Urine Protein, Urine Glucose	366 days
Changes in Vital signs (blood pressure [systolic/diastolic], pulse rate, body temperature)	Number of participants of the vital signs abnormalities for each parameter: blood pressure (mmHg), pulse rate (bpm) and body temperature (℃).	366 days
Changes in Oxygen saturation (SpO2)		366 days
Changes in findings of imaging examination by Magnetic Resonance Imaging (MRI) or Computed Tomography (CT).		31 days

Collaborators and Investigators

• Sponsor: Teijin Pharma Limited

Publications and helpful links

General Publications

• Suda S, Nito C, Ihara M, Iguchi Y, Urabe T, Matsumaru Y, Sakai N, Kimura K; J- REPAIR trial group. Randomised placebo-controlled multicentre trial to evaluate the efficacy and safety of JTR-161, allogeneic human dental pulp stem cells, in patients with Acute Ischaemic stRoke (J-REPAIR). BMJ Open. 2022 May 24;12(5):e054269. doi: 10.1136/bmjopen-2021-054269.

Study record dates

Study Major Dates

• Study Start (Actual): January 30, 2019
• Primary Completion (Actual): February 15, 2021
• Study Completion (Actual): November 24, 2021

Study Registration Dates

• First Submitted: September 8, 2020
• First Submitted That Met QC Criteria: October 28, 2020
• First Posted (Actual): October 29, 2020

Study Record Updates

• Last Update Posted (Actual): June 30, 2022
• Last Update Submitted That Met QC Criteria: June 28, 2022
• Last Verified: June 1, 2022

More Information

Terms related to this study

• Keywords: Acute Ischemic Stroke
• Additional Relevant MeSH Terms: Pathologic Processes; Necrosis; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Ischemia; Infarction; Brain Infarction; Stroke; Ischemic Stroke; Ischemia; Cerebral Infarction
• Other Study ID Numbers: JTR-161-201

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