Stem Cell Strategies for the Treatment of Chronic Asthma

Exploring the Role of Stem Cell Strategies for the Treatment of Chronic Asthma

The study is a pilot/laboratory study comparing the effects of MSC conditioned media on samples of airway cells in 3 participant groups with mild/moderate asthma (5 participants), severe asthma (5 participants), or no asthma (5 participants).

Study Overview

• Status: Active, not recruiting
• Conditions: Asthma

Detailed Description

Asthma is a significant global health challenge with the prevalence of allergic asthma increasing by 1% each year. Atopic asthma is a complex disorder driven by cellular mechanisms in response to allergens. The response is two-fold; a chronic inflammatory response accompanied by remodelling of the respiratory airways. Airway remodelling is characterised by smooth muscle hypertrophy (and mucous gland) and hyperplasia, fibrosis of the sub-epithelium and reticular basement thickening, and epithelial damage. Over time the airway suffers remodelling due to thickening of the smooth muscle component which is in turn accompanied by irreversible fibrotic changes and a tendency towards treatment unresponsiveness. The inflammatory response on the other hand is characterised by IgE activation of mucous mast cells, infiltration of eosinophils, increased CD4+Th2 lymphocytes, and Type 2 cytokine secretion (e.g. IL13). The primary challenge in the development of new asthma treatments is to deliver long-lasting relief to the inflammatory response and also to 'repair' the remodelling associated with repeated asthmatic events. Mesenchymal stem cells (MSC), derived primarily from the bone marrow, have a multipotent differentiation potential (primarily bone, fat, and cartilage) and are currently in clinical trial for over 350 diseases and disorders. These include diverse areas such as ischemic stroke, graft vs. host disease, Crohns disease, and type 1 diabetes alongside anticipated applications related to the musculoskeletal system. Their application into the treatment of musculoskeletal damage relies primarily on functional incorporation (differentiation into the damaged tissue to repair in situ). In contrast their application in many other instances is due to their unique inherent characteristic, namely their immunomodulatory role. MSC secrete a wide range of growth factors and cytokines (the secretome) which have the capacity to silence immune reactions preventing T cell activation. In addition to this property the MSC secretome has also been shown to reverse the remodelling associated with fibrotic disease.

• Study Type: Observational
• Enrollment (Estimated): 15

Contacts and Locations

Study Locations

• United Kingdom
  • Staffordshire
    • Stoke-on-Trent, Staffordshire, United Kingdom, ST4 6QG
      • University Hospitals of North Midlands NHS Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Trial participants will be identified from those attending respiratory medicine outpatient clinics at the Royal Stoke University Hospital. Participants will donate samples of upper airway cells during bronchoscopy by biopsy, brush biopsy and bronchoalveolar lavage (BAL)

Description

Inclusion Criteria:

Men or women, age (18-70 years old), II. Lifelong never-smokers or ex-smokers (< 10 pack years). (1 pack year= 20 cigarettes/day for 1 year).

III. Must be competent to give written informed consent. IV. Female participants of child bearing potential must have a negative urine pregnancy test prior to bronchoscopy.

V Potential participants must meet the safety criteria to have a Spirometry test where necessary.

vi Must meet the safety criteria to have a bronchoscopy.

Asthmatic participants:

VI. Have a physician diagnosis of asthma. VII. All asthma patients will have either bronchodilator reversibility of ≥12% or 200 mL at screening, or historic data confirming bronchodilator reversibility or bronchial hyperreactivity to methacholine (PC20). Those without prior confirmed reversibility will have bronchodilator reversibility testing to salbutamol at screening and the asthma control questionnaire (ACQ) administered. Where reversibility to salbutamol is inconclusive a methacholine challenge will be performed.

VIII. Must have stable disease with no recent flare-ups (within 4 weeks). IX. Oxygen saturations whilst breathing room air must be > 90% (a measure of how well the lungs are providing oxygen to the body).

X. When blowing forcefully into a tube (forced expiratory volume or FEV), the patient must be able to blow out at least one litre of air in the first second (FEV1 > 1Litre).

Non-asthmatic participants:

XI. Have no physician diagnosis of asthma. XII. Have no evidence of any long term lung condition or any other disabling condition and they must not have had a chest infection in the preceding 4 weeks.

Exclusion Criteria:

I. Significant smoking history (>10 pack year). II. Significant lung co-morbidities III. Patient unable to give informed consent IV. History of myocardial infarction within the preceding 6 weeks V. Any subject with asthma who requires home oxygen will not be included for safety reasons

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
participants with no asthma; Have no evidence of any long term lung condition or any other disabling condition and they must not have had a chest infection in the preceding 4 weeks.
participants with mild/moderate asthma
participants with severe asthma

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The overall aim of this proposal is to determine the effects of adult stem cell products on asthmatic respiratory epithelium.	Our primary objective is to determine this with in vitro models, where we will explore the utility of the MSC secretome in abrogating IgE and Type 2 cytokine driven immune responses and in reversing airway remodelling.	Through to study completion, average of one year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Develop in virto models	Our secondary objective is to develop in vitro models derived from patient materials obtained by brush and biopsied airway epithelium and bronchial airway cells via BAL from patients with established history of asthma and atopy and commercially sourced MSCs.	Through to study completion, average of one year

Collaborators and Investigators

• Sponsor: University Hospitals of North Midlands NHS Trust

Study record dates

Study Major Dates

• Study Start (Actual): August 31, 2016
• Primary Completion (Actual): December 31, 2024
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: April 30, 2021
• First Submitted That Met QC Criteria: May 11, 2021
• First Posted (Actual): May 12, 2021

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 18, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Asthma
• Other Study ID Numbers: 1175

Drug and device information, study documents

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