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Autologous Bone Marrow-derived Mononuclear Cells for Therapeutic Arteriogenesis in Patients With Limb Ischemia (ABC)
Autologous Bone Marrow-derived Mononuclear Cells for Therapeutic Arteriogenesis in Patients With Limb Ischemia A Double Blind, Placebo Controlled, Study in Diabetic and Non-diabetic Patients
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
Although the safety and beneficial effects of intramuscular transplantation of bone marrow derived mononuclear cells procedure appear well documented, a number of critical question regarding application of BM-MNC for peripheral vascular disease remain to be answered. First, although the original study has been partially performed as semi-blinded study (patients with double sided claudication were recruited and blindly treated with BM-MNC in one leg and peripheral blood injections in the other leg), this approach does exclude a placebo effect. Second, although patients with mild diabetes were included in the protocol, the results for diabetic patients were not analyzed separately. Diabetic disease is characterized by monocyte and endothelial progenitor cell dysfunction and it is still unclear whether this approach is also effective in diabetic patients. Third, although six-month results are reported long-term efficacy has not been established yet.
To address these issues, the investigators now propose confirm and extend the findings from open studies in a randomized double-blind study in patients with severe claudication or critical leg ischemia and pay special attention to the influence of diabetic disease on the outcome of the study and to the possible pro-atherogenic/ pro-inflammatory effects of BM-MNC injections.
Studietype
Inschrijving (Verwacht)
Fase
- Fase 2
- Fase 3
Contacten en locaties
Studie Locaties
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Leiden, Nederland, 2300RC
- Werving
- Leiden University Medical Center
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Contact:
- Jan HN Lindeman, MD, PhD
- Telefoonnummer: #31 (0)71 5263968
- E-mail: Lindeman@lumc.nl
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- persistent (>3 months) disabling claudication (Fontaine's stages IIb or Rutherford's categories 3, viz. pain free walking distance less than 100 meter) despite optimal therapy or critical limb ischemia (Fontaine's stages III/IV or Rutherford's categories 4-6)
- ineligibility for angioplasty or bypass procedures
- male of female, >18 years old
- life expectancy > 1 year
- written informed consent
Exclusion Criteria:
- candidates for angioplasty or bypass procedures
- inability to undergo bone marrow harvesting
- any condition in the affected limb that is anticipated to require surgical intervention in the first weeks after BM-MNC treatment
- life threatening co-morbidity
- poorly controlled diabetes (HbA1C > 10%)
- active malignancy in the 5 years prior to treatment
- INR >1.5 at the time of bone-marrow harvest
- bleeding diathesis
- inability to undergo arterial catheterization
- inability to follow the protocol and to comply with the follow up requirements
- any other conditions that, in the opinion of the investigators, could interfere with the therapy or could pose a significant threat to the subject if the investigational therapy was to be initiated
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verviervoudigen
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Actieve vergelijker: 1
non diabetic patients with Fontaine IIb-IV peripheral artery disease
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40 IM injections (calf muscle) of 1-8 10E9 mono nuclear cells
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Placebo-vergelijker: 2
non diabetic patients with Fontaine IIb-IV peripheral artery disease
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40 IM injections (calf muscle) of placebo suspension
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Actieve vergelijker: 3
diabetic patients with Fontaine IIb-IV peripheral artery disease
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40 IM injections (calf muscle) of 1-8 10E9 mono nuclear cells
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Placebo-vergelijker: 4
diabetic patients with Fontaine IIb-IV peripheral artery disease
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40 IM injections (calf muscle) of placebo suspension
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
|---|---|
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Limb salvage/wound healing at t=6 months; Pain free walking distance
Tijdsspanne: 6 months
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6 months
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Secundaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
|---|---|
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quality of life (RAND-36), pain Scores (Brief Pain Inventory), tcO2 (wrist/ankle ratio) ABI Collateral artery scores (angiogram) at t=6 months, Limb salvage/wound healing at t= 3 and 12 months, Pain free walking distance at t=3 and 12 months,
Tijdsspanne: 3, 6 and 12 months
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3, 6 and 12 months
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Jan HN Lindeman, MD, PhD, Leiden University Medical Center
Publicaties en nuttige links
Algemene publicaties
- Moazzami B, Mohammadpour Z, Zabala ZE, Farokhi E, Roohi A, Dolmatova E, Moazzami K. Local intramuscular transplantation of autologous bone marrow mononuclear cells for critical lower limb ischaemia. Cochrane Database Syst Rev. 2022 Jul 8;7(7):CD008347. doi: 10.1002/14651858.CD008347.pub4.
- Lindeman JHN, Zwaginga JJ, Kallenberg-Lantrua G, van Wissen RC, Schepers A, van Bockel HJ, Fibbe WE, Hamming JF. No Clinical Benefit of Intramuscular Delivery of Bone Marrow-derived Mononuclear Cells in Nonreconstructable Peripheral Arterial Disease: Results of a Phase-III Randomized-controlled Trial. Ann Surg. 2018 Nov;268(5):756-761. doi: 10.1097/SLA.0000000000002896.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Verwacht)
Studie voltooiing (Verwacht)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- P07.058
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