Bone Marrow Aspirate Concentrate (BMAC) for Treatment of Critical Limb Ischemia (CLI)

Critical Limb Ischemia Clinical Trial

Official title:

Pivotal Study of the Safety and Effectiveness of Autologous Bone Marrow Aspirate Concentrate (BMAC) for the Treatment of Critical Limb Ischemia Due to Peripheral Arterial Disease

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01245335
• Other study ID #: CLI-2011-1
• Status: Completed
• Phase: Phase 3
• First received: November 18, 2010
• Last updated: December 14, 2015
• Start date: May 2011
• Est. completion date: November 2015

Study information

• Verified date: December 2015
• Source: Harvest Technologies
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Critical Limb Ischemia prevents the legs and feet from receiving oxygen and nutrients needed for proper function. This severe lack of blood flow can lead to painful legs while walking or at rest and can result in foot sores, ulcers, gangrene, and even amputation. The purpose of this study is to determine if injections of concentrated bone marrow into damaged tissues will result in improved blood flow. If successful, this treatment could improve blood flow to the lower limb, reduce pain, and reduce the frequency of limb amputations.

Description:

Bone marrow aspirate is collected and processed by centrifugation to remove red blood cells. The resulting concentrate of cells is injected into ischemic tissues of the lower limb. The purpose of this study is to determine if injections of concentrated bone marrow nucleated cells into ischemic tissues will result in vasculogenesis.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 97
• Est. completion date: November 2015
• Est. primary completion date: August 2015
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patient has Peripheral Arterial Occlusive Disease (PAOD) with clinical Rutherford Category 5 disease, as defined in the reporting standards adopted by the Society of Vascular Surgeons(table 1); Minor Tissue loss-focal gangrene with diffuse pedal ischemia

• Patient meets at least one of the following diagnostic criteria in the study limb:

• Ankle artery occlusion pressure absolute =60 mmHg or ABI =0.6

• Toe artery occlusive pressure < 50mm Hg or TBI =0.6

• There is no reasonable open surgical or endovascular revascularization option as determined by the treating vascular specialist. Factors that may contribute to the determination of inoperability may include:

• Anatomical considerations

• No outflow targets

• No appropriate conduit (i.e. vein for bypass)

• Long segment occlusions or calcified lesions that predict poor outcome with endovascular approaches.

• High risk medical conditions i.e. Unstable cardiac disease.

• History of prior failed revascularization attempts

• The Patient's case was reviewed at the treating institution's Multidisciplinary Vascular Conference where the patient's status as a poor candidate for conventional therapies was confirmed.

• Age =18 years and ability to understand the planned treatment

• Subject has read and signed the IRB approved Informed Consent form

• Patients for whom the following medication(s) is prescribed must have a one month stable baseline therapy prior to enrollment: Plavix/asprin therapy, anticoagulation therapy, cholesterol lowering agent, and or blood pressure medication. If any of these medications are not prescribed notation of the reason for omission is to be provided.

• Hematocrit = 28.0%, White Blood Cell count = 14,000, Platelet count = 50,000, Creatinine = 2.5 mg / dL, INR = 1.6 unless on Coumadin, or PTT <1.5 x control (to avoid bleeding complications) Patients on Coumadin will be corrected prior to the procedure and must have an INR<1.6 at the time of randomization/surgery.

Exclusion Criteria:

• Life expectancy <6 months due to concomitant illnesses

• History of bone marrow diseases (especially NHL, MDS) that prohibit transplantation

• Terminal renal failure with existing dependence on dialysis or serum creatinine >2.5 mg/dL

• Known active malignancy or results outside of normal limits from the following tests:

PAP, Chest X-ray, PSA, Mammogram, Hemocult unless follow-up studies reveal patient to be cancer free.

• Poorly controlled diabetes mellitus (HgbA1C>10%)

• Medical risk that precludes anesthesia (conscious sedation), or ASA Class 5

• Life-threatening complications of the ischemia necessitating immediate amputation

• Uncorrected occlusion of the common or external iliac artery on index side

• Absence of any pulsatile Doppler flow below the ankle.

• Extensive necrosis of the index limb or other conditions that make amputation inevitable (Rutherford Category 6).

• Ulceration with exposed bone proximal to the distal metatarsal heads (ie. heel or mid foot)

• Active clinical infection or infection being treated by antibiotics within one week of enrollment

• Treatment with immunosuppressant drugs (including Prednisone > 5 mg per day).

• Female who is pregnant or nursing, or of child bearing potential and is not using a reliable birth control method.

• Underwent a major open cardiovascular surgical procedure (carotid endarterectomy, arterial aneurysm or bypass surgery, or coronary artery bypass surgery) or a myocardial infarction within the 3 months prior to randomization

• Underwent a successful or partially successful endovascular intervention for peripheral arterial occlusive disease. (ie. Aorta, iliac, femoral, popliteal, or tibial artery angioplasty, stenting, or atherectomy) within the prior 3 months.

• Endovascular coronary intervention (ie. Angioplasty, atherectomy, stenting) within 1 month prior to randomization.

• Underwent a failed attempt for endovascular revascularization during the prior 1 month. For the purpose of this exclusion criteria an endovascular procedure is considered a failure if:

1. The procedure is diagnostic only with no intervention performed, (for example in the case where wire crossing can not be obtained).

2. The treated artery recoils, thromboses, or dissects resulting in occlusion of the treated arterial segment, documented by intraoperative imaging. Note that endovascular procedures with suboptimal results but not meeting criteria 1 or 2 above may qualify for inclusion after 3 months as in #16 above.

• Cerebrovascular accident within 6 months prior to randomization.

• Treatment with topical growth factors or hyperbaric oxygen (HBO) within 30 days, or systemic growth factor treatment within 6 months of enrollment.

• Known hypersensitivity to heparin; or history of heparin-induced thrombocytopenia (HIT).

Related Conditions & MeSH terms

• Critical Limb Ischemia
• Ischemia
• Peripheral Arterial Disease
• Peripheral Vascular Diseases

Intervention

Device:
• BMAC injection
Injection of 40 ml of autologous bone marrow aspirate concentrate (BMAC injection) prepared with the SmartPReP2 BMAC System
• Placebo injection
Injection of placebo into ischemic tissue of the lower extremity

Locations

Country	Name	City	State
United States	Johns Hopkins Hospital	Baltimore	Maryland
United States	University of Alabama	Birmingham	Alabama
United States	Beth Israel Deaconess	Boston	Massachusetts
United States	Tufts Medical Center	Boston	Massachusetts
United States	Cooper University Hospital	Camden	New Jersey
United States	University of North Carolina at Chapel Hill	Chapel Hill	North Carolina
United States	Charleston Area Medical Center Institute	Charleston	West Virginia
United States	Roper St Francis Medical Center	Charleston	South Carolina
United States	University of Illinois-Chicago	Chicago	Illinois
United States	University of Cincinnati	Cincinnati	Ohio
United States	Baylor Medical Ctr	Dallas	Texas
United States	Medical Center of South Arkansas	El Dorado	Arkansas
United States	Greenville Health System	Greenville	South Carolina
United States	University of Texas - Houston Medical School	Houston	Texas
United States	Kansas City Vascular	Kansas City	Missouri
United States	University of Tennessee	Knoxville	Tennessee
United States	North Shore-Long Island Jewish	Lake Success	New York
United States	Dartmouth Hitchcock Medical Ctr	Lebanon	New Hampshire
United States	Regional Infectious Disease and Infusion Ctr	Lima	Ohio
United States	USC Keck School of Medicine	Los Angeles	California
United States	Ochsner Clinic	New Orleans	Louisiana
United States	St. Luke's Roosevelt	New York	New York
United States	Florida Hospital - Vascular Institute of Central Florida	Orlando	Florida
United States	Coastal Vascular & Interventional	Pensacola	Florida
United States	Maine Medical Ctr	Portland	Maine
United States	Oregon Health Science University	Portland	Oregon
United States	Rhode Island Hospital	Providence	Rhode Island
United States	Mercy Hospital	St. Louis	Missouri
United States	USF / Tampa General	Tampa	Florida
United States	Holy Name Medical Center	Teaneck	New Jersey
United States	University of Oklahoma	Tulsa	Oklahoma
United States	Peace Health Southwest Medical Center	Vancouver	Washington
United States	Cadence Health, Central DuPage Hospital	Winfield	Illinois
United States	Wake Forest Baptist Health	Winston-Salem	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
Harvest Technologies

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Amputation Free Survival	Survival without a major (above the ankle) amputation	Six Months
Secondary	Change In Rutherford Classification	Change in the subjects clinical status as measured by Rutherford Classification	Six Months
Secondary	Change in Pain	Change in Subjects perception of pain as measured on a 100 mm visual analog scale	Six Months