Spinal Cord Contusion Clinical Trial
Official title:
Allogeneic Mononuclear Umbilical Cord Blood Systemic Infusions for Adult Patients With Severe Acute Contusion Spinal Cord Injury: Phase I Safety Study and Phase IIa Primary Efficiency Study
| Verified date | March 2020 |
| Source | Sklifosovsky Institute of Emergency Care |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | |
| Study type | Interventional |
Study evaluates the safety and primary efficiency of systemic (i.v.) allogeneic human umbilical cord blood mononuclear cell infusions in patients with severe acute contusion spinal cord injury (ASIA A/B). 20 patients were included. Half of patients received cell therapy in addition to standard therapy, while the other half received standard therapy only.
| Status | Completed |
| Enrollment | 20 |
| Est. completion date | September 5, 2018 |
| Est. primary completion date | March 21, 2018 |
| Accepts healthy volunteers | No |
| Gender | All |
| Age group | 18 Years to 65 Years |
| Eligibility |
Inclusion Criteria: - acute spinal cord injury (first 3 days after trauma) - contusion type of SCI (MRI-confirmed) - Russian citizenship - Informed consent understood and signed by the patient Exclusion Criteria: - systolic arterial pressure (APsyst) > 185 mmHg OR diastolic AP (APdia) > 105 mmHg OR indications for aggressive AP lowering using i.v. therapy - myocardial infarction within 3 months prior to SCI - glucose level < 3.5 mM/L or > 21 mM/L - organic CNS pathology - acute internal organs diseases requiring surgical treatment - autoimmune diseases - serious surgical treatment or severe trauma within 3 months prior to SCI - pregnancy or breast feeding - acute infections including tuberculosis, syphilis, HIV, hepatitis B and C etc. - severe acute and chronic hematological diseases - rare patient's blood group parameters preventing adequate hUCBMCs sample selection (e.g. Kell+, A2B group, rare phenotype etc.) - any benign or oncological tumors (if not fully treated prior to SCI) - inability to participate in key examination following clinic discharge - any psychiatric diseases preventing patient from informed consent OR treatment plan understanding - confirmed hypersensitivity and/or allergy to any component of the studied biological compound - inability to accomplish present study protocol |
| Country | Name | City | State |
|---|---|---|---|
| Russian Federation | N.V. Sklifosovsky Emergency Care Institute | Moscow |
| Lead Sponsor | Collaborator |
|---|---|
| Sklifosovsky Institute of Emergency Care | National Medical Research Center for Cardiology, Ministry of Health of Russian Federation |
Russian Federation,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Incidence of Treatment-Emergent Adverse Events [Safety] | All potential adverse events were analyzed during the first year after SCI. All adverse events (AEs) were classified using CTCAE v5.0 classification system in each of 10 patients of pilot group. Severity of AEs: Grade 1 - mild; asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2 - moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental ADL; Grade 3 - severe or medically significant but not immediately life-threatening, hospitalization or prolongation of hospitalization indicated, disabling, limiting self care ADL; Grade 4 - life-threatening consequences; urgent intervention indicated; Grade 5 - death related to AE. Relationship to the investigated therapy method: Degree 1 - unrelated; Degree 2 - possibly related; Degree 3 - probably related; Degree 4 - definitely related. |
1 year | |
| Primary | Neurological Deficit Change [ASIA scale] | Dynamics of neurological deficit level within 1 year after SCI was analyzed using ASIA clinical scale: ASIA A - total motor and sensory impairment; ASIA B - total motor impairment and partial sensory impairment below SCI level or pelvic sensitivity preserved; ASIA C - incomplete motor (at least half of key muscle strength less than 3 points) and sensory impairment; ASIA D - incomplete motor (at least half of key muscle strength more than 3 points) and sensory impairment; ASIA E - normal. Neurological deficit level was compared between pilot and control groups. | Change from Baseline at 1 year after SCI | |
| Primary | Quality of Life [FIM scale] | Quality of life level was assessed within 1 year after SCI using FIM (functional impairment) scale. FIM scale evaluates 5 groups of parameters including motor functions and self-service, mobility, motion level, pelvic functions and intellectual functions (e.g. communication and social activity). Each group includes several parameters assessed using point system (maximum 7 points for each parameter). A total sum of points is counted and compared between pilot and control groups. | 1 year after SCI | |
| Secondary | Motor Deficit Change [Muscle Strength] | A dynamics of motor deficit was assessed using standard scale of key muscle strength. Two groups of parameters were considered including upper extremities strength (UEMS) and lower extremities strength (LEMS). Since patients with different SCI levels were included into the study (both cervical and thoracic/lumbar cone) LEMS parameter is more significant. Upper key muscles: C5 - biceps, ?6 - wrist extensors, C7 - triceps, C8 - fingers flexors, Th1 - V finger abductor. Lower key muscles: L2 - m. psoas, L3 - quadriceps, L4 - m. tibialis anterior, L5 - I toe extensor, S1 - gastrocnemius. Both LEMS and cumulative (UEMS + LEMS) parameters were compared. |
Change from Baseline at 1 year after SCI | |
| Secondary | Independent Verticalization Ability | Patients ability to verticalize independently and mobility level were analyzed. First is determined by patient's ability to get up and stand more than 10 seconds without assistance. Second is determined by patient's ability to move without assistance depending on the distance: grade 1 - less than 10 m; grade 2 - less than 50 m; grade 3 - less than 100 m' grade 4 - 100 - 500 m; grade 5 - more than 500 m. | 1 year after SCI | |
| Secondary | Lower Extremities Spasticity Level [Modified Asworth scale] | Spasticity level of lower extremities muscles was assessed using modified Ashworth scale. Grade 0 - no spasticity. Grade 1 - slight elevation of muscle tone, minimal tension at the end of movement amplitude during flexion and extension; Grade 1+ - slight elevation of muscle tone, minimal tension at least at half of movement amplitude. Grade 2 - moderate elevation of muscle tone during whole movement, but passive movements are not obstructed. Grade 3 - significant elevation of muscle tone, passive movements are partially obstructed. Grade 4 - rigid limb position in flexion or extension (contracture). | 1 year after SCI | |
| Secondary | Feeling of Bladder Filling | Frequency of pelvic function disorders was assessed. Analysis included 2 parameters: (i) feeling of bladder filling and (ii) urinary inconsistence. First parameter is determined by patient's subjective feeling of bladder filling correlating to ultrasound confirmation of full bladder. | 1 year after SCI | |
| Secondary | Urinary Inconsistence | Frequency of pelvic function disorders was assessed. Analysis included 2 parameters: (i) feeling of bladder filling and (ii) urinary inconsistence. Second parameter is determined by patient's ability for passive self-urination without application of any devices (e.g. urinary catheters, medical condoms or cystostomy). | 1 year after SCI | |
| Secondary | Spinal Cord Conductivity [Electrophysiological assessment] | Spinal cord conductive function restoration was assessed using electrophysiological examination. Electroneuromyography supplemented with transcranial magnetic stimulation was performed to assess the level of signal conduction through the injured spinal cord. Significant diversity of SCI levels and baseline neurological deficit resulted in low significance of individual ENMG parameters comparison. Therefore only the parameters of conduction arrest was considered including (i) No conduction arrest (total or subtotal preservation of the overlay signal), (ii) Partial conduction arrest (decreased overlay signal) and (iii) Total conduction arrest (no overlay signal). | 1 year after SCI |