Phase IIa Randomized Placebo Controlled Trial: Mesenchymal Stem Cells as a Disease-modifying Therapy for iPD

Parkinson's Disease Clinical Trial

Official title:

A Randomized, Double-blind, Placebo-controlled Trial of Allogeneic Bone Marrow-derived Mesenchymal Stem Cells as a Disease-modifying Therapy for Idiopathic Parkinson's Disease

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04506073
• Other study ID #: HSC-MS-20-0150
• Status: Completed
• Phase: Phase 2
• Start date: November 9, 2020
• Est. completion date: July 30, 2023

Study information

• Verified date: November 2023
• Source: The University of Texas Health Science Center, Houston
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to select the safest and most effective number of repeat doses of allogeneic bone marrow-derived mesenchymal stem cell (MSC) infusions to slow the progression of Parkinson's disease (PD).

Description:

Single site phase IIa study of allogeneic MSC in a double blind randomized control trial as disease modifying therapy for PD. The design includes three treatment arms with 45 patients.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 45
• Est. completion date: July 30, 2023
• Est. primary completion date: July 30, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years to 79 Years

Eligibility

Inclusion Criteria:

• Diagnosis of Parkinson's disease by the UK brain bank criteria including the presence of 2 cardinal signs of PD plus bradykinesia.

• Mild microsomia to anosmia.

• A modified Hoehn and Yahr stage of 3 or less.

• Date of diagnosis of PD between 3 to 10 years

• Robust response to dopaminergic therapy.

Exclusion Criteria:

• Atypical, vascular, or drug-induced Parkinsonism.

• An atypical DAT scan or MRI supporting an alternative explanation for PD symptoms.

• Patient not on levodopa containing medications.

• Clinical features of psychosis or refractory hallucinations.

• A Montreal Cognitive Assessment (MoCA) score of less than 25.

• Uncontrolled seizure disorder.

• Abnormal Kidney and liver function.

• Presence of clinically refractory orthostatic hypotension at the screening or baseline visit.

• Body mass index of greater than or equal to 35.

• Cardiac disease: History of congestive heart failure, clinically significant bradycardia, presence of 2nd, or 3rd-degree atrioventricular block.

• Pulmonary disease: COPD with oxygen-requirement at rest or with ambulation; or moderate to severe asthma.

• Active malignancy or diagnosis of malignancy within 5 years prior to the start of screening

• Any current suicidal ideation or behaviors.

• Any diagnosis of autoimmune disease or immunocompromised state

• History of medium or large size vessel cerebrovascular accidents.

• History of traumatic brain injury with loss of consciousness and residual neurologic symptoms.

• Major surgery within the previous 3 months or planned in the ensuing 6 months.

• History of use of an investigational drug within 90 days prior to the screening visit.

• History of brain surgery for PD.

• Substance abuse disorder.

• Active anticoagulation treatment and/or abnormal INR.

Related Conditions & MeSH terms

• Parkinson Disease
• Parkinson's Disease

Intervention

Drug:
• MSC+placebo
2 infusions of 10 X 10^6 MSC/kg and 1 placebo every 3 months.
• MSC
3 infusions of 10 X 10^6 MSC/kg every 3 months.
• Placebo
3 infusions of placebo every 3 months. Placebo will be identical to the investigational product but will not contain MSCs.

Locations

Country	Name	City	State
United States	The University of Texas Health Science Center at Houston	Houston	Texas

Sponsors (2)

Lead Sponsor	Collaborator
The University of Texas Health Science Center, Houston	Michael J. Fox Foundation for Parkinson's Research

Country where clinical trial is conducted

United States, 

References & Publications (10)

Braak H, Del Tredici K, Rub U, de Vos RA, Jansen Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging. 2003 Mar-Apr;24(2):197-211. doi: 10.1016/s0197-4580(02)00065-9. — View Citation

Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014 Apr 23-30;311(16):1670-83. doi: 10.1001/jama.2014.3654. — View Citation

Dorsey ER, Sherer T, Okun MS, Bloem BR. The Emerging Evidence of the Parkinson Pandemic. J Parkinsons Dis. 2018;8(s1):S3-S8. doi: 10.3233/JPD-181474. — View Citation

Gray MT, Woulfe JM. Striatal blood-brain barrier permeability in Parkinson's disease. J Cereb Blood Flow Metab. 2015 May;35(5):747-50. doi: 10.1038/jcbfm.2015.32. Epub 2015 Mar 11. — View Citation

Jellinger KA. Basic mechanisms of neurodegeneration: a critical update. J Cell Mol Med. 2010 Mar;14(3):457-87. doi: 10.1111/j.1582-4934.2010.01010.x. Epub 2010 Jan 11. — View Citation

Joyce N, Annett G, Wirthlin L, Olson S, Bauer G, Nolta JA. Mesenchymal stem cells for the treatment of neurodegenerative disease. Regen Med. 2010 Nov;5(6):933-46. doi: 10.2217/rme.10.72. — View Citation

Kortekaas R, Leenders KL, van Oostrom JC, Vaalburg W, Bart J, Willemsen AT, Hendrikse NH. Blood-brain barrier dysfunction in parkinsonian midbrain in vivo. Ann Neurol. 2005 Feb;57(2):176-9. doi: 10.1002/ana.20369. — View Citation

Nagatsu T, Mogi M, Ichinose H, Togari A. Cytokines in Parkinson's disease. J Neural Transm Suppl. 2000;(58):143-51. — View Citation

Orr CF, Rowe DB, Halliday GM. An inflammatory review of Parkinson's disease. Prog Neurobiol. 2002 Dec;68(5):325-40. doi: 10.1016/s0301-0082(02)00127-2. — View Citation

Stypula G, Kunert-Radek J, Stepien H, Zylinska K, Pawlikowski M. Evaluation of interleukins, ACTH, cortisol and prolactin concentrations in the blood of patients with parkinson's disease. Neuroimmunomodulation. 1996 Mar-Jun;3(2-3):131-4. doi: 10.1159/000097237. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Screening
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Week 7, post infusion #1
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Week 20, post infusion #2
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Week 29, post-infusion #3
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Week 39 follow-up
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Week 52 follow-up
Primary	Safest number of effective doses of MSC as measured by the Part III of the Movement Disorder Society Unified Parkinson's disease Rating Scale (MDS-UPDRS) scale		Week 78 follow-up
Secondary	Safety and tolerability as measured by serious adverse reactions.		Baseline,week 7,week 20,week 29,week 39,week 78
Secondary	Safety and tolerability as measured by immunologic responses.	Donor specific antibodies (DSA) in serum of patients will be measured and compared to baseline to determine if there is a development of antibody response to donor HLA (human leukocyte antigen). This will determine if there is a possibility of anti-donor alloimmune response after the first or second infusion of MSC, which might lead to a subsequent antibody-mediated rejection (AMR) with the following infusion. Testing will be done at the these time points to determine if 2nd or 3rd infusions will continue.	Baseline,week 7,week 20,week 29,week 39,week 78
Secondary	Motor function as measured by the Timed-Up-and-Go (TUG) scale	This test uses the time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. A longer duration of time indicates a worse outcome	Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Global measurement of disability as measured by the change in the screening "Off" modified Hoehn and Yahr (H&Y)		Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Quality of life as measured by the modified Schwab and England activities of daily living scale (ADL)		Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Quality of life as measured by the Parkinson's Disease Questionnaire 39 (PDQ-39)		Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Quality of life as measured by the EuroQol- 5 Dimension (EQ-5D)		Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Non-motor symtoms as measured by the The University of Pennsylvania Smell Identification Test (UPSIT- 40 odor test booklet).		Baseline,week 29,week 78
Secondary	Cognitive function as measured by the the change in Montreal Cognitive Assessment (MoCA)		Baseline,week 29,week 78
Secondary	Behavioral changes as measured by the Columbia Suicide Severity Rating Scale (C-SSRS)	The Columbia-Suicide Severity Rating Scale (C-SSRS) is an assessment tool that evaluates suicidal ideation and behavior. It rates an individual's degree of suicidal ideation on a scale, ranging from "wish to be dead" to "active suicidal ideation with specific plan and intent". Exclusionary criteria views 1 or more positive answers in the last month as not eligible for participation. In follow up, one positive response requires further investigation.	Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Behavioral changes as measured by the Geriatric Depression Scale-Short Form (GDS-SF)	The Geriatric Depression Scale Short form (GDS-SF) is a 15-item screening tool that is used to identify depression in older adults. Answers indicating depression are in bold and italicized; score one point for each bold one selected. A score of 0 to 5 is normal. A score greater than 5 suggests depression and requires evaluation, whereas a score of 10 or greater would require evaluation for treatment .	Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Behavioral changes as measured by the Parkinson Anxiety Scale (PAS)		Baseline,week 7,week 20,week 29,week 39,week 52,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs using neuroimaging		Baseline,week 29,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs as measured by concentration of cytokines in patient blood sample.	Examples of these are IL-1beta, IL-6, TNF-alpha, COX-2 and PGE-2. These are measured by Magnetic Bead Panel - Multiplex Assay or ELISA, allowing for specificity in the blood.	Baseline,week 7,week 20,week 29,week 39,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs as measured by concentration of chemokines in patient blood sample.	Examples of these are CCL2 (MCP-1), CCL7 (MCP-3), CCL11 (Eotaxin) CCL2 (MDC), CXCL10 (IP-10), CX3CL1 (Fractalkine). These will be measured by Magnetic Bead Panel - Multiplex Assay or ELISA, allowing for specificity in the blood.	Baseline,week 7,week 20,week 29,week 39,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs as measured by concentration of growth factors	Examples of these are Glial Derived Neurotrophic Factor, Brain Derived Neurotrophic Factor and Vascular Epidermal Growth Factor . These will be measured by ELISA specific to blood and CSF.	Baseline,week 7,week 20,week 29,week 39,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs as measured by concentration of neurotransmitters	Examples of these are homovanillic acid and 5-hydroxytryptamine. These will be measured in CSF and blood by ELISA.	Baseline,week 7,week 20,week 29,week 39,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs as measured by alpha-synuclein oligomers in the blood (serum or plasma)		Basleline,week 29,week 39,week 78
Secondary	Measurement of putative paracrine mechanism of MSCs as measured by alpha-synuclein oligomers in the cerebral spinal fluid		Baseline,week 39