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NCT Number: NCT03269071

Neural Stem Cell Transplantation in Multiple Sclerosis Patients

This is a phase I study evaluating the feasibility, safety and tolerability of intrathecally administered human Neural Stem Cells (hNSCs), at an escalating dose ranging from 0.7x10^6±10% cells to 5.7x10^6±10% cells/kg of body weight, in patients affected by Progressive Multiple Sclerosis

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Key information

Conditions

Progressive Multiple Sclerosis Autoimmune Diseases Autoimmune Diseases of the Nervous System Chronic Disease Demyelinating Autoimmune Diseases, CNS Demyelinating Diseases Disease Attributes Immune System Diseases Multiple Sclerosis Multiple Sclerosis, Chronic Progressive Nervous System Diseases Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

18 year–55 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 1

Primary location

IRCCS Ospedale San Raffaele

Milan, MI, 20132, Italy

About this study

This is a prospective, monocentric, national, therapeutic exploratory, phase I, not randomized, open label, not controlled, single dose escalation clinical trial.

Each subject will participate in the study for approximately 96 weeks. Participation will include a screening evaluation between -28 and -7 days before the Advance Therapy Investigational Medicinal Products (ATIMP) administration.

A follow-up with clinical visits will be performed from 1 to 96 weeks.

The protocol will consist of a total of four treatment cohorts (TCs), labeled from A to D, each receiving a single escalating dose of allogenic fetal-derived human Neural Stem Cells (hNSCs) injected intrathecally, as it follows:

  • TC-A: 0.7x10^6 ± 10% cells/kg of body weight;
  • TC-B: 1.4x10^6 ± 10% cells/kg of body weight;
  • TC-C: 2.8x10^6 ± 10% cells/kg of body weight;
  • TC-D: 5.7x10^6 ± 10% cells/kg of body weight.

The intrathecal injection of hNSCs will be performed in a hospitalized setting. The trial will start with TC-A and will go through the subsequent enrolment of patients to be included in TCs from B to D.

Each cohort will consist of three patients at minimum. In case of safety issue the number in each TC will be increased to six patients.

After the inclusion of the first patient of the TC the investigators will wait at least 14 days to treat the second patient. The same interval time will be used for all the following patient within the same TC. After the inclusion of all the planned patients within a TC and with no Dose Limiting Toxicity (DLT) within the TC, the investigators will wait at least 3 months before switching to the upper TC. In case of 1 DLT within the TC, the cohort will be extended to six patients. If another DLT will be observed, the current dosage will be considered excessive and the immediate lower dosage will be considered the Maximum Tolerated Dose (MTD).

The safety monitoring board will review all safety date in the case of evaluated Adverse Event (AE) ≥ 3 "possibly related to human Neural Stem Cells" by investigators and in any case before the shifts between TCs.

This approach will be repeated for every TC up to the end of the study. At the end of the total follow-up, a long term follow up is planned for all enrolled and treated patients in the study, in accordance with the national applicable laws and the international guidelines.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Signature of the informed consent by the patient or patients' legal tutors
  • Age 18 to 55 years
  • Diagnosis of a. Progressive MS as per the revised MC Donald 2010 criteria with a progressive course according to 2013 Lublin phenotypes classification (PMS) with failure or intolerance to all approved therapies according to the disease course or without any alternative approved therapy
  • Evidence of progression of disease defined by an increase of ≥ 0.5 Expanded Disability Status Scale (EDSS) points in the last 12 months
  • Disease duration 2 to 20 years (included)
  • Expanded Disability Status Scale (EDSS) ≥ 6.5
  • Presence of oligoclonal band in the cerebrospinal fluid (CSF) is required for Primary Progressive MS

Exclusion criteria

They will be excluded from the study patients:

  • with any active or chronic infection or diseases other than MS including but not limited to infection with HIV1-2, Hepatitis B or Hepatitis C and tuberculosis or immune deficiency syndromes;
  • treated with any immunosuppressive therapy, including but not limited to natalizumab and fingolimod, within the 3 months prior to screening;
  • treated with interferon-beta or glatiramer acetate within the 30 days prior to screening;
  • treated with corticosteroids within the 30 days prior to screening;
  • if relapse occurred during the 30 days prior to screening;
  • with contraindications for or intolerance to any medication, treatments and procedures that will be used in the study;
  • pregnant or in lactation or of childbearing age who are not willing to use a contraceptive method effective* for the entire duration of the study;
  • who, in the opinion of the investigator, showing any condition that would preclude study participation.
  • refer to guideline http://www.hma.eu/fileadmin/dateien/Human_Medicines/01 About_HMA/Working_Groups/CTFG/2014_09_HMA_CTFG_Contraception.pdf

Treatment and study plan

human fetal-derived Neural Stem Cells (hNSCs)

Drug

The Drug Product (DP) can be classified as an ATIMP belonging to the class of Cell Therapy Medicinal Products (EU law). The ATIMP consists of human fetal-derived Neural Stem Cells (hNSCs) re-suspended in their final formulation medium as defined in the Investigational Medical Product Dossier (IMPD).

For dosage indications, see specific Treatment Cohorts (TC), from A to D.

The product will be administered intrathecally through lumbar puncture.

Other names: human Neural Stem Cells (hNCSs)

Primary outcomes

  1. SHORT TERM (0-24 hours) Overall survival

    Time frame: 0-24 hours after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of patients alive all over the trial

  2. SHORT TERM (0-24 hours) Overall safety and tolerability measured by Adverse Event (AE) recording

    Time frame: 0-24 hours after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of AEs in alive patients all over the trial

  3. SHORT TERM (0-24 hours) Changes in neurological conditions not related to disease

    Time frame: 0-24 hours after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of changes in neurological conditions not related to disease of alive patients all over the trial

  4. SHORT TERM (0-24 hours) Proportion of successful intrathecal administration procedure (feasibility)

    Time frame: 0-24 hours after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of successful intrathecal administration procedures versus all intrathecal administration procedures in the whole trial

  5. MID TERM (day 1- day 14) Overall survival

    Time frame: from 1 to 14 days after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of alive patients in the whole trial

  6. MID TERM (day 1- day 14) Overall safety and tolerability measured by AE recording

    Time frame: from 1 to 14 days after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of AEs of alive patients in the whole trial

  7. MID TERM (day 1- day 14) Changes in neurological conditions not related to disease

    Time frame: from 1 to 14 days after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of changes in neurological conditions not related to disease in alive patients of the whole trial

  8. LONG TERM (day 15 - week 96) Overall survival

    Time frame: from day 15 to week 96 after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of alive patients in the whole trial

  9. LONG TERM (day 15 - week 96) Overall safety and tolerability measured by AE recording

    Time frame: from day 15 to week 96 after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of AEs in alive patients of the whole trial

  10. Long term incidence of malignancies

    Time frame: from day 0 to week 96 after intrathecal injection of human Neural Stem Cells (hNSCs)

    Incidence of malignancies in alive patients of the whole trial

  11. Evaluation of changes in quality of life measures

    Time frame: 12, 24, 48, 72 and 96 weeks

    Health-related quality of life will be assessed by standardized questionnaires

  12. LONG TERM (day 15 - week 96) Changes in neurological conditions not related to the disease

    Time frame: from day 15 to week 96 after intrathecal injection of human Neural Stem Cells (hNSCs)

    Number of changes in the neurological conditions not related to disease in alive patients of the whole trial

Sponsors and collaborators

Lead sponsor

IRCCS San Raffaele

Other

Collaborators

  • Fondazione Italiana Sclerosi Multipla

Registry information

Official study title

Neural Stem Cell Transplantation in Multiple Sclerosis Patient: a Phase I Study

Acronym: STEMS

Important dates

Study start
2017
Primary completion
2021
Study completion
2021
First posted
Aug 31, 2017
Registry last updated
Sep 5, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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