Efficacy and Safety of Stempeucel® in Patients With Critical Limb Ischemia (CLI) Due to Peripheral Arterial Disease

Sponsor

Cell Biopeutics Resources Sdn Bhd (Industry)

Overall Status

Not yet recruiting

CT.gov ID

NCT05854641

Collaborator

Stempeutics Research Pvt Ltd (Industry), National University of Malaysia (Other)

Enrollment

Location

Arm

19.1

Anticipated Duration (Months)

0.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The goal of this observational, practice-based feasibility study is to observe the efficacy and safety of intramuscular administration of Stempeucel® in Malaysian patients with critical limb ischemia (CLI) due to peripheral arterial disease. The main questions it aims to answer are:

Can intramuscular administration of Stempeucel® reduce symptoms of CLI due to peripheral arterial disease while improving the healing rate and functional outcomes?
Does intramuscular administration of Stempeucel® causes any serious adverse events in CLI due to peripheral arterial disease patients? Study patients will be assessed by the PI before administering the Stempeucel® for any other organ with inflammation. The study patients will also be followed up to the duration of 1 year after study treatment administration for safety and efficacy assessment.

Condition or Disease	Intervention/Treatment	Phase
Critical Limb Ischemia Peripheral Arterial Disease	Biological: Stempeucel®	Phase 4

Detailed Description

Title: An Observational, Practice-Based, Open Label, Feasibility Study to Observe the Efficacy and Safety of Intramuscular Administration of Stempeucel® in Malaysian Patients with Critical Limb Ischemia (CLI) Due to Peripheral Arterial Disease

Study Design: Single arm, practice-based, feasibility study

Study Duration: Estimated duration for the main protocol (e.g. from starts of screening to last subject processed and end of the study) is approximately 18 months

Study Center: Universiti Kebangsaan Malaysia Medical Centre (UKMMMC), Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Wilayah Persekutuan, Malaysia

Objectives: To observe the efficacy and safety of Stempeucel® (adult human bone marrow derived, cultured, pooled, allogeneic mesenchymal stromal cells) in Malaysian patients with critical limb ischemia (CLI) due to peripheral arterial disease.

Investigational Medicinal Product

Description

• Ex-vivo cultured allogeneic mesenchymal stem cells (MSCs) supplied in cryo-bags consisting of 150 or 200 million, suspended in 50 ml of Plasmalyte A containing 1.5% human serum albumin (HSA) and 3% dimethyl sulfoxide (DMSO).

Dosage • Dosing of Stempeucel® is based on body weight. The recommended dose is 2 million cells/kg body weight.

Administration

• 40 - 60 injections administered as 0.6 ml/kg (200 million bag) or 0.8 ml/kg (150 million bag) intramuscularly into different points on the muscle. Additional injections of 2 ml (200 million bag) or 3 ml (150 million bag) administered around the ulcer

Number of Subjects: 10 patients

Data Analysis

Data Management:

Electronic case record form (eCRF) will be used for data entry.
Oracle clinical (or other suitable alternatives with audit trail) will be used for data management.

Statistical Method:

The SPSS® package (IBM Inc., USA, version 22) will be used for statistical evaluation.
All patients in the study with relevant efficacy and safety data will be considered for the analysis.
Efficacy analysis will be done using GEE (Generalized Estimating Equations) method or paired t test as appropriate.
Adverse events monitored using information voluntarily disclosed by the patients and as observed by the PI will be summarized descriptively by total number of AE(s).
AEs will be categorized as: all AEs, all treatment-emergent AEs, all severe AEs, treatment-related AEs and severe treatment-related AEs. These events will be reported as appropriate and summarized.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

10 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

An Observational, Practice-Based, Open Label, Feasibility Study to Observe the Efficacy and Safety of Intramuscular Administration of Stempeucel® in Malaysian Patients With Critical Limb Ischemia (CLI) Due to Peripheral Arterial Disease.

Anticipated Study Start Date :

May 1, 2023

Anticipated Primary Completion Date :

Oct 1, 2024

Anticipated Study Completion Date :

Dec 1, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Stempeucel® Stempeucel® (Ex-vivo cultured MSCs) supplied in 15 ml cryo bags consisting of 200 million or 150 million MSCs, 85% PlasmaLyte-A, 5% HSA and 10% DMSO in a total volume of 15 ml. Following thawing, 35 ml of PlasmaLyte A will be added to the Stempeucel® to make a total volume of 50 ml (Refer section 6.6 IMP Preparation and Designation). The final concentration of components will be 1.5% HSA and 3% DMSO.	Biological: Stempeucel® • Ex-vivo cultured allogeneic mesenchymal stem cells (MSCs) supplied in cryo-bags consisting of 150 or 200 million, suspended in 50 ml of Plasmalyte A containing 1.5% human serum albumin (HSA) and 3% dimethyl sulfoxide (DMSO).

Arm

Intervention/Treatment

Experimental: Stempeucel®

Stempeucel® (Ex-vivo cultured MSCs) supplied in 15 ml cryo bags consisting of 200 million or 150 million MSCs, 85% PlasmaLyte-A, 5% HSA and 10% DMSO in a total volume of 15 ml. Following thawing, 35 ml of PlasmaLyte A will be added to the Stempeucel® to make a total volume of 50 ml (Refer section 6.6 IMP Preparation and Designation). The final concentration of components will be 1.5% HSA and 3% DMSO.

Biological: Stempeucel®

Outcome Measures

Primary Outcome Measures

Change in ischemic rest pain [Screening (Day -14 to -1), Day 30, 90, 180 and 360]
Change in visual analog score (VAS) compared to screening
Change in size of the ulcer [Screening (Day -14 to -1), Day 30, 90, 180 and 360]
Change in size of the ulcer compared to screening
Change in ankle brachial pressure index (ABPI) [Screening (Day -14 to -1), Day 30, 90, 180 and 360]
Change in ankle brachial pressure index (ABPI) compared to screening
Change in total walking distance [Screening (Day -14 to -1), Day 30, 90, 180 and 360]
Change in total walking distance on a treadmill compared to screening
Change in major amputation-free survival [Screening (Day -14 to -1), Day 30, 90, 180 and 360]
Change in amputation-free survival compared to screening
Change in angiogenesis [Screening (Day -14 to -1), Day 180]
Change in angiogenesis measured by digital subtraction angiogram (DSA) compared to screening

Secondary Outcome Measures

The type of AE(s), number of AE(s) and proportion of patients with AE(s) [Screening (Day -14 to -1)]
Monitored and recorded as voluntarily disclosed by the patients and as observed by the Investigator throughout the study
Incidence of abnormal laboratory test results (serum chemistry, haematology, liver function test) [Screening (Day -14 to -1), Day 7, 30, 90, 180 and 360]
The following lab tests will be conducted: serum chemistry, haematology, liver function test. In case of abnormal results, they shall be recorded as an adverse event or excluded from study (screening).
Incidence of abnormal urine test results [Screening (Day -14 to -1), Day 180]
Urine test will be conducted. In case of abnormal results, they shall be recorded as an adverse event or excluded from study (screening).
Incidence of abnormal TNF-α [Screening (Day -14 to -1), Day 7 and 30]
TNF-α test will be conducted. In case of abnormal results, they shall be recorded as an adverse event or excluded from study (screening).
Incidence of abnormal vital signs [Screening (Day -14 to -1), Baseline, Day 7, 30, 90, 180 and 360]
The following assessments will be conducted: blood pressure, heart rate, respiratory rate and temperature. In case of abnormal results, they shall be recorded as an adverse event or excluded from the study (screening).
Incidence of abnormal physical examination [Screening (Day -14 to -1), Baseline, Day 7, 30, 90, 180 and 360]
The following examinations will be conducted: visual, heart, lungs, abdomen, nervous system, muscoskeletal system and etc. In case of abnormal conditions, they shall be recorded as an adverse event or excluded from the study (screening).
Incidence of abnormal ECG parameters [Screening (Day -14 to -1), Baseline, Day 7, 30, 90, 180 and 360]
The following assessments will be conducted: 12 lead ECG recordings with long Lead II, and two-dimensional echocardiography (2D ECHO; if needed). In case of abnormal conditions, they shall be recorded as an adverse event or excluded from study (screening).
Incidence of abnormal chest condition [Screening (Day -14 to -1), Day 180]
Chest x-ray will be conducted. In case of abnormal conditions, they shall be recorded as an adverse event or excluded from study (screening).

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 65 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Patients between 18-65 years old
Patients diagnosed with atherosclerotic peripheral arterial disease
Patients not eligible for or have failed surgical or percutaneous revascularization (No option patients)
Patients with at least one ulcer (between 0.5 to 10 cm2 size)
Ankle brachial pressure index (ABPI) ≤ 0.6 (toe brachial index (TBI) if ABPI out of range; TBI ≤ 0.5)
Patients who are able and willing to provide consent and agrees to comply with study procedures and follow-up evaluations

Exclusion Criteria:

Patients diagnosed with Buerger's disease by Shionoya criteria
Patients eligible for surgical or percutaneous revascularization
Patients with a history of participating in another stem cell trial or therapy within 3 months
Patients who are unsuitable to participate the clinical trial as determined by investigators