Safety and Preliminary Efficacy Study of Mesenchymal Precursor Cells (MPCs) in Subjects With Lumbar Back Pain

Sponsor

Mesoblast, Ltd. (Industry)

Overall Status

Completed

CT.gov ID

NCT01290367

Collaborator

(none)

100

Enrollment

Locations

Arms

Duration (Months)

7.1

Patients Per Site

0.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study is to compare two doses of immunoselected, culture-expanded, nucleated, allogeneic adult MPCs when combined with hyaluronic acid to two control intradiscal injections in subjects with chronic low back pain due to moderate Degenerative Disc Disease (DDD) at one lumbar level from L1 to S1.

All investigational subjects in this study will undergo injection of either 6 million (M) or 18M cells in a hyaluronic acid carrier into the degenerated lumbar disc's nucleus pulposus. All control subjects will undergo an intradiscal control injection with either saline or hyaluronic acid only

Condition or Disease	Intervention/Treatment	Phase
Degenerative Disc Disease	Biological: Single Dose MPCs Injection Procedure: Single injection of saline solution Procedure: Single injection of hyaluronic acid Biological: Single Dose MPCs Injection	Phase 2

Detailed Description

This is a prospective, multicenter, double blinded, controlled clinical study comparing two doses of immunoselected, culture-expanded, nucleated, allogeneic adult MPCs when combined with hyaluronic acid to two control intradiscal injections in subjects with chronic low back pain (> 6 months) due to moderate DDD at one lumbar level from L1 to S1 and unresponsive to conservative therapy for at least 3 months (including physical therapy).

After the screening and injection visits, each subject will be evaluated clinically and radiographically at 30 days, and again at 3, 6, 12, 24 and 36 months after injection.

Subjects will be evaluated at the same time points for safety.

Study Design

Study Type:

Interventional

Actual Enrollment :

100 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Participant, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

A Prospective, Double Blind, Controlled Study Evaluating Safety and Preliminary Efficacy of a Single Injection of Adult Mesenchymal Precursor Cells (MPCs) Combined With Hyaluronan in Subjects With Chronic Discogenic Lumbar Back Pain

Study Start Date :

Aug 1, 2011

Actual Primary Completion Date :

Jul 1, 2013

Actual Study Completion Date :

Jul 1, 2015

Arms and Interventions

Arm	Intervention/Treatment
Experimental: High Dose MPCs Injection of High Dose MPCs with Hyaluronic Acid	Biological: Single Dose MPCs Injection Injection of Low Dose MPCs with Hyaluronic Acid into the degenerated lumbar disc's nucleus pulposus. Other Names: Direct MPCs Lumbar Disc Injection. Stem Cells Biological: Single Dose MPCs Injection Injection of HighDose MPCs with Hyaluronic Acid into the degenerated lumbar disc's nucleus pulposus. Other Names: Stem Cells
Experimental: Low Dose MPCs Injection of Low Dose MPCs with Hyaluronic Acid	Biological: Single Dose MPCs Injection Injection of Low Dose MPCs with Hyaluronic Acid into the degenerated lumbar disc's nucleus pulposus. Other Names: Direct MPCs Lumbar Disc Injection. Stem Cells Biological: Single Dose MPCs Injection Injection of HighDose MPCs with Hyaluronic Acid into the degenerated lumbar disc's nucleus pulposus. Other Names: Stem Cells
Sham Comparator: Saline injection Injection of saline solution.	Procedure: Single injection of saline solution Intradiscal control injection with saline solution Other Names: Saline injection Sham control
Placebo Comparator: Hyaluronic acid injection Injection of hyaluronic acid solution	Procedure: Single injection of hyaluronic acid Intradiscal control injection with hyaluronic acid Other Names: Hyaluronic acid injection Vehicle control

Outcome Measures

Primary Outcome Measures

To determine the overall safety of MPCs plus carrier using physical examinations, vital signs, treatment emergent adverse events (TEAEs), and the results of clinical lab tests (hematology, serum chemistry, inflammation, and immunology). [3 years]

Secondary Outcome Measures

To evaluate the change of treated lumbar intervertebral discs using Magnetic Resonance Imaging (MRI) at 6 months post injection of MPCs. [6 - 36 Months]
To evaluate the effectiveness of MPCs in reducing chronic lumbar back pain using the visual analog scale (VAS). [1 - 36 Months]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male or females at least 18 years of age.
Have the ability to understand the requirements of the study, to provide written informed consent, and to comply with the study protocol.
Have the ability to understand and provide written authorization for the use and disclosure of personal health information (PHI) [per Health Insurance Portability and Accountability Act (HIPAA) privacy ruling in the US].
Have chronic low back pain for at least 6 months.
Have documented symptomatic diagnosis of DDD of one level from L1-S1 as determined by a change in disc hydration on MRI compared to normal disc with or without an annular fissure or a contained disc herniation.
Have failed 3 months of non-operative low back pain management.
Disc height loss of <30% compared to a normal adjacent disc based upon radiographic evaluation.
Pre-treatment baseline low back pain of at least 40 mm on a 100 mm visual analog scale.
Low back pain greater than leg pain.
Pre-treatment baseline Oswestry Disability Index Questionnaire score of at least 30 on the 100-point questionnaire.

Exclusion Criteria:

Female subjects who are pregnant or nursing, or women planning to become pregnant during the first year (12 months) following surgery.
Have a current or prior history within the last 3 years of neoplasm (excluding basal cell carcinoma) and/or any active neoplasm within the last 24 months, prior to screening.
Patients with compressive pathology due to stenosis or frankly herniated disc or sequestered discs are not candidates.
Intact disc bulge/protrusion or focal herniation at the symptomatic level (s) > 3 mm or presence of disc extrusion or sequestration.
Lumbar spondylitis or other undifferentiated spondyloarthropathy.
Have undergone a previous surgery at the involved levels.
Any lumbar intradiscal injection procedure (e.g., injection of corticosteroids, methylene blue, dextrose, or glucosamine and chondroitin sulfate). Discography may be performed, but must be done at least 2 weeks or more prior to the MPC injection procedure.
Have an acute fracture of the spine at the time of enrollment in the study.
Have a history of epidural steroid injections within 1 week prior to study treatment.
Have a known history of hypersensitivity or anaphylactic reaction to murine or bovine products or dimethyl sulfoxide (DMSO).
Have a positive screen for human immunodeficiency virus (HIV) antibodies.
Have a known history of hypersensitivity or anaphylactic reaction to Hyaluronan.
Have a current or prior history within the last 3 years of neoplasm (excluding basal cell carcinoma) and/or any active neoplasm within the last 24 months, prior to screening.
Have been a recipient of prior stem cell/progenitor cell therapy or other biological intervention to repair the target intervertebral disc.
Are transient or has been treated in the last 6 months before enrollment for alcohol and/or drug abuse in an inpatient substance abuse program.
Currently incarcerated (prisoners).

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Arizona Pain Specialists	Scottsdale	Arizona	United States	85258
2	UC Davis Spine Center	Sacramento	California	United States	95816
3	The Spine Institute	Santa Monica	California	United States	90403
4	IPM Medical Group, Inc.	Walnut Creek	California	United States	94598
5	Denver Spine	Denver	Colorado	United States	80111
6	Rocky Mountain Associates in Orthopedic Medicine, P.C.	Loveland	Colorado	United States	80538
7	Emory University School of Medicine	Atlanta	Georgia	United States	30329
8	Carolina Neurosurgery and Spine Associates	Charlotte	North Carolina	United States	28204
9	Central Texas Spine Institute	Austin	Texas	United States	78731
10	Richmond Bone and Joint Clinic, Memorial Hermann Medical Group	Richmond	Texas	United States	77469
11	Virginia Spine Research Institute, Inc.	Richmond	Virginia	United States	23235
12	Washington Center for Pain Management	Edmonds	Washington	United States	98026
13	The Center for Pain Relief, Inc.	Charleston	West Virginia	United States	25301
14	Monash Medical Center	Clayton	Victoria	Australia	3168