Mesenchymal Stromal Cells to Treat Type 1 Diabetes in Children and Adolescents

Sponsor
Uppsala University Hospital (Other)
Overall Status
Recruiting
CT.gov ID
NCT05061030
Collaborator
(none)
66
1
2
82.6
0.8

Study Details

Study Description

Brief Summary

This is a combined phase 1 and 2 study in 66 subjects, male or female, between 7-21 years of age that have recently (< 6 months) been diagnosed with type 1 diabetes. The first phase 1 part of the study includes six subjects openly receiving allogeneic Wharton's jelly derived mesenchymal stromal cells as the Advanced Therapy Medicinal Product (ATMP) Protrans, three each in the age ranges 7-11 and 12-18.The second part is a randomized, double-blinded placebo-controlled phase 2 study in parallel design comparing allogeneic Wharton's jelly derived mesenchymal stromal cells treatment (as Protrans) to placebo in children and adolescent subjects (7-21 years of age) diagnosed with type 1 diabetes, The primary objectives of this study will be to investigate the safety, tolerance and efficacy after an allogieneic infusion of Wharton's jelly derived mesenchymal stromal cells.

Condition or Disease Intervention/Treatment Phase
  • Biological: the ATMP Protrans
Phase 1/Phase 2

Study Design

Study Type:
Interventional
Anticipated Enrollment :
66 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
A Double-blinded, Randomized, Parallel, Placebo-controlled Trial of Wharton's Jelly-derived Allogeneic Mesenchymal Stromal Cells to Treat Type 1 Diabetes in Children and Adolescents
Actual Study Start Date :
Jan 14, 2022
Anticipated Primary Completion Date :
Sep 1, 2028
Anticipated Study Completion Date :
Dec 1, 2028

Arms and Interventions

Arm Intervention/Treatment
Active Comparator: Wharton's jelly derived mesenchymal stromal cells (Protrans)

Cells are dissolved in saline and given intravenously over a period of 20-40 min. 100 million cells to subjects < 50 kg and 200 million cells to subjects 50-100 kg (>100 kg is an exclusion criterion).

Biological: the ATMP Protrans
Protrans consists of Wharton's jelly derived mesenchymal stromal cells

Placebo Comparator: Placebo

Placebo (saline) is given intravenously over a period of 20-40 min.

Biological: the ATMP Protrans
Protrans consists of Wharton's jelly derived mesenchymal stromal cells

Outcome Measures

Primary Outcome Measures

  1. Safety at one year evaluated as adverse events [One year]

    Safety parameters will be evaluated at each study visit and recorded as adverse events.

  2. Safety at five years evaluated as adverse events [Five years]

    Safety parameters will be evaluated at each study visit and recorded as adverse events.

  3. Efficacy measured as change in C-peptide Area under the curve to a mixed mealtolerance test. [One year]

    Change in C-peptide Area under the curve (AUC) (0-120 min) for mixed meal tolerance test (MMTT) at 12 months following Protrans/Placebo infusion when compared to test performed before the start of treatment (baseline).

Secondary Outcome Measures

  1. Insulin independency [One year]

    The proportion of study participants independent of insulin at 6 months

  2. Insulin independency [One year]

    The proportion of study participants independent of insulin at 12 months

  3. Low insulin needs [6 months]

    The proportion of study participants with daily insulin needs <0.25 U/kg at 6 months

  4. Low insulin needs [12 months]

    The proportion of study participants with daily insulin needs <0.25 U/kg at 12 months

  5. Insulin needs [6 months]

    Insulin requirement/kg body weigh at 6 months

  6. Insulin needs [12 months]

    Insulin requirement/kg body weigh at 12 months

  7. HbA1c [6 months]

    HbA1c at 6 months

  8. HbA1c [12 months]

    HbA1c at 12 months

  9. Time in target [6 months]

    Time in target (4-8 mmol/l) as measured by flash glucose monitoring for 14 days at 6 months

  10. Time in target [12 months]

    Time in target (4-8 mmol/l) as measured by flash glucose monitoring for 14 days at 12 months

  11. Time in range [6 months]

    Time in target (3.9-10 mmol/l) as measured by flash glucose monitoring for 14 days at 6 months

  12. Time in range [12 months]

    Time in target (3.9-10 mmol/l) as measured by flash glucose monitoring for 14 days at 12 months

  13. C-peptide [6 months]

    Change in C-peptide Area under the curve (AUC) (0-120 min) for mixed meal tolerance test (MMTT) at 6 months following Protrans/Placebo infusion when compared to test performed before the start of treatment (baseline).

  14. Change in peak C-peptide [6 months]

    Change in peak C-peptide concentration during the first 6 months

  15. Change in peak C-peptide [12 months]

    Change in peak C-peptide concentration during the first 12 months

Other Outcome Measures

  1. Gender differences [6 months]

    Differences in parameters of primary and secondary endpoints between genders

  2. Gender differences [12 months]

    Differences in parameters of primary and secondary endpoints between genders

  3. HLA class 1 genotypes [6 months]

    Differences in parameters of primary and secondary endpoints between HLA class 1 genotypes

  4. HLA class 1 genotypes [12 months]

    Differences in parameters of primary and secondary endpoints between HLA class 1 genotypes

  5. age [6 months]

    Differences in parameters of primary and secondary endpoints between ages 7-11 and 12-21

  6. age [12 months]

    Differences in parameters of primary and secondary endpoints between ages 7-11 and 12-21

  7. Autoantibodies [6 months]

    Change of levels of diabetes-related autoantibodies when compared to test before the start of treatment (baseline)

  8. Autoantibodies [12 months]

    Change of levels of diabetes-related autoantibodies when compared to test before the start of treatment (baseline)

  9. Peripheral blood mononuclear cells [6 months]

    Change in reactivity and cytokine production of peripheral blood mononuclear cells when compared to test before the start of treatment (baseline)

  10. Peripheral blood mononuclear cells [12 months]

    Change in reactivity and cytokine production of peripheral blood mononuclear cells when compared to test before the start of treatment (baseline)

Eligibility Criteria

Criteria

Ages Eligible for Study:
7 Years to 21 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  1. Written informed consent for participation of the study (for subjects below 18 years of age also from both caregivers), given before undergoing any study-specific procedures

  2. Clinical history compatible with type 1 diabetes diagnosed less than 6 months before enrolment

  3. In the first part of the study, six subjects, three between 7-11 and three between 12-18 years of age (both groups inclusive at both ends), will be included. The sixty subjects in the second part of the study are stratified by age (12-21 and 7-11 years, respectively) and randomized to one of two treatment arms (active or placebo), with a 6-month safety delay for the younger stratum.

  4. Mentally stable and, in the opinion of the investigator, able to comply with the procedures of the study protocol.

  5. Fasting plasma C-peptide concentration >0.12 nmol/L.

  6. Subjects of child-bearing potential must agree to using adequate contraception until one year after the administration of WJMSC/Placebo. Adequate contraception is as follows:

  7. oral (except low-dose gestagen (lynestrenol and noretisteron), injectable or implanted hormonal contraceptives.

  8. intrauterine device

  9. intrauterine system (for example progestin-releasing coil)

  10. vasectomized male (with appropriate postvasectomy documentation of the absence of sperm in the ejaculate)

Exclusion Criteria:
  1. Subjects with body weight >100 kg

  2. Subjects with unstable cardiovascular status incl. NYHA class III/IV or symptoms of angina pectoris.

  3. Subjects with uncontrolled hypertension (≥160/105 mmHg).

  4. Subjects with active on-going infections.

  5. Subjects with latent or previous as well as on-going therapy against tuberculosis, or exposed to tuberculosis or has traveled in areas with a high risk of tuberculosis or mycosis within the last 3 months.

  6. Subjects with serological evidence of infection with HIV, Treponema pallidum, hepatitis B antigen (subjects with serology consistent with previous vaccination and a history of vaccination are acceptable), or hepatitis C.

  7. Subjects with any systemic immune suppressive treatment

  8. Subjects with a known demyelinating disease or with symptoms or physical examination findings consistent with possible demyelinating disease.

  9. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test.

  10. Subjects with known, or previous, malignancy.

  11. Taking oral anti-diabetic therapies or any other concomitant medication which may interfere with glucose regulation other than insulin.

  12. Subjects with GFR <60 ml/min/1.73 m2 body surface.

  13. Subject with any condition or any circumstance that, in the opinion of the investigator, would make it unsafe to undergo treatment with MSC.

  14. Known hypersensitivity against any excipients, i.e., dimethyl sulfoxide (DMSO).

Contacts and Locations

Locations

Site City State Country Postal Code
1 Uppsala University Hospital Uppsala Sweden 75185

Sponsors and Collaborators

  • Uppsala University Hospital

Investigators

  • Principal Investigator: Per-Ola Carlsson, MD, PhD, Uppsala University Hospital

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Per-Ola Carlsson, Professor, Senior consultant in Endocrinology and Diabetology, Uppsala University Hospital
ClinicalTrials.gov Identifier:
NCT05061030
Other Study ID Numbers:
  • WJMSC-P01
First Posted:
Sep 29, 2021
Last Update Posted:
May 23, 2022
Last Verified:
May 1, 2022
Individual Participant Data (IPD) Sharing Statement:
No
Plan to Share IPD:
No
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Additional relevant MeSH terms:

Study Results

No Results Posted as of May 23, 2022