Organ TransplantationPhase 1/2MeasureNCT00734396
Mesenchymal Stem Cells and Subclinical Rejection
A Phase 1/2 study testing Mesenchymal stem cell infusion in people with Organ Transplantation, run by Leiden University Medical Center at 1 site in Netherlands.
Trial summary
The purpose of the study is to test the safety and feasibility of autologous mesenchymal stem cell therapy in HLA-DR mismatched patients with subclinical rejection and or an increase in IF?TA in the renal biopsy 4 weeks or 6 months after renal transplantation. Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Organ Transplantation
- What is being tested?
- Mesenchymal stem cell infusion
- Type of treatment
- Injection or infusion, Surgery or procedure
- How many people
- 15 participants
- Where
- 1 siteNetherlands
- Study dates
- Feb 2009to Dec 2012
- Phase
- Phase 1/2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Subject is willing to participate in the study and has signed the informed consent.
- Recipients of a first kidney graft from a living HLA-DR mismatched donor (2 HLA-DR mismatches).
- Subjects included in the study must have kidney biopsy proven SCR 4 weeks after transplantation.
- Patients must be on triple immunosuppressive therapy of prednisone, CsA or tacrolimus and MMF according to current protocol.
- Panel Reactive Antibodies (PRA) ≤ 5%.
- Patients must be able to adhere to the study visit schedule and protocol requirements.
- If female and of child-bearing age, subject must be non-pregnant, non-breastfeeding, and use adequate contraception.
- Patients must be able to give informed consent and the consent must be obtained prior to any study procedure.
Who cannot join
- Double organ transplant recipient.
- Acute clinical rejection after transplantation.
- Patients with evidence of active infection or abcesses before MSC infusion.
- Patients suffering from hepatic failure.
- Patients suffering from an active autoimmune disease.
- Patients who have had a previous BM transplant.
Show all 13Show fewer
- A psychiatric, addictive or any disorder that compromises ability to give truly informed consent for participation in this study.
- Use of any investigational drug after transplantation.
- Documented HIV infection, active hepatitis B, hepatitis C or TB according to current transplantation inclusion criteria.
- Subjects who currently have an active opportunistic infection (e.g., herpes zoster [shingles], cytomegalovirus (CMV), Pneumocystis carinii (PCP), aspergillosis, histoplasmosis, or mycobacteria other than TB) after transplantation.
- Malignancy (including lymphoproliferative disease) within the past 2-5 years (except for squamous or basal cell carcinoma of the skin that has been treated with no evidence of recurrence) according to current transplantation inclusion criteria.
- Known recent substance abuse (drug or alcohol).
- Contraindications to undergo a BM biopsy.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Bone Marrow Derived Mesenchymal Stem Cells for the Treatment of Allograft Rejection After Renal Transplantation
The purpose of the study is to test the safety and feasibility of autologous mesenchymal stem cell therapy in HLA-DR mismatched patients with subclinical rejection and or an increase in IF?TA in the renal biopsy 4 weeks or 6 months after renal transplantation.
Read the detailed description
Kidney transplantation has improved survival and quality of life for patients with end-stage organ failure. Despite dramatic improvements in short-term survival, long-term survival of renal allografts has changed little during the past decade. Recently, it has been demonstrated that chronic lesions originate already very early after transplantation and that subclinical rejection (SCR) in protocol biopsies is a risk factor for late graft loss. However the efficacy of high-dose corticosteroids and other therapies for the treatment of SCR have been shown to be inadequate. Thus, despite the availability of a range of available medications there remains a need for therapeutic alternatives because patients may not respond to existing therapeutic choices, they do not show an improvement of the fibrosis reaction or an effect on long term survival, or they may develop immunosuppression induced serious (sometimes fatal) side effects and toxicities.
In recent years it has become evident that bone marrow (BM) derived mesenchymal stem cells have potent immunomodulatory effects. MSCs are pluripotent cells that can differentiate into several mesenchymal tissues, including fibroblasts, osteoblasts, adipocytes and chondrocyte progenitors. MSCs have potent immunosuppressive effects on T and B cells in vitro and in animal models of chronic inflammation. Encouraging results have been obtained in patients with steroid resistant acute and severe Graft versus Host Disease (GvHD). The investigators hypothesize that infusion of MSCs may similarly provide a novel treatment option in the treatment of patients with allograft rejection with less side effects than existing immunosuppressive therapies.This study will evaluate the safety and feasibility of MSC therapy in renal recipients.
In total 15 de novo renal recipients of 2 HLA-DR mismatched living donors, men and women, 18-65 years of age, will be recruited from the renal transplant clinics of the LUMC. Only patients with SCR abd or an increase in IF/TA in the protocol biopsy 4 weeks or 6 months after transplantation will receive MSC infusions. MSCs from patients without SCR in their biopsy will be only used for feasibility and function studies (as described earlier). Subjects will receive two doses of 1 x 10.6 MSCs per kilogram body weight, intravenously, 7 days apart. The investigators will investigate safety of MSC therapy by assessing the rate of (serious) adverse events in the study population using the World Health Organization (WHO) criteria. Feasibility will be obtained by determining the number of expanded MSCs in relation to the amount of BM collected, number of passages required and time to reach study target doses.
- Conditions
- Organ Transplantation
- Being tested
- Mesenchymal stem cell infusion
- Keywords
- Mesenchymal stem cells, Allograft rejection, Subclinical rejection
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mesenchymal stem cell infusionProcedure or surgery
Also called Bone marrow derived mesenchymal stem cells.
MSC infusion: two doses of 1-2x106 MSCs per kilogram body weight, intravenously, 7 days apart.
What is being measured
The primary outcome is the main question the study is designed to answer.
Primary 1 Safety: rate of (serious) adverse events in the study population 2 Feasibility: determination of the number of expanded MSCs in relation to the amount of BM collected, number of passages required and time to reach study target doses
Measured: 2 years
Secondary outcomes (1)
Secondary endpoints: 1 Presence of late acute rejection (in the 6 month biopsy compared with the 4 week biopsy). 2 Sirius red staining for renal cortical matrix accumulation. 3 Immunologic response before and after MSC infusion.
Measured: 2 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Aug 2008 (estimated)
- Study startFeb 2009
- Primary completionMar 2012
- Study completionDec 2012
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Organ TransplantationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1/2
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 15 participants (actual)
Sponsor and investigators
- Lead sponsor
- Leiden University Medical Center
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, M.E. J. Reinders, Leiden University Medical Center
- Investigators
- Marlies Reinders, MD, PhD, Principal investigator, LUMC
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00734396
- Sponsor's protocol ID
- P08.119
- Other IDs
- NL21298.000.08
- Acronym
- Measure
- Status last verified
- Jan 2013
- First submitted
- 13 Aug 2008
- Last updated
- 7 Jan 2013
- Results posted
- No
- Data monitoring committee
- No
Publications
Reinders ME, de Fijter JW, Roelofs H, Bajema IM, de Vries DK, Schaapherder AF, Claas FH, van Miert PP, Roelen DL, van Kooten C, Fibbe WE, Rabelink TJ. Autologous bone marrow-derived mesenchymal stromal cells for the treatment of allograft rejection after renal transplantation: results of a phase I study. Stem Cells Transl Med. 2013 Feb;2(2):107-11. doi: 10.5966/sctm.2012-0114. Epub 2013 Jan 24.
PubMed 23349326
Study at a glance
From the registry record, last updated by the sponsor on 7 Jan 2013. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Bone Marrow Derived Mesenchymal Stem Cells for the Treatment of Allograft Rejection After Renal Transplantation
- ClinicalTrials.gov ID
- NCT00734396
- Acronym / sponsor ID
- Measure / P08.119
- Conditions
- Organ Transplantation
- Keywords
- Mesenchymal stem cells, Allograft rejection, Subclinical rejection
- Phase
- Phase 1/2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 15 participants (actual)
- Lead sponsor
- Leiden University Medical CenterUniversity, hospital or other
- Study start
- Feb 2009
- Primary completion
- Mar 2012 (actual)
- Study completion
- Dec 2012 (actual)
- First posted
- 14 Aug 2008 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of the study is to test the safety and feasibility of autologous mesenchymal stem cell therapy in HLA-DR mismatched patients with subclinical rejection and or an increase in IF?TA in the renal biopsy 4 weeks or 6 months after renal transplantation.
Detailed description
Kidney transplantation has improved survival and quality of life for patients with end-stage organ failure. Despite dramatic improvements in short-term survival, long-term survival of renal allografts has changed little during the past decade. Recently, it has been demonstrated that chronic lesions originate already very early after transplantation and that subclinical rejection (SCR) in protocol biopsies is a risk factor for late graft loss. However the efficacy of high-dose corticosteroids and other therapies for the treatment of SCR have been shown to be inadequate. Thus, despite the availability of a range of available medications there remains a need for therapeutic alternatives because patients may not respond to existing therapeutic choices, they do not show an improvement of the fibrosis reaction or an effect on long term survival, or they may develop immunosuppression induced serious (sometimes fatal) side effects and toxicities.
In recent years it has become evident that bone marrow (BM) derived mesenchymal stem cells have potent immunomodulatory effects. MSCs are pluripotent cells that can differentiate into several mesenchymal tissues, including fibroblasts, osteoblasts, adipocytes and chondrocyte progenitors. MSCs have potent immunosuppressive effects on T and B cells in vitro and in animal models of chronic inflammation. Encouraging results have been obtained in patients with steroid resistant acute and severe Graft versus Host Disease (GvHD). The investigators hypothesize that infusion of MSCs may similarly provide a novel treatment option in the treatment of patients with allograft rejection with less side effects than existing immunosuppressive therapies.This study will evaluate the safety and feasibility of MSC therapy in renal recipients.
In total 15 de novo renal recipients of 2 HLA-DR mismatched living donors, men and women, 18-65 years of age, will be recruited from the renal transplant clinics of the LUMC. Only patients with SCR abd or an increase in IF/TA in the protocol biopsy 4 weeks or 6 months after transplantation will receive MSC infusions. MSCs from patients without SCR in their biopsy will be only used for feasibility and function studies (as described earlier). Subjects will receive two doses of 1 x 10.6 MSCs per kilogram body weight, intravenously, 7 days apart. The investigators will investigate safety of MSC therapy by assessing the rate of (serious) adverse events in the study population using the World Health Organization (WHO) criteria. Feasibility will be obtained by determining the number of expanded MSCs in relation to the amount of BM collected, number of passages required and time to reach study target doses.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Single group
- Masking
- None (open label)
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Subject is willing to participate in the study and has signed the informed consent.
- Recipients of a first kidney graft from a living HLA-DR mismatched donor (2 HLA-DR mismatches).
- Subjects included in the study must have kidney biopsy proven SCR 4 weeks after transplantation.
- Patients must be on triple immunosuppressive therapy of prednisone, CsA or tacrolimus and MMF according to current protocol.
- Panel Reactive Antibodies (PRA) ≤ 5%.
Key exclusion criteria (13 listed)
- Double organ transplant recipient.
- Acute clinical rejection after transplantation.
- Patients with evidence of active infection or abcesses before MSC infusion.
- Patients suffering from hepatic failure.
- Patients suffering from an active autoimmune disease.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mesenchymal stem cell infusionAlso: Bone marrow derived mesenchymal stem cells.MSC infusion: two doses of 1-2x106 MSCs per kilogram body weight, intravenously, 7 days apart. | Procedure or surgery | – |
Primary outcome
Primary 1 Safety: rate of (serious) adverse events in the study population 2 Feasibility: determination of the number of expanded MSCs in relation to the amount of BM collected, number of passages required and time to reach study target doses
Time frame: 2 years
1 secondary outcome
Secondary endpoints: 1 Presence of late acute rejection (in the 6 month biopsy compared with the 4 week biopsy). 2 Sirius red staining for renal cortical matrix accumulation. 3 Immunologic response before and after MSC infusion.
Time frame: 2 years
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Jan 2013.
- Derived from this study: PubMed 23349326Reinders ME, de Fijter JW, Roelofs H, Bajema IM, de Vries DK, Schaapherder AF, Claas FH, van Miert PP, Roelen DL, van Kooten C, Fibbe WE, Rabelink TJ. Autologous bone marrow-derived mesenchymal stromal cells for the treatment of allograft rejection after renal transplantation: results of a phase I study. Stem Cells Transl Med. 2013 Feb;2(2):107-11. doi: 10.5966/sctm.2012-0114. Epub 2013 Jan 24.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Marlies Reinders, MD, PhD principal investigator
LUMC
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1/2 study testing Mesenchymal stem cell infusion in people with Organ Transplantation, run by Leiden University Medical Center at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Jan 2013. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this combined phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Primary 1 Safety: rate of (serious) adverse events in the study population 2 Feasibility: determination of the number of expanded MSCs in relation to the amount of BM collected, number of passages required and time to reach study target doses (time frame: 2 years). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00734396, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jan 2013.