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Crohn DiseasePhase 1/2NCT01157650

Treatment of Fistulous Crohn's Disease by Implant of Autologous Mesenchymal Stem Cells Derived From Adipose Tissue

A Phase 1/2 study testing Autologous mesenchymal stem cells in people with Crohn Disease, run by Clinica Universidad de Navarra, Universidad de Navarra at 3 sites in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Primary outcome measure: Evaluation of viability, security and tolerance of the adipose-derived mesenchymal stem cells implant (ASCs) in fistulizing Crohn's disease patients, collecting the reactions and adverse events occurred during the study. Secondary outcome measures: 1. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Crohn Disease
What is being tested?
Autologous mesenchymal stem cells
Could I receive a placebo?
No, everyone receives an active treatment
How many people
15 participants
Where
3 sitesSpain
Study dates
Jun 2010to Sep 2013
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Fistulizing Crohn´s disease patients with 1 or more enterocutaneous fistulas, recto-vaginal fistula or complex perianal fistula. The complex perianal fistula is defined as a fistula presenting one of these conditions:
  • Trans-sphincteric, supra-sphincteric or extra-sphincteric tract, determined with:
  • Clinical criteria: No palpation of the tract and surgical exploration
  • Radiological criteria: Nucleal Magnetic Resonance (NMR)or Echoendoscopy
  • Multiple fistulas
  • "Horseshoe" fistula
Show all 15Show fewer
  • Any fistula with fecal incontinence associated
  • Any fistula with a risk of fecal incontinence as a result of:
  • previous anal fistula surgery or other perianal pathology (hemorrhoids, fissures), that involves lesions or muscular complications.
  • Obstetric or iatrogenic sphincter lesions
  • Patients with Crohn Disease (CD) at screening and been diagnosed within 12 months before acceptance of clinical, endoscopical, anatomopathological and/or radiological criteria and have a non-active CD.(Crohn´s Disease Activity Index (CDAI)≤ 200)
  • > 18 Years and both genders eligible.
  • Negative pregnancy test In female fertile subjects
  • Patient must voluntary sign the informed consent before performance of any study-related procedure not part of normal medical care.
  • Patient is, in the investigator's opinion, willing and able to comply with the protocol requirements

Who cannot join

  • Patients with a highly active CD, i.e., if they meet any of the following criteria:
  • Presence of severe proctitis (prominent friability, spontaneous bleeding, multiple erosions, deep ulcers) or dominant active luminal disease that requires immediate treatment, revealed by rectosigmoidoscopy
  • CDAI ≥201
  • Presence of abscess or other collections not drained (revealed by basal radiologic study).
  • Presence of setons drainage, unless they are removed before treatment beginning.
  • Rectal and/ or anal stenosis revealed with rectoscopy or EBA.
Show all 20Show fewer
  • Patients needs surgery in the perianal region for other reasons than fistulas at inclusion or within 26 weeks after treatment administration.
  • Patients who have received infliximab or any other anti-TNF agent within 8 weeks before the cell treatment administration.
  • Patients who have received tacrolimus or cyclosporine within 4 weeks before cell treatment.
  • Patients with a history of alcohol or other addictive substances abuse within 6 months before inclusion.
  • Severe uncontrolled diseases (chronic renal failure, cardio, pulmonary,…).
  • Any type of medical or psychiatric disease which are considered as exclusion criteria, in the investigator's opinion.
  • Patients with diagnosis of malignant neoplasia, except basal cell or epidermoid carcinoma of the skin or previous history of malignant tumours, except those that have no evidence of relapse for at least 5 years.
  • Subjects with congenital or acquired immunodeficiency.
  • Positive serology for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV).
  • Patient had major surgery or serious traumatism within 6 weeks before enrolment.
  • Pregnant or breast-feeding women.
  • Physical or psychical impossibility of following the protocol requirements
  • Patients who are receiving or received other investigational drugs within 30 days prior to basal visit.
  • Impossibility of doing an radiological exploration (reaction to contrast material, pacemakers, claustrophobia,…)

Trial locations and contacts

3 sites in 1 country.

Spain3 sites
  • Clínica Universitaria de Navarra

    Pamplona, Pamplona, 31008

  • Hospital Provincial de Navarra

    Pamplona, Pamplona, 31008

  • Hospital Virgen del Camino

    Pamplona, Pamplona, 31008

Other trials in Spain

About this study

Primary outcome measure:

Evaluation of viability, security and tolerance of the adipose-derived mesenchymal stem cells implant (ASCs) in fistulizing Crohn's disease patients, collecting the reactions and adverse events occurred during the study.

Read more

Secondary outcome measures:

  1. Evaluating the Adipose-derived mesenchymal stem cells therapeutic effect, in particular:
  • Fistulas healing efficiency
  • Changes in quality of life in patients treated
  • Changes of systemic Crohn's disease after implant
  • Relapse rate monitored among patients who achieved Adipose-derived mesenchymal Stem Cells treatment success.
  1. Achieving the biological characterization of the cell product used and its correlation with the therapeutic effect measured with:
  • Phenotype study
  • Suppressor capacity study.
  • Citoquines production analysis
Read the detailed description

The aim of this study is to evaluate the role of Autologous Mesechymal Stem Cells derived from adipose tissue in the treatment of fistulous Crohn disease.

15 Crohn's disease patients with one or more enterocutaneous, recto-vaginal or complex perianal fistula, will be included.

The trial is divided in three phases:

  1. - Selection: Patients evaluation for study eligibility will take place within two weeks after Informed Consent signature.

Fistulous disease will be evaluated by MRI for perianal and rectovaginal fistulas, and by CT scan in the case of enterocutaneous fistula.

Previous laboratory test and radiological studies are valid for evaluation if they were obtained within two and six months, respectively, prior to this evaluation, and in the absence of clinical changes.

II.- Treatment phase includes:

  1. Liposuction procedure to obtain adipose tissue.
  2. Processing and production of Autologous Mesenchymal Stem Cells from adipose tissue (ASCs)
  3. ASCs implant

III.- Follow up: Study visits post-implant will take place at the 1st week (+/- 3 days), 4th week (+/- 3 days), 8th week (+/- 7 days), 12nd week (+/- 7 days), 24th week (+/- 7 days), and 1 year (+/- 7 days) after implant.

Conditions
Crohn Disease
Being tested
Autologous mesenchymal stem cells
Keywords
Fistulizing Crohn's disease, stem cells implant
Medical subject headings
Crohn Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Autologous mesenchymal stem cellsOther

    Also called Implant of ASCs.

    The trial is divided in three phases:

    1. - Selection: Patients evaluation for study eligibility will take place within two weeks after Informed Consent signature.

    II.- Treatment phase includes:

    1. Liposuction procedure to obtain adipose tissue.
    2. Processing and production of Autologous Mesenchymal Stem Cells from adipose tissue (ASCs)
    3. ASCs implant

    III.- Follow up: Study visits post-implant will take place at the 1st week (+/- 3 days), 4th week (+/- 3 days), 8th week (+/- 7 days), 12nd week (+/- 7 days), 24th week (+/- 7 days), and 1 year (+/- 7 days) after implant.

Study groups in NCT01157650
Study groupRoleWhat they receive
Autologous mesenchymal stem cellsExperimentalFistulizing Crohn's disease
Receives: Other: Autologous mesenchymal stem cells

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Security and tolerance

    Evaluation of viability, security and tolerance of the adipose-derived mesenchymal stem cells implant (ASCs) in fistulizing Chron's disease patients, collecting the reactions and adverse events occurred during the study

    Measured: 3 years

Secondary outcomes (1)
  1. therapeutic effect

    1. Evaluting the ASCs therapeutic effect, in particular:
    • Fistulas healing efficiency
    • Changes in quality of life in patients treated
    • Changes of systemic Crohn's disease after implant
    • Relapse rate monitored among patients who achieved ASCs treatment success.
    1. Achieving the biological characterization of the cell product used and its correlation with the therapeutic effect measured with:
    • Phenotype study
    • Suppressor capacity study.
    • Citoquines production analysis

    Measured: 3 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jul 2010 (estimated)
  2. Study startJun 2010
  3. Primary completionSep 2013
  4. Study completionSep 2013

Resources

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
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
15 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01157650
Sponsor's protocol ID
CSM/CROH
Other IDs
2009-009880-71, 2009
Status last verified
Nov 2016
First submitted
5 Jul 2010
Last updated
8 Nov 2016
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Nivatvongs S, Gordon PH. Crohn's Disease. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon rectum and anus Third ed. New York: Informa Healthcare; 2007. p. 819-908.

  • Brullet E, Bonfill X, Urrutia G, Ruiz Ochoa V, Cueto M, Clofent J, Martinez Salmeron JF, Riera J, Obrador A. [Epidemiological study on the incidence of inflammatory bowel disease in 4 Spanish areas. Spanish Group on the Epidemiological Study of Inflammatory Bowel Disease]. Med Clin (Barc). 1998 May 16;110(17):651-6. Spanish.

    PubMed 9656209
  • Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology. 2002 Apr;122(4):875-80. doi: 10.1053/gast.2002.32362.

    PubMed 11910338
  • Arin Letamendia A, Borda Celaya F, Burusco Paternain MJ, Prieto Martinez C, Martinez Echeverria A, Elizalde Apestegui I, Laiglesia Izquierdo M, Macias Mendizabal E, Tamburri Moso P, Sanchez Valverde F. [High incidence rates of inflammatory bowel disease in Navarra (Spain). Results of a prospective, population-based study]. Gastroenterol Hepatol. 2008 Mar;31(3):111-6. doi: 10.1157/13116497. Spanish.

    PubMed 18341841
  • Lapidus A, Bernell O, Hellers G, Lofberg R. Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients. Gastroenterology. 1998 Jun;114(6):1151-60. doi: 10.1016/s0016-5085(98)70420-2.

    PubMed 9609751
  • Parsi MA, Lashner BA, Achkar JP, Connor JT, Brzezinski A. Type of fistula determines response to infliximab in patients with fistulous Crohn's disease. Am J Gastroenterol. 2004 Mar;99(3):445-9. doi: 10.1111/j.1572-0241.2004.04083.x.

    PubMed 15056083
  • Michelassi F, Stella M, Balestracci T, Giuliante F, Marogna P, Block GE. Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease. Ann Surg. 1993 Nov;218(5):660-6. doi: 10.1097/00000658-199321850-00012.

    PubMed 8239781
  • Gardiner KR, Dasari BV. Operative management of small bowel Crohn's disease. Surg Clin North Am. 2007 Jun;87(3):587-610. doi: 10.1016/j.suc.2007.03.011.

    PubMed 17560414
  • Hyder SA, Travis SP, Jewell DP, McC Mortensen NJ, George BD. Fistulating anal Crohn's disease: results of combined surgical and infliximab treatment. Dis Colon Rectum. 2006 Dec;49(12):1837-41. doi: 10.1007/s10350-006-0656-5.

    PubMed 17041753
  • Gelbmann CM, Rogler G, Gross V, Gierend M, Bregenzer N, Andus T, Scholmerich J. Prior bowel resections, perianal disease, and a high initial Crohn's disease activity index are associated with corticosteroid resistance in active Crohn's disease. Am J Gastroenterol. 2002 Jun;97(6):1438-45. doi: 10.1111/j.1572-0241.2002.05685.x.

    PubMed 12094862
  • Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-mercaptopurine in Crohn disease. A meta-analysis. Ann Intern Med. 1995 Jul 15;123(2):132-42. doi: 10.7326/0003-4819-123-2-199507150-00009.

    PubMed 7778826
  • Lecomte T, Contou JF, Beaugerie L, Carbonnel F, Cattan S, Gendre JP, Cosnes J. Predictive factors of response of perianal Crohn's disease to azathioprine or 6-mercaptopurine. Dis Colon Rectum. 2003 Nov;46(11):1469-75. doi: 10.1007/s10350-004-6795-7.

    PubMed 14605564
  • Sandborn WJ, Present DH, Isaacs KL, Wolf DC, Greenberg E, Hanauer SB, Feagan BG, Mayer L, Johnson T, Galanko J, Martin C, Sandler RS. Tacrolimus for the treatment of fistulas in patients with Crohn's disease: a randomized, placebo-controlled trial. Gastroenterology. 2003 Aug;125(2):380-8. doi: 10.1016/s0016-5085(03)00877-1.

    PubMed 12891539
  • Present DH, Lichtiger S. Efficacy of cyclosporine in treatment of fistula of Crohn's disease. Dig Dis Sci. 1994 Feb;39(2):374-80. doi: 10.1007/BF02090211.

    PubMed 8313821
  • Hanauer SB, Smith MB. Rapid closure of Crohn's disease fistulas with continuous intravenous cyclosporin A. Am J Gastroenterol. 1993 May;88(5):646-9.

    PubMed 8480725

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Autologous mesenchymal stem cells in people with Crohn Disease, run by Clinica Universidad de Navarra, Universidad de Navarra at 3 sites in Spain.

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 15 inclusion and 20 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 8 Nov 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Spain. 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?

Security and tolerance (time frame: 3 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 NCT01157650, which also lists 21 linked publications.

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 8 Nov 2016.

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