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Liver CirrhosisPhase 1/2NCT03626090

Mesenchymal Stem Cell Therapy for Liver Cirrhosis

A Phase 1/2 study testing Autologous BM MSC in people with Liver Cirrhosis, run by Stem Med Pte. Ltd. at 3 sites in Singapore.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

MSCs have been studied for the treatment of liver diseases as well as non-liver diseases. MSCs have been successful in treating conditions like acute steroid-resistant GVHD in hematopoietic stem cell transplanted patients and also have shown to improve the MELD score in end-stage liver disease. Read more about this study

Who is it for?
Ages 21 to 69 years
Conditions the study is for
Liver Cirrhosis
What is being tested?
Autologous BM MSC
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
3 sitesSingapore
Study dates
18 Aug 2018to 22 Oct 2021
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 21 to 69 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects must meet all the inclusive criteria to participate in the study:
  • with definite liver cirrhosis, irrespective of aetiology
  • must have Child's B or C stage
  • must have signed an informed consent form

Who cannot join

  • Subjects with any of the following criteria are regarded as an exclusion from the study and will not be permitted to participate:
  • age ≤21 years and >70 years old
  • with life expectancy of < 6 months
  • cancers and bone marrow malignancies
  • patients with an active infection or multiple infections
  • patients with uncontrolled hypertension and diabetes
Show all 9Show fewer
  • immunosuppressed patients (IST must have stopped at least 4 weeks prior to trial enrolment)
  • patients who are HIV positive
  • patients who are pregnant or lactating

Trial locations and contacts

3 sites in 1 country.

Clinical Trial Department contact

63699191

clinicaltrials@stem-med.sg

Singapore3 sites, 3 recruiting
  • Asian American Liver Centre - Gleneagles Hospital (Annexe Block)

    Singapore, 258500

    Clinical Trial Department, 63699191, clinicaltrials@stem-med.sg

    Lee Kang Hoe

    Recruiting
  • Parkway Cancer Centre - Gleneagles Hospital

    Singapore, 258500

    Clinical Trial Department, 63699191, clinicaltrials@stem-med.sg

    Teo Cheng Peng

    Recruiting
  • Desmond Wai Liver & Gastrointestinal Disease Centre - Mount Elizabeth Novena Specialist Centre

    Singapore, 329563

    Clinical Trial Department, 63699191, clinicaltrials@stem-med.sg

    Wai Chun Tao, Desmond

    Recruiting

Other trials in Singapore

About this study

Official title: Mesenchymal Stem Cell Therapy for Liver Cirrhosis: A Phase I/II Study

MSCs have been studied for the treatment of liver diseases as well as non-liver diseases. MSCs have been successful in treating conditions like acute steroid-resistant GVHD in hematopoietic stem cell transplanted patients and also have shown to improve the MELD score in end-stage liver disease. There were no severe side effects observed in using autologous MSCs as a treatment option. The outcome of the studies done so far have been positive and it is encouraged to study the use of MSCs as cell therapy for treating liver diseases.

The estimated rate of cirrhosis in HBV patients in Singapore is about 1.6% per year, rate of hepatocellular carcinoma is about 0.8% per year overall and 3.0% per year in cirrhotic patients. Knowing that there are not many options currently available for Liver Cirrhosis patients and that they have a poor prognosis with an average life expectancy of < 12 months, this study uses autologous MSCs to treat Liver Cirrhosis patients in Singapore. The objective of the study is to demonstrate that autologous bone marrow is safe to be used in patients with liver cirrhosis as well as demonstrate that bone marrow MSC may improve liver function and prolong patient survival.

Read the detailed description

Liver cirrhosis refers to extreme scarring of the liver, resulting in suboptimal function of the liver. It can result from a variety of causes, ranging from hepatitis B and C infection, excessive alcohol consumption, autoimmune causes, fatty liver and others. Irrespective of the cause, once the liver becomes cirrhotic, it is a downhill course.

Liver cirrhosis is irreversible and most patients will progressively worsen over time. Once liver cirrhosis has reached the stage of decompensation, that is, development of jaundice, ascites, variceal bleeding, hepatic encephalopathy and coagulopathy the two-year survival drops to about 50%.

The definitive treatment of decompensated cirrhosis is liver transplantation. While a liver transplantation is potentially curative, the high costs, lack of a donor, treatment-related mortality and the immunosuppression complications make this option possible only for a limited number of patients. The vast majority do not have an effective option at all, thus the need to develop alternative therapies. Various types of Stem Cells had been investigated as a regenerative therapy for liver cirrhosis. These stem cells include bone marrow mesenchymal stem cells (MSC), bone marrow mononuclear cells (MNC) and peripheral CD34 positive cells. Some early studies have shown encouraging results in patients who had autologous bone marrow stem cell transplantation. There was improved liver function in these patients with cirrhotic livers.

The sponsor is proposing a study to look into the role of MSC therapy for patients with liver cirrhosis in Singapore. This will be a Phase I/II study with the main emphasis on the safety profile first. The trial will be conducted in compliance with the protocol, GCP and local regulatory requirement(s).

Conditions
Liver Cirrhosis
Being tested
Autologous BM MSC
Keywords
Liver, Cirrhosis, Child B, Child C, Advance, Advanced, Singapore, MSC, Mesenchymal, Stem Cell, Cell Therapy, MSC Therapy, Treatment
Medical subject headings
Liver Cirrhosis, Fibrosis

What participants receive

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

  • Autologous BM MSCBiological

    A total of 100-200ml will be harvested from the subject, in either a single or multiple punctures. This will be processed for autologous MSC infusion.

Study groups in NCT03626090
Study groupRoleWhat they receive
Treatment ArmExperimentalA single dose of 0.5 to 1 x 10^6/kg autologous BM MSCs (Total volume: 30 - 50 ml) will be infused via peripheral venous access.
Receives: Biological: Autologous BM MSC

What is being measured

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

  1. Clinical Examination

    To observe for the following:

    • absence of grade IV anaphylactic reactions (in reference to CTCAE 4.03)
    • absence of grade IV febrile reactions or septic/ infective complications (in reference to CTCAE 4.03).

    Measured: Up to 34 weeks

  2. MR Elastography

    To detect liver stiffness

    Measured: Up to 34 weeks

  3. The level of serum alanine aminotransferase (ALT)

    To ensure the absence of deterioration of liver function.

    Measured: Up to 34 weeks

  4. The level of glomerular filtration rate (GFR)

    To ensure the absence of deterioration of renal function.

    Measured: Up to 34 weeks

Secondary outcomes (4)
  1. The level of serum prothrombin time (PT)

    To assess the efficacy of treatment

    Measured: Up to 6 months, post-infusion

  2. The level of serum total bilirubin (TB)

    To assess the efficacy of treatment

    Measured: Up to 6 months, post-infusion

  3. The level of serum albumin (ALB)

    To assess the efficacy of treatment

    Measured: Up to 6 months, post-infusion

  4. MELD Score

    To assess the efficacy of treatment

    Measured: Up to 6 months, post-infusion

Timeline

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

  1. First posted10 Aug 2018
  2. Study start18 Aug 2018
  3. Primary completion22 Oct 2021 (estimated)
  4. Study completion22 Oct 2021 (estimated)

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
Model description
As the primary objective of the study is to assess safety of MSC infusion, a single arm non-blinded study design has been adopted.
Masking
None (open label)
Enrolment
20 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03626090
Sponsor's protocol ID
P-SM-L0001
Status last verified
Mar 2021
First submitted
26 Jul 2018
Last updated
17 Mar 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Poh Z, Goh BB, Chang PE, Tan CK. Rates of cirrhosis and hepatocellular carcinoma in chronic hepatitis B and the role of surveillance: a 10-year follow-up of 673 patients. Eur J Gastroenterol Hepatol. 2015 Jun;27(6):638-43. doi: 10.1097/MEG.0000000000000341.

    PubMed 25831135
  • Lyra AC, Soares MB, da Silva LF, Fortes MF, Silva AG, Mota AC, Oliveira SA, Braga EL, de Carvalho WA, Genser B, dos Santos RR, Lyra LG. Feasibility and safety of autologous bone marrow mononuclear cell transplantation in patients with advanced chronic liver disease. World J Gastroenterol. 2007 Feb 21;13(7):1067-73. doi: 10.3748/wjg.v13.i7.1067.

    PubMed 17373741
  • Terai S, Ishikawa T, Omori K, Aoyama K, Marumoto Y, Urata Y, Yokoyama Y, Uchida K, Yamasaki T, Fujii Y, Okita K, Sakaida I. Improved liver function in patients with liver cirrhosis after autologous bone marrow cell infusion therapy. Stem Cells. 2006 Oct;24(10):2292-8. doi: 10.1634/stemcells.2005-0542. Epub 2006 Jun 15.

    PubMed 16778155
  • Peng L, Xie DY, Lin BL, Liu J, Zhu HP, Xie C, Zheng YB, Gao ZL. Autologous bone marrow mesenchymal stem cell transplantation in liver failure patients caused by hepatitis B: short-term and long-term outcomes. Hepatology. 2011 Sep 2;54(3):820-8. doi: 10.1002/hep.24434. Epub 2011 Jul 14.

    PubMed 21608000
  • Zhao DC, Lei JX, Chen R, Yu WH, Zhang XM, Li SN, Xiang P. Bone marrow-derived mesenchymal stem cells protect against experimental liver fibrosis in rats. World J Gastroenterol. 2005 Jun 14;11(22):3431-40. doi: 10.3748/wjg.v11.i22.3431.

    PubMed 15948250
  • Ortiz LA, Gambelli F, McBride C, Gaupp D, Baddoo M, Kaminski N, Phinney DG. Mesenchymal stem cell engraftment in lung is enhanced in response to bleomycin exposure and ameliorates its fibrotic effects. Proc Natl Acad Sci U S A. 2003 Jul 8;100(14):8407-11. doi: 10.1073/pnas.1432929100. Epub 2003 Jun 18.

    PubMed 12815096
  • Meier RP, Muller YD, Morel P, Gonelle-Gispert C, Buhler LH. Transplantation of mesenchymal stem cells for the treatment of liver diseases, is there enough evidence? Stem Cell Res. 2013 Nov;11(3):1348-64. doi: 10.1016/j.scr.2013.08.011. Epub 2013 Aug 29.

    PubMed 24090934
  • Amorin B, Alegretti AP, Valim V, Pezzi A, Laureano AM, da Silva MA, Wieck A, Silla L. Mesenchymal stem cell therapy and acute graft-versus-host disease: a review. Hum Cell. 2014 Oct;27(4):137-50. doi: 10.1007/s13577-014-0095-x. Epub 2014 Jun 6.

    PubMed 24903975
  • Jacobs SA, Roobrouck VD, Verfaillie CM, Van Gool SW. Immunological characteristics of human mesenchymal stem cells and multipotent adult progenitor cells. Immunol Cell Biol. 2013 Jan;91(1):32-9. doi: 10.1038/icb.2012.64.

    PubMed 23295415
  • Uccelli A, Moretta L, Pistoia V. Mesenchymal stem cells in health and disease. Nat Rev Immunol. 2008 Sep;8(9):726-36. doi: 10.1038/nri2395.

    PubMed 19172693
  • Di Nicola M, Carlo-Stella C, Magni M, Milanesi M, Longoni PD, Matteucci P, Grisanti S, Gianni AM. Human bone marrow stromal cells suppress T-lymphocyte proliferation induced by cellular or nonspecific mitogenic stimuli. Blood. 2002 May 15;99(10):3838-43. doi: 10.1182/blood.v99.10.3838.

    PubMed 11986244
  • Krampera M, Glennie S, Dyson J, Scott D, Laylor R, Simpson E, Dazzi F. Bone marrow mesenchymal stem cells inhibit the response of naive and memory antigen-specific T cells to their cognate peptide. Blood. 2003 May 1;101(9):3722-9. doi: 10.1182/blood-2002-07-2104. Epub 2002 Dec 27.

    PubMed 12506037
  • Meisel R, Zibert A, Laryea M, Gobel U, Daubener W, Dilloo D. Human bone marrow stromal cells inhibit allogeneic T-cell responses by indoleamine 2,3-dioxygenase-mediated tryptophan degradation. Blood. 2004 Jun 15;103(12):4619-21. doi: 10.1182/blood-2003-11-3909. Epub 2004 Mar 4.

    PubMed 15001472
  • Suva D, Passweg J, Arnaudeau S, Hoffmeyer P, Kindler V. In vitro activated human T lymphocytes very efficiently attach to allogenic multipotent mesenchymal stromal cells and transmigrate under them. J Cell Physiol. 2008 Mar;214(3):588-94. doi: 10.1002/jcp.21244.

    PubMed 17786951
  • Kisseleva T, Cong M, Paik Y, Scholten D, Jiang C, Benner C, Iwaisako K, Moore-Morris T, Scott B, Tsukamoto H, Evans SM, Dillmann W, Glass CK, Brenner DA. Myofibroblasts revert to an inactive phenotype during regression of liver fibrosis. Proc Natl Acad Sci U S A. 2012 Jun 12;109(24):9448-53. doi: 10.1073/pnas.1201840109. Epub 2012 May 7.

    PubMed 22566629

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Autologous BM MSC in people with Liver Cirrhosis, run by Stem Med Pte. Ltd. at 3 sites in Singapore.

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 4 inclusion and 9 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: status not confirmed, as of the sponsor's last update on 17 Mar 2021. 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 Singapore. 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?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Clinical Trial Department (63699191, clinicaltrials@stem-med.sg), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical Examination (time frame: Up to 34 weeks). The study lists 4 primary outcomes in all. 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 NCT03626090, which also lists 56 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 17 Mar 2021.

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