This study evaluates whether intravitreal autologous CD34+ stem cell therapy is safe, feasible and potentially beneficial in eyes with vision loss from central retinal vein occlusion (CRVO). Half of the participants will receive immediate cellular therapy followed by sham therapy 6 months later, while the other half will receive immediate sham therapy followed by cellular therapy 6 months later. Participants will be followed for a total of 1 year.
The goal of this phase I/II prospective, randomized, sham-controlled, double-masked clinical trial is to determine whether intravitreal autologous CD34+ stem cell therapy is safe, feasible and potentially beneficial in eyes with vision loss from central retinal vein occlusion (CRVO). Retinal Vein Occlusion (RVO) is a leading retinal vascular cause of vision loss in the elderly. CD34+ stem cells in human bone marrow are mobilized into the circulation in response to tissue ischemia for tissue revascularization and repair. Since local delivery of CD34+ stem cells benefits ischemic tissue, intravitreal delivery of CD34+ stem cells may benefit vision and retinal ischemia in eyes with RVO. A pilot clinical trial has shown no major safety or feasibility concerns using intravitreal autologous CD34+ bone marrow stem cells. In this proposed expanded phase I/II study, 20 participants (20 eyes) with persistent vision loss from CRVO will be enrolled and followed for 1 year. Participants will be randomized 1:1 to immediate cell therapy/deferred sham therapy or immediate sham therapy/deferred cell therapy. At month 6, the cell treated eye will receive sham treatment and the sham treated eye will get cell therapy. The cellular therapy involves bone marrow aspiration, isolation of CD34+ cells from the aspirate under Good Manufacturing Practice (GMP) conditions, and intravitreal injection of isolated CD34+ cells. The sham therapy involves a sham bone marrow aspiration with penetration of the skin but no penetration of the bone and a sham intravitreal injection without penetrating the eye. The participant, examining ophthalmologist, visual acuity examiner, photographers and OCT, perimetry, and electroretinography (ERG) technicians will remain masked to study treatment assignment for study duration. A comprehensive eye examination with ETDRS best-corrected visual acuity, optical coherence tomography (OCT) and OCT angiography (OCTA), autofluorescence, fundus photography, fluorescein angiography, microperimetry, and electroretinography will be performed at baseline and serially. A subset of participants with good fixation on microperimetry and clear media on exam and commercial-grade OCTA and who give consent will have ultra-high resolution cellular retinal imaging using research-grade OCT and OCTA and adaptive optics-OCT at baseline. Participants with high quality images will have repeat imaging at 1 month after stem cell treatment, with at least 2 of the participants randomized to the deferred cellular therapy arm also having imaging 1 month after sham therapy. Post-release flow cytometry characterization will be performed to determine the composition of the CD34+ enriched final product in terms of hematopoietic versus angiogenic stem cells based on cell surface markers (i.e., CD133(+)/CD45(+)/CD34(+) vs CD31(+)/VEGFR-2(+)/CD45(-)/CD34(+)). The long-term objective is to determine whether intravitreal autologous CD34+ cell therapy can minimize, or reverse vision loss associated with retinal ischemia without compromising safety.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
16
Single intravitreal injection of autologous bone marrow CD34+ stem cells. The number of cells to be injected per eye will range from 800,000 to 10 million, depending on the yield of the bone marrow aspiration and the isolation procedure.
Sham bone marrow aspiration procedure that penetrates the skin, but does not penetrate the bone followed by sham intravitreal injection without penetration of the eye
Department of Ophthalmology & Vision Science, University of California Davis Eye Center
Sacramento, California, United States
Incidence and Severity of Ocular and Systemic Adverse Events
The primary safety outcome will be assessed at month 6. Adverse events (AE) that occur during the first 6 months of the trial will be broken down by whether the AE occurred following the sham or cellular treatment to assess differences in the adverse event experience between the cellular and sham therapies.
Time frame: Months 0 to 6
Feasibility of the Stem Cell Therapy
Number of CD34+ cells isolated from the bone marrow aspirate and number of cells injected into the eye
Time frame: Day 0 and Day 182
Change in Early Treatment Diabetic Retinopathy Study (ETDRS) Visual Acuity Letter Score
Mean change from baseline of visual acuity letter score at Month 6. The measure is calculated by subtracting the baseline visual acuity letter score from the month 6 visual acuity letter score. The participant is refracted for best corrected vision, and then reads single letters from the ETDRS charts using a visual acuity light box at a 4 meter distance (or 1 meter for participants with sufficiently reduced vision) according to a specific algorithm. A letter score is provided that ranges from 0 (unable to read any letters) to 100. A visual acuity letter score of 85 corresponds to a visual acuity of 20/20 as a Snellen equivalent. Higher is better.
Time frame: Months 0 to 6
Change in % Reduced Sensitivity
Mean change from baseline of % reduced sensitivity at Month 6 as measured by microperimetry (decrease is better)
Time frame: Months 0 to 6
Change in Average Threshold
Mean change from baseline of average threshold (dB) at Month 6 as measured by microperimetry (increase is better)
Time frame: Months 0 to 6
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Change in Percent Normal Amplitude for ERG+OP (Oscillatory Potential) A-wave Under Scotopic Conditions
Mean change from baseline of percent of normal amplitude for ERG+OP a-wave under scotopic conditions at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Percent Normal Amplitude for ERG+OP B-wave Under Scotopic Conditions
Mean change from baseline of percent of normal amplitude for ERG+OP b-wave under scotopic conditions at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Percent Normal Latency of ERG+OP A-wave Under Scotopic Conditions
Mean change from baseline of percent normal latency of ERG+OP a-wave under scotopic conditions at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Change in Percent Normal Latency of ERG+OP B-wave Under Scotopic Conditions
Mean change from baseline of percent normal latency of ERG+OP b-wave under scotopic conditions at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Change in Percent Normal Amplitude for A-wave Under Photopic Conditions
Mean change from baseline of percent normal amplitude for a-wave under photopic conditions at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Percent Normal Amplitude for B-wave Under Photopic Conditions
Mean change from baseline of percent normal amplitude for b-wave under photopic conditions at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Percent Normal Latency for A-wave Under Photopic Conditions
Mean change from baseline of percent normal latency for a-wave under photopic conditions at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Change in Percent Normal Latency for B-wave Under Photopic Conditions
Mean change from baseline of percent normal latency for b-wave under photopic conditions at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Change in Percent Normal Flicker Amplitude
Mean change from baseline in percent normal flicker amplitude at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Flicker Latency Trough
Mean change from baseline of latency trough at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Change in Percent Normal Amplitude for A-wave Under Scotopic Conditions
Mean change from baseline of percent normal amplitude for a-wave under scotopic conditions at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Percent Normal Latency of A-wave Under Scotopic Conditions
Mean change from baseline of percent normal latency of a-wave under scotopic conditions at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Change in Percent Normal Amplitude for B-wave Under Scotopic Conditions
Mean change from baseline of percent normal amplitude for b-wave under scotopic conditions at Month 6 as measured by Full-field ERG (increase is better)
Time frame: Months 0 to 6
Change in Percent Normal Latency for B-wave Under Scotopic Conditions
Mean change from baseline of percent normal latency for b-wave under scotopic conditions at Month 6 as measured by Full-field ERG (decrease is better)
Time frame: Months 0 to 6
Foveal Avascular Zone Integrity
Number of study eyes in each of the following categories as it relates to the integrity of the foveal avascular zone: Intact, Questionable, Disrupted (\<900 microns), Disrupted (900-1800 microns), Disrupted (\>1800 microns), and Cannot grade. Measured at Month 6 by fluorescein angiogram
Time frame: 6 months
Change in Area of Non-perfusion Within ETDRS Grid
Mean change from baseline of area of non-perfusion within ETDRS grid at Month 6 as measured by fluorescein angiogram (decrease is better)
Time frame: Months 0 to 6
Change in Area of Non-perfusion Within Networc Grid
Mean change from baseline of area of non-perfusion within Networc grid at Month 6 as measured by fluorescein angiogram (decrease is better)
Time frame: Months 0 to 6