The objective of this study is to evaluate the safety of intrathecal administration of Wharton's Jelly Mesenchymal Stem Cells (WJMSC) and the impact on the immune system of patients with Amyotrophic Lateral Sclerosis.
Clinical Phase: I/II Population: Patients with Amyotrophic Lateral Sclerosis. Project Design: One arm, non-blinded, open label study Planned Sample Size: 20 patients Investigational Medicinal Product: active IMP - mesenchymal stem cells isolated from Wharton's jelly Screening: Three visits on site to check the eligibility criteria (around 90, 60 and 30 days before first IMP administration) Treatment (IMP administration): Each patient will receive IMP three times: on baseline (day 0), 30 and 60 days after baseline (+/- 7 days). Administration route: intrathecal Follow up: Duration: 18 months after first IMP administration Four on-site visits (3, 6, 9, 12 months after first IMP administration) and seven phone visits (4, 5, 7, 8, 10, 11 and 18 months after first IMP administration)
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Intrathecal administration of mesenchymal stem cells
JST sp. z o.o.
Częstochowa, Poland
The number of (S)AESI [(Serious) Adverse Event of Special Interest]
(S)AESI are defined as: 1. Meningitis and encephalitis. 2. Toxic encephalopathy. 3. High fever \>39⁰C. 4. Epileptic seizures that are not connected to conditions above (meningitis, encephalitis, toxic encephalopathy, high fever).
Time frame: 3 month FU (follow-up)
Disease progression
Disease progression assessed in ALSFRS-R scale (Revised Amyotrophic Lateral Sclerosis Functional Rating Scale). Higher scores mean a better outcome. Minimum: 0 points Maximum: 48 points
Time frame: screening, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 18 month FU
Pulmonary function decline
Pulmonary function decline assessed in spirometry (forced vital capacity)
Time frame: screening, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 6, 9 and 12 month FU.
Muscle strength decline
Muscle strength decline
Time frame: screening, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 6, 9 and 12 month FU
Upper motor neuron function
Upper motor neuron function assessed in UMNS scale (Upper Motor Neuron Scale). Best outcome 16 points, worst outcomes: 0 points and 48 points Minimum: 0 points Maximum: 48 points
Time frame: screening, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 6, 9 and 12 month FU
Cognitive function
Cognitive function assessed in ECAS (The Edinburgh Cognitive and Behavioural ALS Screen). Higher scores mean a better outcome. Minimum: 0 points Maximum: 136 points
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Time frame: screening and 12 month FU
Quality of life changes
Quality of life changes, assessed by EQ-5D questionnaire - standardized instrument for measuring generic health status. Higher scores mean a better outcome.
Time frame: screening, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 18 month FU
The change of defined cytokines, chemokines, growth factors and pNFH (phosphorylated neurofilament heavy chain) level in CSF (Cerebrospinal fluid)
The change of defined cytokines, chemokines, growth factors and pNFH level assessed in the samples of CSF
Time frame: run-in visit (-60 day), at baseline and at 1, 2 and 6 month FU (12 month FU optional)
The change of defined cytokines, chemokines level in blood
The change of defined cytokines, chemokines level assessed in the samples of blood serum
Time frame: screening visit, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 6, 9 and 12 month FU.
The change of creatinine and p75ECD level in urine
The change of creatinine and p75ECD level
Time frame: screening visit, run-in period (-60 day and -30 day), at baseline and at 1, 2, 3, 6, 9 and 12 month FU.
Muscle function changes
Muscle function changes, assessed based on EMG examination (Electrophysiological examination of the muscle - MUNIX - motor unit number estimation)
Time frame: baseline and at 1, 2, 6 and 12 month FU
The change of the brain visualization
The change of the brain visualization in MRI (T1, T2 and DTI)
Time frame: run-in visit (-60 day), 6 and 12 month FU
SAE (Serious Adverse Event)/AE (Adverse Event) and (S)AESI
The number of SAE/AE and (S)AESI - defined as in Outcome 1
Time frame: 18 month FU
Survival period to disease progression
The number of days from patients randomization to the end of the patients participation in the trial or to the one of the following: * PAV (permanent assisted ventilation) * Tracheostomy * Death
Time frame: 18 month FU
Mortality rate
Percentage of deaths in the entire study population.
Time frame: 18 month FU