The purpose of this trial is to assess the safety and efficacy of Holour in patients suffering from hypospadias treatment failure. Holour is intended for urethral replacement and is made from ex vivo expanded autologous oral mucosal cells including stem cells.
Holour is a prospective, open-label, uncontrolled pilot clinical trial phase i/ii. The aim of this clinical trial is to perform a tissue engineering therapy to assess the safety (at 3 and 12 months) and efficacy (at 12 months) of the autologous treatment. Patients will be screened according to the study inclusion and exclusion criteria and will be candidate for the treatment if all eligibility criteria are met. Up to 8 patients will be treated by means of autologous cultured oral mucosa grafts containing oral mucosa stem cells. Holour is produced by ex vivo expansion of cells obtained from oral mucosa biopsy collected from patient. The biopsy will be processed in a laboratory of a regenerative medicine manufacturing site where the epithelial cells will be isolated, expanded and prepared as final graft to be implanted. Holour administration will be planned according to the procedures and the need of the patient. The entire procedure envisages the following steps: 1. Oral mucosa biopsy to manufacture autologous grafts of Holour. 2. Penile urethroplasty in two stages: * First stage: application of holour on the wound bed prepared according to standard surgery. * Second stage: penis reconstruction according to standard surgical procedure. The surgical procedures may be followed by a post-implantation treatment (if necessary) with corticosteroids and antibiotics. The treatment includes a single administration of Holour; in case of "failure" of the first procedure eligible patients can undergo to a second implantation. Three months after the transplantation, primary endpoint will be evaluated by the investigator. The study completion will be reached when 1 year (secondary endpoint) of follow-up after the last transplant in the last patient will be accomplished. The end of the trial is defined as the last visit of the last patient after the last treatment if any.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
1
The treatment includes a single administration of investigational product through a dedicated surgical procedure of penis wound bed preparation, epithelial surface adaption and product application followed by urethra tubularization and penis reconstruction.
Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
Milan, Italy
Number and percentage of patients experiencing AESI
To demonstrate the safety of Holour in terms of AESI (persistent fever, infections)
Time frame: 3 months after treatment
Number and percentage of patients experiencing ADRs
To demonstrate the safety of Holour in terms of ADRs
Time frame: 3 months after treatment
Number and percentage of patients experiencing SAEs
To demonstrate the safety of Holour in terms of SAEs
Time frame: 3 months after treatment
Number and percentage of patients experiencing Serious ADRs
To demonstrate the safety of Holour in terms of Serious ADRs
Time frame: 3 months after treatment
Number and percentage of patients experiencing AESI
To demonstrate the safety of Holour in terms of AESI (persistent fever, infections)
Time frame: 12 months after treatment
Number and percentage of patients experiencing ADRs
To demonstrate the safety of Holour in terms of AESI ADRs
Time frame: 12 months after treatment
Number and percentage of patients experiencing SAEs
To demonstrate the safety of Holour in terms of SAEs
Time frame: 12 months after treatment
Number and percentage of patients experiencing Serious ADRs
To demonstrate the safety of Holour in terms of Serious ADRs
Time frame: 12 months after treatment
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Number of patients with implantation success
Implantation success is defined on the basis of the degree of clinical (no lesions, no significant retractions) epithelial stability on the transplanted area. The degree of epithelial stability will be evaluated by visual inspection, cistouretrography, uretroscophy and checked for evaluating reepithelialization, erosions, infection, etc. and documented with photos with measures.
Time frame: 12 months after treatment
percentage of patients with implantation success
Implantation success is defined on the basis of the degree of clinical (no lesions, no significant retractions) epithelial stability on the transplanted area. The degree of epithelial stability will be evaluated by visual inspection, cistouretrography, uretroscophy and checked for evaluating reepithelialization, erosions, infection, etc. and documented with photos with measures.
Time frame: 12 months after treatment
Number of patients with the treatment efficacy after Holour implantation and surgical reconstruction
Regeneration of a clinically normal appearing urethra epithelium with absence of detectable erosions/retractions and Clinical functionality (uroflowmetry) after the second step (urethral reconstruction) of transplant.
Time frame: up to 1 year after implantation
Evaluation of the percentage of re-epithelialization
Evaluation of the percentage of re-epithelialization
Time frame: up to 1 year after implantation
Evaluation of the clinical epithelial stability on the transplanted area by visual inspections
Evaluation of the regeneration of a clinically normal appearing epithelium with absence of detectable erosions/retractions
Time frame: up to 1 year after implantation
Evaluation of scar retraction presence
Evaluation of the penile retraction due to presence/absence of scars
Time frame: up to 1 year after implantation
Evaluation of uroflowmetry rate
Evaluation of the change of uroflowmetry compared to the baseline value with change of the curve shape and significant increase of the qmax flow rate;
Time frame: From 3 to 12 months after the treatment
Evaluation of the post-void residual volume through uroflowmetry
Evaluation of the change of the post-void residual compared to the baseline
Time frame: From 3 to 12 months after the treatment
Evaluation of the presence and severity of surgical complications
Presence and severity of surgical complications using the Clavien Dindo scale with the classification into 5 grades (I, II, III, IV and V from no need for clinical intervention to the death of the patient)
Time frame: up to 1 year after implantation
Evaluation of the adeverse events in terms of SAEs, AESI, ADR Serious ADRs,
Evaluation of the adeverse events in terms of SAEs, AESI, ADR Serious ADRs,
Time frame: up to 1 year after implantation