The first primary objective is to assess the effect of three intra-arterial administrations of autologous mesoangioblasts (MABs) with respect to improving muscle strength and reduce fatigue of the treated biceps brachii (BB) compared to the untreated BB. The second primary objective is safety of three intra-arterial administrations of autologous MABs, which the investigators will assess by monitoring (serious) adverse events ((S)AEs), blood flow in left arm pre- and post-intervention, and neurological vital signs during 8h post-intervention observation in the hospital. Secondary objectives are to assess changes in muscle mass of the treated and untreated BB muscle, and microscopic changes and m.3243A\>G mutation load at tissue level in treated biceps brachii (BB) muscle at baseline and after treatment. Up to 20 adult m.3243A\>G patients will undergo a \~30mg m. biceps brachii muscle biopsy at visit 1. The first six eligible patients will enroll the clinical study based on their m.3243A\>G mutation load in skeletal muscle (50-90%) and mesoangioblasts (\<10%), and on a decreased BB muscle strength and increased fatigue. These 6 selected patients will visit the Maastricht University Medical Center for 8 additional times. From each patient, during visit 2 till 9: * BB muscle biopsies of the left arm will be collected (1x \~130 mg at visit 2 and 1x \~30mg at visit 9) * MRI of the BB muscles in both arms will be performed (visit 2 and 9). * Autologous MABs will be injected into the left arm via axillary artery delivery. Angiography will be performed before and after infusion to assess vascular obstructions, and the participant will be monitored in the hospital for 8 hours (visit 4,6,8). * Tc99m macroaggregated albumin (MAA) is infused to quantify blood flow to the BB muscle (visit 4). * A bout of maximal eccentric exercise of BB muscles on both sides will be executed at visit 3, 5 and 7. * BB muscle strength will be assessed using a Biodex dynamometer (visit 3-9) * venous blood samples will be taken for assessing muscle damage and inflammation markers (visit 3-9), kidney functioning, coagulation and viral screening (visit 1 and 2).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
three times intra-arterial administration of autologous mesoangioblasts in biceps brachii of the left arm at 4-6 week interval
Maastricht University Medical Center
Maastricht, Netherlands
RECRUITINGAssess blood flow in left arm following i.a. arterial delivery of autologous MABs
Assess blood flow in left arm using digital subtraction angiography (DSA) before and directly after MABs administration in week 1, 5 and 10.
Time frame: before and directly after each administration in week 1,5 and 10
Assess (serious) adverse events following 3 i.a. deliveries of autologous MABs
Assessment of (serious) adverse events
Time frame: 15 weeks
Assess temperature following 3 i.a. deliveries of autologous MABs
Temperature will be checked 0,1,2,3,4,6 and 8 hours after administration in week 1,5 and 10.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess oxygen saturation following 3 i.a. deliveries of autologous MABs
Oxygen saturation will be checked 0,1,2,3,4,6 and 8 hours after administration in week 1,5 and 10.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Muscle strength arm following 3 i.a. deliveries of autologous MABs
Using Medical Research Council (MRC) scale for muscle strength, muscle strength of left arm will be assessed 0,1,2,3,4,6 and 8 hours after administration in week 1, 5 and 10. MRC scale ranges from 0 (no visible contraction) to 5 (normal)).
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess breathing frequency following 3 i.a. deliveries of autologous MABs
Breathing frequency will be checked 0,1,2,3,4,6 and 8 hours after administration in week 1, 5 and 10.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess vital signs following 3 i.a. deliveries of autologous MABs
Heart rate will be checked 0,1,2,3,4,6 and 8 hours after administration in week 1, 5 and 10.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess systolic and diastolic blood pressure following 3 i.a. deliveries of autologous MABs
Systolic and Diastolic blood pressure will be checked 0,1,2,3,4,6 and 8 hours after administration in week 1, 5 and 10.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess Glasgow Coma scale (GCS) score following 3 i.a. deliveries of autologous MABs
Glasgow Coma Scale (GCS) score will be determined 0,1,2,3,4,6 and 8 hours after administration in week 1, 5 and 10. GCS score ranges from 3 to 15, 3 being the worst and 15 being the best score.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess if pupil size is symmetrical in both eyes following 3 i.a. deliveries of autologous MABs
Pupil size of both eyes will be assessed 0,1,2,3,4,6 and 8 hours after administration in week 1, 5 and 10. If pupil size is not equal, this can indicate disease or trauma.
Time frame: 0, 1,2,3,4,6 and 8 hours after each administration.
Assess pupil reaction following 3 i.a. deliveries of autologous MABs
To assess brain functioning, reaction of pupils to light will be determined 0,1,2,3,4,6 and 8 hours after administration. Upon light, both pupils should become smaller in week 1, 5 and 10. No reaction or only reaction in one eye can indicate nerve damage.
Time frame: 0,1,2,3,4,6 and 8 hours after each administration.
Assess changes in muscle strength of biceps brachii muscle in both arms at baseline and 4-6 weeks after third i.a. delivery of autologous MABs in left arm, which is 12-16 weeks after baseline measurements.
Determine maximum muscle force generating capacity (peak torque N/m) of the biceps brachii muscle in both arms using Biodex dynamometer measurements. Measurements will be performed in left (intervention) and right (no intervention) biceps brachii muscle using Biodex dynamometer measurements at baseline and 5 weeks after the third autologous MABs administration, which is 15 weeks after baseline measurements.
Time frame: baseline and 15 weeks after 1st administration
Assess changes in muscle fatigue of biceps brachii muscle in both arms at baseline and 4-6 weeks after third i.a. delivery of autologous MABs in left arm, which is 12-16 weeks after baseline measurements.
Asses changes in muscle fatigue by measuring percentage decrease in maximum muscle force generating capacity (peak torque N/m) between first and sixth repetition. Measurements will be performed in left (intervention) and right (no intervention) biceps brachii muscle using Biodex dynamometer measurements at baseline and 5 weeks after the third autologous MABs administration, which is 15 weeks after baseline measurements.
Time frame: baseline and 15 weeks after 1st administration
Assess changes in muscle volume biceps brachii muscles of both arms following 3 i.a. deliveries of autologous MABs in left arm.
MRI T3 analysis to assess changes in muscle volume in both arms at baseline and 5 weeks after the third autologous MABs administration, which is 15 weeks after baseline measurements.
Time frame: baseline and 15 weeks after 1st administration
Assess formation of new muscle fibers following 3 i.a. deliveries of autologous MABs
Perform embryonic myosin heavy chain (MHC)+ immunostaining to assess percentage of new / regenerating muscle fibers in muscle biopsies collected at baseline and 5 weeks after the third autologous MABs administration, which is 15 weeks after baseline measurements.
Time frame: baseline and 15 weeks after 1st administration
Mitochondrial mutation load and functioning following 3 i.a. deliveries of autologous MABs
Assess changes in m.3243A\>G mutation load in new/regenerating muscle fibers compared to existing muscle fibers isolated via laser microdissection from muscle biopsies left arm collected at baseline and 5 weeks after the third autologous MABs administration, which is 15 weeks after baseline measurements.
Time frame: baseline and 15 weeks after 1st administration
Mitochondrial functioning following 3 i.a. deliveries of autologous MABs in left arm.
Assess changes in mitochondrial functioning by performing Cytochrome C Oxidase / Succinate Dehydrogenase (COX/SDH) staining in muscle biopsies from left arm collected at baseline and 5 weeks after the third autologous MABs administration, which is 15 weeks after baseline measurements.
Time frame: baseline and 15 weeks after 1st administration
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