The goal of this clinical trial is to learn if CG-BM1 Allogeneic Human Bone Marrow Mesenchymal Stem Cell Injection (hereinafter referred to as CG-BM1) can treat acute-on-chronic liver failure (ACLF) patients. Main purposes of this clinical trial are: * To evaluate the safety and tolerability of CG-BM1 for the treatment of adult patients with ACLF. * To observe the preliminary effectiveness of CG-BM1 in treating adult ACLF patients, and to provide a basis for subsequent clinical trial protocol design.
CG-BM1 is a bone marrow mesenchymal stem cell product independently developed by Guangzhou Cellgenes Biotechnology Co., Ltd. The active ingredient of CG-BM1 is human bone marrow mesenchymal stem cell, which is derived from bone marrow donated by healthy adults and prepared into stem cell injection under aseptic conditions. CG-BM1 is the first bone marrow mesenchymal stem cell (BMSC) therapeutic drug for the treatment of ACLF in China. Preclinical data showed that CG-BM1 has the ability to immunomodulate, inhibit the secretion of pro-inflammatory factors by immune cells, and up-regulate the level of anti-inflammatory factors, which can significantly improve the liver function, reduce the inflammatory response, and reverse hepatic fibrosis in ACLF animal models, and the results of the study suggest that it is safe and effective, supporting its further clinical development. The purpose of this study was to evaluate the safety and tolerability of CG-BM1 for the treatment of patients with ACLF, as well as to evaluate the preliminary efficacy of CG-BM1 for the treatment of patients with ACLF. The study was divided into 2 phases, the first with an open-labeled, dose-escalation design; the second with a multicenter, randomized, double-blind, placebo-controlled design. Phase I: Patients was divided into three dose groups using a traditional "3+3" design. 3-6 subjects were enrolled in each dose. Phase II: Multiple-dose, randomized, double-blind, placebo-controlled trial. Based on the results of the phase I trial, two dose groups were selected for phase II. A total of 90 subjects were enrolled and randomized 1:1:1. The experiment group received CG-BM1 + conventional treatment regimen, and the control group received placebo + conventional treatment regimen.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
Administered intravenously. For phase I: single infusion, 1.0×10\^6 cells/kg. For phase II: 1.0×10\^6 cells /kg once a week for a total of 4 times.
Administered intravenously, once a week for a total of 4 doses.
Administered intravenously. For phase I: single infusion, 2.0×10\^6 cells /kg. For phase II: 2.0×10\^6 cells /kg once a week for a total of 4 times.
Third Affliated Hospital of Sun Yat-sen University
Guangzhou, Guangdong, China
RECRUITINGPhase I: Incidence of CG-BM1-related dose-limiting toxicity (DLT) events
Incidence of CG-BM1-related DLT events.
Time frame: From first dose to 180 days after the first dose.
Phase I: Adverse event related to CG-BM1 treatment
Any adverse event related to CG-BM1 treatment that occurred during the study period.
Time frame: From first dose to 180 days after the first dose.
Phase II: Liver transplant-free survival
90-day liver transplant-free survival.
Time frame: 90 day after the first dose.
Phase I: Liver transplant-free survival
28-day, 90-day, and 180-day liver transplant-free survival.
Time frame: 28 day, 90 day, and 180 days after the first dose.
Phase I: Changes of aspartate aminotransferase (AST)
Amount of increase or decrease in serum AST.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
Phase I: Changes of alanine aminotransferase (ALT)
Amount of increase or decrease in serum ALT.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
Phase I: Changes of albumin
Amount of increase or decrease in serum albumin.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
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TREATMENT
Masking
QUADRUPLE
Enrollment
90
Administered intravenously. For phase I: single infusion, 4×10\^6 cells /kg.
Phase I: Changes of alkaline phosphatase (ALP)
Amount of increase or decrease in serum ALP.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
Phase I: Changes of γ-glutamyl transpeptidase (GGT)
Amount of increase or decrease in serum GGT.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
Phase I: Changes of total bilirubin (TBil)
Amount of increase or decrease in serum TBil.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
Phase I: Changes of international normalized ratio (INR)
Amount of increase or decrease in INR.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days, 90 days after the first dose.
Phase I: Changes in liver stiffness measurement (LSM) values
Changes in LSM values measured by transient elastography (TE).
Time frame: Pre-treatment, 14 days, 28 days, 60 days, 90 days after the first dose.
Phase I: Changes of 15-minute retention rate obtained by indocyanine green (ICG) retention test
Changes of 15-minute retention rate obtained by indocyanine green (ICG) retention test. Inject indocyanine green (ICG) rapidly into a peripheral vein on one side of the patient at a dose of 0.5mg/kg body weight, and start timing immediately after the injection. After 15 minutes, draw 2ml of blood from the opposite side peripheral vein, separate the serum, and measure the concentration of indocyanine green using a spectrophotometer. Calculate the indocyanine green retention rate at 15 minutes using the following formula: ICG Retention Rate (%) = (C15 mg% ÷ 1 mg%) × 100%.
Time frame: Pre-treatment, 7 days, 14 days, 28 days, 60 days, 90 days after the first dose.
Phase I: Complication rate
Complication rate within 180 days.
Time frame: 180 days after the first dose.
Phase I: Changes in chronic liver failure consortium organ failure score (CLIF-C OFs)
Changes in CLIF-C OFs. Each organ system is scored on a scale to generate the overall CLIF-C OF score, ranging from 0 to 18. The higher the CLIF C OF score, the poorer the prognosis for the patient, which means a higher short-term mortality rate.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 28 days, 60 days, 90 days after the first dose.
Phase I: Changes in Model for end-stage liver disease (MELD) score
MELDScore = 10 \* ((0.957 \* ln(Creatinine)) + (0.378 \* ln(Bilirubin)) + (1.12 \* ln(INR))) + 6.43. An increase in the MELD score indicates worse liver function, poorer prognosis, and a higher urgency for liver transplantation.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 28 days, 60 days, 90 days after the first dose.
Phase I: Anti-human histocompatibility antigen antibody (HLA-Ab) positivity rate
Serum HLA-Ab positivity rate.
Time frame: Pre-treatment, 28 days, 60 days after the first dose.
Phase I: Serum Interleukin-6 (IL-6) levels
Serum IL-6 levels.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days after the first dose.
Phase I: Serum tumor necrosis factor-α (TNF-α) levels
Serum TNF-α levels.
Time frame: Pre-treatment, 3 days, 7 days, 14 days, 21 days, 28 days after the first dose.
Phase II: Adverse event related to CG-BM1 treatment
Any adverse event related to CG-BM1 treatment that occurred during the study period.
Time frame: From first dose to 180 days after the first dose.
Phase II: Liver transplant-free survival
28-day, 180-day liver transplant-free survival.
Time frame: 28 days, 180 days after the first dose.
Phase II: Changes in Model for end-stage liver disease (MELD) score
MELDScore = 10 \* ((0.957 \* ln(Creatinine)) + (0.378 \* ln(Bilirubin)) + (1.12 \* ln(INR))) + 6.43. An increase in the MELD score indicates worse liver function, poorer prognosis, and a higher urgency for liver transplantation.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes in chronic liver failure consortium organ failure score (CLIF-C OFs)
Changes in CLIF-C OFs. Each organ system is scored on a scale to generate the overall CLIF-C OF score, ranging from 0 to 18. The higher the CLIF-C OF score, the poorer the prognosis for the patient, which means a higher short-term mortality rate.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Complication rate
Complication rate within 180 days. Including: cerebral edema, hepatic encephalopathy, infection, hyponatremia, refractory ascites, acute kidney injury, hepatorenal syndrome, hemorrhage, hepatopulmonary syndrome.
Time frame: 180 days after the first dose.
Phase II: Changes of aspartate aminotransferase (AST)
Amount of increase or decrease in serum AST.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of alanine aminotransferase (ALT)
Amount of increase or decrease in serum ALT.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of albumin
Amount of increase or decrease in serum albumin.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of alkaline phosphatase (ALP)
Amount of increase or decrease in serum ALP.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of γ-glutamyl transpeptidase (GGT)
Amount of increase or decrease in serum GGT.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of total bilirubin (TBil)
Amount of increase or decrease in serum TBil.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of international normalized ratio (INR)
Amount of increase or decrease in INR.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes in liver stiffness measurement (LSM) values
Changes in LSM values measured by transient elastography (TE).
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Changes of 15-minute retention rate obtained by indocyanine green (ICG) retention test
Changes of 15-minute retention rate obtained by indocyanine green (ICG) retention test. Inject indocyanine green (ICG) rapidly into a peripheral vein on one side of the patient at a dose of 0.5mg/kg body weight, and start timing immediately after the injection. After 15 minutes, draw 2ml of blood from the opposite side peripheral vein, separate the serum, and measure the concentration of indocyanine green using a spectrophotometer. Calculate the indocyanine green retention rate at 15 minutes using the following formula: ICG Retention Rate (%) = (C15 mg% ÷ 1 mg%) × 100%.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Anti-human histocompatibility antigen antibody (HLA-Ab) positivity rate
Serum HLA-Ab positivity rate.
Time frame: Pre-treatment, 28 days, 90 days after the first dose.
Phase II: Serum Interleukin-6 (IL-6) levels
Serum IL-6 levels.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Serum tumor necrosis factor-α (TNF-α) levels
Serum TNF-α levels.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.
Phase II: Serum hepatocyte growth factor (HGF) levels
Serum HGF levels.
Time frame: Pre-treatment, 28 days, 60 days, 90 days, 180 days after the first dose.