To evaluate the safety and tolerability of IxCell hUC-MSC-P in the treatment of patients with connective tissue disease-related interstitial lung disease. To evaluate the efficacy, pharmacokinetics and immunogenicity of IxCell hUC-MSC-P in the treatment of connective tissue disease-associated interstitial lung disease (CTD-ILD).
Mesenchymal stem cells (MSCs) are a kind of adult stem cells, which express CD73, CD40 and CD105 on the cell surface, but not CD34, CD45 and HLA-DR. They can self-renew in vitro culture environment and have the ability to differentiate into bone, adipose and chondrocytes. Because of its anti-inflammatory, immunomodulatory and natural regenerative functions, it has become a potential therapeutic drug to control lung immune dysfunction and inflammatory response. MSCs can regulate the microenvironment of injured tissues by secreting anti-inflammatory factors and exert immunomodulatory ability through cell interaction. Firstly, MSCs can directly inhibit the proliferation of T cells, thereby reducing the number of T cells in the inflammatory site. Secondly, MSCs can also suppress T cell responses through paracrine effects. MSCs can secrete soluble immunosuppressive factors such as prostaglandin E2 (PEG2), transforming growth factor β (TGF-β), indole2, 3-dioxygenase (IDO) and nitric oxide (NO) to inhibit the ongoing T cell inflammatory response and promote T cell apoptosis. Thirdly, MSCs can attenuate the antigen-presenting ability of dendritic cells (DCs) by inhibiting DCS; Fourth, MSC-induced DCs showed a tolerogenic phenotype, which promoted the transformation of inflammatory M1 macrophages into immunosuppressive M2 macrophages. Fifth, in the manner described above, MSCs reduce the production of inflammatory factors (TNF-α, IL-1β, and IL-12) in DC cells and M1 macrophages, promote the production of anti-inflammatory factors IL-10 and TGF-β, and promote tissue repair and regeneration capacity. At the same time, immunotolerant DCs and M2 macrophages induce MSCs to produce human leukocyte antigen (HLA) G5, which promotes MSCS-induced Treg cells to form an anti-immune environment around the injured lung tissue. The development of CTD-ILD is accompanied by chronic inflammation, and the use of MSCs can alleviate this inflammatory response. Some animal experiments and in vitro culture studies have also shown that MSCs can differentiate into alveolar epithelial cells and have potential regenerative treatment ability for lung diseases. By routine intravenous infusion, MSCs can be captured by the pulmonary vasculature and facilitate the treatment of lung injury. According to the above immunomodulatory and anti-inflammatory functions of MSCs, MSCs therapy can theoretically inhibit the inflammatory response of CTD-ILD and block or even reverse the process of pulmonary fibrosis in patients.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
18
a single injection dose i.v.
Shanghai Sixth People's Hospital
Shanghai, China
AE
Adverse events and serious adverse events.
Time frame: 1 week, 2 weeks, 4 weeks, 12 weeks, 24 weeks
Forced Vital Capacity(FVC)
Absolute change in FVC
Time frame: 24 weeks
Forced Expiratory Volume in One Second (FEV1)
Forced expiratory volume in 1 second (FEV1)
Time frame: 12 weeks, 24 weeks
Diffusing Capacity of the Lung for Carbon Monoxide (DLco)
Absolute change in carbon monoxide diffusing capacity (DLco)
Time frame: 12 weeks, 24 weeks
St. George's Respiratory Questionnaire (SGRQ)
Score range: 0-100; Higher scores indicate worse health status, while lower scores indicate better health; Changes in the St George's Respiratory questionnaire (SGRQ)
Time frame: 12 weeks, 24 weeks
Short Form Health Survey (SF-36)
Score range: 0-100; Higher scores indicate better health status, while lower scores indicate worse health; Changes in the Short Form Health Survey (SF-36);
Time frame: 12 weeks, 24 weeks
Modified Rodnan Skin Score(MRSS)
Score range: 0-51; Higher scores indicate worse health status, while lower scores indicate better health; Changes in the modified Rodnan Skin Score (MRSS)
Time frame: 12 weeks, 24 weeks
High-resolution computed tomography (HRCT)
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Pulmonary interstitial fibrosis on high-resolution computed tomography (HRCT)
Time frame: 12 weeks, 24 weeks
6-MWT
Changes of oxygen saturation and walking distance in six-minute walk test (6MWT)
Time frame: 12 weeks, 24 weeks
Health assessment questionnaire (HAQ)
Score range: 0-3; Higher scores indicate worse health status, while lower scores indicate better health; Changes in health assessment questionnaire (HAQ)
Time frame: 12 weeks, 24 weeks
Survival
Disease progression-free survival
Time frame: 12 weeks, 24 weeks