A Phase I/IIa clinical study evaluating the safety, tolerability and efficacy of intravenously administered human umbilical cord mesenchymal stem cell (hUC-MSCs) injection in patients with premature ovarian insufficiency (POI). The primary objective of the Phase I dose-escalation stage is to assess the safety and tolerability of intravenous infusion of hUC-MSCs injection for the treatment of POI, and to determine the recommended phase II dose (RP2D) for the Phase IIa clinical trial. The primary objective of the Phase IIa dose-expansion stage is to evaluate the efficacy of intravenous infusion of hUC-MSCs injection in POI treatment, and to generate data to support pivotal/confirmatory clinical trials.
Premature ovarian insufficiency (POI) is defined as ovarian dysfunction occurring in women before the age of 40, which is mainly characterized by menstrual abnormalities (amenorrhea, oligomenorrhea or polymenorrhea), elevated gonadotropin levels (FSH \> 25 U/L), and fluctuating decline in estrogen levels. The incidence of POI is age-specific: 1 in 250 women develops POI before 35 years of age, and 1 in 100 women develops POI before 40 years of age. The incidence rate of POI in China is 2.8%, showing an upward trend year by year with a younger onset age. hormone replacement therapy (HRT) relieves symptoms caused by low estrogen through estrogen supplementation. Sequential estrogen-progestogen therapy is recommended for POI patients with an intact uterus. Since patients with POI require long-term HRT, natural or nearly natural estrogens and progestogens can be selected to minimize adverse effects on the mammary gland, metabolism, cardiovascular system and other systems. Nevertheless, HRT still increases the risks of breast cancer, heart disease and stroke. Studies have demonstrated that mesenchymal stem cells can home to ovarian stroma, regulate the balance of Th1/Th2 cytokines and the expression of endometrial natural killer cells, alleviate inflammatory responses, inhibit apoptosis of ovarian granulosa cells and reduce ovarian interstitial fibrosis, thereby improving the ovarian microenvironment. Meanwhile, these cells can secrete growth factors including VEGF, IGF-1 and HGF, promote proliferation of various ovarian cells and angiogenesis, repair ovarian structure and restore ovarian ovarian function. This study aims to evaluate the safety, tolerability and efficacy of intravenously administered hUC-MSCs in the treatment of patients with POI.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
59
hUC-MSCs Injection, administered via intravenous infusion as a single dose on D0.
hUC-MSCs Injection, 3 infusions in total, dosing interval ≥7 days.
3 infusions in total, dosing interval ≥7 days
Peking Union Medical College Hospital
Beijing, Beijing Municipality, China
RECRUITINGPhase I : Incidence and number of subjects with treatment-emergent adverse events and serious adverse events.
In this Phase I stage, safety is the primary endpoint. Types, frequencies, severities and causal relationships of all adverse events (AEs) and serious adverse events (SAEs) occurring from the first administration of study drug to the end of safety follow-up (48 weeks), assessed in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 6.0; together with the proportion of adverse events judged by the investigator to be related to the study drug.
Time frame: 48 weeks
Phase II :FSH
To evaluate the changes from baseline in serum follicle-stimulating hormone (FSH) levels at Week 24 post-treatment.
Time frame: at Week 24 post-treatment
Phase II :E2
To evaluate the changes from baseline in serum festradiol (E2) levels at Week 24 post-treatment.
Time frame: at Week 24 post-treatment
Phase II :AMH
To evaluate the changes from baseline in serum anti-Müllerian hormone (AMH) levels at Week 24 post-treatment.
Time frame: at Week 24 post-treatment
Phase I: FSH
To evaluate the changes from baseline in serum follicle-stimulating hormone (FSH) levels.
Time frame: 48 weeks
Phase I :E2
To evaluate the changes from baseline in serum estradiol (E2) levels
Time frame: 48 weeks
Phase I : AMH
To evaluate the changes from baseline in serum anti-Müllerian hormone (AMH) levels.
Time frame: 48 weeks
Phase II: Incidence and number of subjects with treatment-emergent adverse events and serious adverse events.
In this Phase II stage, safety is the secondary endpoint. Types, frequencies, severities and causal relationships of all adverse events (AEs) and serious adverse events (SAEs) occurring from the first administration of study drug to the end of safety follow-up (48 weeks), assessed in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 6.0; together with the proportion of adverse events judged by the investigator to be related to the study drug.
Time frame: 48 weeks
Phase I/II: AFC
Changes from baseline in antral follicle count (AFC) by transvaginal ultrasound.
Time frame: 48 weeks
Phase I/II: endometrial thickness
Changes from baseline in endometrial thickness measured by transvaginal ultrasound.
Time frame: 48 weeks
Phase I/II: menstrual recovery status
Menstrual recovery status will be assessed via patient inquiry at each visit.
Time frame: 48 weeks
Phase I/II:Modified Kupperman Index
To evaluate the changes in the Modified Kupperman Index from baseline across all post-baseline follow-up visits. Modified Kupperman Index will be assessed through physician interview.The total score ranges from 0 to 63 points. Total score stratification: \>30 points indicates severe symptoms, 16-30 points moderate symptoms, 6-15 points mild symptoms, and \<6 points normal status.
Time frame: 48 weeks
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