Publicação

Phase I/II trial of liver–derived mesenchymal stem cells in pediatric liver–based metabolic disorders : a prospective, open label, multicenter, partially randomized, safety study of one cycle of heterologous human adult liver–derived progenitor cells (HepaStem) in urea cycle disorders and Crigler-Najjar syndrome patients

Detalhes bibliográficos
Resumo:	Regenerative medicine using stem cell technology is an emerging field that is currently tested for inborn and acquired liver diseases. Objective. This phase I/II prospective, open label, multicenter, randomized trial aimed primarily at evaluating the safety of Heterologous Human Adult Liver–derived Progenitor Cells (HepaStem) in pediatric patients with urea cycle disorders (UCDs) or Crigler-Najjar (CN) syndrome 6 months posttransplantation. The secondary objective included the assessment of safety up to 12 months postinfusion and of preliminary efficacy. Methods. Fourteen patients with UCDs and 6 with CN syndrome were divided into 3 cohorts by body weight and intraportally infused with 3 doses of HepaStem. Clinical status, portal vein hemodynamics, morphology of the liver, de novo detection of circulating anti– human leukocyte antigen antibodies, and clinically significant adverse events (AEs) and serious adverse events to infusion were evaluated by using an intent-to-treat analysis. Results. The overall safety of HepaStem was confirmed. For the entire study period, patient-month incidence rate was 1.76 for the AEs and 0.21 for the serious adverse events, of which 38% occurred within 1 month postinfusion. There was a trend of higher events in UCD as compared with CN patients. Segmental left portal vein thrombosis occurred in 1 patient and intraluminal local transient thrombus in a second patient. The other AEs were in line with expectations for catheter placement, cell infusion, concomitant medications, age, and underlying diseases. Conclusions. This study led to European clinical trial authorization for a phase II study in a homogeneous patient cohort, with repeated infusions and intermediate doses.
Autores principais:	Smets, Françoise
Outros Autores:	Dobbelaere, Dries; McKiernan, Patrick; Dionisi-Vici, Carlo; Broué, Pierre; Jacquemin, Emmanuel; Lopes, Ana Isabel; Gonçalves, Isabel; Mandel, Hanna; Pawlowska, Joanna; Kamińska, Diana; Shteyer, Eyal; Torre, Giuliano; Shapiro, Riki; Eyskens, François; Clapuyt, Philippe; Gissen, Paul; Pariente, Danièle; Grunewald, Stephanie; Yudkoff, Marc; Binda, Maria Mercedes; Najimi, Mustapha; Belmonte, Nathalie; de Vos, Beatrice; Thonnard, Joelle; Sokal, Etienne
Assunto:	Adolescent Child Female Liver Urea cycle disorders, inborn Stem cell transplantation Infant Liver regeneration Treatment outcome Male Liver transplantation Time factors Humans Europe Child, preschool Age factors Transplantation, heterologous Prospective studies Urea cycle disorders, inborn Crigler-Najjar syndorme
Ano:	2019
País:	Portugal
Tipo de documento:	artigo
Tipo de acesso:	acesso restrito
Instituição associada:	Universidade de Lisboa
Idioma:	inglês
Origem:	Repositório da Universidade de Lisboa

Descrição
Resumo:	Regenerative medicine using stem cell technology is an emerging field that is currently tested for inborn and acquired liver diseases. Objective. This phase I/II prospective, open label, multicenter, randomized trial aimed primarily at evaluating the safety of Heterologous Human Adult Liver–derived Progenitor Cells (HepaStem) in pediatric patients with urea cycle disorders (UCDs) or Crigler-Najjar (CN) syndrome 6 months posttransplantation. The secondary objective included the assessment of safety up to 12 months postinfusion and of preliminary efficacy. Methods. Fourteen patients with UCDs and 6 with CN syndrome were divided into 3 cohorts by body weight and intraportally infused with 3 doses of HepaStem. Clinical status, portal vein hemodynamics, morphology of the liver, de novo detection of circulating anti– human leukocyte antigen antibodies, and clinically significant adverse events (AEs) and serious adverse events to infusion were evaluated by using an intent-to-treat analysis. Results. The overall safety of HepaStem was confirmed. For the entire study period, patient-month incidence rate was 1.76 for the AEs and 0.21 for the serious adverse events, of which 38% occurred within 1 month postinfusion. There was a trend of higher events in UCD as compared with CN patients. Segmental left portal vein thrombosis occurred in 1 patient and intraluminal local transient thrombus in a second patient. The other AEs were in line with expectations for catheter placement, cell infusion, concomitant medications, age, and underlying diseases. Conclusions. This study led to European clinical trial authorization for a phase II study in a homogeneous patient cohort, with repeated infusions and intermediate doses.