A Randomized Clinical Trial Phase I&II of 3 Times Intratechal Injections of Umbilical Cord Derived Mesenchymal cells in Children with Spastic Cerebral Palsy 2-14 years old in comparison with control group
This study designed for the evaluation of safety and therapeutic effects of intrathecal injection (ITI) of mesenchymal stem cells (MSC) derived from allogenic umbilical cord in change of developmental functions of spastic cerebral Palsy (CP) in comparison with control group .
Design
Two arm parallel group , double blind ,blocked randomized controlled trial phase 1-2 .
Settings and conduct
70 cases of Spastic CP cases between 2-14 years that have inclusion criteria will be selected and randomly divided in 2 groups of injection of MSC derived from umbilical cord and control of no injection .The trial is double blind and the participants and clinical evaluators are unaware of study groups .
Participants/Inclusion and exclusion criteria
Diparetic , quadriparetic and hemiparetic spastic CP Between the ages of 2-14 years Gross motor function classification ( GMFC) between 2 -4 Brain MRI finding compatible with CP
Exclusion criteria : Other types of CP Normal brain MRI Uncontrolled seizures Serious diseases of other organs
Intervention groups
Intervention group: Three ITI of MSC every 2 weeks Control group: without injection ,that after needle insertion into the skin without entrance to CSF space needle withdrawn and only simulation of ITI was done without the awareness of the participants . All of the participants had a baseline brain neuroimaging , that will be repeated after 12 months . Patients will be evaluated by predicted scales during the 12 months and will be followed for similar rehabilitation protocol .
Main outcome variables
Motor development alteration by Gross Motor Function Measurement (GMFM 66), Change of motor function by GMFCS , Change of motor function by Manual Ability Classification System (MACS), Change of motor function by Pediatric Disability Inventory ( PEDI) Score, Spasticity change by Ashworth Scale , Change of quality of life (QOL) by CP QOL Questionnaire
General information
Reason for update
Acronym
MSCCP
IRCT registration information
IRCT registration number:IRCT20110628006907N14
Registration date:2020-03-11, 1398/12/21
Registration timing:prospective
Last update:2020-03-11, 1398/12/21
Update count:0
Registration date
2020-03-11, 1398/12/21
Registrant information
Name
Mahmoudreza Ashrafi
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 21 6612 9252
Email address
ashrafim@tums.ac.ir
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2020-04-20, 1399/02/01
Expected recruitment end date
2022-04-20, 1401/01/31
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
A Randomized Clinical Trial Phase I&II of 3 Times Intratechal Injections of Umbilical Cord Derived Mesenchymal cells in Children with Spastic Cerebral Palsy 2-14 years old in comparison with control group
Public title
Effects of umbilical cord derived mesenchymal stem cells injection in the treatment of children with cerebral palsy
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
Spastic cerebral palsy (Dip , Quadri, Hemiparetic ) Ages between 2 - 14 years Gross motor function classification (GMFC) 2 -4 No seizure disorder or with controlled seizure Acquired brain MRI finding compatible with CP Informed consent of parents
Exclusion criteria:
Normal brain MRI Progressive neurological diseases Congenital brain cortical malformations TORCH infections( Toxoplasmosis, Others, Rubella Cytomegalovirus Hepatitis C ) Other types of cerebral palsy (athetoid , atonic , ataxic , mixed ) Acute infections (Human Immunodeficiency Virus , Hepatitis C Virus ) Hemorrhagic diathesis Severe anemia ( Hemoglobin less than 8 ) Ventilator dependent pulmonary diseases Severe renal dysfunction Severe liver dysfunction
Age
From 2 years old to 14 years old
Gender
Both
Phase
1-2
Groups that have been masked
Participant
Care provider
Outcome assessor
Data analyser
Sample size
Target sample size:
70
Randomization (investigator's opinion)
Randomized
Randomization description
The patients are randomly allocated into two groups of intervention and control using a balanced block randomization technique. To do that, they were divided into blocks of 6 and 9. All subjects randomly allocated with online randomization software to generate random-number sequences. {Sealed Envelope Ltd. 2015. Create a blocked randomization list. [Online] Available from: https://www.sealedenvelope.com/simple-randomiser/v1/lists [Accessed 15 Dec 2015]}. Coordinator and Physician responsible for assessing inclusion / exclusion criteria and registering individuals are blind.
Blinding (investigator's opinion)
Double blinded
Blinding description
As this study designed as double blind , In the control group after insertion of the needle into the skin with an appearance of simulating of lumbar puncture no injection were done without the awareness of the patients or their parents and clinical evaluators . At the end of the study if safety and effectiveness of cell therapy will be proved , for ethical consideration cell therapy will be performed for control group .
Placebo
Used
Assignment
Parallel
Other design features
Designing of 3 injection of stem cells with defined interval in intervention group - including of hemiparetic CP in the study
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Tehran University of Medical Sciences
Street address
No 226, Central organization, Ghods Street, Keshavarz Boulvar
City
Tehran
Province
Tehran
Postal code
1417653761
Approval date
2020-02-11, 1398/11/22
Ethics committee reference number
IR.TUMS.VCR.REC.1398.932
Health conditions studied
1
Description of health condition studied
Spastic Cerebral Palsy
ICD-10 code
G80
ICD-10 code description
Cerebral palsy
Primary outcomes
1
Description
Motor development alteration with GMFM 66 score
Timepoint
Before intervention , 3 months after first intervention ,6 months after first intervention , 12 months after first intervention
Method of measurement
GMFM 66 score Questionnaire
2
Description
Change of motor function with GMFCS score
Timepoint
Before intervention , 3 months after first intervention ,6 months after first intervention , 12 months after first intervention
Method of measurement
GMFCS Questionnaire
3
Description
Change of motor function according to PEDI score
Timepoint
Before intervention , 3 months after first intervention ,6 months after first intervention , 12 months after first intervention
Method of measurement
PEDI Questionnaire
4
Description
Change of motor function according to MACS score
Timepoint
Before intervention , 3 months after first intervention ,6 months after first intervention , 12 months after first intervention
Method of measurement
MACS Questionnaire
5
Description
Spasticity change of patients according to Ashworth scale
Timepoint
Before intervention , 3 months after first intervention ,6 months after first intervention , 12 months after first intervention
Method of measurement
Ashworth Questionnaire
6
Description
Change of quality of life
Timepoint
Before intervention , 6 months after first intervention , 12 months after first intervention
Method of measurement
CPQOL Questionnaire
Secondary outcomes
1
Description
Probable Change of brain lesions
Timepoint
Before intervention , 1 year after first intervention
Method of measurement
Brain Magnetic Resonance Imaging (MRI), Brain Magnetic Resonance Spectroscopy (MRS) , Brain Deep Tensor Imaging (DTI)
2
Description
Number of participants experiencing adverse effects and serious adverse effects
Timepoint
First 24 hours after injection and then any time if occurred
Method of measurement
Questionnaire , parents report and periodic planned clinical evaluations
Intervention groups
1
Description
Intervention group : CP patients receiving ،three intrathecal injection of 20 millions allogenic mesenchymal stem cellls derived from umbilical cord , prepared by Cell Thec Pharmed Company. Interval of injections is every 2 weeks . Intrathecal injection will be done under anesthesia via lumbar puncture . After taking 3-5 milliliter of cerebrospinal fluid , 2 milliliter prepared stem cells will be injected with a syringe . The patient will be admitted for one day for monitoring of probable adverse reactions . One year followup and evaluation with regular similar rehabilitative therapy will be done .
Category
Treatment - Drugs
2
Description
Control group : CP patients without injection , that after insertion of needle into the skin without entering into the cerebrospinal fluid space , needle will be withdrawn without any injection and only with an appearance of simulation of lumbar puncture without the awareness of the patient or their parents. The patient will be admitted one day for monitoring of probable adverse reaction . One year followup and evaluation with regular similar rehabilitative therapy will be done .
Category
Placebo
Recruitment centers
1
Recruitment center
Name of recruitment center
Children's Medical Center Hospital
Full name of responsible person
Reza Shervin Badv
Street address
Children's Medical Center Hospital , No 62 , Gharib Street , end of keshavarz Blvd
City
Tehran
Province
Tehran
Postal code
1419733151
Phone
+98 21 6692 9234
Fax
Email
drbadv@gmail.com
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Mohammad َAli Sahraeian
Street address
No 226, Central organization, Ghods Street, Keshavarz Boulvar
City
Tehran
Province
Tehran
Postal code
1417653761
Phone
+98 21 8898 7381
Email
msahrai@tums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?