Ignite Creation Date:
2024-07-17 @ 12:03 PM
Last Modification Date:
2024-10-26 @ 3:33 PM
Study NCT ID:
NCT06485648
Status:
NOT_YET_RECRUITING
Last Update Posted:
2024-07-03
First Post:
2024-06-15
Brief Title:
Mesenchymal Stem Cell Transfusion for the Treatment of Refractory Lupus Nephritis
Sponsor:
Chinese PLA General Hospital
Organization:
Chinese PLA General Hospital
Study Overview
Official Title:
Safety and Efficacy of Umbilical Cord Mesenchymal Stem Cell Transfusion for the Treatment of Refractory Lupus Nephritis
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-06
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
LN
Brief Summary:
Lupus nephritis LN is the most common and serious complication of systemic lupus erythematosus SLE which can lead to permanent kidney injury and uremia At present the combination of glucocorticoids and immunosuppressants is still the first line of clinical treatments Only about 20-30 of patients with LN can achieve a complete response In addition attainment of clinical remission does not necessarily reflect improvement in the kidney tissues A substantial proportion of patients who show a clinical response to treatment still have histological findings in their kidney biopsy samples that are consistent with active kidney disease after clinical complete remission Because of the complexity of refractory lupus nephritis there is no uniform and effective treatment for them Mesenchymal stem cells MSCs are a class of pluripotent stem cells that can secrete hundreds of cytokines to participate in immune regulation anti-inflammatory and anti-fibrosis processes etc so they have been actively explored for the treatment of autoimmune diseases which Including systemic lupus erythematosus and lupus nephritis recently Therefore MSCs have been considered as a potential therapeutic regimen for the treatment of refractory LN Several clinical trials have been performed but the results have been inconsistent and the outcome indicators of treatment were not verified by pathological findings Therefore this trial wishes to investigate whether MSCs can improve renal recovery in patients with refractory lupus nephritis and to evaluate the effectiveness of treatment by renal biopsy
Detailed Description:
Systemic lupus erythematosus SLE is an autoimmune disease in which the immune system loses its immune tolerance to endogenous nuclear substances due to unknown reasons The incidence and prevalence of SLE in different ethnic groups are different and the overall incidence and prevalence are about 14-86100000 person-years and 13-3666100000 person respectively The incidence and prevalence of SLE in China are about 4-10100000 person-years and 975-100100000 person respectively Based on this it is estimated that there are about 1 million patients with SLE in China which is a major serious chronic disease Among patients with systemic lupus erythematosus SLE the reported lifetime incidence of lupus nephritis LN is 20-60 depending on the demographics of the population studied Kidney involvement in SLE has been associated with higher mortality especially for patients progressing to kidney failure The ultimate goal of treating LN is to preserve kidney function and reduce the morbidity and mortality associated with chronic kidney disease CKD and kidney failure while minimizing medication-associated toxicities
At present the pathogenesis of LN remains unclear A genome-wide association study GWAS conducted by investigators team found that 9 single nucleotide polymorphism loci were associated with the occurrence of LN The interaction of multiple factors such as gene polymorphism viral infection estrogen ultraviolet light and smoking leads to increased production and decreased clearance of endogenous nuclear substances inside and outside the kidneys in the body which induce the imbalance of regulation of innate immune system and adaptive immune system especially the generation of more long-lived plasma cells resulting in continuous production of autoantibodies in kidney and they did not respond to standard immunosuppressive therapy Deposition of antigen-antibody complexes in all parts of the kidneys which triggers an inflammatory cascade that includes complement activation and aggregation of various immune cells such as T cells B cells dendritic cells DCs and macrophages Many of them have pro-inflammatory phenotypes These factors eventually put the kidneys in a storm of proinflammation
The clinical manifestations of LN vary from asymptomatic to nephrotic syndrome acute nephritis syndrome and chronic nephritis syndrome but the severity of clinical manifestations does not match the actual pathological involvement of the kidneys The 2024 EULAR Guideline and the 2024 KDIGO guideline recommend the use of kidney biopsy results as the basis for standard diagnosis and treatment of LN Currently according to the 2016 revised International Society of NephrologyRenal Pathology Society ISNRPS classification system the pathological manifestations of LN are divided into 6 types I-VI
Active LN National Institutes of Health NIH activity index1 with or without chronicity index of Class III IV or IIIV or IVV are the focus of clinical treatment The rationale for classifying LN into different classes is based on differences in the prognosis Patients with proliferative LN class IIIIV present the worst prognosis without treatment and the higher rate of refractory response and patients with class III IV or V LN but not class I or II LN are at immediate risk of CKD progression and involve irreversible nephron loss that reduces kidneys lifespan Immunosuppressive therapy is mostly used for the treatment of class III and class IV and combined with or without class V LN which is divided into two phases an induction phase with intensive immunosuppression usually lasting 3-6 months and a maintenance phase of prolonged less intensive treatment to prevent renal flares The recommended standard first-line treatment for these lesions is as follows initially with glucocorticoids combined with one of the following options Calcineurin inhibitors VoclosporinTacrolimuscyclosporine Mycophenolic acid analogs MPAA Cyclophosphamide BelimumabMPAA or reduced-dose cyclophosphamide The maintenance phase of treatment mainly includes reducing prednisone to lt5 mgd and combined with mycophenolate mofetil The treatment efficacy indicators include the following complete response partial response and no kidney response However the complete response rate of LN is only 20-30 after receiving six months of standard treatment which is far from satisfactory Refractory lupus nephritis indicates an inadequate response to lupus nephritis therapy At present there is no clear definition for refractory cases which is defined in 2024 KDIGO Guidelines as no kidney response within initial first-line standard treatment
In recent years in addition to the first-line standard treatment regimen of glucocorticoid combined with immunosuppressants More and more biological agents are being developed including Rituximab Ocrelizumab Caplacizumab Belimumab Abatacept Anifrolumab APL-2 BI 655064 BMS-986165 Iscalimab Obinutuzumab etc With the exception of Belimumab and Rituximab were recommended for the treatment of some patients especially those in refractory cases most of these drugs are being studied in clinical trials However the clinical data of the current treatment are too few the long-term treatment effects of these drugs are not exact and more new treatment options are urgently needed
Mesenchymal stem cells MSCs are a class of pluripotent stem cells that are derived from early-developing mesoderm tissues and can be extracted from bone marrow umbilical cord umbilical cord blood embryo adipose tissue and other tissues More and more studies suggest that MSCs can secrete hundreds of cytokines chemokines and signaling molecules involved in immune regulation and anti-inflammatory and anti-fibrosis processes so they have been actively explored for the treatment of autoimmune diseases in recent years The immunomodulatory mechanisms of MSCs have been studied using in vitro and in vivo experimental animal models of many autoimmune disorders Our previous studies have also shown that MSC can effectively alleviate renal lesions in lupus nephritis mice by regulating the kidney region immunity especially reduce the number of long-lived plasma cells and decrease the level of autoantibodies secreted locally in the kidney tissue
At present more than ten clinical trials of stem cell therapy for LN have been registered on the ClinicalTrial website and among these two trial results have been published However the results of the two clinical trials were inconsistent
Human Umbilical Cord-Mesenchymal Stem Cells uc-MSCs were derived from umbilical cord Wharton jelly which are non-invasive acquisition non-ethical controversy easy sampling and extraction low immunogenicity easy in vitro expansion and have a stronger immunomodulatory function and stronger proliferation ability compared with other MSCs
Given that the results of the published clinical studies so far are inconsistent and the outcome indicators of these clinical trials were not confirmed by the pathological results of kidney biopsy investigators prompted to design a patient-blinded randomized placebo-controlled parallel-design clinical trial RCT to test the safety and efficacy of MSC therapy for refractory lupus nephritis
At present the pathogenesis of LN remains unclear A genome-wide association study GWAS conducted by investigators team found that 9 single nucleotide polymorphism loci were associated with the occurrence of LN The interaction of multiple factors such as gene polymorphism viral infection estrogen ultraviolet light and smoking leads to increased production and decreased clearance of endogenous nuclear substances inside and outside the kidneys in the body which induce the imbalance of regulation of innate immune system and adaptive immune system especially the generation of more long-lived plasma cells resulting in continuous production of autoantibodies in kidney and they did not respond to standard immunosuppressive therapy Deposition of antigen-antibody complexes in all parts of the kidneys which triggers an inflammatory cascade that includes complement activation and aggregation of various immune cells such as T cells B cells dendritic cells DCs and macrophages Many of them have pro-inflammatory phenotypes These factors eventually put the kidneys in a storm of proinflammation
The clinical manifestations of LN vary from asymptomatic to nephrotic syndrome acute nephritis syndrome and chronic nephritis syndrome but the severity of clinical manifestations does not match the actual pathological involvement of the kidneys The 2024 EULAR Guideline and the 2024 KDIGO guideline recommend the use of kidney biopsy results as the basis for standard diagnosis and treatment of LN Currently according to the 2016 revised International Society of NephrologyRenal Pathology Society ISNRPS classification system the pathological manifestations of LN are divided into 6 types I-VI
Active LN National Institutes of Health NIH activity index1 with or without chronicity index of Class III IV or IIIV or IVV are the focus of clinical treatment The rationale for classifying LN into different classes is based on differences in the prognosis Patients with proliferative LN class IIIIV present the worst prognosis without treatment and the higher rate of refractory response and patients with class III IV or V LN but not class I or II LN are at immediate risk of CKD progression and involve irreversible nephron loss that reduces kidneys lifespan Immunosuppressive therapy is mostly used for the treatment of class III and class IV and combined with or without class V LN which is divided into two phases an induction phase with intensive immunosuppression usually lasting 3-6 months and a maintenance phase of prolonged less intensive treatment to prevent renal flares The recommended standard first-line treatment for these lesions is as follows initially with glucocorticoids combined with one of the following options Calcineurin inhibitors VoclosporinTacrolimuscyclosporine Mycophenolic acid analogs MPAA Cyclophosphamide BelimumabMPAA or reduced-dose cyclophosphamide The maintenance phase of treatment mainly includes reducing prednisone to lt5 mgd and combined with mycophenolate mofetil The treatment efficacy indicators include the following complete response partial response and no kidney response However the complete response rate of LN is only 20-30 after receiving six months of standard treatment which is far from satisfactory Refractory lupus nephritis indicates an inadequate response to lupus nephritis therapy At present there is no clear definition for refractory cases which is defined in 2024 KDIGO Guidelines as no kidney response within initial first-line standard treatment
In recent years in addition to the first-line standard treatment regimen of glucocorticoid combined with immunosuppressants More and more biological agents are being developed including Rituximab Ocrelizumab Caplacizumab Belimumab Abatacept Anifrolumab APL-2 BI 655064 BMS-986165 Iscalimab Obinutuzumab etc With the exception of Belimumab and Rituximab were recommended for the treatment of some patients especially those in refractory cases most of these drugs are being studied in clinical trials However the clinical data of the current treatment are too few the long-term treatment effects of these drugs are not exact and more new treatment options are urgently needed
Mesenchymal stem cells MSCs are a class of pluripotent stem cells that are derived from early-developing mesoderm tissues and can be extracted from bone marrow umbilical cord umbilical cord blood embryo adipose tissue and other tissues More and more studies suggest that MSCs can secrete hundreds of cytokines chemokines and signaling molecules involved in immune regulation and anti-inflammatory and anti-fibrosis processes so they have been actively explored for the treatment of autoimmune diseases in recent years The immunomodulatory mechanisms of MSCs have been studied using in vitro and in vivo experimental animal models of many autoimmune disorders Our previous studies have also shown that MSC can effectively alleviate renal lesions in lupus nephritis mice by regulating the kidney region immunity especially reduce the number of long-lived plasma cells and decrease the level of autoantibodies secreted locally in the kidney tissue
At present more than ten clinical trials of stem cell therapy for LN have been registered on the ClinicalTrial website and among these two trial results have been published However the results of the two clinical trials were inconsistent
Human Umbilical Cord-Mesenchymal Stem Cells uc-MSCs were derived from umbilical cord Wharton jelly which are non-invasive acquisition non-ethical controversy easy sampling and extraction low immunogenicity easy in vitro expansion and have a stronger immunomodulatory function and stronger proliferation ability compared with other MSCs
Given that the results of the published clinical studies so far are inconsistent and the outcome indicators of these clinical trials were not confirmed by the pathological results of kidney biopsy investigators prompted to design a patient-blinded randomized placebo-controlled parallel-design clinical trial RCT to test the safety and efficacy of MSC therapy for refractory lupus nephritis
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 2020YFA0113004 | OTHER_GRANT | None | None |