Regenerative Medicine Program, The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada.
Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO) and CHEO Research Institute, Ottawa, Ontario, Canada.
Stem Cells Transl Med. 2021 Jul;10(7):968-975. doi: 10.1002/sctm.20-0508. Epub 2021 Feb 11.
Cell-based therapies hold promise to substantially curb complications from extreme preterm birth, the main cause of death in children below the age of 5 years. Exciting preclinical studies in experimental neonatal lung injury have provided the impetus for the initiation of early phase clinical trials in extreme preterm infants at risk of developing bronchopulmonary dysplasia. Clinical translation of promising therapies, however, is slow and often fails. In the adult population, results of clinical trials so far have not matched the enticing preclinical data. The neonatal field has experienced many hard-earned lessons with the implementation of oxygen therapy or postnatal steroids. Here we briefly summarize the preclinical data that have permitted the initiation of early phase clinical trials of cell-based therapies in extreme preterm infants and describe the INCuBAToR concept (Innovative Neonatal Cellular Therapy for Bronchopulmonary Dysplasia: Accelerating Translation of Research), an evidence-based approach to mitigate the risk of translating advanced therapies into this vulnerable patient population. The INCuBAToR addresses several of the shortcomings at the preclinical and the clinical stage that usually contribute to the failure of clinical translation through (a) systematic reviews of preclinical and clinical studies, (b) integrated knowledge transfer through engaging important stakeholders early on, (c) early economic evaluation to determine if a novel therapy is viable, and (d) retrospective and prospective studies to define and test ideal eligibility criteria to optimize clinical trial design. The INCuBAToR concept can be applied to any novel therapy in order to enhance the likelihood of success of clinical translation in a timely, transparent, rigorous, and evidence-based fashion.
基于细胞的疗法有望显著减少因极早产而导致的并发症,这是 5 岁以下儿童死亡的主要原因。在实验性新生儿肺损伤方面的令人兴奋的临床前研究为在有发生支气管肺发育不良风险的极早产儿中开展早期临床试验提供了动力。然而,有前途的疗法的临床转化速度缓慢,而且往往失败。在成年人群中,迄今为止临床试验的结果与诱人的临床前数据并不匹配。新生儿领域在实施氧疗或产后类固醇方面吸取了许多宝贵的经验教训。在这里,我们简要总结了允许在极早产儿中开展基于细胞的疗法早期临床试验的临床前数据,并描述了 INCuBAToR 概念(支气管肺发育不良的创新新生儿细胞疗法:加速研究转化),这是一种基于证据的方法,可以降低将先进疗法转化为这一脆弱患者群体的风险。INCuBAToR 解决了临床前和临床阶段的几个缺陷,这些缺陷通常会导致临床转化失败,包括:(a) 对临床前和临床研究进行系统评价;(b) 通过尽早让重要利益攸关方参与来整合知识转移;(c) 进行早期经济评估,以确定新疗法是否可行;以及 (d) 进行回顾性和前瞻性研究,以定义和测试理想的纳入标准,从而优化临床试验设计。INCuBAToR 概念可应用于任何新型疗法,以提高及时、透明、严谨和基于证据的临床转化成功率。
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