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异体脐带血单个核细胞系统给药治疗成人严重急性创伤性脊髓损伤的 1/2a 期临床试验:安全性和初步疗效评估。

Systemic Administration of Allogeneic Cord Blood Mononuclear Cells in Adults with Severe Acute Contusion Spinal Cord Injury: Phase 1/2a Pilot Clinical Study-Safety and Primary Efficacy Evaluation.

机构信息

Department of Neurosurgery, N.V. Sklifosovsky Research Institute of Emergency Care, Moscow, Russian Federation.

Department of Neurosurgery, N.V. Sklifosovsky Research Institute of Emergency Care, Moscow, Russian Federation.

出版信息

World Neurosurg. 2022 May;161:e319-e338. doi: 10.1016/j.wneu.2022.02.004. Epub 2022 Feb 5.

DOI:10.1016/j.wneu.2022.02.004
PMID:35134580
Abstract

OBJECTIVE

Phase 1 of the SUBSCI I/IIa (Systemic Umbilical Cord Blood Administration in Patients with Acute Severe Contusion Spinal Cord Injury) study focused on safety and primary efficacy of multiple systemic infusions of allogeneic unrelated human umbilical cord blood mononuclear cells in patients with severe acute spinal cord contusion having severe neurologic deficit. The primary end point was safety. The secondary end point was the restoration of motor and sensory function in lower limbs within a 1-year period.

METHODS

Ten patients with acute contusion spinal cord injury (SCI) and American Spinal Injury Association (ASIA) level A/B deficit were enrolled into phase 1. Patients were treated with 4 infusions of group-matched and rhesus-matched cord blood samples after primary surgery within 3 days after SCI. All patients were followed up for 12 months after SCI. Safety was assessed using adverse events classification depending on severity and relation to cell therapy. Primary efficacy was assessed using dynamics of deficit (ASIA scale).

RESULTS

The overall number of adverse events reached 419 in 10 patients. Only 2 were estimated as possibly related to cell therapy, and the remaining 417 were definitely unrelated. Both adverse events were mild and clinically insignificant. No signs of immunization were found in participants. Analysis of clinical outcomes also showed that cell therapy promotes significant functional restoration of motor function.

CONCLUSIONS

The data obtained suggest that systemic administration of allogeneic, non-human leukocyte antigen-matched human umbilical cord blood is safe and shows primary efficacy in adults with severe acute contusion SCI and ASIA level A/B deficit.

摘要

目的

SUBSCI I/IIa 阶段 1 研究(在患有急性严重挫伤性脊髓损伤的患者中全身脐带血输注)的重点是在具有严重神经功能缺损的严重急性脊髓挫伤患者中多次全身输注同种异体无关人类脐带血单核细胞的安全性和主要疗效。主要终点是安全性。次要终点是在 1 年内下肢运动和感觉功能的恢复。

方法

10 例急性挫伤性脊髓损伤(SCI)和美国脊髓损伤协会(ASIA)水平 A/B 缺陷的患者纳入第 1 阶段。患者在 SCI 后 3 天内进行初次手术时接受 4 次同种匹配和恒河猴匹配的脐带血样本输注。所有患者在 SCI 后随访 12 个月。安全性通过根据严重程度和与细胞治疗的关系进行的不良事件分类进行评估。主要疗效通过缺陷的动态(ASIA 量表)进行评估。

结果

10 例患者共发生不良事件 419 例。只有 2 例被估计与细胞治疗可能相关,其余 417 例则肯定无关。这两种不良事件均为轻度且无临床意义。参与者未发现免疫迹象。临床结果分析还表明,细胞治疗可促进运动功能的显著功能恢复。

结论

获得的数据表明,全身给予同种异体、非人类白细胞抗原匹配的人类脐带血是安全的,并在具有严重急性挫伤性 SCI 和 ASIA 水平 A/B 缺陷的成人中显示出主要疗效。

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