Neural Regeneration Research ›› 2020, Vol. 15 ›› Issue (8): 1532-1538.doi: 10.4103/1673-5374.274347

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Human umbilical cord mesenchymal stem cells to treat spinal cord injury in the early chronic phase: study protocol for a prospective, multicenter, randomized, placebo-controlled, single-blinded clinical trial

Yang Yang1, #, Mao Pang1, #, Yu-Yong Chen1 , Liang-Ming Zhang1 , Hao Liu2 , Jun Tan3 , Bin Liu1, * , Li-Min Rong1, *   

  1. 1 Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, Guangdong Province, China 2 Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China 3 Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
  • Online:2020-08-15 Published:2020-09-16
  • Contact: Li-Min Rong, MD, ronglm@mail.sysu.edu.cn; Bin Liu, MD, johnliu2001@sina.com.
  • Supported by:
    This work was supported by the National Key Research and Development Program of China, No. 2017YFA0105403 (to LMR); the Key Research and Development Program of Guangdong Province of China, No. 2019B020236002 (to LMR); The Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory of China, No. 2018GZR0201006 (to LMR); the National Natural Science Foundation of China, Nos. 81772349 (to BL), 31470949 (to BL); the Guangzhou Science and Technology Project of China, Nos. 201704020221 (to LMR), 201707010115 (to BL); the Natural Science Foundation of Guangdong Province of China, No. 2017A030313594 (to BL); the Medical Scientific Research Foundation of Guangdong Province of China, No. A2018547 (to MP).

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Abstract: Human umbilical cord mesenchymal stem cells (hUC-MSCs) support revascularization, inhibition of inflammation, regulation of apop tosis, and promotion of the release of beneficial factors. Thus, they are regarded as a promising candidate for the treatment of intractable spinal cord injury (SCI). Clinical studies on patients with early chronic SCI (from 2 months to 1 year post-injury), which is clinically common, are rare; therefore, we will conduct a prospective, multicenter, randomized, placebo-controlled, single-blinded clinical trial at the Third Affiliated Hospital of Sun Yat-sen University, West China Hospital of Sichuan University, and Shanghai East Hospital, Tongji University School of Medicine, China. The trial plans to recruit 66 early chronic SCI patients. Eligible patients will undergo randomization at a 2:1 ratio to two arms: the observation group and the control group. Subjects in the observation group will receive four intrathecal transplantations of stem cells, with a dosage of 1 × 106 /kg, at one calendar month intervals. Subjects in the control group will receive intrathecal administrations of 10 mL sterile normal saline in place of the stem cell transplantations. Clinical safety will be assessed by the analysis of adverse events and laboratory tests. The American Spinal Injury Association (ASIA) total score will be the primary efficacy endpoint, and the secondary efficacy outcomes will be the following: ASIA impairment scale, International Association of Neural Restoration-Spinal Cord Injury Functional Rating Scale, muscle tension, electromyogram, cortical motor and cortical sensory evoked potentials, residual urine volume, magnetic resonance imaging–diffusion tensor imaging, T cell subtypes in serum, neurotrophic factors and inflammatory factors in both serum and cerebrospinal fluid. All evaluations will be performed at 1, 3, 6, and 12 months following the final intrathecal administration. During the entire study procedure, all adverse events will be reported as soon as they are noted. This trial is designed to evaluate the clinical safety and efficacy of subarachnoid transplantation of hUC-MSCs to treat early chronic SCI. Moreover, it will establish whether cytotherapy can ameliorate local hostile microenvironments, promote tracking fiber regeneration, and strengthen spinal conduction ability, thus improving overall motor, sensory, and micturition/defecation function in patients with early chronic SCI. This study was approved by the Stem Cell Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, China (approval No. [2018]-02) on March 30, 2018, and was registered with ClinicalTrials.gov (registration No. NCT03521323) on April 12, 2018. The revised trial protocol (protocol version 4.0) was approved by the Stem Cell Research Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University, China (approval No. [2019]-10) on February 25, 2019, and released on ClinicalTrials.gov on April 29, 2019.

Key words: clinical study, early chronic phase, efficacy, human umbilical cord mesenchymal stem cell, multicenter trial, prospective study, randomized controlled trial, safety, spinal cord injury, study protocol