Using fat-derived cells to heal digital ulcers in scleroderma patients

Subcutaneous Injections of Cultured Adipose-derived Stroma/ Stem Cells to Heal Refractory Ischemic Digital Ulcers in Patients With Scleroderma

This study is testing if injections of fat-derived cells can help heal stubborn finger ulcers in people with scleroderma who haven't found relief from other treatments.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 32 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University Hospital, Toulouse (Academic / other)
• Drugs / interventions: chemotherapy, radiation, methotrexate, cyclophosphamide, prednisone
• Locations: 7 sites (Grenoble and 6 other locations)
• Trial ID: NCT04356755 on ClinicalTrials.gov

What this trial studies

This phase 2 study aims to evaluate the efficacy and safety of subcutaneous injections of adipose-derived stromal cells (AdMSC) compared to a placebo for treating refractory ischemic digital ulcers in patients with systemic sclerosis. Ischemic digital ulcers are a common and debilitating complication of systemic sclerosis, significantly affecting patients' quality of life. The study will involve patients who have at least one active ulcer that has not responded to standard treatments. By leveraging the angiogenic and anti-inflammatory properties of AdMSC, the study seeks to improve healing outcomes for these challenging ulcers.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with systemic sclerosis and at least one refractory active ischemic digital ulcer.

Not a fit: Patients with non-refractory digital ulcers or those not meeting the specific inclusion criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly enhance healing rates and improve the quality of life for patients suffering from refractory digital ulcers due to scleroderma.

How similar studies have performed: Previous pilot studies have shown safety and feasibility of using adipose-derived cells for similar conditions, suggesting potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

* Male or female patient ≥18 years of age,
* Patient with systemic sclerosis according to the 2013 ACR/EULAR classification criteria9,
* SSc patient with at least one refractory active ischemic digital ulcer at "inclusion visit" (see below the eligibility conditions of a DU),
* Age \> 50 years and not treated with any kind of hormone replacement therapy for at least 2 years prior to screening, with amenorrhea for at least 24 consecutive months prior to screening. An assessment of serum follicle stimulating hormone showing a level of \> 40 TU/L at screening may be used to exclude childbearing potential, based on the discretion of the investigator,
* Patient must have provided written informed consent prior to enrolment,
* Patient must be able to understand their requirements of participating in the protocol,
* Patient affiliated to a social security system.
* Relative to each DU :

The DU at " inclusion visit " must show all the following characteristics:

1. Located beyond the proximal interphalangeal joint, on finger surface (included periungual ulcers),
2. Of ischemic origin according to the physician,
3. Not over subcutaneous calcifications or bone relief,
4. Active DU,
5. Refractory after 10±2 weeks of standard of care according to EULAR recommendations26 (that is either still active (chronic) or new occurrence despite standard of care)

Exclusion Criteria:

* Current smoker or tobacco consumption stopped for less than 3 months prior to inclusion, - Patient participating in a clinical trial or having participated in a clinical trial within the previous 3 months,
* Patients on statins, who have received treatment for less than 3 months prior to Screening or whose treatment has not been stable during this period,
* Patients on vasodilators, such as endothelin receptor antagonists (ERAs), PDE5 inhibitors (e.g. sildenafil, tadalafil), calcium channel blockers, ACE-inhibitors, nitroglycerin, alpha adrenergic blockers, or angiotensin II receptor antagonists, N-acetylcysteine, antiplatelet aggregation therapy and low molecular weight heparin who have received treatment if present for less than 3 months prior to "inclusion visit" or whose treatment has not been stable for at least 1 month prior to "inclusion visit",
* Treatment with disease modifying agents such as methotrexate, mycophenolate mofetil, azathioprine, tacrolimus, Interferons and cyclophosphamide, those drugs should be stop at least 1 month prior study entry.
* Treatment with oral corticosteroids (\> 10 mg/day of prednisone or equivalent),
* Systemic antibiotics (oral and TV) to treat infected DU(s) within 4 weeks prior to "inclusion visit",
* Use of topical growth factors, hyperbaric oxygen,
* Local injection of botulinum toxin in an affected finger within 4 weeks prior to "inclusion visit",
* Surgical sympathectomy of the upper limbs or surgical wound debridement within 1 month prior to "inclusion visit",
* Liposuction technically impossible,
* Patient who underwent autologous hematopoietic stem cell transplantation (HSCT) within less than 1 year,
* Patients with an indication for intensification by autologous HSCT (according to EBMT guidelines and national RCP MATHEC),
* History of cancer in the last five years, except for successfully excised basal cell/squamous cell carcinoma, or successfully excised early melanoma of the skin. Subjects, who had successfully tumor resection or radiation or chemotherapy more than 5 years from inclusion and no recurrence, may be enrolled in the study, - Subjects who have active proliferative retinopathy,
* Positive HIV-1 or 2, HTLV-1 or 2, HBV or HCV,
* Patients with a history of stroke, myocardial infarction or severe arrhythmia in the last 6 months
* Patient who had severe cardiac failure in the last 6 months,
* Females who are pregnant or breastfeeding or plan to do so during the course of this study,
* Patient under judicial protection, - Refusal of the patient to participate in the study.
* Relative to each DU:

  1. Digital ulcer due to conditions other than scleroderma,
  2. Non ischemic digital ulcer,
  3. Ulcers with osteomyelitis, or clinically uncontrolled infection,
  4. Infected digital ulcer requiring systemic antibiotherapy,
  5. Digital ulcer requiring urgent surgery.

Where this trial is running

Grenoble and 6 other locations

• Grenoble Hospital — Grenoble, France (Not_yet_recruiting)
• Lille Hopsital — Lille, France (Not_yet_recruiting)
• Marseille Hospital — Marseille, France (Not_yet_recruiting)
• Montpellier Hospital — Montpellier, France (Not_yet_recruiting)
• Nantes Hospital — Nantes, France (Not_yet_recruiting)
• Poitiers Hospital — Poitiers, France (Not_yet_recruiting)
• CHU de Toulouse - Hôpital PURPAN-TSA — Toulouse, France (Recruiting)

Study contacts

• Principal investigator: Grégory PUGNET, MD, PHD
• Study coordinator: Grégory PUGNET, MD, PHD

Conditions Systemic Sclerosis