A Phase I Study of ExoFlo, an ex Vivo Culture-expanded Adult Allogeneic Bone Marrow Mesenchymal Stem Cell Derived Extracellular Vesicle Isolate Product, for the Treatment of Medically Refractory Crohn's Disease

Study Purpose

Protocol Summary.

  • - Title: A Phase I study of ExoFlo, an ex vivo culture-expanded adult allogeneic bone marrow mesenchymal stem cell derived extracellular vesicle isolate product, for the treatment of medically refractory Crohn's disease.
  • - Short Title: ExoFlo for Crohn's Disease.
  • - Phase: 1.
  • - Methodology: Open label.
  • - Study Duration: 24 months.
  • - Subject Participation: 70 weeks.
  • - Single or Multi-Site: Single site.
Primary Objectives:
  • - To evaluate the feasibility of intravenous ExoFlo in subjects with moderately to severely active Crohn's disease who have failed or are intolerant to one or more monoclonal antibodies.
  • - To evaluate the safety of intravenous ExoFlo in subjects with moderately to severely active Crohn's disease who have failed or are intolerant to one or more monoclonal antibodies.
Secondary Objectives:
  • - To evaluate the efficacy of intravenous ExoFlo in inducing clinical remission in subjects with moderately to severely active Crohn's disease who have failed or are intolerant to one or more monoclonal antibodies.
  • - To evaluate the efficacy of intravenous ExoFlo in inducing clinical response in subjects with moderately to severely active Crohn's disease who have failed or are intolerant to one or more monoclonal antibodies.
  • - To evaluate the efficacy of intravenous ExoFlo in improving disease-specific health-related quality of life.
  • - To evaluate the pharmacokinetics and pharmacodynamics of ExoFlo therapy, including changes in C-reactive protein (CRP), fecal calprotectin, fecal lactoferrin, and other pharmacodynamic biomarkers.
  • - Number of Subjects: 10.
  • - Diagnosis and Main Inclusion Criteria: Subjects must have colitis, ileitis, or ileocolitis previously confirmed at any time in the past by radiography, histology, and/or endoscopy, and must allow a 8-week washout for prior TNF antagonist use.
  • - Study Product, Dose, Route, Regimen: Arm 1: IV administration of study agent at Day 0, Day 2, Day 4, Week 2, Week 6 and every 8 weeks thereafter to week 46 (n=5), (total # doses = 10).
Arm 2: IV administration of study agent at Day 0, Day 2, Day 4, Week 2, Week 6 and every 4 weeks thereafter to week 46 (n=5), (total # doses = 15).
  • - Statistical Methodology: This is a safety study with exploratory assessment of efficacy.
The study has insufficient power to confirm efficacy. All assessments of efficacy will be exploratory for the purpose of hypothesis-generation in larger sample sizes.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years - 75 Years
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - 1.
Males and females 18-75 years of age.
  • - 2.
Crohn's colitis of at least 6 months duration with medically refractory symptoms who has failed one anti-TNF therapy (failed to have improvement of disease while receiving at least one monoclonal antibody for 8 weeks duration prior to enrollment, including Infliximab, Adalimumab, Certolizumab, Golimumab, Vedolizumab, Ustekinumab, and Tofacitinib), with a next step of subtotal colectomy or escalation in medical management.
  • - 3.
Patient with moderately to severely active Crohn's disease as defined by a CDAI score >220 and SES-CD score ≥ 6 (or ≥4 isolated ileal disease)
  • - 4.
Exposure to corticosteroids, 5-ASA drugs, thiopurines, methotrexate, anti-TNF therapy, anti-integrin and anti-interleukin in the past are permitted but a washout period of 8 weeks for any monoclonal antibody is necessary. 1. If receiving conventional immunomodulators (ie, AZA, 6-MP, or MTX), must have been taking them for ≥12 weeks, and on a stable dose for at least 4 weeks. 2. If AZA, 6-MP, or MTX has been recently discontinued, it must have been stopped for at least 4 weeks. 3. If receiving oral 5-ASA compounds, the dose must have been stable for at least 4 weeks. If receiving oral corticosteroids, the dose must be ≤20 mg/day prednisone or its equivalent and must have been stable for at least 4 weeks. 4. If receiving budesonide, the dose must have been stable for at least 2 weeks. 5. If oral 5-ASA compounds or oral corticosteroids (including budesonide) have been recently discontinued, they must have been stopped for at least 2 weeks.
  • - 5.
The following medications/therapies must have been discontinued before first administration of study agent: 1. TNF-antagonist therapy (e.g., infliximab, etanercept, certolizumab, adalimumab, golimumab), vedolizumab, ustekinumab for at least 8 weeks. 2. Cyclosporine, tacrolimus, or sirolimus, for at least 4 weeks. 3. 6-thioguanine (6-TG) must have been discontinued for at least 4 weeks. 4. Rectal corticosteroids (i.e., corticosteroids [including budesonide] administered to the rectum or sigmoid colon via foam or enema or suppository) for at least 2 weeks. 5. Rectal 5-ASA compounds (i.e., 5-ASAs administered to the rectum or sigmoid colon via foam or enema or suppository) for at least 2 weeks. 6. Parenteral corticosteroids for at least 2 weeks. 7. Total parenteral nutrition (TPN) for at least 2 weeks. 8. Antibiotics for the treatment of CD (e.g., ciprofloxacin, metronidazole, or rifaximin) for at least 2 weeks.
  • - 6.
No colonic dysplasia and malignancy as ruled out by colonoscopy within 90 days of first ExoFlo delivery.
  • - 7.
Ability to comply with protocol.
  • - 8.
Competent and able to provide written informed consent.
  • - 9.
Stated willingness to comply with all study procedures and availability for the duration of the study.
  • - 10.
If patient is of reproductive capacity, willing to use adequate birth control measures while they are in the study.

Exclusion Criteria:

  • - 1.
Inability to give informed consent.
  • - 2.
Clinically significant medical conditions within the six months before administration of ExoFlo: e.g., myocardial infarction, active angina, congestive heart failure or other conditions that would, in the opinion of the investigators, compromise the safety of the patient.
  • - 3.
Patients with confirmed HIV, Hepatitis B, or Hepatitis C infections.
  • - 4.
Abnormal AST or ALT at screening defined as AST >100 or ALT > 100.
  • - 5.
Abnormal basic laboratory values with the following cut-offs: 1. Alkaline phosphate >200. 2. WBC >13. 3. Hemoglobin <7. 4. Platelets <50 or > 1 million. 5. eGRF < 60. 6. HbA1C > 8%
  • - 6.
Subjects with abnormal coagulation studies: 1. Prothrombin time (PT) > 1.5 times the upper limits of normal. 2. Partial thromboplastin time (PTT) > 1.5 times the upper limits of normal. 3. International normalized ratio (INR) > 1.5 times the upper limits of normal.
  • - 7.
Subjects with hyperbilirubinemia and evidence of liver disease as defined by AST > 100 or ALT > 100 or PT > 1.5 times the upper limits or normal or PT/INR > 1.5 time the upper limits of normal.
  • - 8.
Subjects with abnormal vital signs as defined by: 1. Systolic blood pressure >160 or <90 mmHg. 2. Diastolic blood pressure >90 or <60 mmHg. 3. Pulse <60 or >105 bpm. 4. Respiratory Rate <9 and >25 breaths per minute. 5. Temperature: >100.4 degrees Fahrenheit. 6. SpO2 : <92%
  • - 9.
History of cancer including melanoma (with the exception of localized skin cancers) within 5 years of study enrollment.
  • - 10.
Investigational drug within one year of study enrollment.
  • - 11.
Pregnant or breast feeding.
  • - 12.
If patient is of reproductive capacity, unwilling to use adequate birth control measures while they are in the study.
  • - 13.
Fulminant colitis requiring emergency surgery.
  • - 14.
Concurrent active clostridium difficile infection of the colon.
  • - 15.
Concurrent CMV infection of the colon.
  • - 16.
Evidence of colonic perforation.
  • - 17.
Massive hemorrhage from the colon requiring emergent surgery.
  • - 18.
Ulcerative colitis or indeterminate colitis.
  • - 19.
Microscopic, ischemic or infectious colitis.
  • - 20.
Neoplasia of the colon on preoperative biopsy.
  • - 21.
Presence of an ostomy.
  • - 22.
Three or more prior small bowel resections.
  • - 23.
Previous colonic resection.
  • - 24.
Colonic stricture that unable to pass an adult colonoscope.
  • - 25.
Active or latent tuberculosis.
  • - 26.
Unable to wean off corticosteroids.
  • - 27.
Patients with primary sclerosing cholangitis.
  • - 28.
Patients with history of or current evidence of alcohol or drug abuse or dependence, recreational use of illicit drug or prescription medications, or have use of medical marijuana within 90 days of study entry.
  • - 29.
Patients with known allergy to local anesthetics.
  • - 30.
Patients taking anticoagulant medications (e.g. warfarin, heparin) or clopidogrel (Plavix) to reduce the risk of bleeding/ hemarthrosis.
  • - 31.
Individuals with inherited or acquired hypercoagulable states, history of thromboembolic events or bleeding disorders.
  • - 32.
Electrocardiogram demonstrating cardiac arrhythmia, except for sinus tachycardia within the predefined limit of no greater than 105 bpm.

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT05130983
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 1
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Direct Biologics, LLC
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Amy Lightner, MD
Principal Investigator Affiliation Direct Biologics, LLC
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Industry
Overall Status Recruiting
Countries United States
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Crohn Disease, IBD - Irritable Bowel Disease
Arms & Interventions

Arms

Experimental: 15ml of ExoFlo at Day 0, 2, 4 Week 2, 6, and every 8 weeks after that to week 46

Arm 1: IV administration of study agent at Day 0, Day 2, Day 4, Week 2, Week 6 and every 8 weeks thereafter to week 46 (n=5), (total # doses = 10).

Experimental: 15ml of ExoFlo at Day 0, 2, 4 Week 2, 6, and every 4 weeks after that to week 46

Arm 2: IV administration of study agent at Day 0, Day 2, Day 4, Week 2, Week 6 and every 4 weeks thereafter to week 46 (n=5), (total # doses = 15).

Interventions

Drug: - Bone Marrow MSC Derived Extracellular Vesicle Isolate

ExoFlo 15ml, IV

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

Phillip Fleshner, MD, Los Angeles, California

Status

Recruiting

Address

Phillip Fleshner, MD

Los Angeles, California, 90048

Site Contact

Gayane Ovsepyan, MPH

Gayane.Ovsepyan@cshs.org

512-354-7124