Parkinson's Disease
Conditions
Keywords
Parkinson's Disease, Xenotransplantation, choroid plexus
Brief summary
To assess the safety of xenotransplantation of NTCELL \[immunoprotected (alginate-encapsulated) choroid plexus cells\] in patients with Parkinson's disease, assessed over the duration of the study, by monitoring the occurrence of adverse events and serious adverse events, including clinical and laboratory evidence of xenogeneic infection in transplant recipients and their partners/close contacts. Subsequent safety follow-up will include lifelong monitoring for clinical and laboratory evidence of xenogeneic infection. To assess the clinical effects of NTCELL \[immunoprotected (alginate-encapsulated) choroid plexus cells\] in patients with Parkinson's disease. This will be quantified by testing the secondary endpoints of the trial as described below (see Endpoints/Outcome Measures).
Detailed description
Parkinson's disease is characterized by widespread neural degeneration, particularly in the substantia nigra and its projections to the basal ganglia. Current therapy for Parkinson's disease is purely symptomatic. There is a pressing need for a treatment that reverses or slows the degeneration of the nigrostriatal pathway. Numerous transplant-based therapies have attempted to support, repair or replace the degenerating nigrostriatal neurons. These have included the transplantation of foetal and other neuronal stem cells, gene transfers, and the implantation of devices releasing neural growth factors. All these have been shown to have some effectiveness in animal models, but have been generally disappointing in human studies. Intracranial choroid plexus cell transplantation has the potential to deliver biological neural agents for the treatment of Parkinson's disease which cannot be achieved by conventional treatment. The overall aim of delivering neural proteins and compounds over many months to the basal ganglia of the brain is to enhance neural repair currently not possible with antiparkinsonian medication or deep brain stimulation (DBS). As animal-derived tissues have to be protected from immune rejection when transplanted into humans, transplants are usually accompanied by immunosuppressive therapy. However, porcine choroid plexus cells are preferably implanted without the use of immunosuppressive drugs which cause significant morbidity. To protect them from immune rejection, the cells can be encapsulated in alginate microcapsules which permit the inward passage of nutrients and the outward passage of biologic neural proteins and compounds normally secreted by choroid plexus cells. Alginate-encapsulated porcine choroid plexus cells implanted into the brain without immunosuppressive drugs have survived rejection for many months in animal studies. NTCELL comprises neonatal porcine choroid plexus cells encapsulated in alginate microcapsules. NTCELL has been safely implanted in rats, and non-human primates. Following NTCELL implants, animals with chemically-induced Parkinson's-like lesions showed improvement of functional neurological motor abnormalities that was associated with histologic changes consistent with amelioration of the lesion. The initial dose for intracranial implantation of the current NTCELL preparation for the treatment of Parkinson's disease in humans is based on the effective dose in a non-human primate (rhesus monkey) model. Parkinson's disease patients will be followed up for 26 weeks after receiving an implantation of NTCELL administered into the putamen of the corpus striatum on the side contralateral to the greatest clinical deficit. Based upon the data obtained during the 26-week follow-up period a decision will be made as to whether the patient will receive: * an implantation of a second dose of NTCELL * unilateral DBS * bilateral DBS * no further intervention The data will be reviewed by the investigators and the Data Safety Monitoring Board (DSMB), the data will consist of clinical outcomes and clinimetric data, an MRI scan, PET scanning, and adverse events. Patients will be followed up for a further 48 weeks if there is no further intervention, however if it is decided that either DBS or implantation of a second dose of NTCELL occurs then the frequency of follow-up will be the subject of a protocol amendment.
Interventions
OTHERNTCELL
Sponsors
Living Cell Technologies
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
To be assessed at the Week -10 to -4 Visit * Adults (males or females) in the age range 40 to 70 years * Diagnosis of Parkinson's disease (minimum duration of 5 years) in accordance with the London Brain Bank criteria * Patients diagnosed with idiopathic Parkinson's disease * Stable medication for Parkinson's for at least 1 month * Patients with advanced and fluctuating Parkinson's disease who have met the criteria for DBS and who have been accepted for DBS at Auckland City Hospital. These criteria include exhaustion of available medication treatments for Parkinson's disease, normal brain MRI, intact cognitive, psychological and psychiatric function, appropriate carer support, and competence and willingness to consent to the placement of deep brain probes * If female, no childbearing capability (those who are more than 2 years postmenopausal or have undergone voluntary sterilisation can be considered for enrolment) * Provision of written informed consent. Patients will be required to agree to comply with all tests and visits specified in the protocol, and they (and their partners/close contacts) will also be required to consent to long-term microbiological monitoring, which is an integral part of the study.
Exclusion criteria
To be assessed at the Week -10 to -4 Visit Note: the criteria for acceptance for DBS would exclude patients with comorbidities that normally would exclude them from similar studies, including uncontrolled depression, dementia, focal neurological deficits, or secondary parkinsonism. Specific
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the safety of xenotransplantation of NTCELL | 26 weeks | measured by the incidence of adverse events, clinical laboratory tests (including xenogeneic viral analysis), physical examination, review by infectious disease physician |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Scores measured by the modified walking test in accordance with the CAPSIT-PD protocol (Defer et al. 1999) (walking 4.5m back and forth instead of 7m back and forth) over 26 weeks post-implant 1 compared with the baseline scores | 26 weeks | — |
| Brain metabolism as demonstrated on PET with [18F]-fluorodopa measured at 26 weeks post-implant 1 compared with baseline | 26 weeks | — |
| Brain metabolism as demonstrated on PET with [11C]-tetrabenazine measured at 26 weeks post-implant 1 compared with baseline | 26 weeks | — |
| Scores measured by the Unified Parkinson's Disease Rating Scale (UPDRS Parts I, II, III, IV - Parts II and III will be performed in the 'off' and 'on' state) over 26 weeks post-implant 1 compared with the baseline scores | 26 weeks | — |
| Scores measured by the Parkinson's Disease Questionnaire (PDQ-39) over 26 weeks post-implant 1 compared with the baseline scores | 26 weeks | — |
| Scores measured by the Unified Dyskinesia Rating Scale (UDysRS Parts I, II, III, IV - Parts III and IV will be performed in the 'off' and 'on' state) over 26 weeks post-implant 1 compared with the baseline scores | 26 weeks | — |
| Times for hand-arm movement between 2 points (tapping test) in accordance with the CAPSIT-PD protocol (Defer et al. 1999) over 26 weeks post-implant 1 compared with the baseline times | 26 weeks | — |
| Scores measured by neuropsychological tests at 26 weeks post-implant 1 compared with the baseline scores | 26 weeks | TESTS USED * National Adult Reading Test * Speed and Capacity of Language Processing Test * Boston Naming Test * Trail Making Test A * Trail Making Test B * WMS IV Logical Memory I * WMS IV Logical Memory II * RAVLT List Learning * RAVLT Short Delay Recall * RAVLT Long Delay Recall * Rey Complex Figure Copy * Rey Complex Figure Delayed Recall * WAIS IV Digit Span * WAIS IV Matrix Reasoning * WAIS IV Symbol Search * WAIS IV Coding * DKEFS Word Fluency * DKEFS Category Fluency * DKEFS Category Switching * DKEFS Colour Naming * DKEFS Word Reading * DKEFS Inhibition * DKEFS Inhibition/switching * Mini Mental State Examination * Montreal Cognitive Assessment * HADS Anxiety * HADS Depression |
| Psychiatric assessment at 26 weeks post-implant 1 compared with the baseline psychiatric assessment | 26 weeks | — |
| Modified Hoehn and Yahr stages over 26 weeks post-implant 1 compared with the baseline stages | 26 weeks | — |
Countries
New Zealand
Outcome results
None listed