Cerebral Palsy, Child Development
Conditions
Keywords
Umbilical cord blood transplantation, Cytokine changes
Brief summary
In our prior study on the therapeutic mechanism of UCB, changes in cytokine levels were observed but the results are inconclusive and further studies on animal models and changes of protein expression before and after UCB therapy in the clinical settings are required. The changes in protein expression will be assessed by multiplex RT-PCR mRNA assay. Clinical efficacy of UCB therapy will be evaluated with various functional assessment tools. Factors regarding UCB therapy (number of transplanted cells, HLA matching status, serum level of immunosuppressant, etc.) and patient factors (age, functional status, etc.) will be analyzed for correlation with protein expression after UCB therapy. Several target proteins for analysis are available. Pentraxin and toll-like receptor (TLR) 4 are receptors modulating intrinsic immune reaction and was shown to have a significant correlation with clinical efficacy of stem cell therapy. Ubiquitine is a regulatory protein that combines with the target protein and affects its degradation, interaction, localization and activation. The ubiquitine system controls total protein quantity for homeostasis and can be found in all tissues. Deubiquitination (DUB) enzyme down-regulates this ubiquitine and is known to modulate all cellular changes
Interventions
BIOLOGICALallogeneic cord blood transplantation
UCB with total nucleated cell count ≤ 7x108/kg will be used for this clinical trial. Suitable UCB (i.e., containing total nucleated cell count ≥2x107/kg with three or less mismatch among HLA-A, -B, and -DR) will be selected. This criterion was selected upon the rationale that even though minimal HLA mismatch is preferred, prior studies indicate significant effects of UCB therapy for patients with 3 HLA mismatches.
Sponsors
Bundang CHA Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Patients diagnosed with cerebral palsy volunteered for participation in this study.
Eligibility
Sex/Gender
ALL
Age
10 Months to 20 Years
Healthy volunteers
No
Inclusion criteria
1. Diagnosed with cerebral palsy 2. Age of ≥10 months and ≤20 years 3. Mismatch in HLA-A, B, and DR ≤3, and total nucleated cell count ≥2x107/kg. If the cell count is less than given values, more than 2 units may be used. 4. Voluntary decision to participation in the study with informed consent agreed and obtained from the subject's representative. 5. Patient and/or representatives are both willing and capable of being hospitalized according to the schedule specified in the protocol and continue the study for 12 months after study entry. 6. If the patient has participated in another clinical trial, at least 3 months should have passed since end of the study.
Exclusion criteria
1. Current aspiration pneumonia 2. Known genetic disease 3. History of hypersensitivity reaction to any study drugs pertinent to the study 4. Patient with severe convulsion disease who has clinical convulsion despite combination therapy with 3 or more agents 5. Uncontrolled hypertension defined as systolic blood pressure \>115 mmHg and/or diastolic blood pressure \>70 mmHg 6. Hepatic impairment defined as asparate aminotransferase (AST) \>55 IU/L and/or alanine aminotrasferase (ALT) \>45 IU/L 7. Renal impairment defined as creatinine (Cr) ≥1.3 mg/dL 8. Presence of diagnosed or suspected malignant tumor and/or hematologic malignancy 9. Non-compliance with study visits specified in the protocol or poor compliance of care-giver. 10. Any factors not specified above that the principal investigator determines medically inadequate for participation in this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of GMFM | Baseline before UCB administration, months 3, 6, and 12 after UCB treatment | Gross motor function measure measured at baseline before UCB administration is compared to the score measured at months 3, 6, and 12 after UCB treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change of mRNA assay | Change between the baseline level before UCB therapy and levels after UCB administration at 2 days, 1 week, 5 weeks, and 12 months | Separate peripheral blood mononuclear cell (PBMC) from the patients' blood sample and screen for changes in protein enzymes including those related to DUB at the mRNA level after UCB therapy. |
| Change of GMPM | Baseline before UCB administration, months 3, 6, and 12 after UCB treatment | Dissociated Movement, Coordination, Alignment, Weight shift, and Stability are rated with GMPM (Gross Motor Performance Measure). Each raw score (1-5 point) and converted percent scores are evaluated. Total score is 100(%), higher scores indicate better function. GMPM measured at baseline before UCB administration is compared to the score measured at months 3, 6, and 12 after UCB treatment. |
Countries
South Korea
Outcome results
None listed