Premature Ovarian Insufficiency
Conditions
Keywords
hUC-MSCs, POI, Premature Ovarian Insufficiency
Brief summary
A Phase I/IIa clinical study evaluating the safety, tolerability and efficacy of intravenously administered human umbilical cord mesenchymal stem cell (hUC-MSCs) injection in patients with premature ovarian insufficiency (POI). The primary objective of the Phase I dose-escalation stage is to assess the safety and tolerability of intravenous infusion of hUC-MSCs injection for the treatment of POI, and to determine the recommended phase II dose (RP2D) for the Phase IIa clinical trial. The primary objective of the Phase IIa dose-expansion stage is to evaluate the efficacy of intravenous infusion of hUC-MSCs injection in POI treatment, and to generate data to support pivotal/confirmatory clinical trials.
Detailed description
Premature ovarian insufficiency (POI) is defined as ovarian dysfunction occurring in women before the age of 40, which is mainly characterized by menstrual abnormalities (amenorrhea, oligomenorrhea or polymenorrhea), elevated gonadotropin levels (FSH \> 25 U/L), and fluctuating decline in estrogen levels. The incidence of POI is age-specific: 1 in 250 women develops POI before 35 years of age, and 1 in 100 women develops POI before 40 years of age. The incidence rate of POI in China is 2.8%, showing an upward trend year by year with a younger onset age. hormone replacement therapy (HRT) relieves symptoms caused by low estrogen through estrogen supplementation. Sequential estrogen-progestogen therapy is recommended for POI patients with an intact uterus. Since patients with POI require long-term HRT, natural or nearly natural estrogens and progestogens can be selected to minimize adverse effects on the mammary gland, metabolism, cardiovascular system and other systems. Nevertheless, HRT still increases the risks of breast cancer, heart disease and stroke. Studies have demonstrated that mesenchymal stem cells can home to ovarian stroma, regulate the balance of Th1/Th2 cytokines and the expression of endometrial natural killer cells, alleviate inflammatory responses, inhibit apoptosis of ovarian granulosa cells and reduce ovarian interstitial fibrosis, thereby improving the ovarian microenvironment. Meanwhile, these cells can secrete growth factors including VEGF, IGF-1 and HGF, promote proliferation of various ovarian cells and angiogenesis, repair ovarian structure and restore ovarian ovarian function. This study aims to evaluate the safety, tolerability and efficacy of intravenously administered hUC-MSCs in the treatment of patients with POI.
Interventions
DRUGhUC-MSCs Injection (Phase I)
hUC-MSCs Injection, administered via intravenous infusion as a single dose on D0.
DRUGhUC-MSCs Injection (Phase IIa)
hUC-MSCs Injection, 3 infusions in total, dosing interval ≥7 days.
DRUGPlacebo
3 infusions in total, dosing interval ≥7 days
Sponsors
Shenzhen Wingor Biotechnology Co., Ltd.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
Phase 1: This is an open-label, dose-escalation trial consisting of three sequential ascending-dose cohorts enrolling 3 subjects per cohort (total 9 subjects). Extra 3 subjects may be added to the highest-dose cohort to assess the maximum tolerated dose (MTD). Each subject receives one single intravenous infusion on Day 0. Phase IIa: This randomized, double-blind, placebo-controlled trial includes two active dose groups and one placebo group with a 2:1 randomization ratio of combined active arms to placebo. Each active group plans 20 subjects and the placebo group plans 10 subjects, all receiving three administrations of study treatment, with a total intended enrollment of 50 subjects.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
1. Aged 18 to 40 years at the time of signing the informed consent form (exclusive of the boundary values); 2. Meet the diagnostic criteria specified in the Expert Consensus on Clinical Diagnosis and Treatment of Premature Ovarian Insufficiency (2023 Edition): oligomenorrhea (menstrual cycle longer than 35 days) or amenorrhea for more than 4 months, with basal serum follicle-stimulating hormone (FSH) \> 25 U/L (tested on Days 2-4 of the menstrual cycle or during amenorrhea, at least twice with an interval of ≥4 weeks); 3. Satisfy one of the following two criteria: 1. Total number of antral follicles (AFC) with a diameter of 2-10 mm in bilateral ovaries \< 5; 2. Serum anti-Müllerian hormone (AMH) ≤ 7.85 pmol/L (equivalent to 1.1 ng/mL); 4. Have received standardized hormone replacement therapy (HRT) at a stable dose for ≥3 months prior to drug administration with stable hormone levels, and maintain stable HRT per medical advice throughout the trial (within 24 weeks after enrollment); 5. Have no fertility requirements; 6. Agree to use effective contraceptive measures throughout the trial period (such as complete abstinence, condoms, cervical caps plus spermicides, intrauterine devices, etc.); 7. Negative serum β-hCG test result during the screening period (to rule out pregnancy); 8. Fully understand the trial information and sign the informed consent form.
Exclusion criteria
1. Subjects with primary amenorrhea; 2. Subjects with thyroid disorders (hypothyroidism/hyperthyroidism or thyroid malignant tumors) or resistant ovary syndrome (ROS); 3. Subjects with abnormal female karyotypes (e.g., Turner syndrome, Fragile X syndrome); 4. Positive serology tests (HBV antibody, HCV antibody, HIV antibody, syphilis). Exceptions: HBV carriers, patients with stable HBV after drug treatment (HBV DNA titer ≤500 IU/mL or copies \<1000 copies/mL), and patients with cured HCV (negative HCV RNA test) may be enrolled if deemed eligible by the investigator; 5. Subjects receiving or planning to use the following medications during the trial: oral or systemic corticosteroids, danazol, anticoagulants, Chinese herbal medicines or botanical supplements that may affect hormone levels or ovarian function; 6. History of hypersensitivity to human serum albumin; 7. Pregnant or breastfeeding subjects; 8. Participation in another clinical trial within the past 3 months, or receipt of other cell therapies (excluding blood transfusion); 9. History of malignant tumors; 10. Subjects with contraindications or cautions for estrogen use, including known or suspected breast cancer, endometrial cancer, other known or suspected sex hormone-dependent malignancies, active venous or arterial thromboembolic diseases within the last 6 months, undiagnosed abnormal genital bleeding, severe hepatic or renal insufficiency \[serum aspartate aminotransferase (AST) \>3×ULN, serum alanine aminotransferase (ALT) \>3×ULN, estimated glomerular filtration rate (eGFR) \<60 mL/min\], etc.; 11. Uncontrolled diabetes, hypertension (\>150/100 mmHg), heart disease, etc.; 12. Any other conditions judged by the investigator to render the subject unsuitable for participation in this study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase I : Incidence and number of subjects with treatment-emergent adverse events and serious adverse events. | 48 weeks | In this Phase I stage, safety is the primary endpoint. Types, frequencies, severities and causal relationships of all adverse events (AEs) and serious adverse events (SAEs) occurring from the first administration of study drug to the end of safety follow-up (48 weeks), assessed in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 6.0; together with the proportion of adverse events judged by the investigator to be related to the study drug. |
| Phase II ：FSH | at Week 24 post-treatment | To evaluate the changes from baseline in serum follicle-stimulating hormone (FSH) levels at Week 24 post-treatment. |
| Phase II ：E2 | at Week 24 post-treatment | To evaluate the changes from baseline in serum festradiol (E2) levels at Week 24 post-treatment. |
| Phase II ：AMH | at Week 24 post-treatment | To evaluate the changes from baseline in serum anti-Müllerian hormone (AMH) levels at Week 24 post-treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Phase I: FSH | 48 weeks | To evaluate the changes from baseline in serum follicle-stimulating hormone (FSH) levels. |
| Phase I ：E2 | 48 weeks | To evaluate the changes from baseline in serum estradiol (E2) levels |
| Phase I : AMH | 48 weeks | To evaluate the changes from baseline in serum anti-Müllerian hormone (AMH) levels. |
| Phase II: Incidence and number of subjects with treatment-emergent adverse events and serious adverse events. | 48 weeks | In this Phase II stage, safety is the secondary endpoint. Types, frequencies, severities and causal relationships of all adverse events (AEs) and serious adverse events (SAEs) occurring from the first administration of study drug to the end of safety follow-up (48 weeks), assessed in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 6.0; together with the proportion of adverse events judged by the investigator to be related to the study drug. |
| Phase I/II: AFC | 48 weeks | Changes from baseline in antral follicle count (AFC) by transvaginal ultrasound. |
| Phase I/II: endometrial thickness | 48 weeks | Changes from baseline in endometrial thickness measured by transvaginal ultrasound. |
| Phase I/II: menstrual recovery status | 48 weeks | Menstrual recovery status will be assessed via patient inquiry at each visit. |
| Phase I/II:Modified Kupperman Index | 48 weeks | To evaluate the changes in the Modified Kupperman Index from baseline across all post-baseline follow-up visits. Modified Kupperman Index will be assessed through physician interview.The total score ranges from 0 to 63 points. Total score stratification: \>30 points indicates severe symptoms, 16-30 points moderate symptoms, 6-15 points mild symptoms, and \<6 points normal status. |
Countries
China
Contacts
CONTACTXiaohong Wang,MD
Outcome results
None listed