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Respiratory Distress Syndrome, AdultPhase 2STARTNCT02097641

Human Mesenchymal Stromal Cells For Acute Respiratory Distress Syndrome (START)

A Phase 2 study testing Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells and Plasma-Lyte A in people with Respiratory Distress Syndrome, Adult, run by Michael A. Matthay at 6 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This was a Phase 2a, randomized, double-blind, placebo-controlled, multi-center trial to assess the safety and efficacy of a single dose of Allogeneic Bone Marrow-derived Human Mesenchymal Stromal Cells (hMSCs) infusion in patients with Acute Respiratory Distress Syndrome (ARDS). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Respiratory Distress Syndrome, Adult
What is being tested?
Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells and Plasma-Lyte A
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
6 sitesUnited States
Study dates
15 Mar 2014to 9 Feb 2018
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients will be eligible for inclusion if they meet all of the below criteria. Criteria 1-3 must all be present within a 24-hour time period and at the time of enrollment:
  • Acute onset (defined below) of:
  • A need for positive pressure ventilation by an endotracheal or tracheal tube with a PaO2/FiO2 ratio < 200 with at least 8 cm H2O positive end-expiratory airway pressure (PEEP)
  • Bilateral infiltrates consistent with pulmonary edema on frontal chest radiograph
  • No clinical evidence of left atrial hypertension for bilateral pulmonary infiltrates.

Who cannot join

  • Age less than 18 years
  • Greater than 96 hours since first meeting ARDS criteria per the Berlin definition of ARDS
  • Pregnant or breast-feeding
  • Prisoner
  • Presence of any active malignancy (other than non-melanoma skin cancer) that required treatment within the last 2 years
  • Any other irreversible disease or condition for which 6-month mortality is estimated to be greater than 50%
Show all 18Show fewer
  • Moderate to severe liver failure (Childs-Pugh Score > 12)
  • Severe chronic respiratory disease with a PaCO2 > 50 mm Hg or the use of home oxygen
  • Patient, surrogate, or physician not committed to full support (exception: a patient will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest)
  • Major trauma in the prior 5 days
  • Lung transplant patient
  • No consent/inability to obtain consent
  • Moribund patient not expected to survive 24 hours
  • World Health Organization (WHO) Class III or IV pulmonary hypertension
  • Documented deep venous thrombosis or pulmonary embolism within past 3 months
  • No arterial line/no intent to place an arterial line
  • No intent/unwillingness to follow lung protective ventilation strategy or fluid management protocol
  • Currently receiving extracorporeal life support (ECLS) or high-frequency oscillatory ventilation (HFOV)

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

United States6 sites
  • Massachusetts General Hospital

    Boston, Massachusetts, 02114

  • Ohio State University

    Columbus, Ohio, 43210

  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15213

  • University of Minnesota Medical Center

    Saint Paul, Minnesota, 55108

  • University of California San Francisco

    San Francisco, California, 94143

  • Stanford University

    Stanford, California, 94305

Other trials in United States

About this study

Official title: Prospective, Randomized, Multi-center Phase 2 Clinical Trial of Allogeneic Bone Marrow-derived Human Mesenchymal Stromal Cells (hMSCs) for the Treatment of Acute Respiratory Distress Syndrome (ARDS)

This was a Phase 2a, randomized, double-blind, placebo-controlled, multi-center trial to assess the safety and efficacy of a single dose of Allogeneic Bone Marrow-derived Human Mesenchymal Stromal Cells (hMSCs) infusion in patients with Acute Respiratory Distress Syndrome (ARDS).

Read the detailed description

We carried out a randomized, double-blind placebo-controlled trial of allogeneic bone marrow derived human mesenchymal stromal cells for treatment of moderate to severe ARDS in 60 patients, 40 MSC and 20 placebo, in a 2:1 randomization. This trial is the extension of the Phase 1 pilot trial (NCT01775774). Patients were followed daily for adverse events through day 28, death or hospital discharge, whichever occurs first. Vital status was collected at 6 and 12 months after study enrollment.

Being tested
Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells, Plasma-Lyte A
Keywords
Allogeneic Bone Marrow-derived Human Mesenchymal Stromal Cells, Acute Respiratory Distress Syndrome
Medical subject headings
Respiratory Distress Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal CellsBiological

    Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells was administered intravenously over approximately 60-80 minutes.

  • Plasma-Lyte ABiological

    Plasma-Lyte A placebo was administered intravenously over approximately 60-80 minutes.

Study groups in NCT02097641
Study groupRoleWhat they receive
Human Mesenchymal Stromal Cells (hMSCs)ExperimentalA single dose of 10 million cells/kg PBW (predicted body weight) Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells was administered intravenously over approximately 60-80 minutes.
Receives: Biological: Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells
Plasma-Lyte A (placebo)Placebo comparatorA single dose of Plasma-Lyte A was administered intravenously over approximately 60-80 minutes.
Receives: Biological: Plasma-Lyte A

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Numbers of Patients Occurred Pre-specified Infusion Associated Events Occurring Within 6 Hours of Study Infusion

    Within 6 h of study product infusion:

    • Increase in vasopressor dose to the following values or higher:
    • Norepinephrine 10 μg/min
    • Phenylephrine 100 μg/min
    • Dopamine 10 μg/kg per min
    • Epinephrine 0.1 μg/kg per min or addition of a third vasopressor
    • New ventricular tachycardia, ventricular fibrillation or asystole
    • New cardiac arrhythmia requiring cardioversion
    • Hypoxaemia requiring an increase in FiO2 of 0·2 or more and an increase in PEEP of 5·0 or more to maintain SpO2 in the target range of 88-95%
    • Clinical scenario consistent with transfusion incompatibility or transfusion-related infection (eg, urticaria, new bronchospasm)

    Measured: 6 hours

  2. Numbers of Patients Occurred Any Cardiac Arrest or Death Within 24 Hours of Study Infusion

    Within 24 h of study product infusion

    • Any cardiac arrest or death

    Measured: 24 hours

  3. Numbers of Patients Occurred Any Unexpected Severe Adverse Events (Including All-cause Deaths)

    Safety endpoint: Any unexpected severe adverse events in two groups

    Measured: 12 months

Secondary outcomes (16)
  1. PaO2:FiO2 Change From Baseline to Day 3

    Efficacy endpoint: PaO2:FiO2 change from baseline to day 3

    Measured: baseline and day 3

  2. Lung Injury Score From Baseline to Day 3

    Murray score for acute lung injury. The range is 0 to 4. The higher score, the worst outcome.

    Measured: baseline and day 3

  3. Oxygenation Index Change From Baseline to Day 2

    Oxygenation index with the following validated measure of respiratory function: FiO2 (%) x mean airway pressure / PaO2

    Measured: baseline and day 2

  4. SOFA Score Change From Baseline to Day 3

    Sequential organ failure assessment score (SOFA). The SOFA score ranges from 0 to 24. The higher, the worse.

    Measured: baseline and day 3

  5. Number of Patients Death to Day 28

    Efficacy endpoint: all-cause mortality at day 28

    Measured: 28 days

  6. Mortality to Day 60

    Efficacy endpoint: all-cause mortality at day 60

    Measured: 60 days

  7. Number of Ventilator-free Days to Day 28

    Efficacy endpoint: Number of ventilator-free days to day 28.

    Measured: 28 days

  8. Non-pulmonary Organ-failure-free Days to Day 28

    Efficacy endpoint: Non-pulmonary organ-failure-free days to day 28

    Measured: 28 days

  9. Angiopoietin 2 Change From Baseline to 6 h

    Biological markers of endothelial injury: angiopoietin 2

    Measured: baseline and 6 hours

  10. Angiopoietin 2 Change From Baseline to 24 h

    Biological markers of endothelial injury: angiopoietin 2

    Measured: baseline and 24 hours

  11. Interleukin 6 Change From Baseline to 6 h

    Biological markers of inflammation: interleukin 6

    Measured: baseline and 6 hours

  12. Interleukin 6 Change From Baseline to 24 h

    Biological markers of inflammation: interleukin 6

    Measured: baseline and 24 hours

  13. Interleukin 8 Change From Baseline to 6 h

    Biological markers of inflammation: interleukin 8

    Measured: baseline and 6 hours

  14. Interleukin 8 Change From Baseline to 24 h

    Biological markers of inflammation: interleukin 8

    Measured: baseline and 24 hours

  15. RAGE Change From Baseline to 6 h

    Biological markers of alveolar epithelial injury: receptor for advanced glycation end products (RAGE)

    Measured: baseline and 6 hours

  16. RAGE Change From Baseline to 24 h

    Biological markers of alveolar epithelial injury: receptor for advanced glycation end products (RAGE)

    Measured: baseline and 24 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Mar 2014 (estimated)
  2. Study start15 Mar 2014
  3. Primary completion9 Mar 2017
  4. Study completion9 Feb 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02097641
Sponsor's protocol ID
UCSF-hMSC-ARDS-P2
Other IDs
1U01HL108713-01
Acronym
START
Status last verified
Mar 2019
First submitted
19 Mar 2014
Last updated
10 Apr 2019
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Matthay MA, Calfee CS, Zhuo H, Thompson BT, Wilson JG, Levitt JE, Rogers AJ, Gotts JE, Wiener-Kronish JP, Bajwa EK, Donahoe MP, McVerry BJ, Ortiz LA, Exline M, Christman JW, Abbott J, Delucchi KL, Caballero L, McMillan M, McKenna DH, Liu KD. Treatment with allogeneic mesenchymal stromal cells for moderate to severe acute respiratory distress syndrome (START study): a randomised phase 2a safety trial. Lancet Respir Med. 2019 Feb;7(2):154-162. doi: 10.1016/S2213-2600(18)30418-1. Epub 2018 Nov 16.

    PubMed 30455077
  • Wick KD, Leligdowicz A, Zhuo H, Ware LB, Matthay MA. Mesenchymal stromal cells reduce evidence of lung injury in patients with ARDS. JCI Insight. 2021 Jun 22;6(12):e148983. doi: 10.1172/jci.insight.148983.

    PubMed 33974564
  • Liu KD, Wilson JG, Zhuo H, Caballero L, McMillan ML, Fang X, Cosgrove K, Calfee CS, Lee JW, Kangelaris KN, Gotts JE, Rogers AJ, Levitt JE, Wiener-Kronish JP, Delucchi KL, Leavitt AD, McKenna DH, Thompson BT, Matthay MA. Design and implementation of the START (STem cells for ARDS Treatment) trial, a phase 1/2 trial of human mesenchymal stem/stromal cells for the treatment of moderate-severe acute respiratory distress syndrome. Ann Intensive Care. 2014 Jul 3;4:22. doi: 10.1186/s13613-014-0022-z. eCollection 2014.

    PubMed 25593740
  • Asmussen S, Ito H, Traber DL, Lee JW, Cox RA, Hawkins HK, McAuley DF, McKenna DH, Traber LD, Zhuo H, Wilson J, Herndon DN, Prough DS, Liu KD, Matthay MA, Enkhbaatar P. Human mesenchymal stem cells reduce the severity of acute lung injury in a sheep model of bacterial pneumonia. Thorax. 2014 Sep;69(9):819-25. doi: 10.1136/thoraxjnl-2013-204980. Epub 2014 Jun 2.

    PubMed 24891325

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Allogeneic Bone Marrow-Derived Human Mesenchymal Stromal Cells and Plasma-Lyte A in people with Respiratory Distress Syndrome, Adult, run by Michael A. Matthay at 6 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 18 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Apr 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Apr 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Numbers of Patients Occurred Pre-specified Infusion Associated Events Occurring Within 6 Hours of Study Infusion (time frame: 6 hours). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02097641, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Apr 2019.

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