Allocetra-OTS in COVID-19

Study Rationale

COVID-19, the name given to the clinical syndrome associated with the newly recognized virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become pandemic with a mortality estimated based on reports from China between 1-3% and complications among hospitalized patients leading to up to 15-25% admissions to the Intensive Care Unit (ICU). The clinical presentation includes both upper and lower respiratory tract infection, but patients may also be asymptomatic.

The term "cytokine storm" calls up vivid images of an immune system gone awry and an inflammatory response flaring out of control. The term has captured the attention of the public and the scientific community alike and is increasingly being used in both the popular media and the scientific literature. Indeed, a few publications have indicated an important part of the complications in COVID-19 are related to a cytokine storm.

In that regard, the investigators have recently completed a successful phase 1b clinical trial of immune-modulation in patients with sepsis (NCT03925857).

Taken together, in patients with moderate to severe COVID-19, there may be a comparable underlying immunological mechanism of action that may be similar to the one that was recently shown by us in sepsis, which is a hyper-inflammatory pathway associated with increased death. 40 previous trials using monoclonal antibodies against a single cytokine in septic patients have failed in sepsis pointing out that there is a need to modify the cytokine storm rather than treating with a single anti-cytokine.

This solution is provided by Allocetra-OTS, which targets macrophages and dendritic cells that produce most of the cytokine storm.

Study Design This is a multi-center, open-label study evaluating the safety of Allocetra-OTS, in five subjects with severe COVID-19 and respiratory dysfunction. Subjects, who will be identified as suffering from COVID-19, will be recruited.

After signing an informed consent by the patient and, within 24+6 hours following the time of eligibility (time 0), on Day 1, eligible recipient subjects will receive single intravenous (IV) administration of investigational product as described below:

● Allocetra-OTS treatment at 140 x 106 ±20% cells/kg body weight (screening body weight) in 375 mL of Ringer's lactate solution.

Subjects will be followed for efficacy and safety assessments over 28 days following investigational product administration.

Subjects will be hospitalized for COVID-19, and later as medically indicated. Following IP administration (Day 1), subjects will be followed for efficacy and safety assessments through 28 days. The number of visits for subjects participating in this study will be on Days 3, 5, 7, 14, and 28.

Study Intervention, Route of Administration, and Dosage Form Allocetra-OTS is a cell-based therapeutic composed of donor early apoptotic cells.

Patient Classification [National Institutes of Health (NIH)]- www.covid19treatmentguidelines.nih.gov/overview/management-of-covid-19/

In general, adults with COVID-19 can be grouped into the following severity of illness categories:

• Asymptomatic or Pre-symptomatic Infection: Individuals who test positive for SARS-CoV-2 by virologic testing using a molecular diagnostic (e.g., polymerase chain reaction) or antigen test, but have no symptoms.
• Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.
• Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment or imaging and saturation of oxygen (SpO2) ≥94% on room air at sea level.
• Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%
• Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

Standard of Care (SOC) The SOC for COVID-19 will be according to institutional standards. Institutional SOC may include Clexane, anti-viral agents such as Remdesivir, Dexamethasone, or other agents.

Concomitant Medications Prohibited medications: Significant immune-suppressing agents including Azathioprine, Cyclosporine, Cyclophosphamide, and any biological treatment.

Concomitant Medical Conditions Apart from patients with a tumor or end-stage organ condition, chronic diseases like cardiovascular or diabetes are allowed.