PMID- 36788520 OWN - NLM STAT- MEDLINE DCOM- 20230216 LR - 20240410 IS - 1479-5876 (Electronic) IS - 1479-5876 (Linking) VI - 21 IP - 1 DP - 2023 Feb 14 TI - Safety and efficacy of first-in-man intrathecal injection of human astrocytes (AstroRx(R)) in ALS patients: phase I/IIa clinical trial results. PG - 122 LID - 10.1186/s12967-023-03903-3 [doi] LID - 122 AB - BACKGROUND: Malfunction of astrocytes is implicated as one of the pathological factors of ALS. Thus, intrathecal injection of healthy astrocytes in ALS can potentially compensate for the diseased astrocytes. AstroRx(R) is an allogeneic cell-based product, composed of healthy and functional human astrocytes derived from embryonic stem cells. AstroRx(R) was shown to clear excessive glutamate, reduce oxidative stress, secrete various neuroprotective factors, and act as an immunomodulator. Intrathecal injection of AstroRx(R) to animal models of ALS slowed disease progression and extended survival. Here we report the result of a first-in-human clinical study evaluating intrathecal injection of AstroRx(R) in ALS patients. METHODS: We conducted a phase I/IIa, open-label, dose-escalating clinical trial to evaluate the safety, tolerability, and therapeutic effects of intrathecal injection of AstroRx(R) in patients with ALS. Five patients were injected intrathecally with a single dose of 100 x 10(6) AstroRx(R) cells and 5 patients with 250 x 10(6) cells (low and high dose, respectively). Safety and efficacy assessments were recorded for 3 months pre-treatment (run-in period) and 12 months post-treatment (follow-up period). RESULTS: A single administration of AstroRx(R) at either low or high doses was safe and well tolerated. No adverse events (AEs) related to AstroRx(R) itself were reported. Transient AEs related to the Intrathecal (IT) procedure were all mild to moderate. The study demonstrated a clinically meaningful effect that was maintained over the first 3 months after treatment, as measured by the pre-post slope change in ALSFRS-R. In the 100 x 10(6) AstroRx(R) arm, the ALSFRS-R rate of deterioration was attenuated from - 0.88/month pre-treatment to - 0.30/month in the first 3 months post-treatment (p = 0.039). In the 250 x 10(6) AstroRx(R) arm, the ALSFRS-R slope decreased from - 1.43/month to - 0.78/month (p = 0.0023). The effect was even more profound in a rapid progressor subgroup of 5 patients. No statistically significant change was measured in muscle strength using hand-held dynamometry and slow vital capacity continued to deteriorate during the study. CONCLUSIONS: Overall, these findings suggest that a single IT administration of AstroRx(R) to ALS patients at a dose of 100 x 10(6) or 250 x 10(6) cells is safe. A signal of beneficial clinical effect was observed for the first 3 months following cell injection. These results support further investigation of repeated intrathecal administrations of AstroRx(R), e.g., every 3 months. TRIAL REGISTRATION: NCT03482050. CI - (c) 2023. The Author(s). FAU - Gotkine, Marc AU - Gotkine M AD - Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. FAU - Caraco, Yoseph AU - Caraco Y AD - Hadassah Clinical Research Center (HCRC), Hadassah-Hebrew University Medical Center, Jerusalem, Israel. FAU - Lerner, Yossef AU - Lerner Y AD - Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. FAU - Blotnick, Simcha AU - Blotnick S AD - Hadassah Clinical Research Center (HCRC), Hadassah-Hebrew University Medical Center, Jerusalem, Israel. FAU - Wanounou, Maor AU - Wanounou M AD - Hadassah Clinical Research Center (HCRC), Hadassah-Hebrew University Medical Center, Jerusalem, Israel. FAU - Slutsky, Shalom Guy AU - Slutsky SG AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Chebath, Judith AU - Chebath J AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Kuperstein, Graciela AU - Kuperstein G AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Estrin, Elena AU - Estrin E AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Ben-Hur, Tamir AU - Ben-Hur T AD - Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. FAU - Hasson, Arik AU - Hasson A AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Molakandov, Kfir AU - Molakandov K AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Sonnenfeld, Tehila AU - Sonnenfeld T AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Stark, Yafit AU - Stark Y AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Revel, Ariel AU - Revel A AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. FAU - Revel, Michel AU - Revel M AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. AD - Department of Molecular Genetics, Weizmann Institute of Science, 76100, Rehovot, Israel. FAU - Izrael, Michal AU - Izrael M AUID- ORCID: 0000-0002-2937-9961 AD - Neurodegenerative Diseases Department, Kadimastem Ltd, Pinchas Sapir 7, Weizmann Science Park, Ness-Ziona, Israel. M.izrael@kadimastem.com. LA - eng SI - ClinicalTrials.gov/NCT03482050 PT - Clinical Trial, Phase I PT - Clinical Trial, Phase II PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230214 PL - England TA - J Transl Med JT - Journal of translational medicine JID - 101190741 SB - IM MH - Humans MH - *Amyotrophic Lateral Sclerosis/therapy MH - Astrocytes MH - Injections, Spinal MH - *Mesenchymal Stem Cell Transplantation/methods PMC - PMC9927047 OTO - NOTNLM OT - ALS OT - Astrocytes OT - Cell therapy OT - Clinical trial OT - Intrathecal injection COIS- The authors declare that they have no conflicts of interest. EDAT- 2023/02/16 06:00 MHDA- 2023/02/17 06:00 PMCR- 2023/02/14 CRDT- 2023/02/15 00:25 PHST- 2022/11/16 00:00 [received] PHST- 2023/01/18 00:00 [accepted] PHST- 2023/02/15 00:25 [entrez] PHST- 2023/02/16 06:00 [pubmed] PHST- 2023/02/17 06:00 [medline] PHST- 2023/02/14 00:00 [pmc-release] AID - 10.1186/s12967-023-03903-3 [pii] AID - 3903 [pii] AID - 10.1186/s12967-023-03903-3 [doi] PST - epublish SO - J Transl Med. 2023 Feb 14;21(1):122. doi: 10.1186/s12967-023-03903-3.