Patient case: 47-year-old male with melanoma; genetic feature: APC loss of function

Clinical trial: Effectiveness and Safety of Adipose-Derived Regenerative Cells for Treatment of Erectile Dysfunction

Summary: Autologous adipose-derived regenerative cells (ADRC) extracted using Celution 800/CRS System (Cytori Therapeutics Inc) from a portion of the fat harvested from the patient's front abdominal wall. ADRC will be administered one-time intracavernosally. This is a single arm study with no control. All patients receive cell therapy.

Detailed description: Fat tissue obtainment:
  Subjects will undergo liposuction under local anesthesia. In this procedure, Ringer's solution with the anesthetic lidocaine and vasoconstrictor adrenaline infused into the adipose compartment to minimize blood loss and contamination of the tissue by peripheral blood cells. 15 minutes later a hollow blunt-tipped 3 mm cannula introduced into the subcutaneous space through small (0.5 cm) incision. The cannula attached to syringe and under gentle suction moved through the adipose compartment, mechanically disrupting the fat tissue. Aspirate volume - approximately 150-200 cc. Procedure time - 30 minutes.
  ADRC isolation:
  Aspirated fat tissue placed into sterile vessel which inserted into Celution 800/CRS System (Cytori Therapeutics Inc) - closed system for automated and standardized extraction and concentration of ADRC. Celution 800/CRS System drains excess of fluid from fat tissue and estimate it's volume After that lipoaspirate washed extensively with equal volumes of Ringer's solution to remove blood. At the end of this process System indicates required volume of enzyme reagent (Celase®) which should be added immediately by operator. After enzyme treatment Celution 800/CRS System automatically transfers isolated ADRC into washing compartment where ADRC washed and concentrated in 5 mL suspension. Tissue processing time - approximately 60 minutes. ADRC suspension match all requirements listed in technical documentation for Celution 800/CRS System. Obtained ADRC divided into 2 portions. First portion (0.2-0.5 mL) used for counting, viability and sterility assessment. Second portion placed into sterile insulin syringes with needle size 30 G for injection.
  Intracavernosal injection of ADRC:
  Tourniquet applied immediately prior to injection at the base of the penis. Penis and surrounding skin treated with antiseptic solution. The injection performed on lateral surface of penis bilaterally proximally into the middle and distal parts of corpus cavernosum. Needle is inserted into the corpus cavernosum at the depth of 5-7 mm. Up to 1.0 ml of ADRC suspension injected per single injection. Equal portions of ADRC suspension injected into both corpora cavernosa. Tourniquet removed 20 minutes after ADRC injection.

Eligibility: Inclusion Criteria:
  -  Patient suffers from erectile dysfunction
  -  IIEF-5 score less than 21
  -  Endothelial dysfunction confirmed by EndoPAT measurements
  -  Patient is familiar with Participant information sheet
  -  Patient signed informed consent form
  Non-inclusion Criteria:
  -  Contraindications to the local anesthesia or medical history of allergic reactions to local anesthetics
  -  Patient prescribed for systemic corticosteroids, immunosuppressive drugs, nonsteroidal antiinflammatory drugs, phosphodiesterase-5 inhibitors
  -  Medical history of penile prosthesis implantation
  -  Peyronie's disease
  -  Subcompensated or decompensated forms of chronic diseases of internal organs
  -  Clinically significant abnormalities in results of laboratory tests
  -  Any conditions limiting compliance (dementia, neuropsychiatric disease, drug and alcohol abuse etc.)
  -  Participation in other clinical trials (or administration of investigational drugs) during 3 months prior inclusion
  -  Patients with malignant tumors including postoperative period, patients receiving chemotherapy and/or radiotherapy.
  -  Patient's activated partial thromboplastin time exceeds normal levels more than 1,8 times
  -  Patients prescribed for anticoagulants treatment or patient received anticoagulants at least one hour prior liposuction
  -  Medical history of heterotopic ossifications
  -  Patients prescribed for glycoprotein inhibitors treatment
  -  Patients with infections or septic condition
  Exclusion Criteria:
  -  Patient's refusal from the further participation in trial
  -  Chronic kidney disease IV- V stages (creatinine clearance < 30 mL/min estimated by Cockcroft-Gault formula)
  -  Confirmed syphilis, HIV, hepatitis B or C infections
  -  Patients with hypogonadism
  Dropout Criteria:
  -  Direct indications on immediate initiation of treatment with drugs that have proven effect on erectile function

Relevance to patient case: not relevant