Mechanisms of Interferon Gamma-primed Mesenchymal Stromal Cells (MSCs) for Moderate-to-severe Persistent Asthma

This study is a two strata, dose escalation Phase I clinical trial designed to assess the safety and determine the maximal tolerated dose (MTD) of allogenic cord tissue derived MSCs (cMSCs, stratum 1) and allogeneic, interferon-γ primed bone marrow MSCs (γMSCs, stratum 2). Each stratum is designed to independently accrue 3 children at a dose level 1 of 2x106 cells/kg and 6 children at dose level 2 of 10x106 cells/kg, resulting in 9 children in each stratum. The primary objectives are to determine the safety and toxicity of allogeneic cord tissue derived MSCs and allogeneic interferon-γ primed bone marrow derived MSCs.

Asthma affects one out of every 10 patients in the United States. Many of these patients have poor asthma symptom control. For example, patients with moderate-to-severe persistent asthma have ongoing symptoms and airway inflammation despite aggressive treatment with asthma medications. These patients are at increased risk for medication-related side effects and potentially life-threatening exacerbations. Novel therapies are critically needed for this population.

Mesenchymal stem cells (MSCs) are cells that reside in the bone marrow. MSCs are anti-inflammatory and also promote body tissue repair. This study will determine whether one form of MSCs called "interferon gamma-primed MSCs or γMSCs" are safe for patients with moderate-to-severe asthma.

Patients will receive a single intravenous infusion of γMSCs at either 2x10\^6 cells/kg or 5x10\^6 cells/kg. Up to 12 young adults will be enrolled. The total sample size will not exceed 24 participants.

The study will take place at Children's Healthcare of Atlanta (for patient activities) and at Emory University (for laboratory research activities). Participants will be identified from the asthma clinics at Children's Healthcare of Atlanta. Participants will complete up to 12 visits over 1 year and will be compensated for their time and travel. At the completion of the study, any samples remaining after experimentation will be de-identified and made available for future research.

While some study participants may receive no direct benefit from participating in this study, others may benefit from the close monitoring of their respiratory health, specialized asthma education, and general evaluation of their condition, including lung function tests. Some participants also achieve psychological benefit from participating in an important research study and from interaction with the study staff. It is also possible that the knowledge obtained from this study, such as identification of biomarkers, may assist in the creation of novel asthma therapies in the future.

Eligibility Criteria:
Inclusion Criteria:

* Age 18 through 30 years at the screening visit
* Physician diagnosis of asthma
* Onset of asthma during childhood
* Evidence of atopy, evidenced by allergic rhinitis, aeroallergen sensitization, elevated total immunoglobulin E (IgE) level based on age-dependent reference values, or blood eosinophil counts \> or = 150 cells/microliter
* Moderate-to-severe persistent asthma as defined by the National Asthma Education and Prevention Program Expert Panel Report-4

Exclusion criteria at the screening visit include any of the following (\*may be re-enrolled):

* A Panel Reactive Antibodies (PRA) test is positive for human leukocyte antigens (HLA) antibodies against the γMSC product
* Oral or injectable corticosteroid use within the two-week period prior to the screening visit.\* Nasal corticosteroids may be used at any time during this trial at the discretion of the study's Medical Principal Investigator.
* Use of medications known to significantly interact with corticosteroid disposition within the two-week period prior to the screening visit, including but not limited to carbamazepine, erythromycin or other macrolide antibiotics, phenobarbital, phenytoin, rifampin, and ketoconazole\*
* Presence of chronic or active lung disease other than asthma, including disorders of the airways or chest wall
* Current smoking or vaping
* History of premature birth before 35 weeks gestation
* Significant medical illness other than asthma, including thyroid disease, diabetes mellitus, sickle cell disease, Cushing's disease, Addison's disease, hepatic disease, immune deficiency, or concurrent medical problems that could require oral corticosteroids during the study or that would place the subject at increased risk of participating in the study
* A history of cataracts, glaucoma, or any other medical disorder associated with an adverse effect to corticosteroids
* History of adverse reactions to corticosteroids or short-acting bronchodilators or any of their ingredients
* Receiving allergen immunotherapy other than an established maintenance regimen (continuous regimen for ≥ 3 months)\*
* Pregnancy or lactation
* If the participant is a female, failure to practice abstinence or use of an acceptable birth control method
* Inability to perform study procedures
* Current participation in another investigational drug trial
* Evidence that the participant may be unreliable or nonadherent, or may move from the clinical center area before trial completion

Exclusion criteria at the randomization/infusion visit include any of the following:

* Clinically significant deterioration in the level of asthma control, evidenced by:

  * Decrease in post-bronchodilator forced expiratory volume in one second (FEV1) of 15% (absolute change) compared to the post-bronchodilator FEV1 value obtained at the baseline visit, or
  * An asthma exacerbation
* Clinically significant thrombocytopenia, anemia, neutropenia or elevations in the white blood cell count, assessed at the screening visit
* Positive pregnancy test

The investigators will also ask participants to refrain from receiving new asthma therapies such as biologics until the final safety determination is made 7 days after the γMSC infusion (at study Day 14). They will also ask participants to refrain from participating in other interventional drug studies for the duration of their participation.