Effectiveness and Safety of Adipose-Derived Regenerative Cells for Treatment of Glaucomatous Neurodegeneration

Study Overview
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Brief Summary
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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 into subtenon space of patient's eyeball. This is a single arm study with no control. All patients receive cell therapy.

Detailed Description
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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 syringe for injection. Subtenon injection of ADRC: Antiseptic and anesthetic solutions instilled into conjunctival sac. After that blepharostat installed. The patient is asked to look in opposite to the injection side direction. Doctor inserts a needle into inferior temporal quadrant between rectus muscles,10-12 mm from the limbus. Needle should be moved slowly, as close as possible to the eyeball. After needle placement at the depth of 5-7 mm doctor injects concentrated solution of ADRC (up to 0,5 ml per single injection). Injection is made by insulin syringe with a needle size 0.45 mm * 12mm (26 G).

Official Title
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Effectiveness and Safety of Subtenon Administration of Autologous Adipose-Derived Regenerative Cells for Treatment of Glaucomatous Neurodegeneration

Conditions
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Retinal Degeneration, Primary Open-Angle Glaucoma

Intervention / Treatment
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* Other: Subtenon administration of autologous ADRC
* Procedure: Liposuction
* Device: ADRC isolation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient suffers from primary open-angle glaucoma (II and III stages; singe eye or both eyes) at least for 6 months Intraocular pressure is stable for at least for 3 months Visual acuity of each eye (measured by using visual acuity charts projector) not less than 0,1 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 Any anomalies or conditions of at least one eye which can limit tonometry implementation Inflammatory disease of at least one eye or auxiliary apparatus (both infectious and non-infectious etiology: conjunctivitis, keratitis, uveitis, dacryocystitis etc.) Medical history of surgery on at least one eye during preceding 6 months. Medical history of heavy traumatic injury of eyes Patient has a cataract with high degree of lens opacification which can limit planned eye examination Patient prescribed for systemic corticosteroids or other medications treatment with proven effect leading on intraocular pressure increase Medical history or present dry eye syndrome accompanied by corneal and conjunctival xerosis 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 lipoaspiration Medical history of heterotopic ossifications Patients prescribed for glycoprotein inhibitors treatment Acute vascular pathology Age-related macular degeneration Exclusion Criteria: Patient's refusal from the further participation in trial Patient's refusal from compliance with the requirements of contraception during the participation in research Chronic kidney disease IV- V stages (creatinine clearance < 30 mL/min estimated by Cockroft-Gault formula) Confirmed syphilis, HIV, hepatitis B or C infections Dropout Criteria: Direct indications on immediate initiation of treatment with medications with proven effect leading to intraocular pressure increase Pregnancy Development of cataract with high degree of lens opacification which can limit planned eye examination

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ADRC injection<br>Subjects will undergo liposuction under local anesthesia. Lipoaspirate will be processed to isolate and concentrate adipose-derived regenerative cells (ADRC). After ADRC isolation autologous cells suspension will be injected into subtenon space of patient's eye. | Other: Subtenon administration of autologous ADRC<br> <br> Procedure: Liposuction<br> <br> Device: ADRC isolation<br>* ADRC isolation performed using Celution 800/CRS System (Cytori Therapeutics Inc) according to manufacturer's protocol<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SAEs and SARs monitoring | Types, probability and severity of treatment emergent serious adverse events (SAEs) and serious adverse reactions (SARs) | 4 weeks after treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in visual acuty | Change from baseline in visual acuity assessed by visual acuty test | Follow up to completion (up to 48 weeks after treatment) | 
| Changes in structures of fundus of the eye-1 | Changes in structures of fundus of the eye assessed by funduscopy: changes of configuration and size of optic disc, neuroretinal rim thinning, degree of optic disc pallor, hemorrhages on the optic nerve and retina, vascular changes, presence of degenerative changes of retina, optic disc drusen, edema and retinal detachment. | Follow up to completion (up to 48 weeks after treatment) | 
| Changes in structures of fundus of the eye-2 | Changes in structures of fundus of the eye assessed by optical coherence tomography: changes of optic disc, neuroretinal rim and macula, retinal nerve fiber layer thickness. | Follow up to completion (up to 48 weeks after treatment) | 
| Change in visual field | Change from baseline in visual field assessed by computer perimetry | Follow up to completion (up to 48 weeks after treatment) | 
| Change in retinal flicker responce | Change from baseline in critical flicker fusion threshold | Follow up to completion (up to 48 weeks after treatment) | 
| Change in intraocular pressure | Change from baseline in intraocular pressure assessed by pneumotonometry and tonography | Follow up to completion (up to 48 weeks after treatment) | 
| Quality of life monitoring | Quality of life estimated by validated questionnaires: the Short Form (36) Health Survey (SF-36)., Visual Functioning-14 Quality of Life (VF-14 QOL) and Glaucoma Quality of Life-15 (GQL-15) | Follow up to completion (up to 48 weeks after treatment) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ADRC, Optic nerve atrophy, Glaucomatous Neurodegeneration, Retinal Degeneration, Primary Open-Angle Glaucoma, Optic Neuropathy, Intraocular pressure, Retinal ganglion cell degeneration, Subtenon injection, Glaucomatous damage, Adipose-derived regenerative cells, Fat tissue, Stem cells