Clinical Safety Study of Human Embryonic Stem Cell Derived Mesenchymal Cells in the Treatment of Moderate and Severe Intrauterine Adhesions

Study Overview
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Brief Summary
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To observe the clinical safety of intrauterine injection of human embryonic stem cell derived mesenchymal cells in the treatment of moderate and severe intrauterine adhesion, and to preliminarily explore its clinical effectiveness in promoting endometrial regeneration and repair.

Detailed Description
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In this study, a single-center, controlled, open-label design was used for a dose escalation study.To observe the clinical safety of intrauterine injection of human embryonic stem cell derived mesenchymal cells in the treatment of moderate and severe intrauterine adhesion, and to preliminarily explore its clinical effectiveness in promoting endometrial regeneration and repair.

Official Title
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Clinical Safety Study of Human Embryonic Stem Cell Derived Mesenchymal Cells in the Treatment of Moderate and Severe Intrauterine Adhesions

Conditions
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Intrauterine Adhesion

Intervention / Treatment
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* Biological: Inject a solution of stem cell preparation
* Biological: Inject stem cells


Participation Criteria
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Eligibility Criteria
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Criteria: Inclusion Criteria: 18 ≤ age ≤38, female; According to the 1988 American Fertility Society (AFS) diagnostic criteria, patients with uterine adhesions diagnosed with full civil capacity and with a score of ≥5 were enrolled in the study; The patient had one or more of the following clinical symptoms: reduced menstruation or amenorrhea, periodic abdominal pain, secondary infertility, recurrent abortion, premature delivery and other adverse pregnancy outcomes; The uterus was smaller than 8 weeks gestation and the uterine cavity depth was less than 12 cm; The second to fifth day of menstruation FSH <10mIU/mL, AMH >1.2ng/mL, AFC>6; Understand and sign informed consent voluntarily. Exclusion Criteria: Patients with acute pelvic inflammation or endometriosis; Having or having a history of malignancy; Thrombus, lupus erythematosus and other hormone use contraindications; Allergic to albumin products; Patients with uterine malformation, adenomyosis, submucosal uterine fibroids,and uterine fibroids of any site >5cm; Patients who were using anticoagulants or who had not recovered normal platelet function 10 days after discontinuation of antiplatelet drugs; Previous history of abnormal coagulation function or abnormality before cell transplantation; Always has a history of abnormal bleeding (such as abnormal bleeding during tooth extraction), or their immediate family members have hemorrhagic disease,such as hemophilia, bleeding symptoms (e.g., hematemesis, black, serious or recurrent nasal bleeding, coughing up blood, obvious hematuria, gastrointestinal bleeding, or intracranial hemorrhage), or suspected of vascular malformation such as aneurysm by researchers determine influence cell implant operation; Alcohol or drug addiction; Participated in other interventional clinical trials within 90 days before the informed consent was signed or before the cell transplantation; Had used glucocorticoids or immunosuppressive drugs within 12 weeks before signing the informed consent; Had used antipsychotic drugs, such as antidepressants and anti-manic drugs, within 12 weeks before signing the informed consent; Severe heart failure within 24 weeks before the informed consent; Glomerular filtration rate (eGFR) <90ml/min; ALT>3 times normal upper limit; Concomitant with other serious systemic diseases, such as pulmonary heart disease, severe chronic obstructive pulmonary disease (COPD), etc; Patients with severe clinical infection should receive antibiotics within 1 week before signing the informed consent; Active infectious diseases, including but not limited to positive human immunodeficiency virus and syphilis antibody; The researchers considered poor compliance; Other conditions not suitable for participation in this clinical trial.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 38 Years

Sexes Eligible for Study
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Female

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
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stem cell preparation solution injection group<br>The solution of stem cells preparation will be injected. | Biological: Inject a solution of stem cell preparation<br>* The control group was injected with a solution of stem cell preparation<br>|
| Experimental: Injected stem cell group<br>The stem cells will injected. | Biological: Inject stem cells<br>* Three dose groups were designed: low dose group, medium dose group and high dose group.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of different Adverse Events of transplantation of mesenchymal cells from human embryonic stem cells | Adverse events (AE), severe adverse events (SAE), and treatment-related adverse events (TEAE) occurred within 48 weeks after surgery. | Within 48 weeks after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Normal recovery rate of endometrial thickness | Normal recovery rate of endometrial thickness at 1 and 2 months after surgery will be measured (effective rate = endometrium > 6mm after surgery/all participants ×100%). | 12 months | 
| recurrence rate of intrauterine adhesions | Recurrence rate of intrauterine adhesions (defined as patients with recurrence of intrauterine adhesions reviewed by hysteroscopy at 1 month/total patients ×100%) will be measured. | 12 months | 
| Intrauterine adhesions score | Intrauterine adhesions score will be measured according to the American Fertility Society in 1988 diagnostic criteria for intrauterine adhesions.The scores range from 1 to 12. Higher scores mean a worse outcome. | 12 months | 
| The endometrial biopsies for CD31 | Immunohistochemical results of CD31 during the two endometrial biopsies will be measured. | 12 months | 
| Menstrual volume change | Menstrual volume change will be assessed according to menstrual blood loss chart. | 12 months | 
| Clinical pregnancy rate | Clinical pregnancy rate, abortion rate, live birth rate, and sustained pregnancy rate (defined as live pregnancy over 12 weeks) will be assessed. | 12 months | 
| The endometrial biopsies for estrogen | Estrogen receptor levels during the two endometrial biopsies will be measured. | 12 months | 
| The endometrial biopsies for Ki67 | Ki67 expression levels during the two endometrial biopsies will be measured. | 12 months |