Augmentation Cystoplasty Using an Autologous Neo-Bladder Construct

Study Overview
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Brief Summary
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The purpose of this research study is to find out if autologous neo-bladder construct for the treatment of fibrotic and/or contracted bladder can improve bladder compliance and be safe long term. The neo-bladder is like a reservoir or pouch that will be surgically attached to the bladder to assist with urine collection.

Detailed Description
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This is a prospective, open-label, single-group clinical study. All subjects will have non-neurogenic, fibrotic contracted bladder that is refractory to medical treatment and require augmentation cystoplasty for preventing long-term sequelae (i.e., kidney failure) that result from persistently high intravesical pressure. Subjects will undergo an open full thickness bladder biopsy from which autologous urinary bladder smooth muscle and urothelial cells will be procured and expanded ex vivo. After approximately 5 - 7 weeks, expanded cells will be seeded on a biodegradable scaffold to produce the neo-bladder construct that will be surgically implanted onto an opened native bladder during an augmentation cystoplasty. Subjects will be followed for 36 months.

Official Title
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A Phase 2 Study of Augmentation Cystoplasty Using an Autologous Neo-Bladder Construct In Subjects With Fibrotic Contracted Bladder

Conditions
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Contracted Bladder

Intervention / Treatment
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* Biological: Neo-Bladder Construct


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects with small contracted and/or fibrotic non-neurogenic bladder. Small bladder <150cc capacity Willing and able to give signed informed consent in English. Ability of subject to be successfully trained in clean intermittent catheterization and bladder cycling Failure to respond to maximum approve dose of medical therapy (e.g. anticholinergics) or failure to tolerate /contraindication to such agents Medical need for bladder augmentation, as defined by the presence of: Decreased and inadequate bladder compliance with a bladder pressure ≥40 cmH20. OR New-onset of upper urinary tract changes (hydronephrosis, vesicoureteral reflux) in the last 12 months Exclusion: Neurogenic bladder Recent (< 12 months) urological or intraperitoneal surgery or device implantation; recent (<6 month neurologic surgery-brain or spine) Any prior bladder augmentation procedure Known or suspected limitation to obtaining omentum for implantation procedure (e.g., extensive intraperitoneal adhesions) Any contraindication to general anesthesia Any contraindication or known anaphylactic or severe systemic reaction to either human blood products or materials of bovine origin Human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV), active hepatitis A (HAV) or other known active infection Subjects with active tuberculosis (TB) requiring treatment in the past 3 years. Subjects with a current positive (≥5 mm induration for high-risk subjects; otherwise ≥10 mm of induration) purified protein derivative (PPD) test are excluded unless they have completed a full course of treatment for latent TB and have a negative chest x-ray film at enrollment. Subjects known to be colonized with either methicillin-resistant staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE), or gentamicin-resistant organisms. Receipt of blood or blood products for transfusion during the 3 months prior to biopsy Immunocompromised subjects or subjects receiving immunosuppressive agents (inhaled corticosteroids and chronic low-dose corticosteroids [≤0.25 mg/kg prednisone or equivalent per day] are permitted). Brief pulsed corticosteroids for intermittent symptoms (e.g., asthma) are permitted. Known history of hypersensitivity to aminoglycosides or fluoroquinolones. History of true allergy to iodine or iodinated x-ray contrast agents Use of any investigational product within 3 months Prior participation in the study Any history of alcohol and/or any drug abuse Current incarceration for any reason Unwillingness, inability, or unlikely compliance with study related procedures Any circumstance in which the investigator deems participation in the study is not in the subject's best interest Subjects with an Alanine Aminotransferase (ALT) or aspartate aminotransferase (AST) value >3 times the upper limit of normal Subjects with an albumin value <3.0 g/dL Subjects with a history of an anaphylactic or a severe systemic reaction to the biodegradable polymers glycolic acid (PGA) and lactic-co-glycolic acid (PLGA) Subjects with acute or chronic abdominal skin infections and/or acute or chronic inflammatory bowel disease Subjects with uncontrolled diabetes, unstable cardiac and/or pulmonary disorders, or bleeding disorders Subjects who have received Botulinum Toxin A injections into the bladder within the previous 12 months. Female subjects who are pregnant, planning to get pregnant or lactating/breast-feeding. Female subjects of child-bearing potential unwilling to practice an effective method of birth control as determined by the investigator (e.g., oral contraceptives, double barrier methods, hormonal injectable or implanted contraceptives, tubal ligation, or partner with vasectomy) for duration of the study. If a patient has had a hysterectomy, a bilateral oophorectomy, documented ovarian failure or is older than age 51.5 years and has not had a menstrual period in more than 12 months, they will be considered to be non-childbearing. This will be ascertained from patient interview/self-report, medical records (if necessary) and the investigator's judgment. Spontaneous menopause, occurs in the United States at a mean age of 51.5 years.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 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: Autologous Neo-Bladder Construct<br>All subjects enrolled will have non-neurogenic, fibrotic contracted bladder that is refractory to medical treatment and require augmentation cystoplasty for preventing long-term sequelae (i.e., kidney failure) that result from persistently high intravesical pressure. | Biological: Neo-Bladder Construct<br>* Subjects will undergo an open full thickness bladder biopsy from which autologous urinary bladder smooth muscle and urothelial cells will be procured and expanded ex vivo. After approximately 5 - 7 weeks, expanded cells will be seeded on a biodegradable scaffold to produce the neo-bladder construct that will be surgically implanted onto an opened native bladder during an augmentation cystoplasty.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bladder Compliance Average | Average bladder capacity as found on Urodynamics results | Month 12 | 
| Average Number of 24 Hour Voids | Per voiding diary | Month 6 | 
| Average Number of 24 Hour Voids | Per voiding diary | Month 9 | 
| Average Number of 24 Hour Voids | Per voiding diary | Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Bladder Capacity | Shown through urodynamics study | From Baseline through Month 12 | 
| End filling pressure | At age-related nomogram-derived bladder capacity | Baseline, Month 6, Month 9 and Month 12 | 
| Urogenital Distress Inventory-6 Question (UDI-6) | Evaluation of urogenital function from self-reported questionnaire. Score ranges from 0-18 with higher score denoting worsening in urogenital function. | Month 6, Month 9 and Month 12 | 
| Urogenital Distress Inventory-7 Question (UDI-7) | Evaluation of urogenital function from self-reported questionnaire. Score ranges from 0-21 with higher score denoting worsening in urogenital function. | Month 6, Month 9 and Month 12 | 
| Genitourinary Pain Index (GUPI) | Evaluation of pain from self-reported questionnaire. Score ranges from 0-45 with a higher score denoting worse symptoms. | Month 6, Month 9 and Month 12 | 
| Quality of Life (QOL) Questionnaire | Self-reported quality of life evaluation. Score ranges from 0-6 with highest score denoting the worst feelings about quality of life. | Month 6, Month 9 and Month 12 | 
| American Urological Association Symptom Score (AUASS) | Self-reported urological symptom assesment. Score ranges from 1-35 with score of 1-7 denoting mild symptoms, 8-19 denoting moderate symptoms and 20-35 denoting severe symptoms. | Month 6, Month 9 and Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neo-bladder, fibrotic bladder, bladder compliance