Clinical Study of Allogeneic Adipovarian Active Protein in the Treatment of Severe Idiopathic Pulmonary Fibrosis

Study Overview
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Brief Summary
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The goal of this clinical trail is to study the efficacy and safety of allogeneic adipocyclical active protein in the treatment of severe idiopathic pulmonary fibrosis. The main questions it aims to answer are: Efficacy of allogeneic adipromic active protein in the treatment of severe idiopathic pulmonary fibrosis Safety of allogeneic adipovularic active protein in the treatment of severe idiopathic pulmonary fibrosis. A total of 7 participants will be enrolled. Participants will be asked that they will receive 2ml of each nebulized inhalation Cell Free Fat Extract (CEFFE), inhaled every 3 days, for a total of 7 nebulized inhalation treatments. The clinical trial was designed using a single-center, self-controlled trial with no control group and no blinding.

Detailed Description
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Research purpose: Main Objective: To study the efficacy and safety of allogeneic adipocyclical active protein in the treatment of severe idiopathic pulmonary fibrosis, and the main observation and evaluation indicators include: clinical efficacy, clinical adverse events and laboratory abnormalities. The basis of the question: Animal experiments have found that Cell Free Fat Extract (CEFFE) has a certain improvement effect in bleomycin-induced mouse pulmonary fibrosis model. At present, domestic clinical studies have found that Cell Free Fat Extract (CEFFE) is safe for the treatment of human diseases without obvious side effects. Therefore, in this study, the Cell Free Fat Extract (CEFFE) was inhaled by nebulized inhalation for the treatment of severe idiopathic pulmonary fibrosis, and its efficacy and safety were observed. Research Design: Overall design: single-center, self-controlled trial design was adopted, no control group was established, and blinding was not used. Number of planned cases: 7. Indications: severe idiopathic pulmonary fibrosis. Clinical trails process: 3.1 Sign the informed consent form and collect relevant clinical data; For patients with a definitive diagnosis of severe idiopathic pulmonary fibrosis 3.2 Allogeneic Cell Free Fat Extract (CEFFE) treatment process: 3.2.1 Preparation of CEFFE of allogeneic origin: Healthy donors undergoing liposuction at the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, sign a written informed consent. By a healthy donor under local anesthesia, inject swelling fluid into the abdomen, operate with a 20mL syringe or mechanical negative pressure machine (auxiliary liposuction methods such as laser, ultrasound and microwave cannot be added), determine the group according to the order of enrollment, and extract fat according to the required dose, and the single liposuction amount should be 150ml -200ml. The collected adipose tissue was rinsed with normal saline, allowed to stand, and centrifuged in a centrifuge at 1200g for 3min. After centrifugation, excess water at the bottom is removed, collected in a sterile 50mL syringe, stored, and transferred. Preparation of adipose tissue active factors is performed in the laboratory and cryopreservation. Two 10mL syringes connected by tee tubes, mechanically emulsified 60 times, collected into 50mL centrifuge tubes, centrifuged at 2000g for 5min. After centrifugation, the bottom transparent liquid layer was collected and filtered through a 0.22um filter to obtain fat decellularization active protein, which was frozen in a -20 °C freezer. 3.2.2 Health Donor Selection Criteria: 3.2.2.1 Age 18-45, male or female 3.2.2.2 Liposuction at the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine 3.2.2.3 Sign the informed consent form for biological sample donation 3.2.3 Exclusion Criteria: 3.2.3.1 Patients with hepatitis B, hepatitis C, HIV, syphilis, cytomegalovirus, herpesvirus and other infections 3.2.3.2 Patients with severe hypertension, diabetes, heart disease and other chronic diseases 3.2.3.3 Patients with tumors or previous history of tumors 3.3 After negative percutaneous test, allogeneic CEFFE is inhaled by nebulization; 0.2ml CEFFE was injected intradermally 1 cm above the palmar stria on the palmar side of the right forearm, and 0.2ml of normal saline was injected intradermally 1 cm above the palmar stria on the palmar side of the left forearm as a control. Interpretation of skin test results: local pichu bulge, and red halo hard lump, diameter > 1 cm is positive. Give a single dose of 2ml allogeneic CEFFE stock solution (protein concentration of 3mg/ml), administered by nebulization inhalation, 8 minutes between each atomization time, 3 days apart; A total of 7 doses were given. 3.4 Observe the clinical symptoms, chest CT, lung function and related adverse reactions of patients at 1, 3, 6 and December after the end of allogeneic fat decellularization active protein treatment. Evaluation Criteria: 4.1 Efficacy criteria: 4.1.1 Obvious effect means that the main symptoms and signs are significantly relieved, and the objective indicators are significantly improved. 4.1.2 Effective means that the main symptoms and signs have improved, and the objective indicators have improved. 4.1.3 Ineffective means that the main symptoms and signs have not changed, and the objective indicators have not changed significantly or worsened. 4.2 Safety evaluation: Clinical adverse events and laboratory tests are definitely related to allogeneic CEFFE treatment, likely related to allogeneic CEFFE treatment, may be related to allogeneic CEFFE treatment, may not be related to allogeneic CEFFE treatment, and may not be related to allogeneic CEFFE treatment. 4.3 Evaluation endpoints: Clinical efficacy, comprehensive efficacy and safety evaluation at 1, 3, 6 and 12 months after the end of treatment were the main evaluation endpoints. Quality assurance of clinical trial data The quality control of this clinical trial is controlled and controlled by the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, and the research work is carried out in accordance with GCP, SOP and quality control requirements. Develop a clinical research plan. GCP training for relevant researchers participating in the trial. 5.1 Before the start of the trial, the plan should be submitted to the Ethics Committee of the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine for approval; 5.2 in accordance with GCP guidelines, necessary steps should be taken during the design and implementation phases of the study to ensure that the data collected is accurate, consistent, complete and credible; 5.3 The participating researchers will strictly follow China's GCP standards to conduct the trial, collect and record the contents of the case report form truthfully, carefully and in detail in accordance with the clinical trial standard operating procedures (SOP), and verify them to ensure the reliability of the data; 5.4 The investigator fills in the information required by the protocol into the Case Report Form (CRF), and the supervisor verifies that it is complete and accurate, and instructs the staff of the research center to make necessary corrections and supplements; 5.5 All kinds of instruments, equipment, reagents, standards, etc. used in various inspection items in clinical trials should have strict quality standards and ensure that they work under normal conditions; 5.6 Send statistical issues in the test plan to statistical experts for review and check; 5.7 During the trial, the investigator monitors the research process, informed consent, and the correctness and completeness of the data in the case report form (CRF). Recording and preservation of research materials In accordance with the GCP principle, the investigator should keep all the detailed original files of the subjects, and record the relevant test process, medication, laboratory test data, safety data and efficacy evaluation in the case report form, and the recorded data should be complete, timely and clear. Case report forms, original documents, medical records, etc. should be clear, detailed and easily identifiable by personnel participating in this clinical trial. At a minimum, the principal investigator must sign the inclusion confirmation page and completion page of the case report form to confirm the accuracy and completeness of all data. The case report form and the original file can only be modified by the investigator. Any changes to the case report form and the original file must not erase the original data. The correct modification method is to draw a single line on the original data, and then write the modified data next to the original data, and sign the date and the initials of the person who modified it. Test data should be retained for 10 years after the end of the test. However, if required by current regulations or agreements with sponsors, these data should be kept for a longer period of time. statistical treatment scheme 7.1 filling in the case report form (CRF) The investigator should complete the filling of case report form in time, modify it according to the correct modification method, and the completed case report form shall be reviewed and signed by the main researchers 7.2 statistical analysis method and statistical description 7.2.1 Treatment of missing value of main efficacy index data: when some subjects lack a major efficacy data, the method of filling deficiency is determined from the statistical and professional perspective. If the case is missing, the data of the previous measurement shall be transferred. 7.2.2 Case analysis of incomplete test: the reasons for exfoliation should be analyzed one by one. 7.2.3 Descriptive statistics: mean, standard deviation, maximum value, minimum value, median, confidence interval, frequency (composition ratio), etc. 7.3 Statistical expression 7.3.1 The report mainly uses tables to show that the tables are self-evident, that is, they have table questions, table notes and examples. 7.3.2 The results of repeated measurement data are expressed in tables and statistical charts are attached to increase readability. 7.4 Statistical software SAS 9.1.3 and Das for clinical trial 3.0 software were used to analyze the software simultaneously, and the results were confirmed. Modification and interim analysis in the course of the test Once the research plan has been discussed by the research group and reviewed by the ethics committee, it is not allowed to change at will; before the modification is implemented, the researcher must report the content and reason of the modification to the ethics committee of clinical trial for approval, and then carry out the research according to the modified scheme.

Official Title
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Clinical Study of Allogeneic Adipovarian Active Protein in the Treatment of Severe Idiopathic Pulmonary Fibrosis

Conditions
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Idiopathic Pulmonary Fibrosis

Intervention / Treatment
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* Drug: Cell Free Fat Extract(CEFFE)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who sign the informed consent form. Age 30 80 years old, gender is not limited. Patients with IPF with obvious IPF symptoms, signs, HRCT abnormalities, diagnosed as IPF specified in this protocol, DLCO < 40% of the predicted value, and the existing treatment regimen is not effective or does not accept the existing treatment regimen Exclusion Criteria: Patients with any of the following diseases: active tuberculosis, lung abscess, aspiration pneumonia, lung tumors, pulmonary edema, atelectasis, pneumothorax, pleural effusion, pulmonary embolism, pulmonary eosinophilic infiltration, pulmonary vasculitis and immunosuppression or immunodeficiency (including: hepatitis B surface antigen, hepatitis C antibody, AIDS antibody, syphilis antibody test positive); Patients with active infection within 4 weeks; Patients with acute exacerbation of IPF within 4 weeks or/and requiring invasive ventilator-assisted ventilation; Patients with a history of tumor or current tumors; The patient has a severe life-threatening disease and is expected to survive less than 12 months; The patient has leukopenia (neutrophil count< 1000/mm3); Patients with severe renal impairment: creatinine clearance < 30ml/min/1.73m2 or serum creatinine >265μmol/L (>3mg/dL); Patients with liver disease or severe liver function impairment: ALT, AST > 2 times the upper limit of normal value; Those with central nervous system dysfunction, such as convulsions, impaired consciousness, history of epilepsy or seizures; Have a clear history of mental disorders, or a history of psychotropic substance abuse or drug abuse Long-term use of glucocorticoids for treatment of more than 10 mg of prednisone or equivalent, immunosuppressants or antifibrotic drugs, such as penicillamine, colchicine, cyclosporine A, TNFα antagonists, imatinib, IFN-γ, azathioprine, cyclophosphamide; Women who are pregnant, breastfeeding or do not use proper contraception; Those who are allergic to known ingredients of drugs and who are known or suspected of being allergic to the active or inactive ingredients of the study drug; Allergy to acetaminophen or history of hypersensitivity reactions; Alcohol abuse (defined as drinking >2 units per day/1>4 units per week, drinking 1 unit equivalent to 360ml of beer or 45ml of spirits with 40% alcohol content or 150ml of wine) or drug abusers; Any situation that the investigator believes may increase the risk of the patient or interfere with the clinical trial, and the patient is not suitable for entering the investigator.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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: Experimental group<br>Case Inclusion Criteria: Patients who sign the informed consent form. Age 30 80 years old, gender is not limited. Clinical diagnosis basis for idiopathic pulmonary fibrosis (IPF) in patients with IPF with obvious IPF symptoms, signs, HRCT abnormalities, diagnosed as IPF as prescribed by this protocol, DLCO < 40% of the predictive value, and the existing treatment regimen is ineffective or does not accept the existing treatment regimen: | Drug: Cell Free Fat Extract(CEFFE)<br>* The subjects inhaled 2ml of CEFFE each time in a nebulized inhalation method, inhaling every 3 days, for a total of 7 inhalations<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified UK Medical Research Council Respiratory Questionnaire (mMRC) | The change of mMRC at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 
| Borg grading scale | The change of Borg grading scale at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 
| SGRQ Quality of Life Questionnaire | The change of SGRQ at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Vital capacity (VC) | The change of VC at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 
| Forced vital capacity (FVC) | The change of FVC at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 
| Forced expiratory volume in the first second (FEV1) | The change of FEV1 at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 
| The ratio of the measured carbon monoxide dispersion to the expected value (DLCO%) | The change of DLCO at each time node | baseline; 1 month, 3 months, 6 months, 12 months after treatment | 
| Adverse reactions | Number of participants with treatment-related adverse events as assessed by CTCAE v5.0 at each time node | 1 month, 3 months, 6 months, 12 months after treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cell Free Fat Extract ，CEFFE, Idiopathic Pulmonary Fibrosis, nebulized inhalation