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    Summary
    EudraCT Number:2015-002994-39
    Sponsor's Protocol Code Number:Cx611-0204
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-02-16
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2015-002994-39
    A.3Full title of the trial
    A phase Ib/IIa, randomised, double blind, parallel group, placebo controlled, multicentre study to assess the safety and efficacy of expanded Cx611 allogeneic adipose-derived stem cells (eASCs) for the intravenous treatment of adult patients with severe community-acquired bacterial pneumonia and admitted to the intensive care unit
    Studio di Fase Ib/IIa multicentrico, randomizzato, in doppio cieco, a gruppi paralleli, controllato con placebo per valutare la sicurezza e l’efficacia delle cellule staminali allogeniche espanse derivate dal tessuto adiposo (eASC) Cx611 per il trattamento endovenoso di pazienti adulti affetti da polmonite batterica grave acquisita in comunità e ricoverati in terapia intensiva”
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Clinical trial to study the effects and safety of stem cells, derived from fat tissue from human donors, administered intravenously to treat patients with severe bacterial pneumonia acquired outside the hospital, nursing home or long-term care facilities.
    Sperimentazione clinica volta a studiare l'efficacia e la sicurezza di cellule staminali derivate da tessuto adiposo provenienti da un donatore umano. somministrate endovena per trattare pazienti affetti da polmonite batterica grave acquisita in comunità.
    A.3.2Name or abbreviated title of the trial where available
    SEPCELL
    SEPCELL
    A.4.1Sponsor's protocol code numberCx611-0204
    A.5.4Other Identifiers
    Name:SEPCELLNumber:Cx611-0204
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorTIGENIX S.A.U
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportTIGENIX S.A.U.
    B.4.2CountrySpain
    B.4.1Name of organisation providing supportHorizon 2020
    B.4.2CountryEuropean Union
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationTIGENIX
    B.5.2Functional name of contact pointClinical Development Director
    B.5.3 Address:
    B.5.3.1Street AddressC/ Marconi,1 Parque Tecnologicode Madrid
    B.5.3.2Town/ cityTRES CANTOS, MADRID
    B.5.3.3Post code28760
    B.5.3.4CountrySpain
    B.5.4Telephone number0034918049264
    B.5.5Fax number0034918049263
    B.5.6E-mailjesus.gonzales@tigenix.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.1.1.1Trade name COSENTIX
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Europharm Ltd
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameCosentix
    D.3.2Product code [PRD489989]
    D.3.4Pharmaceutical form Suspension for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.9.2Current sponsor codeCx611
    D.3.9.4EV Substance CodeSUB30305
    D.3.10 Strength
    D.3.10.1Concentration unit Munit million units
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number80
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) Yes
    D.3.11.3.1Somatic cell therapy medicinal product Yes
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSuspension for injection
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Severe community-acquired bacterial pneumonia requiring mechanical ventilation and/or vasopressors.
    Polmonite batterica grave acquisita in comunità che richiede ventilazione meccanica e / o vasopressori
    E.1.1.1Medical condition in easily understood language
    Severe bacterial pneumonia acquired in the community which makes the patient require assistance in breathing and/or medication that raises the blood pressure.
    Polmonite batterica grave acquisita nella comunità per la quale il paziente necessita di assistenza nella respirazione e / o di farmaci che alzino la pressione sanguigna.
    E.1.1.2Therapeutic area Diseases [C] - Bacterial Infections and Mycoses [C01]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.1
    E.1.2Level PT
    E.1.2Classification code 10060945
    E.1.2Term Bacterial infection
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Investigate the safety profile of two allogeneic Cx611 central line 80 mL
    infusions within 3 days (on days 1 and 3) at a dose of 160 million cells
    each (320 million cells total) and to monitor any adverse event and
    potential immunological host responses against the administered cells
    during 90 days of follow-up after the first infusion.
    Studiare il profilo di sicurezza di due infusioni da 80 ml di Cx611 allogeniche tramite catetere venoso centrale nell’arco di 3 giorni (Giorni 1 e 3) a una dose di 160 milioni di cellule ciascuna (320 milioni di cellule in totale) e monitorare gli eventuali eventi avversi e le potenziali risposte immunitarie dell’ospite contro le cellule somministrate nel corso di un follow-up di 90 giorni successivi alla prima infusione
    E.2.2Secondary objectives of the trial
    1. Explore the clinical efficacy of Cx611 in terms of a reduction of the
    duration of mechanical ventilation and/or need for vasopressors and/or
    improved survival, and/or clinical cure of the CABP, and other efficayrelated
    endpoints
    2. Understand the mode-of-action of Cx611 in patients with sCABP by
    identifying the pro-inflammatory and anti- inflammatory pathways
    through which Cx611 may affect the underlying processes of sepsis.
    3. Follow-up safety (only SAEs) at months 6 and 12 after the first IMP
    dose administration (Day 1).
    Exploratory objective:
    Safety data collection at months 18 and 24.
    The study will contribute to the basic knowledge on stem cells and their
    mode-of-action, and has a large translational character, i.e. to document
    the safety and explore the efficacy of Cx611 in patients with sCABP. The
    results will be critical for the design of further confirmatory clinical trials
    in terms of definition of endpoints, key biomarkers and sample size
    determination.
    1. Esplorare l’efficacia clinica di Cx611 in termini di riduzione della durata della ventilazione meccanica e/o della necessità di vasocostrittori e/o di miglioramento della sopravvivenza e/o di guarigione clinica dalla sCABP e altri endpoint correlati all’efficacia.
    2. Comprendere il meccanismo d’azione di Cx611 nei pazienti con sCABP attraverso l’identificazione delle vie proinfiammatorie e antinfiammatorie con cui Cx611 potrebbe influire sulla sepsi.
    3. Monitorare la sicurezza (solo SAE) ai mesi 6 e 12 dalla somministrazione della prima dose del medicinale sperimentale (Investigational Medicinal Product, IMP) (Giorno 1).
    Obiettivo esplorativo:
    Raccolta di dati di sicurezza (raccolta dei SAE tramite contatti telefonici) ai mesi 18 e 24.
    Lo studio, il cui completamento arricchirà le conoscenze di base sulle cellule staminali e sul relativo meccanismo d’azione, ha un carattere fortemente traslazionale, essendo teso a documentare la sicurezza e ad esplorare l’efficacia di Cx611 nei paz.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Adult subjects of either gender (aged = 18 years and = 80 years old).
    2. Body weight between 50 kg and 100 kg.
    3. Clinical diagnosis of acute (developed within = 21 past days) community-acquired bacterial pneumonia based on the presence of two relevant signs (fever, tachypnea, leukocytosis, or hypoxemia) and radiographic findings of new pulmonary infiltrate/s.
    4. Subjects with pneumonia of sufficient severity requiring ICU management and with at least one of the two following major criteria of severity present for less than 18 hours:
    a) Requiring invasive mechanical ventilation for respiratory failure due to pneumonia, or
    b) Requiring treatment with vasopressors (i.e., dopamine >5 µg/kg/min or any dose of epinephrine, norepinephrine, phenylephrine or vasopressin) for at least 2 hours to maintain or attempt to maintain systolic blood pressure (SBP) >90 mm Hg (or mean arterial pressure (MAP) >70 mm Hg) after adequate fluid resuscitation (i.e. for shock).
    NOTE: Patients that are for 18 hours or more under high flow nasal cannula (HFNC) at =50 liters per minute and FiO2 =0.6 or under non-mechanical ventilation (NMV) are not eligible for the study.
    5. Female subject of no childbearing potential i.e. non fertile, pre-menarchic, permanently sterile (i.e. underwent hysterectomy, bilateral salpingectomy or bilateral ovariectomy) or post-menopausal (history of no menses for at least 12 months without an alternative medical cause)
    or
    Woman of childbearing potential* with a negative serum or urine pregnancy test (sensitive to 25 IU human chorionic gonadotropin [hCG]) and agree to use an adequate method of contraception for three months after the last dose of the investigational medicinal product according to her preferred and usual life style. Adequate methods of female contraception for this study are: sexual abstinence (refraining from heterosexual intercourse), hormonal contraception (both progestron-only or combined oestrogen and progestron; both with inhibition of ovulation or where inhibition of ovulation is not the primary mechanism of action) intra-uterine device, bilateral tubal occlusion, condom use by male sexual partner(s) or medically-assessed successfully vasectomised male sexual partner(s).
    *A woman of childbearing potential is a woman between menarche and post-menopause (history of no menses for at least 12 months without an alternative medical cause) unless she has undergone hysterectomy, bilateral salpingectomy or bilateral ovariectomy
    Male subject agreeing to use one of the following methods of birth control according to his preferred and usual life style for three months after the last dose of the investigational medicinal product: sexual abstinence (refraining from heterosexual intercourse), use of condoms or medically-assessed successfull vasectomy, or having a female sexual partner(s) who is using an adequate method of contraception as described above.
    6. Signed informed consent provided by the subject, the relatives or the designated legal representative according to local guidelines.
    1. 1. Soggetti adulti ambosessi (di età =18 e =80 anni).
    2. Peso corporeo compreso tra 50 kg e 100 kg.
    3. Diagnosi clinica di polmonite batterica acquisita in comunità acuta (sviluppata nei =21 giorni precedenti) basata sulla presenza di due segni rilevanti (febbre, tachipnea, leucocitosi o ipossiemia) e reperti radiografici di nuovo/i infiltrato/i polmonare/i
    4. Soggetti con polmonite di sufficiente gravità, richiedente la gestione in ICU, e che presentano almeno uno dei seguenti due criteri principali di gravità per meno di 18 ore:
    a) Necessità di ventilazione meccanica invasiva per insufficienza respiratoria dovuta alla polmonite, oppure
    b) Necessità di trattamento con vasocostrittori (ossia dopamina >5 µg/kg/min o qualsiasi dose di adrenalina, noradrenalina, fenilefrina o vasopressina) per almeno 2 ore, al fine di mantenere o tentare di mantenere la pressione arteriosa sistolica (PAS) >90 mm Hg (o la pressione arteriosa media [PAM] >70 mg Hg) dopo adeguato ripristino di liquidi (ovvero per shock).
    NOTA: non sono ritenuti idonei per la partecipazione allo studio i pazienti trattati per 18 ore o più con cannula nasale ad alto flusso (High Flow Nasal Cannula, HNFC) a =50 litri al minuto e FiO2 =0,6 oppure sottoposti a ventilazione non meccanica (Non-Mechanical Ventilation, NMV).
    5. Soggetti di sesso femminile non in età fertile, ovvero non fertili, in pre-menarca, sterilizzate definitivamente (ovvero sottoposte a isterectomia, salpingectomia bilaterale o ovariectomia bilaterale) o in post-menopausa (storia di assenza di mestruazioni da almeno 12 mesi senza una causa medica alternativa)
    oppure
    Donne in età fertile* con test di gravidanza negativo sul siero o sulle urine (sensibile a 25 UI di gonadotropina corionica umana [human Chorionic Gonadotropin, hCG]) e disposte ad utilizzare un adeguato metodo di contraccezione per tre mesi in seguito all’ultima dose del medicinale sperimentale secondo il proprio stile di vita preferito ed abituale. Tra i metodi contraccettivi femminili adeguati per questo studio si annoverano: astinenza sessuale (astensione dai rapporti eterosessuali); contraccezione ormonale (contraccettivi a base di solo progesterone o combinati a base di estrogeno e progesterone; associati all’inibizione dell’ovulazione o il cui principale meccanismo di azione non è l’inibizione dell’ovulazione); dispositivo intrauterino; occlusione tubarica bilaterale; uso del preservativo da parte del o dei partner sessuali maschili o partner sessuale/i maschile/i sottoposto/i a vasectomia efficace secondo la valutazione medica.
    *È considerata in età fertile una donna che si trova tra il menarca e la post-menopausa (storia di assenza di mestruazioni da almeno 12 mesi senza una causa medica alternativa) a meno che non sia stata sottoposta ad isterectomia, salpingectomia bilaterale o ovariectomia bilaterale.
    oppure
    Soggetti di sesso maschile che acconsentono all’utilizzo di uno dei seguenti metodi contraccettivi secondo il proprio stile di vita preferito ed abituale per tre mesi in seguito all’ultima dose del medicinale sperimentale: astinenza sessuale (astensione dai rapporti eterosessuali); uso di preservativi; vasectomia efficace secondo la valutazione medica o uso da parte della o delle partner sessuali femminili di un metodo contraccettivo adeguato come precedentemente descritto.
    6. Consenso informato firmato, fornito dal soggetto, dai parenti o dal rappresentante legale nominato in conformità alle linee guida locali
    E.4Principal exclusion criteria
    A patient will not be included in the study if he/she meets ANY of the following criteria:
    1. Subjects with Hospital acquired (HAP)-, Health Care Associated (HCAP)- or Ventilator associated-pneumonia (VAP).
    2. Subjects with pneumonia exclusively of viral or fungal origin*. Subjects with bacterial pneumonia co-infected with viruses and/or other microorganisms may be entered into the study.
    *Due to the short time window (up to 18 hours) between fulfilment of severity criteria (i.e. initiation of invasive mechanical ventilation or vasopressors, whichever comes first) and the start of the first dose of study treatment, patients with a pneumonia of suspected bacterial origin can be entered into the study (confirmation of bacterial origin must be obtained afterwards)
    3. Subjects with known or suspected Pneumocystis jirovecii (formerly known as Pneumocystis carinii) pneumonia.
    4. Subjects with an aspiration pneumonia.
    5. Subjects with known active tuberculosis.
    6. Subjects with a history of post-obstructive pneumonia.
    7. Subjects with cystic fibrosis.
    8. Subjects with any chronic lung disease requiring oxygen therapy at home.
    9. Presence of infection in another organ location caused by same pathogen (e.g. pneumococcal meningitis in the context of pneumococcal pneumonia).
    10. Subjects expected to have rapidly fatal disease within 72 hours after randomisation.
    11. Inability to maintain a mean arterial pressure =50 mmHg prior to screening despite the presence of vasopressors and intravenous fluids.
    12. Subjects not expected to survive for 3 months due to other pre-existing medical conditions such as end-stage dementia or other diseases.
    13. Subjects with a history of malignancy in the 5 years prior to screening, except for successfully surgically treated non-melanoma skin malignancies.
    14. Subjects with known primary immunodeficiency disorder or with HIV infection and acquired immune deficiency syndrome (AIDS) with CD4 count <200 cells/mm3 or not receiving highly active antiretroviral therapy (HAART) for HIV.
    15. Subjects receiving immunosuppressant therapy (including chronic treatment with any anti-tumour necrosis factor alpha (TNFa) or on chronic high doses of steroids (single administration of =2 mg/kg body weight for =2 weeks or 20 mg/day of prednisone or equivalent for =2 weeks).
    16. Chronic granulocytopenia, not thought to be due to sepsis, as evidenced by an absolute neutrophil count <500 per µL >21 days prior to onset of pneumonia symptoms.
    17. Subjects who received stem cell therapy, or allogenic transplantation (organ or bone marrow transplant) within the past 6 months.
    18. Subjects receiving treatment with a biological agent (e.g. antibodies, cells), immunotherapy or plasma exchange treatment within the last 8 weeks.
    19. Subjects currently receiving, or having received another investigational medication within 90 days prior to start of the study (or 5 half-lives of the investigational compound, whichever is longer).
    20. Known allergies or hypersensivity to Penicillin or Streptomycin and/or any component of CryoStor® CS10 (please refer to section 9.1.2)
    please see the Synopsis for the other ones exclusion criteria
    1. 1. Soggetti con polmonite nosocomiale (Hospital Acquired Pneumonia, HAP), polmonite correlata ad assistenza sanitaria (Health Care Associated Pneumonia, HCAP) o polmonite associata alla ventilazione meccanica (Ventilator Associated-Pneumonia, VAP).
    2. Soggetti affetti da polmonite di origine esclusivamente virale o micotica.* I soggetti con polmonite batterica co-infetti da virus e/o altri microrganismi potranno essere inclusi nello studio.
    *Data la brevità della finestra temporale (fino a 18 ore) tra la soddisfazione dei criteri di gravità (ossia istituzione della ventilazione meccanica invasiva o avvio della terapia con vasopressori, a seconda dell’evento che si verifica per primo) e l’inizio della prima dose del trattamento in studio, possono essere inseriti nello studio i pazienti con polmonite di sospetta origine batterica (la conferma dell’origine batterica deve essere ottenuta successivamente)
    3. Soggetti con presenza nota o sospetta di polmonite da Pneumocystis jirovecii (precedentemente noto come Pneumocystis carinii).
    4. Soggetti con polmonite da aspirazione.
    5. Soggetti con tubercolosi attiva nota.
    6. Soggetti con precedenti anamnestici di polmonite post-ostruttiva.
    7. Soggetti con fibrosi cistica.
    8. Soggetti con qualsiasi malattia polmonare cronica che richieda l’ossigenoterapia a domicilio.
    9. Presenza di infezioni in altri organi causate dallo stesso patogeno (ad es. meningite pneumococcica in caso di polmonite pneumococcica).
    10. Soggetti con prognosi di malattia rapidamente fatale entro 72 ore in seguito alla randomizzazione.
    11. Impossibilità di mantenere una pressione arteriosa media =50 mm Hg prima dello screening, nonostante l’uso di vasopressori e la somministrazione di liquidi per via endovenosa.
    12. Soggetti con aspettativa di vita inferiore a 3 mesi a causa di altre patologie pre-esistenti, quali demenza in stadio terminale o altre malattie.
    13. Soggetti con anamnesi di neoplasie maligne nei 5 anni precedenti allo screening, fatta eccezione per le neoplasie maligne cutanee non melanoma trattate efficacemente mediante intervento chirurgico.
    14. Soggetti con disturbo da immunodeficienza primaria nota o con infezione da HIV e sindrome da immunodeficienza acquisita (Acquired Immune Deficiency Syndrome, AIDS) con conta CD4 <200 cellule/mm3 o non trattati con una terapia antiretrovirale altamente attiva (Highly Active Antiretroviral Therapy, HAART) per l’HIV.
    15. Soggetti in terapia immunosoppressiva, incluso il trattamento cronico con qualsiasi anti-fattore di necrosi tumorale alfa (Anti-tumour Necrosis Factor alpha, TNFa) o in trattamento cronico con alte dosi di steroidi (somministrazione singola di =2 mg/kg di peso corporeo per =2 settimane o 20 mg/die di prednisone o equivalente per =2 settimane).
    16. Granulocitopenia cronica, non ritenuta dovuta a sepsi, evidenziata da una conta assoluta dei neutrofili <500/µl >21 giorni prima dell’insorgenza dei sintomi della polmonite.
    17. Soggetti sottoposti a terapia con cellule staminali o trapianto allogenico (trapianto di organo o di midollo osseo) nei 6 mesi precedenti.
    18. Soggetti in trattamento con un agente biologico (es. anticorpi, cellule) o sottoposti a immunoterapia o trattamento plasmaferetico nelle ultime 8 settimane.
    19. Soggetti trattati con un altro farmaco sperimentale, attualmente o nei 90 giorni prima dell’avvio dello studio (o 5 emivite del composto sperimentale, se più lungo).
    20. Allergie o ipersensibilità note alla penicillina o streptomicina e/o a qualsiasi componente di CryoStor® CS10 (consultare la sezione 9.1.2).
    please see the Synopsis for the other ones exclusion criteria
    E.5 End points
    E.5.1Primary end point(s)
    Primary Safety Endpoints by Day 90
    Safety measured throughout the study by the incidence of treatment
    emergent adverse events (TEAEs) judged related or not to study
    treatment. Safety analyses will be performed based on the Safety
    Population.
    An independent Data Monitoring Committee (DMC) will review safety
    data on a regular basis and ad hoc if needed. This DMC will be composed
    by a Chairman, expert in stem cells and former Chair of the Safety
    Committee of the completed CELLULA phase I trial, at least two
    Intensivists and an Independent Statistician. Membership, roles,
    responsibilities and operating procedures for the DMC will be specified in
    a separate independent DMC charter.
    Subjects will be continuously monitored during and after treatment for:
    · Frequency, duration, severity, seriousness, relatedness to study
    treatment, actions taken and outcome of adverse events (AEs), from
    time of signature of informed consent until visit 11 (Day 90) or study
    discontinuation. AEs will start being recorded after signing the informed
    consent. AEs occurring from the beginning of the administration of study medication and until visit 11 (Day 90) or study discontinuation will be
    analysed as treatment-emergent AEs
    (TEAEs).
    · Adverse events of special interest (see Sections 5.10 and 11.1.6 and
    also refer to the Investigators' Brochure (1)).
    · Signs for hypersensitivity reactions such as anaphylaxis (changes in
    systolic and diastolic blood pressure, core temperature [tympanic, rectal
    or bladder], respiratory rate [nonventilated patients], heart rate), at
    Days 1 and 3 (at Pre-dose and at 0.5h (±5 min), 1h (±10 min), 2h (±10
    min), 4h (±20 min), 12h (±30 min) and 24 h (±1 h) post each IMP
    infusion.
    Episodes of skin reactions and respiratory distress requiring therapeutic
    intervention and their description during the first 24 hours after the
    infusion of IMP.
    · Changes in vital signs (daily: systolic and diastolic blood pressure,
    heart rate, core temperature [tympanic, rectal or bladder], respiratory
    rate [in non-ventilated patients]) as follows:
    Screening, Day 1 (at Pre-dose, and at 0.5h (±5 min), 1h (±10 min), 2h
    (±10 min), 4h (±20 min), 12h (±30 min) and 24 h (±1 h) post each IMP
    infusion), Day 2 (at least 4 times), Day 3 (at Predose, and at 0.5h (±5
    min), 1h (±10 min), 2h (±10 min), 4h (±20 min), 12h (±30 min) and 24
    h (±1 h) post each IMP infusion), then at least 4 times daily while in the
    ICU or, if discharged from ICU at least once on Days 4, 5, 6, 7, 8-10, 14,
    29, 90 or study discontinuation.
    · Changes in 12-lead electrocardiogram (ECG) from Screening, Day 1 and
    Day 3 both 5 hours ± 1h post-study treatment administration.
    · Changes in haematology and coagulation, clinical chemistry (at least
    including renal, liver, cholesterol and triglycerides profiles), and urine
    analysis at Screening, Day 1 Pre-dose, and then at least on Days 2, 3
    (only haematology and coagulation), 4, 7, 14, 29, 90, 180 and 365 or
    study discontinuation.
    · Anti-human leukocyte antigen complex
    Endpoint primari di efficacia entro il Giorno 90
    Sicurezza misurata per l’intera durata dello studio in base all’incidenza di eventi avversi emergenti dal trattamento (Treatment Emergent Adverse Event, TEAE) ritenuti correlati o meno al trattamento in studio. Le analisi di sicurezza saranno eseguite sulla base della Popolazione di sicurezza.
    Un Comitato indipendente per il monitoraggio dei dati (Data Monitoring Committee, DMC) riesaminerà i dati di sicurezza periodicamente e ad hoc, se necessario. Il DMC sarà costituito da un presidente, esperto in cellule staminali e precedente presidente del Comitato di sicurezza dello studio di Fase I completato CELLULA, da almeno due medici di terapia intensiva e da uno statistico indipendente. Appartenenza, ruoli, responsabilità e procedure operative del DMC saranno specificati in un apposito statuto del DMC indipendente.
    I soggetti saranno continuamente monitorati durante e dopo il trattamento per:
    • Frequenza, durata, intensità, gravità, correlazione con il trattamento in studio, azioni intraprese ed esito degli eventi avversi (Adverse Event, AE) dal momento della firma del consenso informato fino alla visita 11 (Giorno 90) o all’interruzione dello studio. Gli AE inizieranno a essere registrati dopo la firma del consenso informato. Gli AE che si verificano dall’inizio della somministrazione del farmaco in studio e fino alla visita 11 (Giorno 90) o all’interruzione dello studio saranno analizzati come AE emergenti dal trattamento (TEAE).
    • Eventi avversi di particolare interesse (vedere le sezioni 5.10 e 11.1.6 e consultare anche il Dossier per lo Sperimentatore [1]).
    • Segni di reazioni di ipersensibilità quali anafilassi (alterazioni della pressione arteriosa sistolica e diastolica, temperatura interna [auricolare, rettale o vescicale], frequenza respiratoria [pazienti non ventilati], frequenza cardiaca), ai Giorni 1 e 3, pre-dose e 0,5h (±5 min), 1h (±10 min), 2h (±10 min), 4h (±20 min), 12h (±30 min) e 24h (±1h) dopo ogni infusione del medicinale sperimentale (IMP). Episodi di reazioni cutanee e di problemi respiratori che richiedono l’intervento terapeutico e loro descrizione nelle prime 24 ore dopo l’infusione dell’IMP.
    • Cambiamenti nei segni vitali (ogni giorno: pressione arteriosa sistolica e diastolica, frequenza cardiaca, temperatura interna [auricolare, rettale o vescicale], frequenza respiratoria [nei pazienti non ventilati]) come segue: Screening, Giorno 1, pre-dose e 0,5h (±5 min), 1h (±10 min), 2h (±10 min), 4h (±20 min), 12h (±30 min) e 24h (±1h) dopo ogni infusione dell’IMP, Giorno 2 (almeno 4 volte), Giorno 3, pre-dose e 0,5h (±5 min), 1h (±10 min), 2h (±10 min), 4h (±20 min), 12h (±30 min) e 24 h (±1h) dopo ogni infusione dell’IMP, dopodiché almeno 4 volte/die durante la permanenza in ICU o, se il paziente viene dimesso dall’ICU, almeno una volta durante i Giorni 4, 5, 6, 7, 8-10, 14, 29, 90 o all’interruzione dello studio.
    • Variazioni all’elettrocardiogramma (ECG) a 12 derivazioni dal
    E.5.1.1Timepoint(s) of evaluation of this end point
    see point E.5.1.EN
    vedi il punto E.5.1.IT
    E.5.2Secondary end point(s)

    Efficacy endpoints
    1. Mechanical ventilator and vasopressors treatment-free days (number
    of days that a patient is alive and free from mechanical ventilation and
    vasopressors) over 28 days.
    2. Percentage of patients alive and free of mechanical ventilation and
    free of vasopressors at Day 29.
    3. Percentage of patients alive and free of mechanical ventilation at Day
    29.
    4. Ventilator free days (VFD) over 28 days. VFD are defined as one point
    for each day during the measurement period that are both alive and free
    of mechanical ventilation.
    5. Percentage of patients alive and free of vasopressors at Day 29.
    6. Vasopressors-free days over 28 days defined as one point for each day
    during the measurement period that subjects are both alive and free ofvasopressors.
    7. Time to end of invasive mechanical ventilation.
    8. Time to end of invasive and/or non-invasive mechanical ventilation.
    9. Time to end of vasopressors treatment.

    Other Secondary Endpoint are reported on the Protocol.
    Endpoint di efficacia
    1. Giorni senza ventilazione meccanica e trattamento con vasocostrittori (numero di giorni durante i quali il paziente è in vita e non sottoposto a ventilazione meccanica o vasocostrizione) nell’arco di 28 giorni.
    2. Percentuale di pazienti in vita e senza ventilazione meccanica e uso di vasocostrittori al Giorno 29.
    3. Percentuale di pazienti in vita e senza ventilazione meccanica al Giorno 29.
    4. Giorni senza ventilazione (Ventilator-free Day, VFD) nell’arco di 28 giorni. Si definisce VDF un punto per ciascun giorno durante il periodo di misurazione in cui [i soggetti] sono sia in vita, sia senza ventilazione meccanica (es. un paziente estubato il Giorno 2 dello studio che rimane in vita e senza ventilatore per la restante parte del periodo dello studio di 28 giorni riceverà un punteggio VDF di 26, mentre un paziente ventilato fino al decesso il Giorno 2 riceverà un punteggio pari a zero).
    5. Percentuale di pazienti in vita e liberi dall’uso di vasocostrittori al Giorno 29.
    6. I giorni senza vasocostrittori nell’arco di 28 giorni sono definiti come un punto per ciascun giorno durante il periodo di misurazione in cui i soggetti sono sia in vita, sia senza vasocostrittori.
    7. Tempo al termine della ventilazione meccanica invasiva.
    8. Tempo al termine della ventilazione meccanica invasi
    va e/o non invasiva.
    9. Tempo al termine del trattamento con vasocostrittori.

    Altri Endopoints secondari vengono riportati all'interno del Protocollo
    E.5.2.1Timepoint(s) of evaluation of this end point
    See the point E.5.2.EN
    Vedi la sezione E.5.2.IT
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Mechanism of action
    Meccanismo d'azione
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    phase Ib/IIa
    fase Ib/IIa
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA90
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years4
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months4
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 90
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 90
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Subjects admitted to ICU requiring invasive mechanical ventilation because of the pneumonia
    Soggetti ammessi all'Unità di terapia intensiva che richiedono una ventilazione meccanica invasiva a causa della polmonite
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state20
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 50
    F.4.2.2In the whole clinical trial 50
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    none
    nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2017-12-22
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2018-02-22
    P. End of Trial
    P.End of Trial StatusCompleted
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