Journal Article

Human intracerebroventricular (ICV) injection of autologous, non-engineered, adipose-derived stromal vascular fraction (ADSVF) for neurodegenerative disorders: results of a 3-year phase 1 study of 113 injections in 31 patients

Singh, Elisa, Berman, Sean, Chung, Karlyssa, Bravo, Anthony, Scord, Kristin, Elam, Michael, Yassa, Christian, Kopyov, Oleg, Weiland, David, Lander, Elliot, Rapaport, Benjamin, Khoudari, Samuel, Kopyov, Alex, Caraway, Chad, Arata, Michael, Cannell, Ruslana, Farmer, Sawyer, Duma, Christopher, Berman, Mark, Duma, Chace, Sanathara, Ami, McRory, Rory, Stemler, Lian

2019

Overview

We have chosen to test the safety of human intracerebroventricular (ICV) brain injections of autologous non-genetically-modified adipose-derived stromal vascular fraction (ADSVF). In this IRB-approved trial, 24 patients received ICV ADSVF via an implanted reservoir between 5/22/14 and 5/22/17. Seven others were injected via their ventriculo-peritoneal shunts. Ten patients had Alzheimer’s disease (AD), 6 had amyotrophic lateral sclerosis (ALS), 6 had progressive multiple sclerosis (MS-P), 6 had Parkinson’s “Plus” (PD+), 1 had spinal cord injury, 1 had traumatic brain injury, and 1 had stroke. Median age was 74 (range 41–83). Injections were planned every 2–3 months. Thirty-one patients had 113 injections. Patients received SVF injection volumes of 3.5–20 cc (median:4 cc) containing 4.05 × 105 to 6.2 × 107 cells/cc, which contained an average of 8% hematopoietic and 7.5% adipose stem cells. Follow-up ranged from 0 to 36 months (median: 9.2 months). MRIs post injection(s) were unchanged, except for one AD patient whose hippocampal volume increased from < 5th percentile to 48th percentile (NeuroQuant® volumetric MRI). Of the 10 AD patients, 8 were stable or improved in tests of cognition. Two showed improvement in P-tau and ß-amyloid levels. Of the 6 MS-P patients all are stable or improved. Four of 6 ALS patients died of disease progression. Twelve of 111 injections (11%) led to 1-4 days of transient meningismus, and mild temperature elevation, which resolved with acetaminophen and/or dexamethasone. Two (1.8% of injections) required hospitalization for these symptoms. One patient (0.9% of injections) had his reservoir removed and later replaced for presumed infection. In this Phase 1 safety trial, ADSVF was safely injected into the human brain ventricular system in patients with no other treatment options. Secondary endpoints of clinical improvement or stability were particularly promising in the AD and MS-P groups. These results will be submitted for a Phase 2 FDA-approved trial.

• Publisher: Springer Nature B.V
• Subject: Acetaminophen / Alzheimer's disease / Amyloid / Amyotrophic lateral sclerosis / Autografts / Cognition / Dexamethasone / Disease progression / Hippocampus / Magnetic resonance imaging / Movement disorders / Multiple sclerosis / Neurodegenerative diseases / Parkinson's disease / Patients / Peritoneum / Shunts / Spinal cord injuries / Stem cells / Tau protein / Traumatic brain injury / Ventricle