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Published in: Trials 1/2016

Open Access 01-12-2016 | Study protocol

A prospective multicenter phase I/II clinical trial to evaluate safety and efficacy of NOVOCART Disc plus autologous disc chondrocyte transplantation in the treatment of nucleotomized and degenerative lumbar disc to avoid secondary disease: study protocol for a randomized controlled trial

Authors: Anja Tschugg, Felix Michnacs, Martin Strowitzki, Hans Jörg Meisel, Claudius Thomé

Published in: Trials | Issue 1/2016

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Abstract

Background

Intervertebral disc degeneration is emphasized as an important cause of low back pain. Current surgical treatment provides relief to the accompanying pain and disability but does not restore the biological function of the intervertebral disc. NOVOCART™ Disc plus, an autologous cell compound for autologous disc chondrocyte transplantation, was developed to reduce the degenerative sequelae after lumbar disc surgery or to prophylactically avoid degeneration in adjacent discs.

Methods/design

This is a multicenter, randomized, controlled, clinical phase I/II combination study. A total of 120 adult patients are allocated in a ratio of 2:1:1. Sample size and power calculations were performed to detect the minimal clinically important difference of 10 units, with an expected standard deviation of 12 in the Oswestry Disability Index, which is the primary outcome parameter. Secondary outcome parameters include the visual analog scale and the EQ-5D questionnaire. Changes in physical and mental health are evaluated using the Short Form-12 (SF-12). Moreover, radiological and functional outcomes are evaluated. The major inclusion criterion is a single lumbar disc herniation that requires sequestrectomy. Transplantation is performed 90 days thereafter. Study data generation (study sites) and data storage, processing, and statistical analysis are clearly separated.

Discussion

In this phase-I/II study, NDplus is being investigated for its clinical applicability, safety, and efficacy in the repair of herniated, nucleotomized discs, and of adjacent degenerated discs, if present. To date, autologous disc chondrocytes have not been transplanted into degenerative discs without previous disc herniation. As such, this is the first study to investigate a therapeutic as well as a prophylactic approach to treat degenerative discs of the lumbar spine.

Trial registration

EudraCT No: 2010-023830-22, ID NCT01640457, 8 November 2010
Literature
1.
2.
go back to reference Siddiqui AH, Rafique MZ, Ahmad MN, Usman MU. Role of magnetic resonance imaging in lumbar spondylosis. J Coll Physicians Surg Pak. 2005;15:396–9.PubMed Siddiqui AH, Rafique MZ, Ahmad MN, Usman MU. Role of magnetic resonance imaging in lumbar spondylosis. J Coll Physicians Surg Pak. 2005;15:396–9.PubMed
3.
go back to reference Förster M, Mahn F, Gockel U, Brosz M, Freynhagen R, Tölle TR, et al. Axial low back pain: one painful area--many perceptions and mechanisms. PLoS One. 2013;8:e68273.PubMedCentralCrossRefPubMed Förster M, Mahn F, Gockel U, Brosz M, Freynhagen R, Tölle TR, et al. Axial low back pain: one painful area--many perceptions and mechanisms. PLoS One. 2013;8:e68273.PubMedCentralCrossRefPubMed
4.
go back to reference Johnstone B, Bayliss MT. The large proteoglycans of the human intervertebral disc. Changes in their biosynthesis and structure with age, topography, and pathology. Spine (Phila Pa 1976). 1995;20:674–84.CrossRef Johnstone B, Bayliss MT. The large proteoglycans of the human intervertebral disc. Changes in their biosynthesis and structure with age, topography, and pathology. Spine (Phila Pa 1976). 1995;20:674–84.CrossRef
5.
go back to reference Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4:190S–4.CrossRefPubMed Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4:190S–4.CrossRefPubMed
6.
go back to reference Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976). 2010;35:S281–6.CrossRef Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976). 2010;35:S281–6.CrossRef
7.
go back to reference Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976). 2010;35:S294–301.CrossRef Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine (Phila Pa 1976). 2010;35:S294–301.CrossRef
8.
go back to reference Ganey TM, Meisel HJ. A potential role for cell-based therapeutics in the treatment of intervertebral disc herniation. Eur Spine J. 2002;11 Suppl 2:S206–14.PubMedCentralPubMed Ganey TM, Meisel HJ. A potential role for cell-based therapeutics in the treatment of intervertebral disc herniation. Eur Spine J. 2002;11 Suppl 2:S206–14.PubMedCentralPubMed
9.
go back to reference Meisel HJ, Ganey T, Hutton WC, Libera J, Minkus Y, Alasevic O. Clinical experience in cell-based therapeutics: intervention and outcome. Eur Spine J. 2006;15:397–405.PubMedCentralCrossRef Meisel HJ, Ganey T, Hutton WC, Libera J, Minkus Y, Alasevic O. Clinical experience in cell-based therapeutics: intervention and outcome. Eur Spine J. 2006;15:397–405.PubMedCentralCrossRef
10.
go back to reference Bertram H, Kroeber M, Wang H, Unglaub F, Guehring T, Carstens C, et al. Matrix-assisted cell transfer for intervertebral disc cell therapy. Biochem Biophys Res Commun. 2005;331:1185–92.CrossRefPubMed Bertram H, Kroeber M, Wang H, Unglaub F, Guehring T, Carstens C, et al. Matrix-assisted cell transfer for intervertebral disc cell therapy. Biochem Biophys Res Commun. 2005;331:1185–92.CrossRefPubMed
11.
go back to reference Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25:2940–52. discussion 2952.CrossRef Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25:2940–52. discussion 2952.CrossRef
12.
go back to reference Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther. 2002;82:8–24.PubMed Davidson M, Keating JL. A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther. 2002;82:8–24.PubMed
13.
go back to reference Hurst NP, Jobanputra P, Hunter M, Lambert M, Lochhead A, Brown H. Validity of Euroqol--a generic health status instrument--in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol. 1994;33:655–62.CrossRefPubMed Hurst NP, Jobanputra P, Hunter M, Lambert M, Lochhead A, Brown H. Validity of Euroqol--a generic health status instrument--in patients with rheumatoid arthritis. Economic and Health Outcomes Research Group. Br J Rheumatol. 1994;33:655–62.CrossRefPubMed
14.
go back to reference Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMed Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.CrossRefPubMed
15.
go back to reference Chapman CR. New directions in the understanding and management of pain. Soc Sci Med. 1984;19:1261–77.CrossRefPubMed Chapman CR. New directions in the understanding and management of pain. Soc Sci Med. 1984;19:1261–77.CrossRefPubMed
16.
go back to reference Thomé C, Barth M, Scharf J, Schmiedek P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005;2:271–8.CrossRefPubMed Thomé C, Barth M, Scharf J, Schmiedek P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005;2:271–8.CrossRefPubMed
17.
go back to reference Eicker SO, Rhee S, Steiger HJ, Herdmann J, Floeth FW. Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations. Neurosurg Focus. 2013;35:E1.CrossRefPubMed Eicker SO, Rhee S, Steiger HJ, Herdmann J, Floeth FW. Transtubular microsurgical approach to treating extraforaminal lumbar disc herniations. Neurosurg Focus. 2013;35:E1.CrossRefPubMed
18.
go back to reference Gruber HE, Johnson TL, Leslie K, Ingram JA, Martin D, Hoelscher G, et al. Autologous intervertebral disc cell implantation: a model using Psammomys obesus, the sand rat. Spine (Phila Pa 1976). 2002;27:1626–33.CrossRef Gruber HE, Johnson TL, Leslie K, Ingram JA, Martin D, Hoelscher G, et al. Autologous intervertebral disc cell implantation: a model using Psammomys obesus, the sand rat. Spine (Phila Pa 1976). 2002;27:1626–33.CrossRef
19.
go back to reference Ganey T, Libera J, Moos V, Alasevic O, Fritsch KG, Meisel HJ, et al. Disc chondrocyte transplantation in a canine model: a treatment for degenerated or damaged intervertebral disc. Spine (Phila Pa 1976). 2003;28:2609–20.CrossRef Ganey T, Libera J, Moos V, Alasevic O, Fritsch KG, Meisel HJ, et al. Disc chondrocyte transplantation in a canine model: a treatment for degenerated or damaged intervertebral disc. Spine (Phila Pa 1976). 2003;28:2609–20.CrossRef
20.
go back to reference Adkisson HD, Milliman C, Zhang X, Mauch K, Maziarz RT, Streeter PR. Immune evasion by neocartilage-derived chondrocytes: Implications for biologic repair of joint articular cartilage. Stem Cell Res. 2010;4:57–68.CrossRefPubMed Adkisson HD, Milliman C, Zhang X, Mauch K, Maziarz RT, Streeter PR. Immune evasion by neocartilage-derived chondrocytes: Implications for biologic repair of joint articular cartilage. Stem Cell Res. 2010;4:57–68.CrossRefPubMed
21.
go back to reference Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006; CD005321;pub2. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006; CD005321;pub2.
22.
go back to reference Greenberg DD, Stoker A, Kane S, Cockrell M, Cook JL. Biochemical effects of two different hyaluronic acid products in a co-culture model of osteoarthritis. Osteoarthritis Cartilage. 2006;14:814–22.CrossRefPubMed Greenberg DD, Stoker A, Kane S, Cockrell M, Cook JL. Biochemical effects of two different hyaluronic acid products in a co-culture model of osteoarthritis. Osteoarthritis Cartilage. 2006;14:814–22.CrossRefPubMed
23.
go back to reference Karna E, Miltyk W, Surazyński A, Pałka JA. Protective effect of hyaluronic acid on interleukin-1-induced deregulation of beta1-integrin and insulin-like growth factor-I receptor signaling and collagen biosynthesis in cultured human chondrocytes. Mol Cell Biochem. 2008;308:57–64.CrossRefPubMed Karna E, Miltyk W, Surazyński A, Pałka JA. Protective effect of hyaluronic acid on interleukin-1-induced deregulation of beta1-integrin and insulin-like growth factor-I receptor signaling and collagen biosynthesis in cultured human chondrocytes. Mol Cell Biochem. 2008;308:57–64.CrossRefPubMed
24.
go back to reference Scholz B, Kinzelmann C, Benz K, Mollenhauer J, Wurst H, Schlosshauer B. Suppression of adverse angiogenesis in an albumin-based hydrogel for articular cartilage and intervertebral disc regeneration. Eur Cell Mater. 2010;20:24–36. discussion 36-7.PubMed Scholz B, Kinzelmann C, Benz K, Mollenhauer J, Wurst H, Schlosshauer B. Suppression of adverse angiogenesis in an albumin-based hydrogel for articular cartilage and intervertebral disc regeneration. Eur Cell Mater. 2010;20:24–36. discussion 36-7.PubMed
26.
go back to reference Inkinen RI, Lammi MJ, Agren U, Tammi R, Puustjärvi K, Tammi MI. Hyaluronan distribution in the human and canine intervertebral disc and cartilage endplate. Histochem J. 1999;31:579–87.CrossRefPubMed Inkinen RI, Lammi MJ, Agren U, Tammi R, Puustjärvi K, Tammi MI. Hyaluronan distribution in the human and canine intervertebral disc and cartilage endplate. Histochem J. 1999;31:579–87.CrossRefPubMed
27.
go back to reference Anderson DG, Tannoury C. Molecular pathogenic factors in symptomatic disc degeneration. Spine J. 2005;5:260S–6.CrossRefPubMed Anderson DG, Tannoury C. Molecular pathogenic factors in symptomatic disc degeneration. Spine J. 2005;5:260S–6.CrossRefPubMed
28.
go back to reference Feng H, Danfelter M, Strömqvist B, Heinegård D. Extracellular matrix in disc degeneration. J Bone Joint Surg Am. 2006;88 Suppl 2:25–9.CrossRefPubMed Feng H, Danfelter M, Strömqvist B, Heinegård D. Extracellular matrix in disc degeneration. J Bone Joint Surg Am. 2006;88 Suppl 2:25–9.CrossRefPubMed
29.
go back to reference Wilke HJ, Heuer F, Neidlinger-Wilke C, Claes L. Is a collagen scaffold for a tissue engineered nucleus replacement capable of restoring disc height and stability in an animal model? Eur Spine J. 2006;15 Suppl 3:S433–8.CrossRefPubMed Wilke HJ, Heuer F, Neidlinger-Wilke C, Claes L. Is a collagen scaffold for a tissue engineered nucleus replacement capable of restoring disc height and stability in an animal model? Eur Spine J. 2006;15 Suppl 3:S433–8.CrossRefPubMed
30.
go back to reference Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26:1873–8.CrossRef Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26:1873–8.CrossRef
31.
go back to reference Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230:583–8.CrossRefPubMed Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230:583–8.CrossRefPubMed
Metadata
Title
A prospective multicenter phase I/II clinical trial to evaluate safety and efficacy of NOVOCART Disc plus autologous disc chondrocyte transplantation in the treatment of nucleotomized and degenerative lumbar disc to avoid secondary disease: study protocol for a randomized controlled trial
Authors
Anja Tschugg
Felix Michnacs
Martin Strowitzki
Hans Jörg Meisel
Claudius Thomé
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1239-y

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