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HOSPITAL CLÍNIC VETERINARI RCT in stem cells From theory to prac4ce

Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

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RCT in stem cells. From theory to practice

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Page 1: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

HOSPITAL CLÍNIC VETERINARI

RCT  in  stem  cells  From  theory  to  prac4ce  

Page 2: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

MSC  RESEARCH  2013  

DISC  

Ovine  P.  NERVE  

Aastrom

IBGM

Ovine  CARTILAGE  

Pseudoarthrosis  

Osteonecrosis  

Maxilar  

Equine  CARTILAGE  

Pseudoarthrosis  clinical  trials  

Pseudoarthrosis   PEi  

PEi  Salvat - Histocell

Aastrom

Aastrom

Aastrom

BONE   05-048

BST

BST

BST

BST

PEi   10-134

OA    II-­‐III°    

OA    II-­‐IV°  

BST PEi  

OA    II-­‐IV°  crio  

OA    II-­‐IV°  alo  vs  hialur.  

IBGM

IBGM

IBGM

10-005

OA    II-­‐IV°  (MSC  vs  PRP)  

CARTILAGE  

animal  model  

Equine  tendon  

Page 3: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

Ensayo  clínico  I-­‐II  

ONT  

preclínica  BPL  

Procedimiento  Centralizado  

Cláusula  Exclusión  

Ensayo  clínico  III  

OCATT   AEMPS  

protocolo  

CEICs  

Laboratorio  GMP  

Hospital  

PEi  

CRO  

Promotor  

inves4gadores  RD  2043/94  

RD  1369/2000  

Gestora  

Uso  Compasivo  EMA  

Financiación  

RD  223/2004  Ley  29/2006  

RD  1344/2007  

Ley  14/2007  

RD1825/2009  RD  1301/2006  

Page 4: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

Advanced Therapy

characterized

accurate dose

presentation

Medicines Agency control

Page 5: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

phenotype

immunophenotype

plastic adherence

presentation

Page 6: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

osteocito

condrocito

miocito

c. estroma

tenocito

adipocito

dexametasona indometacina

isobutilmetilxilina

dexametasona ácido ascórbico

TGF-β

MSC

in vitro

•  Osiris Therapeutics

glucocorticoides 5% suero equino

pluripotency

Page 7: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain
Page 8: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

1 w 2 w 3 w

degeneration inflammation

regeneration fibrosis

muscle repair timing Time  Factor  

Dose  Factor  

Page 9: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

BM or AT harvest

crio preserved intermediate product

therapeutic dose

Cell Therapy

cellular pre plating expantion cells

10 days

RICES

Page 10: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

BM or AT allogenic

crio preserved intermediate product

therapeutic dose

Cell Therapy

cellular pre plating expantion cells

10 days

RICES

A

Page 11: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

1 w 2 w 3 w

degeneration inflammation

regeneration fibrosis

muscle repair timing Time  Factor  

Dose  Factor  

Page 12: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

osteocito

condrocito

miocito

c. estroma

tenocito

adipocito

MSC

in vitro

•  Osiris Therapeutics

Page 13: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

BM-­‐MSC      6  AT-­‐MSC        6  

SF  

prp  

12  equinos  lesión  SDTF  20x10E6  MSC  

Page 14: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

manguito rotadores 20x10E6 MSC + membrana Hospital Universitario San Carlos. Madrid

epicondilitis 1x10E6 vs 10x10E6 allo-AT MSC

Page 15: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

Conclusiones

Terapia celular con MSC (dosis: 15x10E6 a 40x10E6)

§  Viable §  Segura §  Indicios de eficacia §  Actual: Solo bajo ensayo o UC §  Control Agencia Medicamento      

Page 16: Robert Soler and Lluis Orozco. Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain

HOSPITAL CLÍNIC VETERINARI

RCT  in  stem  cells  From  theory  to  prac4ce