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Drew CJG, Sharouf F, Randell E, Brookes-Howell L, Smallman K, Sewell B, Burrell A, Kirby N, Mills L, Precious S, Pallmann P, Gillespie D, Hood K, Busse M, Gray WP, Rosser A. Protocol for an open label: phase I trial within a cohort of foetal cell transplants in people with Huntington's disease. Brain Commun 2021; 3:fcaa230. [PMID: 33543141 PMCID: PMC7850012 DOI: 10.1093/braincomms/fcaa230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
Huntington's disease is a progressive neurodegenerative disorder characterized by motor, cognitive and psychiatric symptoms. Currently, no disease-modifying therapies are available to slow or halt disease progression. Huntington's disease is characterized by relatively focal and specific loss of striatal medium spiny neurons, which makes it suitable for cell-replacement therapy, a process involving the transplantation of donor cells to replace those lost due to disease. TRIal DEsigns for delivery of Novel Therapies in neurodegeneration is a phase I Trial Within a Cohort designed to assess safety and feasibility of transplanting human foetal striatal cells into the striatum of people with Huntington's disease. A minimum of 18 participants will be enrolled in the study cohort, and up to five eligible participants will be randomly selected to undergo transplantation of 12-22 million foetal cells in a dose escalation paradigm. Independent reviewers will assess safety outcomes (lack of significant infection, bleeding or new neurological deficit) 4 weeks after surgery, and ongoing safety will be established before conducting each subsequent surgery. All participants will undergo detailed clinical and functional assessment at baseline (6 and 12 months). Surgery will be performed 1 month after baseline, and transplant participants will undergo regular clinical follow-up for at least 12 months. Evaluation of trial processes will also be undertaken. Transplant participants and their carers will be interviewed ∼1 month before and after surgery. Interviews will also be conducted with non-transplanted participants and healthcare staff delivering the intervention and involved in the clinical care of participants. Evaluation of clinical and functional efficacy outcomes and intervention costs will be carried out to explore plausible trial designs for subsequent randomized controlled trials aimed at evaluating efficacy and cost-effectiveness of cell-replacement therapy. TRIal DEsigns for delivery of Novel Therapies in neurodegeneration will enable the assessment of the safety, feasibility, acceptability and cost of foetal cell transplants in people with Huntington's disease. The data collected will inform trial designs for complex intra-cranial interventions in a range of neurodegenerative conditions and facilitate the development of stable surgical pipelines for delivery of future stem cell trials. Trial Registration: ISRCTN52651778.
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Affiliation(s)
- Cheney J G Drew
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
- Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Feras Sharouf
- Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Cardiff, CF24 4HQ, UK
- Department of Neurosurgery, University Hospital Wales, Cardiff, CF14 4XW, UK
| | - Elizabeth Randell
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | | | - Kim Smallman
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Bernadette Sewell
- Swansea Centre for Health Economics, Swansea University, Swansea, SA2 8PP, UK
| | - Astrid Burrell
- Public and Patient Representative, BRAIN Involve, Cardiff University, Cardiff, UK
| | - Nigel Kirby
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Laura Mills
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Sophie Precious
- Brain Repair Group, School of Biosciences, Cardiff University, Museum Ave, Cardiff, CF10 3AX, UK
| | - Philip Pallmann
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - David Gillespie
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
- Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Cardiff, CF24 4HQ, UK
| | - William P Gray
- Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Cardiff, CF24 4HQ, UK
- Department of Neurosurgery, University Hospital Wales, Cardiff, CF14 4XW, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Anne Rosser
- Brain Repair and Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Cardiff, CF24 4HQ, UK
- Brain Repair Group, School of Biosciences, Cardiff University, Museum Ave, Cardiff, CF10 3AX, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, CF24 4HQ, UK
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Choompoo N, Bartley OJM, Precious SV, Vinh NN, Schnell C, Garcia A, Roberton VH, Williams NM, Kemp PJ, Kelly CM, Rosser AE. Induced pluripotent stem cells derived from the developing striatum as a potential donor source for cell replacement therapy for Huntington disease. Cytotherapy 2020; 23:111-118. [PMID: 33246883 PMCID: PMC7822401 DOI: 10.1016/j.jcyt.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022]
Abstract
Background Cell replacement therapy (CRT) for Huntington disease (HD) requires a source of striatal (STR) progenitors capable of restoring the function lost due to STR degeneration. Authentic STR progenitors can be collected from the fetal putative striatum, or whole ganglionic eminence (WGE), but these tissues remain impractical for widespread clinical application, and alternative donor sources are required. Here we begin exploring the possibility that induced pluripotent stem cells (iPSC) derived from WGE may retain an epigenetic memory of their tissue of origin, which could enhance their ability to differentiate into STR cells. Results We generate four iPSC lines from human WGE (hWGE) and establish that they have a capacity similar to human embryonic stem cells with regard to their ability to differentiate toward an STR phenotype, as measured by expression and demethylation of key STR genes, while maintaining an overall different methylome. Finally, we demonstrate that these STR-differentiated hWGE iPSCs share characteristics with hWGE (i.e., authentic STR tissues) both in vitro and following transplantation into an HD model. Overall, iPSCs derived from human WGE show promise as a donor source for CRT for HD.
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Affiliation(s)
- Narawadee Choompoo
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK; Department of Anatomy, Faculty of Medical Science, Naresuan University, Phisanulok, Thailand
| | - Oliver J M Bartley
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
| | - Sophie V Precious
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
| | - Ngoc-Nga Vinh
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
| | - Christian Schnell
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
| | - Ana Garcia
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
| | | | - Nigel M Williams
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul J Kemp
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK
| | - Claire M Kelly
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK; Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Anne E Rosser
- Brain Repair Group, School of Biosciences, Cardiff University, Cardiff, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK; Wales Brain Repair and Intracranial Neurotherapeutics Unit, School of Medicine, Cardiff University, Cardiff, UK.
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