Allogeneic Stem Cell Therapy for Acute Ischemic Stroke

But why go thru all the trouble of stem cells if exosomes are the reason for the benefits? Which must be why no one seems to be monitoring stem cell survival.

Application of stem cell-derived exosomes in ischemic diseases: opportunity and limitations

The latest here:

Allogeneic Stem Cell Therapy for Acute Ischemic Stroke

The Phase 2/3 TREASURE Randomized Clinical Trial

Kiyohiro Houkin, MD¹; Toshiya Osanai, MD²; Shinichiro Uchiyama, MD^3,4; et al Kazuo Minematsu, MD⁵; Akihiko Taguchi, MD⁶; Katsuhiko Maruichi, MD⁷; Yoshimasa Niiya, MD⁸; Katsuyuki Asaoka, MD⁹; Yoshihiro Kuga, MD¹⁰; Katsumi Takizawa, MD¹¹; Koichi Haraguchi, MD¹²; Shinichi Yoshimura, MD¹³; Kazumi Kimura, MD¹⁴; Koji Tokunaga, MD¹⁵; Atsuo Aoyama, MD¹⁶; Fusao Ikawa, MD¹⁷; Chikanori Inenaga, MD¹⁸; Tatsuya Abe, MD¹⁹; Atsushi Tominaga, MD²⁰; Shinichi Takahashi, MD²¹; Kohsuke Kudo, MD²²; Miki Fujimura, MD²; Taku Sugiyama, MD²; Masaki Ito, MD²; Masahito Kawabori, MD²; David C. Hess, MD²³; Sean I. Savitz, MD²⁴; Teruyuki Hirano, MD²⁵; for the TREASURE Study Investigators

Author Affiliations Article Information

JAMA Neurol. Published online January 16, 2024. doi:10.1001/jamaneurol.2023.5200

Key Points

Question  Is intravenous allogeneic multipotent adult progenitor cell (MultiStem) therapy safe and effective for patients with acute ischemic stroke?

Findings  In this randomized clinical trial with 206 participants, intravenous administration of MultiStem therapy within 18 to 36 hours of ischemic stroke onset was safe but did not improve short-term outcomes at 90 days compared with placebo. There were no grade 3 or 4 allergic reactions, including in older patients.

Meaning  The results of this study support the safety of MultiStem, but further research is needed to determine whether MultiStem therapy for ischemic stroke has a beneficial effect in patients who meet specific criteria.

Abstract

Importance  Cell therapy is a promising(Really? I just see a waste of money and time!) treatment approach for stroke and other diseases. However, it is unknown whether MultiStem (HLCM051), a bone marrow–derived, allogeneic, multipotent adult progenitor cell product, has the potential to treat ischemic stroke.

Objective  To assess the efficacy and safety of MultiStem when administered within 18 to 36 hours of ischemic stroke onset.

Design, Setting, and Participants  The Treatment Evaluation of Acute Stroke Using Regenerative Cells (TREASURE) multicenter, double-blind, parallel-group, placebo-controlled phase 2/3 randomized clinical trial was conducted at 44 academic and clinical centers in Japan between November 15, 2017, and March 29, 2022. Inclusion criteria were age 20 years or older, presence of acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 8-20 at baseline), confirmed acute infarction involving the cerebral cortex and measuring more than 2 cm on the major axis (determined with diffusion-weighted magnetic resonance imaging), and a modified Rankin Scale (mRS) score of 0 or 1 before stroke onset. Data analysis was performed between May 9 and August 15, 2022.

Exposure  Patients were randomly assigned to either intravenous MultiStem in 1 single unit of 1.2 billion cells or intravenous placebo within 18 to 36 hours of ischemic stroke onset.

Main Outcomes and Measures  The primary end points were safety and excellent outcome at day 90, measured as a composite of a modified Rankin Scale (mRS) score of 1 or less, a NIHSS score of 1 or less, and a Barthel index score of 95 or greater. The secondary end points were excellent outcome at day 365, mRS score distribution at days 90 and 365, and mRS score of 0 to 1 and 0 to 2 at day 90. Statistical analysis of efficacy was performed using the Cochran-Mantel-Haenszel test.

Results  This study included 206 patients (104 received MultiStem and 102 received placebo). Their mean age was 76.5 (range, 35-95) years, and more than half of patients were men (112 [54.4%]). There were no between-group differences in primary and secondary end points. The proportion of excellent outcomes at day 90 did not differ significantly between the MultiStem and placebo groups (12 [11.5%] vs 10 [9.8%], P = .90; adjusted risk difference, 0.5% [95% CI, −7.3% to 8.3%]). The frequency of adverse events was similar between treatment groups.

Conclusions and Relevance  In this randomized clinical trial, intravenous administration of allogeneic cell therapy within 18 to 36 hours of ischemic stroke onset was safe but did not improve short-term outcomes. Further research is needed to determine whether MultiStem therapy for ischemic stroke has a beneficial effect in patients who meet specific criteria, as indicated by the exploratory analyses in this study.

Trial Registration  ClinicalTrials.gov Identifier: NCT02961504