Stem cell therapy for idiopathic pulmonary fibrosis: a protocol proposal.
BACKGROUND
Idiopathic pulmonary fibrosis represents a lethal form of progressive fibrotic lung disorder with gradually increasing incidence worldwide. Despite intense research efforts its pathogenesis is still elusive and controversial reflecting in the current disappointing status regarding its treatment.


METHODS
We report the first protocol proposal of a prospective, unicentric, non-randomized, phase Ib clinical trial to study the safety and tolerability of the adipose-derived stem cells (ADSCs) stromal vascular fraction (SVF) as a therapeutic agent in IPF. After careful patient selection based on functional criteria (forced vital capacity-FVC > 50%, diffuse lung capacity for carbon monoxide-DLCO > 35% of the predicted values) all eligible subjects will be subjected to lipoaspiration resulting in the isolation of approximately 100- 500 gr of adipose tissue. After preparation, isolation and labelling ADSCs-SVF will be endobronchially infused to both lower lobes of the fibrotic lungs. Procedure will be repeated thrice at monthly intervals. Primary end-point represent safety and tolerability data, while exploratory secondary end-points include assessment of clinical functional and radiological status.


RESULTS
Preliminary results recently presented in the form of an abstract seem promising and tantalizing since there were no cases of clinically significant allergic reactions, infections, disease acute exacerbations or ectopic tissue formation. In addition 6 months follow-up data revealed a marginal improvement at 6-minute walking distance and forced vital capacity.


CONCLUSIONS
Adipose tissue represents an abundant, safe, ethically uncontested and potentially beneficial source of stem cells for patients with IPF. Larger multicenter phase II and III placebo-controlled clinical trials are sorely needed in order to prove efficacy. However, pilot safety studies are of major importance and represent the first hamper that should be overcome to establish a rigid basis for larger clinical trials.
Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
Argyris
A
Tzouvelekis
George
G
Koliakos
Paschalis
P
Ntolios
Irene
I
Baira
Evangelos
E
Bouros
Anastasia
A
Oikonomou
Athanassios
A
Zissimopoulos
George
G
Kolios
Despoina
D
Kakagia
Vassilis
V
Paspaliaris
Ioannis
I
Kotsianidis
Marios
M
Froudarakis
Demosthenes
D
Bouros
D000273:Adipose Tissue / Q000166:cytology; D002985:Clinical Protocols; D017321:Clinical Trials, Phase I as Topic / Q000379:methods*; D023381:Endpoint Determination; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D015609:Organotechnetium Compounds; D010351:Patient Discharge; D011877:Radionuclide Imaging; D033581:Stem Cell Transplantation / Q000009:adverse effects; D013997:Time Factors
D015609:Organotechnetium Compounds