Cryopreserved Human Umbilical Cord (TTAX01) for Late Stage, Complex Non-healing Diabetic Foot Ulcers (AMBULATE DFU II)

Last updated: March 26, 2025
Sponsor: BioTissue Holdings, Inc
Overall Status: Completed

Phase

3

Condition

Diabetes And Hypertension

Diabetes Mellitus Types I And Ii

Ulcers

Treatment

TTAX01

Standard care

Clinical Study ID

NCT04450693
TTAX01-CR005
  • Ages > 18
  • All Genders

Study Summary

It is hypothesized that application at 4-week or greater intervals of the human placental umbilical cord tissue TTAX01 to the surface of a well debrided, complex diabetic foot ulcer (DFU) will, with concomitant management of infection, result in a higher rate of wounds showing complete healing within 25 weeks of initiating therapy, compared with standard care alone. This second confirmatory Phase 3 study examines a population of diabetic foot ulcer patients having adequate perfusion, with or without neuropathy, and a high suspicion of associated osteomyelitis in a complex, high grade wound.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • The subject has signed the informed consent form

  • The subject is male or female, at least 18 years of age inclusive at the date ofScreening

  • The subject has confirmed diagnosis of Type I or Type II diabetes

  • The subject's index ulcer is located on the plantar surface, inter digital, heel,lateral or medial surface of the foot

  • The subject has an index ulcer with visible margins having an area ≤ 12.0 cm2 whenmeasured by the electronic measuring device at Screening

  • The subject's index ulcer extends beyond the dermis, into subcutaneous tissue withevidence of exposed bone, tendon, muscle and/or joint capsule

  • The subject presents with history, signs or symptoms leading to a clinical suspicionof osteomyelitis in the opinion of the Investigator supported by positive Probe toBone (PTB) and any of the following: radiographic (X-ray, Magnetic Resonance Imaging (MRI), or bone scan) or evidence of bone necrosis

  • The subject has an Ankle-Brachial Index ≥ 0.7 to ≤ 1.3 or TcPO2 ≥ 40 mmHg on thedorsum of the affected foot, or Great Toe Pressure ≥ 50 mmHg

  • The subject is under the care of a physician for the management of Diabetes Mellitus

  • The subject is willing to return for all mandatory visits as defined in the protocol

  • The subject is willing to follow the instructions of the trial Investigator

Exclusion

Exclusion Criteria:

  • The subject's index ulcer is primarily located on the dorsal surface of the foot

  • The subject's index ulcer can be addressed by primary closure through the completionof the initial or staged surgical procedure

  • The subject has a contralateral major amputation of the lower extremity

  • The subject has a glycated hemoglobin A1c (HbA1c) level of > 12% †

  • The subject has been on oral steroid use of > 7.5 mg daily for greater than seven (7) consecutive days in 30 days before Screening

  • The subject has been on parenteral corticosteroids, or any cytotoxic agents forseven consecutive days in the period of 30 days before Screening

  • The subject is currently taking the type 2 diabetes medicine canagliflozin (Invokana™, Invokamet™, Invokamet XR™)

  • The subject has malignancy or a history of cancer, other than non-melanoma skincancer, in five years before Screening

  • The subject is pregnant

  • The subject is a nursing mother

  • The subject is a woman of child-bearing potential who is unwilling to avoidpregnancy or use an appropriate form of birth control (adequate birth controlmethods are defined as: topical, oral, implantable, or injectable contraceptives;spermicide in conjunction with a barrier such as a condom or diaphragm; intrauterinecontraceptive device; or surgical sterilization of partner).

  • The subject is unable to sustain off-loading as defined by the protocol

  • The subject has an allergy to primary or secondary dressing materials used in thistrial

  • The subject has an allergy to glycerol

  • The subject's index ulcer is over an acute Charcot deformity

  • The subject has had previous use of NEOX®, CLARIX®, or TTAX01 applied to the indexulcer

  • Per Investigator's discretion the subject is not appropriate for inclusion in thetrial, e.g., undergoing surgical treatments listed in the protocol or the subjectcurrently has sepsis, i.e., life-threatening organ dysfunction caused by adysregulated host response to infection

Study Design

Total Participants: 106
Treatment Group(s): 2
Primary Treatment: TTAX01
Phase: 3
Study Start date:
November 20, 2020
Estimated Completion Date:
March 24, 2025

Study Description

This trial is designed as a confirmatory study of the benefits and risks of TTAX01 when used in the treatment of Wagner Grades 3 and 4 DFU. Experience with the use of a cryopreserved umbilical cord (UC) product in treating such wounds, both prior to this IND and under this IND, has indicated that a frequency of application of no shorter than every 4 weeks is associated with better than expected outcomes. Although treatment cannot be blinded, a "standard care only" arm is included to control for the benefits of aggressive baseline debridement combined with aggressive (6 weeks systemic) antibiotics. Current treatment guidelines indicate that aggressive debridement plus 1-2 weeks of antibiotics, or, minor debridement plus 6 weeks of antibiotics, would produce equivalent outcomes, although the evidence is not strong. By utilizing both maximum debridement and maximum antimicrobial therapy, the standard care described in this protocol may result in healing rates somewhat superior to current standard practice.

The design of this second confirmatory study is matched to the design of the Phase 2 efficacy study TTCRNE-1501, with the exception of extending the primary endpoint from a landmark analysis at 16 to a "wound survival" analysis through 26 weeks, utilizing a proportional risk analysis rather than a simple test of proportions. This design consideration is based on analysis of previous studies (see Background section), and a desire to fold data from every visit into the primary analysis, rather than generating an excessive number of secondary endpoints.

Connect with a study center

  • LakeView Clinical Research

    Guntersville, Alabama 35976
    United States

    Site Not Available

  • Banner University Medical Center Tucson

    Tucson, Arizona 85724
    United States

    Site Not Available

  • Rancho Research Institute

    Downey, California 90242
    United States

    Site Not Available

  • NorthBay Healthcare

    Fairfield, California 94534
    United States

    Site Not Available

  • Clemente Clinical Research

    Los Angeles, California 90033
    United States

    Site Not Available

  • LA Foot and Ankle Clinic

    Los Angeles, California 90057
    United States

    Site Not Available

  • VA Northern California Health Care System

    Mather, California 95655
    United States

    Site Not Available

  • CureCentric

    Palmdale, California 93551
    United States

    Site Not Available

  • PIH Health

    Whittier, California 90606
    United States

    Site Not Available

  • BRCR Medical Center

    Deerfield Beach, Florida 33442
    United States

    Site Not Available

  • Midland Florida Clinical Research Center

    Deland, Florida 32720
    United States

    Site Not Available

  • Delray Physician Care Center

    Delray Beach, Florida 33445
    United States

    Site Not Available

  • Gateway Clinical Trials, LLC

    O'Fallon, Illinois 62269
    United States

    Site Not Available

  • American Health Network

    Avon, Indiana 46123
    United States

    Site Not Available

  • Beth Israel Deaconess Medical Center

    Boston, Massachusetts 02215
    United States

    Site Not Available

  • Boston Medical Center

    Boston, Massachusetts 02118
    United States

    Site Not Available

  • Reno Orthopedic Clinic

    Reno, Nevada 89503
    United States

    Site Not Available

  • Curalta Foot and Ankle

    Westwood, New Jersey 07675
    United States

    Site Not Available

  • Northwell Health Comprehensive Wound Healing Center

    New Hyde Park, New York 11042
    United States

    Site Not Available

  • Cutting Edge Research, LLC

    Circleville, Ohio 43113
    United States

    Site Not Available

  • UPMC Center for Innovation in Restorative Medicine

    Pittsburgh, Pennsylvania 15261
    United States

    Site Not Available

  • University of Texas Southwestern Medical Center

    Dallas, Texas 75390
    United States

    Site Not Available

  • Advantage Foot Care of Houston

    Houston, Texas 77074
    United States

    Site Not Available

  • Biolife Genetics Research

    Houston, Texas 77095
    United States

    Site Not Available

  • Biolife Genetics Research

    Katy, Texas 77494
    United States

    Site Not Available

  • Bio-X-Cell Research

    San Antonio, Texas 78211
    United States

    Site Not Available

  • Wasatch Clinical Research, LLC

    Salt Lake City, Utah 84107
    United States

    Site Not Available

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