The Therapeutic Potential of Mesenchymal Stem Cell-derived Exosomes in Peritoneal Dysfunction

NCT07791667 — Phase 1, Not yet recruiting, 12 participants, Zhujiang Hospital

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A Phase I, Single-center, Open-label Study to Evaluate the Safety, Tolerability, and Dose-finding of Mesenchymal Stem Cell-derived Exosomes in the Treatment of Peritoneal Dialysis-related Peritoneal Dysfunction

Registry	NCT07791667
Status	Not yet recruiting
Phase	Phase 1
Study type	Interventional; non randomized, single group, masking: none, treatment
Enrollment	12 (Estimated)
Sponsor	Zhujiang Hospital (Other)
Conditions	Peritoneal Dysfunction
Interventions	MSC-Exos (Biological)
Dates	start 2026-08-01 (estimated), primary completion 2027-06-01 (estimated), completion 2027-08-01 (estimated), first posted 2026-08-28, last updated 2026-08-28

-Summary

The goal of this clinical trial is to learn if a single intraperitoneal infusion of mesenchymal stem cell-derived exosomes (MSC-Exos) is safe and tolerable in adults with peritoneal dialysis-related peritoneal failure. It will also explore whether MSC-Exos might improve how well the peritoneum works (ultrafiltration and solute transfer).

The main questions it aims to answer are:

What is the highest single dose of MSC-Exos that can be given safely without causing unacceptable side effects? (This helps find the maximum tolerated dose and the dose to use in future phase II studies.)

What medical problems (adverse events) do participants experience after receiving MSC-Exos?

Does MSC-Exos show any early signs of improving ultrafiltration volume and solute transport across the peritoneum?

Researchers will test increasing doses of MSC-Exos in small groups of participants. Each participant will receive one dose of MSC-Exos added to their usual 1.5% glucose dialysis solution (2 litres), which is then left in the abdominal cavity for 8 hours. The study does not use a placebo; instead, different dose levels are tested one after another to find the safest and most promising dose.

Participants will:

Receive a single intraperitoneal infusion of MSC-Exos through their dialysis catheter

Be monitored closely before the infusion；

Attend follow-up visits at 24 hours, 72 hours, 2 weeks, and 4 weeks after the dose;

Have blood and peritoneal effluent samples taken at each visit to check for safety ;

Have their ultrafiltration volume and solute transport ability measured at baseline and 4 weeks after the dose to see if any changes occur.

All participants will be closely observed for any side effects. The results will help decide whether further studies are warranted.

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+Arms and interventions

Arm	Type	Interventions
Dose Level 1 (5×10⁹ particles)	Experimental	Biological: MSC-Exos
Dose Level 2 (2.5×10¹⁰ particles)	Experimental	Biological: MSC-Exos
Dose Level 3 (1×10¹¹ particles)	Experimental	Biological: MSC-Exos

MSC-Exos (Biological): MSC-Exos will be added to 2 L of 1.5% glucose peritoneal dialysis fluid, which will be administered via intraperitoneal infusion and retained for 8 hours.

+Outcome measures

Primary outcomes

Incidence of Dose-Limiting Toxicities (DLTs) [Within 72 hours post-administration]: Number of participants with MSC-Exos-related DLTs, defined as grade ≥3 local peritoneal reactions (abdominal pain / signs of peritonitis) or systemic allergic reactions assessed by CTCAE v5.0. Local reactions will be objectively supported by peritoneal effluent white blood cell count and polymorphonuclear (PMN) cell percentage.
Incidence of Serious Adverse Events (SAEs) [Up to 4 weeks post-administration]: Number of participants experiencing SAEs during the entire study period. Safety monitoring includes serial assessments of complete blood count, C-reactive protein (CRP), and liver/kidney function tests (ALT, AST, creatinine, BUN).

Secondary outcomes

Change in 4-hour Ultrafiltration Volume [Baseline and Week 4]: Change from baseline to Week 4 in 4-hour ultrafiltration volume during modified peritoneal equilibration test (PET).
Change in 4-hour D/Pcr Ratio [Baseline and Week 4]: Change from baseline to Week 4 in 4-hour dialysate-to-plasma creatinine (D/Pcr) ratio during modified PET.
Change in 1-hour Sodium Dip [Baseline and Week 4]: Change from baseline to Week 4 in 1-hour sodium dip (absolute decrease in serum sodium) during modified PET.
Change in Sodium Sieve [Baseline and Week 4]: Change from baseline to Week 4 in sodium sieve, calculated as the ratio of dialysate sodium at 1 hour to baseline plasma sodium during modified PET.

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. Patients who have been on continuous peritoneal dialysis for more than 1 year.
2. Age ≥ 18 years.
3. Patients meeting at least one of the following criteria for peritoneal ultrafiltration insufficiency:

   * Standard PET-confirmed ultrafiltration failure: 4-hour ultrafiltration volume < 400 mL using 4.25% glucose dialysate, or < 100 mL using 2.5% glucose dialysate; ② 1-hour sodium dip < 5 mmol/L and/or 1-hour sodium sieve ratio ≤ 0.03 using 4.25% glucose dialysate; ③ Inability to maintain fluid balance, as evidenced by persistent edema/heart failure symptoms, NT-proBNP >11215.2 ng/L, or bioimpedance spectroscopy-assessed overhydration (OH) >2 L (after excluding non-peritoneal causes).

Exclusion Criteria:

1. Patients with acute renal failure or chronic renal failure who can be temporarily weaned from dialysis.
2. Patients with malignant tumors, active infections, or severe malnutrition.
3. Patients with severe hepatic failure or cirrhosis.
4. Patients with severe cardiovascular disease, severe heart failure (NYHA Class IV or higher), or active systemic diseases.
5. Patients with peritonitis within the past 3 months or currently experiencing peritonitis.
6. Patients with encapsulating peritoneal sclerosis (EPS).
7. Patients with peritoneal dialysis catheter dysfunction.
8. Planned or ongoing pregnancy.
9. Simultaneous participation in another interventional clinical trial or drug study.