Study to Investigate the Safety of the Transplantation (by Injection) of Human Glial Restricted Progenitor Cells (hGRPs; Q-Cells®) Into Subjects With Amyotrophic Lateral Sclerosis (ALS)

Prior treatment

• Subject who is immune compromised or who has a condition contraindicated to treatment with immunosuppression agents (e.g., tuberculosis, latent infection).
• Subject who has been exposed to any other experimental agent (off-label use or investigational) within 30 days of the first day of the Screening Period. Biologic agents may need additional time for washout and will be evaluated by the Sponsor on a case-by-case basis.
• Subject who has previously been administered stem cells.
• Subject with any medical condition or using concomitant medication that would contraindicate the use of tacrolimus, mycophenolate mofetil, or prednisone as determined by Investigator.
• Subject with evidence of deep vein thrombosis (DVT) by venous ultrasound or any previous evidence of DVT.
• Subject who, in the opinion of the Investigator, has taken or is taking concomitant medications, supplements, or other agents that may interfere with the safety evaluation of Q-Cells® or may affect the course of the subject's ALS progression.

Other illness

• Subject with a diagnosis of significant cognitive impairment, clinical dementia, or major psychiatric illness including psychosis, bipolar disease, major depression, as determined by the DSM-V.
• Subject with a diagnosis of other neurodegenerative disease (e.g., Parkinson's disease, Alzheimer's disease).
• Subject with a diagnosis of any medical condition that impairs nerve or muscle function (e.g., notable peripheral neuropathy, metabolic muscle disease).
• Subject with a clinically significant history of unstable cardiac, pulmonary, renal, hepatic, endocrine, hematologic, or active malignancy or infectious disease or other medically significant illness, which, in the opinion of the Investigator, would preclude study participation.
• Subject with a history of spine surgery or anatomic variation incompatible with route of administration (as determined by neurosurgeon).
• Subject demonstrating any evidence of CNS malignancy or CNS lesions as defined by imaging studies of the CNS (MRI of brain and spinal cord).
• Subject having uncontrolled hypertension (Systolic BP\>180mmHg and/or Diastolic BP \>110mmHg) or having a history of thrombotic events or poorly controlled medical conditions that, in the opinion of the Investigator and/or surgeon, increase risk of surgery.
• Subject with a history of alcohol or drug abuse or dependence within 1 year of the first day of the Screening Period, per DSM-V criteria.
• Subject with an allergy to Q-Cells® or any of its constituents (e.g., chicken eggs), or an allergy to any of the co-administered immunosuppressants or any of their excipients.

Lab values

• Subject with clinically significant abnormal clinical laboratory values, as determined by the Investigator during the Screening Period.
• Subject with an aspartate aminotransferase (AST) or alanine aminotransferase (ALT) value \>3.0 times the upper limit of normal or creatinine \>1.5 times the upper limit of normal and/or eGFR \<50cc/min during the Screening Period.
• Subject with pre-existing anti-human leukocyte antigen (HLA) class I or class II antibodies directed against the Q-Cells®, as determined by panel reactive antibody (PRA) assay during the Screening Period.

Other

• Subject in whom causes of neuromuscular weakness other than ALS have not been practically excluded.
• Subject with severe cervical or lumbar stenosis, cord compression, or cervical or lumbar myelopathy.
• Subject with abnormal flow voids on the surface of the spinal cord suggestive of arteriovenous malformation (AVM).
• Subject who cannot undergo MRI examination because of the presence of a pacemaker, an implanted defibrillator or certain other implanted electronic or metallic devices, or who have been or might have been exposed to metal fragments, or any reason the subject cannot undergo an MRI routinely for the duration of the trial.
• Subject unlikely to comply with study requirements, as determined by Investigator.

• Subject has the ability to understand the purpose and risks of the study and provide a signed and dated informed consent and authorization to collect and use protected health information (PHI) in accordance with national and local subject privacy regulations.
• Subject lives within reasonable driving distance of study center (approximately 3 hours).
• Subject has a caregiver willing/able to assist in the transportation and care required by study participation.
• Subject is 18 - 80 years of age (inclusive) on the first day of the Screening Period.
• Subject is diagnosed with sporadic or familial ALS within the past 48 months.
• Subject meets the laboratory-supported probable, clinically probable, or definite criteria for diagnosing ALS according to the World Federation of Neurology El Escorial criteria.
• Subject has an upright FVC ≥65% of predicted value for age, height, and gender at Screening.
• Subject has not taken riluzole for at least 30 days prior to the first day of the Screening Period, or has been on a stable dose of riluzole for at least 30 days prior to the first day of the Screening Period (Riluzole-naïve subjects are permitted in the study).
• Subject is medically able to undergo the study procedures and physically able to adhere to the visit schedule at the time of study entry.
• Women of childbearing capacity must have a negative pregnancy test during the Screening Period and at the Pre-Operative Visit.
• Subject must agree to practice effective birth control during study participation.