Safety Study of Intravenous MiraMSC in Older Adults With Mild to Moderate Frailty Syndrome

A Phase I, Open-Label Study to Evaluate the Safety and Tolerability of MiraMSC Administered Intravenously in Elderly Subjects With Mild to Moderate Frailty Syndrome

The purpose of this Phase I, open-label study is to evaluate the safety and tolerability of intravenous MiraMSC-FS-001 in older adults with mild to moderate frailty syndrome. MiraMSC-FS-001 is an investigational product consisting of allogeneic umbilical cord-derived mesenchymal stem cells (UCMSCs). Eligible participants will receive intravenous administration of MiraMSC-FS-001.

Frailty syndrome (FS) is an age-related clinical condition characterized by reduced physiological reserve and increased vulnerability to adverse health outcomes, including falls, hospitalization, disability, and mortality. Despite its growing prevalence in the aging population, effective treatment options for frailty syndrome remain limited.

MiraMSC-FS-001 is an investigational product consisting of allogeneic umbilical cord-derived mesenchymal stem cells (UCMSCs). Preclinical studies have demonstrated the immunomodulatory, anti-inflammatory, and regenerative properties of UCMSCs, supporting their clinical evaluation as a potential treatment for frailty syndrome. In addition, GLP toxicology studies demonstrated a favorable nonclinical safety profile for MiraMSC-FS-001, supporting its further clinical evaluation in humans.

This Phase I, open-label, dose-escalation study will evaluate the safety and tolerability of intravenous MiraMSC-FS-001 in older adults with mild to moderate frailty syndrome. Eligible participants will receive intravenous MiraMSC-FS-001 according to the study protocol and will undergo scheduled safety evaluations throughout the study. The results of this study are expected to provide clinical safety information to support the further development of MiraMSC-FS-001.

Inclusion Criteria:

Subjects will be eligible for enrollment in the study only if they meet ALL the following criteria at time of Screening:

1. Subjects aged ≥ 60 through ≤ 85 years old.
2. Subjects with clinical diagnosis of mild to moderate Frailty Syndrome as assessed by the Investigator with a Clinical Frailty Scale score between 4 to

6. 3. Subject will not start any new treatment for this condition during the study.

• The new treatment refers to any clinical study of new investigational therapies or any other stem cell therapies. Subject will be allowed to continue ongoing medications and therapies that are not prohibited treatment as listed in Section 6.4.1 and are deemed necessary by the Investigator for appropriate medical care. Minor modifications or dose adjustments to ongoing frailty- related treatments that were initiated prior to study enrollment and are not prohibited by the protocol may be implemented if deemed necessary by the Investigator for appropriate care; such adjustments will not be considered the initiation of a new treatment. ** 4. Subjects with body weight between 40 to 90 kg. 5. Subject is willing to provide written informed consent to participate in the study after reading the informed consent form and the information provided.

Exclusion Criteria:

Subjects meeting ANY of the following criteria at time of Screening will be excluded from enrollment:

1. Subjects unwill ing or unable to perform any of the assessments required by endpoint analysis.

2. Subjects who have a diagnosis of any disabling neurologic disorder including, but not limited to: Parkinson's disease, Amyotrophic Lateral Sclerosis, multiple sclerosis, stroke or dementia.

3. Subjects who have a score on the Mini-Mental State Examination (MMSE) of 24 or below.

4. Subjects who have a significant comorbid medical condition(s) including, but not limited to:

   1. Severe kidney disease requiring hemodialysis or peritoneal dialysis;
   2. Advanced liver disease such as severe liver cirrhosis;
   3. Severe congestive heart failure (NYHA class 3 and 4);
   4. Severe pulmonary dysfunction, including severe chronic obstructive pulmonary disease stage III or IV (Gold classification)

5. Subjects who have a clinical history of malignancy within 5 years (i.e., patients with prior malignancy must be disease free for 5 years), except curatively-treated basal cell carcinoma or in situ carcinomas.

6. Subjects using chronic immunosuppressant therapy, including corticosteroids (> 5 mg/day of prednisone, or equivalent), or TNF-alpha antagonists.

7. Subjects on chronic immunosuppressive transplant therapy.

8. Subjects who have participated in another clinical study of new investigational therapies within 6 months prior to screening.

9. Subjects who have received any other stem cell therapy within 12 months prior to screening.

10. Subjects with known allergy or hypersensitivity to any component of the formulation and cellular therapies (i.e., penicillin or streptomycin).

11. Subjects who have a history of drug or alcohol abuse within the past 3 years.

12. Subjects who are known to be infected with HIV.

13. Subjects currently in hospital stay.

14. Subjects who have a significant illness as judged by principal investigator (PI) including, but not limited to:

    1. Psychiatric illness
    2. Uncontrolled hypertension or hypotension
    3. Unstable cardiac arrhythmia
    4. Active Hepatitis B, Hepatitis C infections

15. Subjects who have any condition that in the opinion of the Principal investigator limits lifespan to < 1 year.

16. Subjects who have any other condition that, in the opinion of the investigator, may compromise the safety or compliance of the patient or preclude successful completion of the study.

17. Subjects with known or suspected bleeding disorders (including but not limited to hemophilia, von Willebrand disease, or platelet function disorders), or clinically significant coagulopathy (including abnormal PT, PTT, or INR) at screening.

18. Subjects receiving medications that may increase the risk of bleeding or coagulopathy (such as anticoagulants, antiplatelet agents, or thrombolytics), unless medically necessary and approved by the Medical Monitor on a case- by-case basis.