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HOPE-Duchenne (Halt cardiomyOPathy progrEssion in Duchenne) (HOPE)

Primary Purpose

Duchenne Muscular Dystrophy, Cardiomyopathy

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Allogeneic Cardiosphere-Derived Cells (CAP-1002)
Sponsored by
Capricor Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Duchenne Muscular Dystrophy focused on measuring Duchenne Muscular Dystrophy, Cardiomyopathy

Eligibility Criteria

12 Years - undefined (Child, Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male subjects 18 years of age or older must be able to provide informed consent and follow up with protocol procedures. Male subjects at least 12 years of age but younger than 18 years of age must be able to provide assent with parent or guardian providing permission for study participation. Only male subjects will be randomized into this study.
  2. Documented diagnosis of Duchenne Muscular Dystrophy by genetic mutation analysis.
  3. Cardiomyopathy with left ventricular scar by LGE in at least 4 segments as assessed by contrast-enhanced MRI and EF >35% at the time of screening.
  4. Use of evidence based medical-therapy in accordance with the "DMD Care Considerations Working Group" guidelines for the management of DMD, for at least three months prior to signing the consent form (or, providing assent) or documented contraindication or intolerance or patient preference.
  5. Subjects must be taking systemic glucocorticoids for at least six months prior to screening.
  6. Subjects must be 12 years of age or older at time of screening
  7. Subjects must be appropriate candidates for cardiac catheterization and intracoronary infusion of CAP-1002, in the judgement of the site's interventional cardiologist.

Exclusion Criteria:

  1. Therapy with intravenous inotropic or vasoactive medications at the time of screening.
  2. Inability to undergo cardiac catheterization and/or MRI without general anesthesia.
  3. Immunologic incompatibility with all available Master Cell Banks (MCBs) by single-antigen bead (SAB) serum antibody profiling.
  4. Planned or likely major surgery in the next 12 months after planned randomization.
  5. Left Ventricular Assist Devices (LVAD) or those subjects actively in the process of acquiring a LVAD.
  6. Contraindication to cardiac MRI.
  7. Known hypersensitivity to contrast agents.
  8. Estimated glomerular filtration rate (GFR) <60 mL/min, as calculated by the CKD-EPI cystatin C equation (Inker, Schmid et al. 2012).
  9. Active infection not responsive to treatment.
  10. Active systemic allergic reaction(s), connective tissue disease or autoimmune disorder(s).
  11. History of cardiac tumor or cardiac tumor demonstrated on screening MRI.
  12. History of previous stem cell therapy.
  13. History of use of medications listed in Appendix 3 within 3 months prior to signing the ICF / Assent through completion of the study infusion.
  14. Known moderate-to-severe aortic stenosis/insufficiency or severe mitral stenosis/regurgitation.
  15. Current active alcohol or drug abuse.
  16. Known history of Human Immunodeficiency Virus (HIV) infection.
  17. Known history of chronic viral hepatitis.
  18. Abnormal liver function (ALT/AST >10 times the upper reference range) and/or abnormal hematology (hematocrit <25%, WBC <3000 μl, platelets <100,000 μl) studies without a reversible, identifiable cause.
  19. Known hypersensitivity to bovine products.
  20. Known hypersensitivity to dimethyl sulfoxide (DMSO).
  21. Uncontrolled diabetes (HbA1c >9.0).
  22. Inability to comply with protocol-related procedures, including required study visits.
  23. Any condition or other reason that, in the opinion of the Investigator or Medical Monitor, would render the subject unsuitable for the study.
  24. Currently receiving investigational treatment on another clinical study or expanded access protocol, including any of the following:

    • Received investigational intervention within 30 days prior to randomization
    • Treatment and/or an incomplete follow-up to treatment with any investigational cell based therapy within 6 months prior to randomization
    • Active participation in other research therapy for cardiovascular repair/regeneration

Sites / Locations

  • Cedars-Sinai Medical Center
  • University of Florida
  • Cincinnati Children's Hospital Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Allogeneic Cardiosphere-Derived Cells (CAP-1002)

Usual Care

Arm Description

CAP-1002 is an investigational product consisting of allogeneic cardiosphere-derived cells (CDCs). All subjects assigned to the active treatment arm will receive an intended total dose of 75 million (M) CAP-1002 cells infused as 25M cells into each of the three left ventricle cardiac territories (anterior, lateral, inferior/posterior). If any of the three coronary arteries are deemed by the infusing Investigator to supply less than 30% of the left ventricular myocardium, the infusing Investigator may choose to infuse only 12.5M cells into that coronary artery or arteries. Therefore the full dose of CAP-1002 delivered may range from 50M cells to 75M cells provided that all three arteries are infused.

Subjects randomized to receive usual care will continue to be cared for and treated in whatever manner the investigator deems most appropriate for the subject on an ongoing basis, and will receive no infusion.

Outcomes

Primary Outcome Measures

Safety and tolerability composite of CAP-1002 will be established as described below.
Will be established by summaries of the occurrence of changes in coronary blood flow events, major cardiac events, laboratory assessments, vital signs, physical examination, ECG, and the occurrence of major adverse events.

Secondary Outcome Measures

Cardiac Structural composite assessed as: Absolute and relative change in parameters measured by cardiac MRI
Functional composite assessed as: Serial change in mobility measurements and Performance of Upper Limb (PUL) scale, spirometry, and 6-minute walk test (6MWT) when deemed appropriate by the Investigator.
Quality of Life composite assessed as: Change in PedsQL (Pediatric Quality of Life Inventory), including the cardiac module, and PODCI Adolescent Questionnaire.
Biomarkers composite assessed as: Osteopontin, ST2, IL-10, Galectin-3, and exploratory biomarkers (if consented/provided assent).

Full Information

First Posted
June 19, 2015
Last Updated
July 18, 2018
Sponsor
Capricor Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02485938
Brief Title
HOPE-Duchenne (Halt cardiomyOPathy progrEssion in Duchenne)
Acronym
HOPE
Official Title
A Randomized, Open-label Study of the Safety and Efficacy of Multi- Vessel Intracoronary Delivery of Allogeneic Cardiosphere-Derived Cells in Patients With Cardiomyopathy Secondary to Duchenne Muscular Dystrophy
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Completed
Study Start Date
January 2016 (Actual)
Primary Completion Date
September 2017 (Actual)
Study Completion Date
September 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Capricor Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Male subjects with cardiomyopathy secondary to Duchenne muscular dystrophy (DMD) meeting all inclusion and no exclusion criteria will be randomized. All subjects will be at least 12 years of age. They will be randomized in a 1:1 manner to either intracoronary infusion of CAP-1002 in three coronary arteries supplying the three major cardiac territories of the left ventricle of the heart (anterior, lateral, inferior/posterior) or usual care. In the active treatment arm, all three major cardiac territories will be treated (infused) during a single procedure in an open-label fashion.
Detailed Description
Approximately 24, and not more than 30, subjects will be randomized into the study, in two sequential enrollment groups. Safety data from Group 1 will undergo a Data Safety Monitoring Board (DSMB) review prior to initiation of enrollment for Group 2. The first 6-8 randomized subjects will comprise Group 1, and will include a minimum of 3 subjects completing intracoronary infusion with CAP-1002. The DSMB will conduct a review of interim safety data through 72 hours post-Day 0 for at least 3 infused subjects and for at least 6 subjects overall. Enrollment of Group 2 will begin per DSMB recommendations following their review of the 72 hour safety data from Group 1. Group 2 will include approximately 18 subjects. Screening and randomization will continue until at total of 12 subjects are infused with CAP 1002 or 30 subjects are randomized into the study, whichever comes first. All subjects assigned to the active treatment arm will receive an intended total dose of up to 75 million (M) CAP-1002 cells infused as 25M cells into each of the three left ventricle cardiac territories (anterior, lateral, inferior/posterior). Subjects randomized to receive usual care will continue to be cared for and treated in whatever manner the investigator deems most appropriate for the subject on an ongoing basis, and will receive no infusion. Randomization will take place within 30 days of the first screening procedure. After completion of the screening procedures, eligible subjects randomized to active treatment arm will receive CAP-1002 administered via intracoronary infusion on Day 0. Day 0 for eligible subjects randomized to the usual care arm will occur 7 days after the date of randomization. All randomized subjects will have a follow-up telephone call on Study Day 3, and study visits at Weeks 2 and 6, and at Months 3, 6 and 12 post Day 0.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Duchenne Muscular Dystrophy, Cardiomyopathy
Keywords
Duchenne Muscular Dystrophy, Cardiomyopathy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Allogeneic Cardiosphere-Derived Cells (CAP-1002)
Arm Type
Experimental
Arm Description
CAP-1002 is an investigational product consisting of allogeneic cardiosphere-derived cells (CDCs). All subjects assigned to the active treatment arm will receive an intended total dose of 75 million (M) CAP-1002 cells infused as 25M cells into each of the three left ventricle cardiac territories (anterior, lateral, inferior/posterior). If any of the three coronary arteries are deemed by the infusing Investigator to supply less than 30% of the left ventricular myocardium, the infusing Investigator may choose to infuse only 12.5M cells into that coronary artery or arteries. Therefore the full dose of CAP-1002 delivered may range from 50M cells to 75M cells provided that all three arteries are infused.
Arm Title
Usual Care
Arm Type
No Intervention
Arm Description
Subjects randomized to receive usual care will continue to be cared for and treated in whatever manner the investigator deems most appropriate for the subject on an ongoing basis, and will receive no infusion.
Intervention Type
Drug
Intervention Name(s)
Allogeneic Cardiosphere-Derived Cells (CAP-1002)
Other Intervention Name(s)
CAP-1002
Intervention Description
Intracoronary delivery of Allogeneic Cardiosphere-Derived Cells (CAP-1002)
Primary Outcome Measure Information:
Title
Safety and tolerability composite of CAP-1002 will be established as described below.
Description
Will be established by summaries of the occurrence of changes in coronary blood flow events, major cardiac events, laboratory assessments, vital signs, physical examination, ECG, and the occurrence of major adverse events.
Time Frame
72 hours post infusion of allogeneic cardiosphere-derived cells
Secondary Outcome Measure Information:
Title
Cardiac Structural composite assessed as: Absolute and relative change in parameters measured by cardiac MRI
Time Frame
12 months post infusion of CAP-1002 or randomization to the usual care arm
Title
Functional composite assessed as: Serial change in mobility measurements and Performance of Upper Limb (PUL) scale, spirometry, and 6-minute walk test (6MWT) when deemed appropriate by the Investigator.
Time Frame
12 months post infusion of CAP-1002 or randomization to the usual care arm
Title
Quality of Life composite assessed as: Change in PedsQL (Pediatric Quality of Life Inventory), including the cardiac module, and PODCI Adolescent Questionnaire.
Time Frame
12 months post infusion of CAP-1002 or randomization to the usual care arm
Title
Biomarkers composite assessed as: Osteopontin, ST2, IL-10, Galectin-3, and exploratory biomarkers (if consented/provided assent).
Time Frame
12 months post infusion of CAP-1002 or randomization to the usual care arm

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male subjects 18 years of age or older must be able to provide informed consent and follow up with protocol procedures. Male subjects at least 12 years of age but younger than 18 years of age must be able to provide assent with parent or guardian providing permission for study participation. Only male subjects will be randomized into this study. Documented diagnosis of Duchenne Muscular Dystrophy by genetic mutation analysis. Cardiomyopathy with left ventricular scar by LGE in at least 4 segments as assessed by contrast-enhanced MRI and EF >35% at the time of screening. Use of evidence based medical-therapy in accordance with the "DMD Care Considerations Working Group" guidelines for the management of DMD, for at least three months prior to signing the consent form (or, providing assent) or documented contraindication or intolerance or patient preference. Subjects must be taking systemic glucocorticoids for at least six months prior to screening. Subjects must be 12 years of age or older at time of screening Subjects must be appropriate candidates for cardiac catheterization and intracoronary infusion of CAP-1002, in the judgement of the site's interventional cardiologist. Exclusion Criteria: Therapy with intravenous inotropic or vasoactive medications at the time of screening. Inability to undergo cardiac catheterization and/or MRI without general anesthesia. Immunologic incompatibility with all available Master Cell Banks (MCBs) by single-antigen bead (SAB) serum antibody profiling. Planned or likely major surgery in the next 12 months after planned randomization. Left Ventricular Assist Devices (LVAD) or those subjects actively in the process of acquiring a LVAD. Contraindication to cardiac MRI. Known hypersensitivity to contrast agents. Estimated glomerular filtration rate (GFR) <60 mL/min, as calculated by the CKD-EPI cystatin C equation (Inker, Schmid et al. 2012). Active infection not responsive to treatment. Active systemic allergic reaction(s), connective tissue disease or autoimmune disorder(s). History of cardiac tumor or cardiac tumor demonstrated on screening MRI. History of previous stem cell therapy. History of use of medications listed in Appendix 3 within 3 months prior to signing the ICF / Assent through completion of the study infusion. Known moderate-to-severe aortic stenosis/insufficiency or severe mitral stenosis/regurgitation. Current active alcohol or drug abuse. Known history of Human Immunodeficiency Virus (HIV) infection. Known history of chronic viral hepatitis. Abnormal liver function (ALT/AST >10 times the upper reference range) and/or abnormal hematology (hematocrit <25%, WBC <3000 μl, platelets <100,000 μl) studies without a reversible, identifiable cause. Known hypersensitivity to bovine products. Known hypersensitivity to dimethyl sulfoxide (DMSO). Uncontrolled diabetes (HbA1c >9.0). Inability to comply with protocol-related procedures, including required study visits. Any condition or other reason that, in the opinion of the Investigator or Medical Monitor, would render the subject unsuitable for the study. Currently receiving investigational treatment on another clinical study or expanded access protocol, including any of the following: Received investigational intervention within 30 days prior to randomization Treatment and/or an incomplete follow-up to treatment with any investigational cell based therapy within 6 months prior to randomization Active participation in other research therapy for cardiovascular repair/regeneration
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John L Jefferies, MD, MPH
Organizational Affiliation
Children's Hospital Medical Center, Cincinnati
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Deborah Ascheim, MD
Organizational Affiliation
Capricor Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Cedars-Sinai Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32611
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States

12. IPD Sharing Statement

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HOPE-Duchenne (Halt cardiomyOPathy progrEssion in Duchenne)

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