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Allogeneic Mesenchymal Human Stem Cell Infusion Therapy for Endothelial DySfunctiOn in Diabetic Subjects With Symptomatic Ischemic Heart Disease. (ACESO-IHD) (ACESO-IHD)

Primary Purpose

Diabetes Mellitus, Ischemic Heart Disease

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
100 million Allogeneic Mesenchymal Human Stem Cells
Placebo
Sponsored by
University of Miami
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus focused on measuring Endothelial dysfunction, Diabetes, Stem cells

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Be ≥ 18 years of age (males and females).
  2. Provide written informed consent.
  3. Have a diagnosis of symptomatic ischemic heart disease (IHD) and an indication for standard-of-care coronary angiography.
  4. Have Diabetes Mellitus (DM) type 2 documented by glycated hemoglobin (HbA1C) > 7%, or on medical therapy for diabetes.

Exclusion Criteria:

  1. Be younger than 18 years of age.
  2. Have history of prior myocardial Infarction and revascularization.
  3. Have a baseline glomerular filtration rate (GFR) <30 ml/min 1.73m2 estimated using the Modification of Diet for Renal Disease (MDRD) formula.
  4. Have poorly controlled blood glucose levels with hemoglobin A1C > 8.5% in the previous 3 months.
  5. Have a history of proliferative retinopathy or severe neuropathy requiring medical treatment.
  6. Have an indication for standard-of-care surgical (including valve surgery, placement of left-ventricular assist device) or percutaneous intervention for the treatment of valvular heart disease (including valvuloplasty).
  7. Have known hypersensitivity or contraindication to aspirin; both heparin and bivalirudin; all available P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor); or any zotarolimus, cobalt, chromium, nickel, tungsten, acrylic, or fluoropolymers; or hypersensitivity to contrast media that cannot be adequately premedicated.
  8. Have a hematologic abnormality as evidenced by hematocrit < 25%, white blood cell < 2,500/microliter (uL) or platelet values < 100,000/uL without another explanation (per investigator discretion).
  9. Have liver dysfunction, as evidenced by enzymes (AST and ALT) greater than three times the upper limit of normal.
  10. Have a bleeding diathesis or coagulopathy (INR > 1.3), cannot be withdrawn from anticoagulation therapy, or will refuse blood transfusions.
  11. Be an organ transplant recipient or have a history of organ or cell transplant rejection.
  12. Have a clinical history of malignancy within the past 5 years (i.e., subjects with prior malignancy must be disease free for 5 years), except curatively-treated basal cell or squamous cell carcinoma, or cervical carcinoma.
  13. Have a condition that limits lifespan to < 1 year.
  14. Have a history of drug or alcohol abuse within the past 24 months.
  15. Be serum positive for HIV, hepatitis B surface antigen (sAg), or viremic hepatitis C.
  16. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial.
  17. Be pregnant, nursing, or of childbearing potential and not on contraceptive medications. (May participate if on 2 forms of contraceptives).
  18. Any other condition that in the judgment of the Investigator would be a contraindication to enrollment or follow-up.
  19. Coronary lesions with restenosis or heavy calcification.

Sites / Locations

  • University of MiamiRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group

Group 2: Placebo Group

Arm Description

Participants in this group will be receive a single administration of intravenous allogeneic human Mesenchymal Stem Cells (hMSCs) (100 million).

Participants in this group will receive a single dose of placebo (Cell-free PlasmaLyte-A medium supplemented with 1% HSA) infusion.

Outcomes

Primary Outcome Measures

Post-Percutaneous Coronary Intervention (PCI) coronary artery endothelial function as assessed via CFR
Coronary Flow Reserve (CFR) as measured via cardiac catheterization angiography
Post-PCI coronary artery endothelial function as assessed via FFR
Fractional Flow Reserve (FFR) as measured via cardiac catheterization angiography

Secondary Outcome Measures

Target lesion lumen loss
Target lesion lumen loss as assessed by quantitative coronary angiography (QCA).
Flow Mediated Diameter Percentage (FMD%)
FMD% is measured via brachial artery ultrasound
EPC-CFUs levels
Endothelial progenitor cells (EPC)-colony forming units (CFUs) will be assessed from blood samples.
Circulating angiogenic factors marker levels
Circulating angiogenic marker levels including Protein Kinase B, Stromal Cell Derived Factor 1 (SDF-1), Notch, Vascular Endothelial Growth Factor (VEGF) and Colony Forming Units (CFU) will be assessed from blood samples.
Circulating inflammatory markers
Circulating inflammatory markers including Cluster of Differentiation (CD) 3 CD 25 or CD 3 CD 69 will be assessed from blood samples.
Seattle Angina Questionnaire (SAQ) Angina Frequency
SAQ is a 7 item questionnaire with a total score ranging from 0-100 with the higher scores indicating less physical limitations, less angina, symptom frequency and better quality of life.
EuroQol(EQ)-5 Dimension (5D) Quality of Life Questionnaire
EQ-5D Quality of Life Questionnaire has a total score ranging from 0-10 with higher scores indicating better quality of life.
EQ-5D Quality of life Questionnaire Overall Health Status Question
EQ-5D Quality of Life Questionnaire Overall Health Status question has a total score ranging from 0-100 with higher scores indicating better quality of life.
Short Form (SF) 36 Questionnaire Quality of Life Questionnaire
SF 36 Quality of Life Questionnaire consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale. Lower scores indicate the more disability, and higher scores indicate less disability.
International Index of Erectile Function (IIEF) Questionnaire
IIEF is a 15 item questionnaire to be completed by males only, with scores ranging from 0-75. Higher scores indicate better male sexual function/quality of life.
Sexual Quality of Life - Females (SQOL-F) Questionnaire
SQOL-F Questionnaire is an 18 item questionnaire in which female participants are asked to record responses on a 6-point Likert scale (completely agree to completely disagree). Total score can range from 18 to 108. Higher scores indicate better female sexual quality of life.
Incidence of Treatment-Emergent Serious Adverse Events (TE-SAE)
TE-SAEs will be defined as the composite of: death, non-fatal myocardial infarction (MI), stroke, hospitalization for heart failure, sustained ventricular arrhythmias or atrial fibrillation. TE-SAEs will be assessed by treating physician.
Incidence of Major Adverse Cardiac Events (MACE)
Defined as the composite incidence of (1) death, (2) hospitalization for cardiovascular events or (3) non-fatal MI. MACE will be assessed by treating physician.
Rates of Adverse Events
Rates of treatment emergent adverse event (AE) and serious adverse event (SAE) as assessed by treating physician will be reported.
Number of participants with abnormal lab values
Number of participants with clinically significant abnormal serum hematology and clinical chemistry values will be reported. Clinical significance will be assessed by treating physician.
Number of participants with Target Vessel Failure
Number of participants with target vessel failure will be reported. Target vessel failure is defined as any participant that encounters revascularization, death, or MI attributed to the target vessel post-PCI

Full Information

First Posted
February 26, 2021
Last Updated
September 20, 2023
Sponsor
University of Miami
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT04776239
Brief Title
Allogeneic Mesenchymal Human Stem Cell Infusion Therapy for Endothelial DySfunctiOn in Diabetic Subjects With Symptomatic Ischemic Heart Disease. (ACESO-IHD)
Acronym
ACESO-IHD
Official Title
Allogeneic Mesenchymal Human Stem Cell Infusion Therapy for Endothelial DySfunctiOn in Diabetic Subjects With Symptomatic Ischemic Heart Disease.
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 16, 2021 (Actual)
Primary Completion Date
July 16, 2024 (Anticipated)
Study Completion Date
July 16, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Miami
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)

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
The purpose of this study is to test the hypothesis that allogeneic Mesenchymal Stem Cells (MSCs) promote systemic and coronary endothelial repair through rescue of bone marrow progenitors in type 2 diabetic patients with symptomatic IHD compared to placebo.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Ischemic Heart Disease
Keywords
Endothelial dysfunction, Diabetes, Stem cells

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group
Arm Type
Experimental
Arm Description
Participants in this group will be receive a single administration of intravenous allogeneic human Mesenchymal Stem Cells (hMSCs) (100 million).
Arm Title
Group 2: Placebo Group
Arm Type
Experimental
Arm Description
Participants in this group will receive a single dose of placebo (Cell-free PlasmaLyte-A medium supplemented with 1% HSA) infusion.
Intervention Type
Drug
Intervention Name(s)
100 million Allogeneic Mesenchymal Human Stem Cells
Other Intervention Name(s)
allo-human Mesenchymal Stem Cells (hMSCs), stem cells
Intervention Description
1 single intravenous infusion
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo delivered via peripheral intravenous infusion
Primary Outcome Measure Information:
Title
Post-Percutaneous Coronary Intervention (PCI) coronary artery endothelial function as assessed via CFR
Description
Coronary Flow Reserve (CFR) as measured via cardiac catheterization angiography
Time Frame
6 months (post-infusion)
Title
Post-PCI coronary artery endothelial function as assessed via FFR
Description
Fractional Flow Reserve (FFR) as measured via cardiac catheterization angiography
Time Frame
6 months (post infusion)
Secondary Outcome Measure Information:
Title
Target lesion lumen loss
Description
Target lesion lumen loss as assessed by quantitative coronary angiography (QCA).
Time Frame
6 months (post-infusion)
Title
Flow Mediated Diameter Percentage (FMD%)
Description
FMD% is measured via brachial artery ultrasound
Time Frame
6 months post-infusion
Title
EPC-CFUs levels
Description
Endothelial progenitor cells (EPC)-colony forming units (CFUs) will be assessed from blood samples.
Time Frame
6 months post-infusion
Title
Circulating angiogenic factors marker levels
Description
Circulating angiogenic marker levels including Protein Kinase B, Stromal Cell Derived Factor 1 (SDF-1), Notch, Vascular Endothelial Growth Factor (VEGF) and Colony Forming Units (CFU) will be assessed from blood samples.
Time Frame
6 months post-infusion
Title
Circulating inflammatory markers
Description
Circulating inflammatory markers including Cluster of Differentiation (CD) 3 CD 25 or CD 3 CD 69 will be assessed from blood samples.
Time Frame
6 months post-infusion
Title
Seattle Angina Questionnaire (SAQ) Angina Frequency
Description
SAQ is a 7 item questionnaire with a total score ranging from 0-100 with the higher scores indicating less physical limitations, less angina, symptom frequency and better quality of life.
Time Frame
6 months post-infusion
Title
EuroQol(EQ)-5 Dimension (5D) Quality of Life Questionnaire
Description
EQ-5D Quality of Life Questionnaire has a total score ranging from 0-10 with higher scores indicating better quality of life.
Time Frame
6 months post-infusion
Title
EQ-5D Quality of life Questionnaire Overall Health Status Question
Description
EQ-5D Quality of Life Questionnaire Overall Health Status question has a total score ranging from 0-100 with higher scores indicating better quality of life.
Time Frame
6 months post-infusion
Title
Short Form (SF) 36 Questionnaire Quality of Life Questionnaire
Description
SF 36 Quality of Life Questionnaire consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale. Lower scores indicate the more disability, and higher scores indicate less disability.
Time Frame
6 months post-infusion
Title
International Index of Erectile Function (IIEF) Questionnaire
Description
IIEF is a 15 item questionnaire to be completed by males only, with scores ranging from 0-75. Higher scores indicate better male sexual function/quality of life.
Time Frame
6 months post-infusion
Title
Sexual Quality of Life - Females (SQOL-F) Questionnaire
Description
SQOL-F Questionnaire is an 18 item questionnaire in which female participants are asked to record responses on a 6-point Likert scale (completely agree to completely disagree). Total score can range from 18 to 108. Higher scores indicate better female sexual quality of life.
Time Frame
6 months post-infusion
Title
Incidence of Treatment-Emergent Serious Adverse Events (TE-SAE)
Description
TE-SAEs will be defined as the composite of: death, non-fatal myocardial infarction (MI), stroke, hospitalization for heart failure, sustained ventricular arrhythmias or atrial fibrillation. TE-SAEs will be assessed by treating physician.
Time Frame
1 month post infusion
Title
Incidence of Major Adverse Cardiac Events (MACE)
Description
Defined as the composite incidence of (1) death, (2) hospitalization for cardiovascular events or (3) non-fatal MI. MACE will be assessed by treating physician.
Time Frame
12 months
Title
Rates of Adverse Events
Description
Rates of treatment emergent adverse event (AE) and serious adverse event (SAE) as assessed by treating physician will be reported.
Time Frame
12 months
Title
Number of participants with abnormal lab values
Description
Number of participants with clinically significant abnormal serum hematology and clinical chemistry values will be reported. Clinical significance will be assessed by treating physician.
Time Frame
12 months
Title
Number of participants with Target Vessel Failure
Description
Number of participants with target vessel failure will be reported. Target vessel failure is defined as any participant that encounters revascularization, death, or MI attributed to the target vessel post-PCI
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be ≥ 18 years of age (males and females). Provide written informed consent. Have a diagnosis of symptomatic ischemic heart disease (IHD) and an indication for standard-of-care coronary angiography. Have Diabetes Mellitus (DM) type 2 documented by glycated hemoglobin (HbA1C) > 7%, or on medical therapy for diabetes. Exclusion Criteria: Be younger than 18 years of age. Have history of prior myocardial Infarction and revascularization. Have a baseline glomerular filtration rate (GFR) <30 ml/min 1.73m2 estimated using the Modification of Diet for Renal Disease (MDRD) formula. Have poorly controlled blood glucose levels with hemoglobin A1C > 8.5% in the previous 3 months. Have a history of proliferative retinopathy or severe neuropathy requiring medical treatment. Have an indication for standard-of-care surgical (including valve surgery, placement of left-ventricular assist device) or percutaneous intervention for the treatment of valvular heart disease (including valvuloplasty). Have known hypersensitivity or contraindication to aspirin; both heparin and bivalirudin; all available P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor); or any zotarolimus, cobalt, chromium, nickel, tungsten, acrylic, or fluoropolymers; or hypersensitivity to contrast media that cannot be adequately premedicated. Have a hematologic abnormality as evidenced by hematocrit < 25%, white blood cell < 2,500/microliter (uL) or platelet values < 100,000/uL without another explanation (per investigator discretion). Have liver dysfunction, as evidenced by enzymes (AST and ALT) greater than three times the upper limit of normal. Have a bleeding diathesis or coagulopathy (INR > 1.3), cannot be withdrawn from anticoagulation therapy, or will refuse blood transfusions. Be an organ transplant recipient or have a history of organ or cell transplant rejection. Have a clinical history of malignancy within the past 5 years (i.e., subjects with prior malignancy must be disease free for 5 years), except curatively-treated basal cell or squamous cell carcinoma, or cervical carcinoma. Have a condition that limits lifespan to < 1 year. Have a history of drug or alcohol abuse within the past 24 months. Be serum positive for HIV, hepatitis B surface antigen (sAg), or viremic hepatitis C. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial. Be pregnant, nursing, or of childbearing potential and not on contraceptive medications. (May participate if on 2 forms of contraceptives). Any other condition that in the judgment of the Investigator would be a contraindication to enrollment or follow-up. Coronary lesions with restenosis or heavy calcification.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Carlos E Alfonso, MD
Phone
(305) 2437589
Email
calfonso@med.miami.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Russell G Saltzman, MSPH
Phone
305-243-1152
Email
r.saltzman@med.miami.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carlos E Alfonso, MD
Organizational Affiliation
University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Carlos E Alfonso, MD
Phone
305-243-5554
Email
calfonso@med.miami.edu
First Name & Middle Initial & Last Name & Degree
Russell G Saltzman, MSPH
Phone
305-243-1152
Email
R.Saltzman@med.miami.edu
First Name & Middle Initial & Last Name & Degree
Carlos E Alfonso, MD

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://isci.med.miami.edu
Description
Description: Interdisciplinary Stem Cell Institute at the University of Miami Miller School website

Learn more about this trial

Allogeneic Mesenchymal Human Stem Cell Infusion Therapy for Endothelial DySfunctiOn in Diabetic Subjects With Symptomatic Ischemic Heart Disease. (ACESO-IHD)

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