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Senolytic Agent Improve the Benefit of Platelet-Rich Plasma and Losartan

Primary Purpose

Femoroacetabular Impingement

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Fisetin
Placebo
Sponsored by
Steadman Philippon Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Femoroacetabular Impingement focused on measuring FAI Labral tear Fisetin Losartan

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Capacity to personally give informed consent (consent via legally authorized representative will not be accepted) and who are willing to comply with all study-related procedures and assessments
  • Between 18 and 80 years of age
  • Have been diagnosed with femoroacetabular impingement (FAI) and/or a hip labral tear
  • You are scheduled to undergo hip arthroscopy to treat FAI and /or a hip labral tear

Exclusion Criteria:

  • Previous or Planned Hip Surgeries, Procedures and/or Treatments:
  • Planned surgery on either the contralateral or target hip at any time during the Study period including dosing and follow-up
  • Require microfracture on the target hip as part of the planned arthroscopy
  • Within 6 months of signing informed consent, has undergone regenerative hip joint procedures on the target hip including, but not limited to, platelet-rich plasma injections, mesenchymal stem cell transplantation
  • Have had previous surgery (including microfracture) or diagnostic arthroscopy on the target hip
  • Joint space less than ≤2mm
  • Tönnis Grade 2-3
  • Have a history of pigmented villonodular synovitis (joint disease characterized by inflammation and overgrowth of the synovial lining of the hip joint)
  • Have a history of synovial chondromatosis (noncancerous tumor that develops in the synovial lining of the hip joint);
  • Have a history of hip dysplasia requiring PAO
  • History of Avascular Necrosis (AVN), Perthes disease, or slipped capital femoral epiphysis (SCFE)
  • Any active known or suspected systemic autoimmune disease (except for vitiligo, residual auto-immune hypothyroidism requiring hormone replacement only, psoriasis not requiring systemic treatment for two years, conditions not expected to recur in the absence of an external trigger) or any history of a systemic inflammatory arthritis such as psoriatic, rheumatoid, ankylosing spondylitis or reactive arthritis
  • Current diagnosis of fibromyalgia based on ACR criteria
  • Are unable to or are unwilling to receive a PRP injection as part of your surgery
  • Inadequate amount of PRP collected to serve the needs of the patient, and/or ProofPoint Biologics
  • Within 2 years of signing informed consent, history of active blood clotting disorders requiring preventative treatment, or active malignancy of any type or history of a malignancy (with the exception of subjects with a history of treated basal or squamous cell carcinoma)
  • Baseline HbA1C greater than 6.5, uncontrolled diabetes mellitus, and/or medication management has not been stable in the previous 2 months
  • Current or prior history of other joint diseases that may (in the opinion of the Principal Clinical Investigator or his/her designee) confound study data or increase Subject risk. These may include including but not limited to joint dysplasia, crystal-induced arthropathy (such as gout, or calcium pyrophosphate deposition disease evidenced by clinical and/or radiographic means), aseptic osteonecrosis, acromegaly, Paget's disease, Ehlers-Danlos Syndrome, Gaucher's disease, Stickler syndrome, joint infection, hemochromatosis, or neuropathic arthropathy of any cause
  • Any medical condition, including findings in laboratory or medical history or in the baseline assessments, that (in the opinion of the Principal Clinical Investigator or his/her designee), constitutes a risk or contraindication for participation in the Study or that could interfere with the Study conduct, endpoint evaluation or prevent the subject from fully participating in all aspects of the Study
  • Females who are nursing a child, are pregnant, or who are planning to become pregnant during study drug dosing, or who are not willing to abstain from sex without the use of contraceptive protection during study drug dosing
  • Males who do not wish to abstain from sex with women of childbearing potential without use of contraceptive protection during study drug dosing
  • Currently taking warfarin or any drug that could cause a coagulopathy event
  • Within 1 week of signing informed consent. taking medications that affect insulin activity, including Metformin or Acarbose
  • Have an allergy to any active or inactive ingredient of Losartan or Fisetin, and/or currently taking medication with known adverse Losartan or Fisetin interaction
  • Within 3 months of signing informed consent have taken senolytic agents including: Fisetin, Quercetin, Luteolin, Dasatinib, Piperlongumine, or Navitoclax;
  • Currently taking the following drugs if they cannot be held for at least 2 days (per enrolling Principal Investigator or Sub Investigator, or healthcare professional appropriately delegated by the Principal Investigator) before and during administration of Fisetin: cyclosporine, tacrolimus, repaglinide, and bosentan
  • Currently taking drugs that induce cellular senescence, including alkylating agents, anthracyclines, platins, other chemotherapy
  • Within 1 month of signing informed consent, taking a glucocorticoid
  • Has current history of drug and/or alcohol abuse
  • Within the 3 months of signing informed consent has received anticonvulsant therapy, pharmacological doses of thyroid hormone (causing decline of thyroid stimulating hormone below normal)
  • Within the 12 months prior to signing informed consent received any medications that affect bone turnover, including: adrenocorticosteroids (> 3 months at any time or > 10 days, estrogen (E) therapy or treatment with a selective E receptor modulator, or teriparatide
  • Inability to tolerate oral medication.

Sites / Locations

  • The Steadman ClinicRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Fisetin group (investigational group)

Placebo group (control group)

Arm Description

20mg/kg of Fisetin per day for days 1 and 2 prior to surgery and days 33, 34, 63, 64, 93, and 94 post surgery. (The pills are 100mg each. For example, if a participant weighs 160 pounds (about 73 kg), the participant will need to take 15 pills per day)

20mg/kg of Placebo per day for days 1 and 2 prior to surgery and days 33, 34, 63, 64, 93, and 94 post surgery. (The pills are 100mg each. For example, if a participant weighs 160 pounds (about 73 kg), the participant will need to take 15 pills per day)

Outcomes

Primary Outcome Measures

Incidence of Treatment-Emergent Adverse Events
Occurrence of adverse events

Secondary Outcome Measures

Patient Reported Outcomes Questionnaire-Modified Harris Hip Score (mHHS)
Consists of 8 questions covering domains of pain, gait, and functional activities. Scored on a 100-point scale, with each answer receiving a specific amount of points. Higher score represents greater hip health.
Patient Reported Outcomes Questionnaire- Hip Outcome Score: activities of daily living and sports subscales (HOS-ADL, HOS-SSS)
Includes two subscales to calculate the total score:19 items in the HOS-ADL subscale and 9 items in the HOS-sports subscale.
Patient Reported Outcomes Questionnaire-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
Scale from 0-96. Higher score represents worse hip health.
Patient Reported Outcomes Questionnaire-Optum Short Form physical and mental component scores (SF-12 PCS and SF-12 MCS)
Includes two subscales to calculate the total score. Higher score represents greater health. Scale standardized to a US Population mean of 50 and standard deviation of 10 points.
Patient Reported Outcomes Questionnaire-Tegner Activity Scale
Scale from 0-10. Higher score represents greater activity level.
Patient Reported Outcomes Questionnaire-Numeric Rating Scale for Hip Pain
Scale from 1-10. Higher score represents greater hip pain.
Patient Reported Outcomes Questionnaire-Patient satisfaction with surgical outcome
1-10-point scale
Multi and singleplex immunoassays and flow cytometry senescence and SASP marker assessment of peripheral blood
Concentrations of secreted protein markers found in serum in pg/ml
Incidence of revision arthroscopy or other hip surgery required post initial arthroscopy
Incidence of revision surgery from day of initial surgery will be recorded

Full Information

First Posted
August 2, 2021
Last Updated
September 28, 2023
Sponsor
Steadman Philippon Research Institute
Collaborators
United States Department of Defense
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1. Study Identification

Unique Protocol Identification Number
NCT05025956
Brief Title
Senolytic Agent Improve the Benefit of Platelet-Rich Plasma and Losartan
Official Title
The Use of Senolytic Agent to Improve the Benefit of Platelet-Rich Plasma and Losartan for Treatment of Femoroacetabular Impingement and Labral Tear: A Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 24, 2021 (Actual)
Primary Completion Date
October 31, 2024 (Anticipated)
Study Completion Date
October 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Steadman Philippon Research Institute
Collaborators
United States Department of Defense

4. Oversight

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

5. Study Description

Brief Summary
The purpose is to explore the possible benefit of administration of Fisetin, (a senolytic agent) to improve the benefit of Platelet-Rich Plasma and losartan for treatment of femoroacetabular impingement and labral tear. We believe that giving Fisetin, a senolytic agent, will improve the benefit of PRP by eliminating senescent cells and senescence-associated secretory phenotype (SASP), known to exist in PRP. The main objectives of this study are to determine if pre- and post-operative administration of a senolytic agent will improve the beneficial effects of PRP when used in conjunction with surgical treatment of FAI and/or labral tear, to determine whether pre- and postoperative administration of Fisetin is associated with adverse events, and to determine if pre- and post-operative administration of Fisetin leads to a decrease in systemic senescence, serum SASP, and fibrotic markers. Patients suffering from femoroacetabular impingement and labral tear, who are planning to undergo hip arthroscopy combined with standard of care intra-operative PRP injection and post-operative losartan administration will be recruited from the clinical practice of the Principal Clinical Investigator or his designee at The Steadman Clinic (TSC).
Detailed Description
This is a pilot, prospective, randomized, double-blind, placebo control clinical trial is proposed to evaluate the safety and efficacy of a senolytic agent (Fisetin) to improve the benefits of standard of care platelet rich plasma (PRP) injection and antifibrotic medication (Losartan) in patients undergoing hip arthroscopy for treatment of femoroacetabular impingement (FAI) and/or labral tear (LT).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Femoroacetabular Impingement
Keywords
FAI Labral tear Fisetin Losartan

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
pilot, prospective, randomized, double-blind, placebo control clinical trial
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The Investigator or properly trained and delegated study team member (research PA) will write the prescription for the study medication. The subject's randomization block and within-block random number will be communicated directly to the Vail Health pharmacy. The Vail Health pharmacy will maintain an unblinded, de-identified randomization spreadsheet that documents group allocation for each subject. The Vail Health Pharmacy oversees and manages drug disbursement for research.
Allocation
Randomized
Enrollment
68 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Fisetin group (investigational group)
Arm Type
Experimental
Arm Description
20mg/kg of Fisetin per day for days 1 and 2 prior to surgery and days 33, 34, 63, 64, 93, and 94 post surgery. (The pills are 100mg each. For example, if a participant weighs 160 pounds (about 73 kg), the participant will need to take 15 pills per day)
Arm Title
Placebo group (control group)
Arm Type
Placebo Comparator
Arm Description
20mg/kg of Placebo per day for days 1 and 2 prior to surgery and days 33, 34, 63, 64, 93, and 94 post surgery. (The pills are 100mg each. For example, if a participant weighs 160 pounds (about 73 kg), the participant will need to take 15 pills per day)
Intervention Type
Drug
Intervention Name(s)
Fisetin
Other Intervention Name(s)
Novusetin, 7,3',4'-flavon-3-ol, 3,3',4',7-tetrahydroxyflavone
Intervention Description
Oral Fisetin 20 mg/kg taken for 8 days total.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Placebo Oral Capsule
Intervention Description
Fisetin appearance-matched microcrystalline cellulose placebo. 20 mg/kg taken for 8 days total.
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events
Description
Occurrence of adverse events
Time Frame
From date of study drug dosing until the end of the study, an average of 12 months
Secondary Outcome Measure Information:
Title
Patient Reported Outcomes Questionnaire-Modified Harris Hip Score (mHHS)
Description
Consists of 8 questions covering domains of pain, gait, and functional activities. Scored on a 100-point scale, with each answer receiving a specific amount of points. Higher score represents greater hip health.
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Patient Reported Outcomes Questionnaire- Hip Outcome Score: activities of daily living and sports subscales (HOS-ADL, HOS-SSS)
Description
Includes two subscales to calculate the total score:19 items in the HOS-ADL subscale and 9 items in the HOS-sports subscale.
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Patient Reported Outcomes Questionnaire-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
Description
Scale from 0-96. Higher score represents worse hip health.
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Patient Reported Outcomes Questionnaire-Optum Short Form physical and mental component scores (SF-12 PCS and SF-12 MCS)
Description
Includes two subscales to calculate the total score. Higher score represents greater health. Scale standardized to a US Population mean of 50 and standard deviation of 10 points.
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Patient Reported Outcomes Questionnaire-Tegner Activity Scale
Description
Scale from 0-10. Higher score represents greater activity level.
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Patient Reported Outcomes Questionnaire-Numeric Rating Scale for Hip Pain
Description
Scale from 1-10. Higher score represents greater hip pain.
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Patient Reported Outcomes Questionnaire-Patient satisfaction with surgical outcome
Description
1-10-point scale
Time Frame
Baseline, 8-12 weeks post-op, 6 months post-op, and 12 months post-op
Title
Multi and singleplex immunoassays and flow cytometry senescence and SASP marker assessment of peripheral blood
Description
Concentrations of secreted protein markers found in serum in pg/ml
Time Frame
Baseline, and 8-12 weeks post-op
Title
Incidence of revision arthroscopy or other hip surgery required post initial arthroscopy
Description
Incidence of revision surgery from day of initial surgery will be recorded
Time Frame
From day of initial surgery until the end of the study, an average of 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Capacity to personally give informed consent (consent via legally authorized representative will not be accepted) and who are willing to comply with all study-related procedures and assessments Between 18 and 80 years of age Have been diagnosed with femoroacetabular impingement (FAI) and/or a hip labral tear You are scheduled to undergo hip arthroscopy to treat FAI and /or a hip labral tear Exclusion Criteria: Previous or Planned Hip Surgeries, Procedures and/or Treatments: Planned surgery on either the contralateral or target hip at any time during the Study period including dosing and follow-up Require microfracture on the target hip as part of the planned arthroscopy Within 6 months of signing informed consent, has undergone regenerative hip joint procedures on the target hip including, but not limited to, platelet-rich plasma injections, mesenchymal stem cell transplantation Have had previous surgery (including microfracture) or diagnostic arthroscopy on the target hip Joint space less than ≤2mm Tönnis Grade 2-3 Have a history of pigmented villonodular synovitis (joint disease characterized by inflammation and overgrowth of the synovial lining of the hip joint) Have a history of synovial chondromatosis (noncancerous tumor that develops in the synovial lining of the hip joint); Have a history of hip dysplasia requiring PAO History of Avascular Necrosis (AVN), Perthes disease, or slipped capital femoral epiphysis (SCFE) Any active known or suspected systemic autoimmune disease (except for vitiligo, residual auto-immune hypothyroidism requiring hormone replacement only, psoriasis not requiring systemic treatment for two years, conditions not expected to recur in the absence of an external trigger) or any history of a systemic inflammatory arthritis such as psoriatic, rheumatoid, ankylosing spondylitis or reactive arthritis Current diagnosis of fibromyalgia based on ACR criteria Are unable to or are unwilling to receive a PRP injection as part of your surgery Inadequate amount of PRP collected to serve the needs of the patient, and/or ProofPoint Biologics Within 2 years of signing informed consent, history of active blood clotting disorders requiring preventative treatment, or active malignancy of any type or history of a malignancy (with the exception of subjects with a history of treated basal or squamous cell carcinoma) Baseline HbA1C greater than 6.5, uncontrolled diabetes mellitus, and/or medication management has not been stable in the previous 2 months Current or prior history of other joint diseases that may (in the opinion of the Principal Clinical Investigator or his/her designee) confound study data or increase Subject risk. These may include including but not limited to joint dysplasia, crystal-induced arthropathy (such as gout, or calcium pyrophosphate deposition disease evidenced by clinical and/or radiographic means), aseptic osteonecrosis, acromegaly, Paget's disease, Ehlers-Danlos Syndrome, Gaucher's disease, Stickler syndrome, joint infection, hemochromatosis, or neuropathic arthropathy of any cause Any medical condition, including findings in laboratory or medical history or in the baseline assessments, that (in the opinion of the Principal Clinical Investigator or his/her designee), constitutes a risk or contraindication for participation in the Study or that could interfere with the Study conduct, endpoint evaluation or prevent the subject from fully participating in all aspects of the Study Females who are nursing a child, are pregnant, or who are planning to become pregnant during study drug dosing, or who are not willing to abstain from sex without the use of contraceptive protection during study drug dosing Males who do not wish to abstain from sex with women of childbearing potential without use of contraceptive protection during study drug dosing Currently taking warfarin or any drug that could cause a coagulopathy event Within 1 week of signing informed consent. taking medications that affect insulin activity, including Metformin or Acarbose Have an allergy to any active or inactive ingredient of Losartan or Fisetin, and/or currently taking medication with known adverse Losartan or Fisetin interaction Within 3 months of signing informed consent have taken senolytic agents including: Fisetin, Quercetin, Luteolin, Dasatinib, Piperlongumine, or Navitoclax; Currently taking the following drugs if they cannot be held for at least 2 days (per enrolling Principal Investigator or Sub Investigator, or healthcare professional appropriately delegated by the Principal Investigator) before and during administration of Fisetin: cyclosporine, tacrolimus, repaglinide, and bosentan Currently taking drugs that induce cellular senescence, including alkylating agents, anthracyclines, platins, other chemotherapy Within 1 month of signing informed consent, taking a glucocorticoid Has current history of drug and/or alcohol abuse Within the 3 months of signing informed consent has received anticonvulsant therapy, pharmacological doses of thyroid hormone (causing decline of thyroid stimulating hormone below normal) Within the 12 months prior to signing informed consent received any medications that affect bone turnover, including: adrenocorticosteroids (> 3 months at any time or > 10 days, estrogen (E) therapy or treatment with a selective E receptor modulator, or teriparatide Inability to tolerate oral medication.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Suzanne L Page, JD
Phone
970-401-8770
Email
spage@sprivail.org
First Name & Middle Initial & Last Name or Official Title & Degree
Luz Thede, MD
Phone
970-409-7566
Email
lthede@sprivail.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Johnny L Huard, PhD
Organizational Affiliation
Steadman Philippon Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Steadman Clinic
City
Vail
State/Province
Colorado
ZIP/Postal Code
81657
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Suzanne L Page, JD
Phone
970-401-8770
Email
spage@sprivail.org
First Name & Middle Initial & Last Name & Degree
Marc J Philippon, MD

12. IPD Sharing Statement

Plan to Share IPD
No

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Senolytic Agent Improve the Benefit of Platelet-Rich Plasma and Losartan

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