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Adipose Stromal Cells Injection in the Myocardium for Induction of Revascularization (ADMIRE)

Primary Purpose

Ischemic Heart Disease, Myocardial Ischemia, Coronary Artery Disease

Status
Withdrawn
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Stromal Cells Injection
Sponsored by
Hospital do Coracao
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ischemic Heart Disease focused on measuring STROMAL CELLS, ADIPOSE STROMAL CELLS, REVASCULARIZATION, MYOCARDIUM REVASCULARIZATION, CARDIAC SURGERY, CORONARY ARTERY DISEASE

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • signing the Informed Consent Form (TCLE)
  • the patient must be a patient with obstructive atherosclerotic coronary artery disease
  • sex: both men and women are eligible-
  • Age: between 18 and 80 years of age
  • the patient should present clinical evidence (angina pectoris or angina equivalent) OR imaging (stress echocardiography, myocardial perfusion scintigraphy, cardiac magnetic resonance imaging) of myocardial ischemia, invasively stratified with coronary angiography
  • the presence of myocardial ischemia should be confirmed by at least 2 (two) distinct diagnostic methods performed within one year of the patient's inclusion in the study
  • the patient is a candidate for myocardial revascularization surgery but coronary obstructive lesions, in their entirety, are NOT amenable for surgical treatment in the opinion of the surgeon (main surgeon), depending on the anatomical type, extent or distal involvement of the lesions OR, even if they can be treated surgically as a whole, an unsatisfactory surgical outcome is anticipated in terms of functional gain (restoration of myocardial perfusion)

Exclusion Criteria:

do not meet ALL criteria for inclusion

  • have a concomitant severe disease, at an advanced stage, or with an unquestionable shortening of life expectancy (<1 year), or that prevents complementary examinations and / or attendance at follow-up visits
  • have a confirmed diagnosis, previous history and / or past treatment of neoplasia, of any location and staging, in the last 5 years
  • being in clinical treatment or awaiting surgical treatment of neoplasia, any location and staging
  • present, during the outpatient investigation, unequivocal findings of neoplasia
  • have symptoms attributable exclusively to left ventricular dysfunction, although of ischemic etiology, without the evidence of current myocardial ischemia, by at least two (2) methods of evaluation
  • presented severe left ventricular dysfunction as defined by transthoracic echocardiography due to the finding of a left ventricular ejection fraction <0.25 (Simpson's method)
  • have a history or current diagnosis of severe ventricular arrhythmias such as sustained ventricular tachycardia unless an automatic cardioverter-defibrillator has been implanted previously
  • Concurrent heart diseases of other etiologies (valvular, idiopathic, hypertensive, Chagasic, etc.).
  • have a history of acute coronary syndrome (unstable angina or acute myocardial infarction) in the last 3 months
  • present chronic renal failure in dialysis treatment
  • have participated in other cell therapy studies in the past 2 years
  • Pregnant women
  • patients diagnosed with acquired immunodeficiency syndrome (AIDS)

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Placebo Comparator

    Active Comparator

    Active Comparator

    Active Comparator

    Arm Label

    PLACEBO GROUP

    Low dose group

    Intermediate Dose

    High dose group

    Arm Description

    injection of saline solution

    hASC injection (1x10e6 / kg body weight)

    injection of hASC (2x10e6 / kg of body weight)

    injection of hASC (4x10e6 / kg body weight)

    Outcomes

    Primary Outcome Measures

    Cardiovascular Death
    Death due to stroke, myocardial infarction or other cardiovascular causes
    Unstable angina
    Occurence of angina requiring hospitalization
    Acute myocardial infarction
    Occurence of acute myocardial infarction (with or without ST segment elevation)
    Unplanned myocardial revascularization surgery
    Need for urgent surgical myocardial revascularization
    Unplanned myocardial revascularization through angioplasty
    Need for urgent non-surgical myocardial revascularization

    Secondary Outcome Measures

    All cause mortality
    Stroke
    Cardiogenic shock
    Occurence of complex ventricular arrhythmia
    New onset atrial fibrilation
    Occurence of acute pulmonary edema
    Pulmonary embolism
    Acute respiratory failure of any cause
    Septic shock
    Disseminated infection requiring vasopressors
    New onset cancer
    Diagnosis of any cancer at any stage during study period

    Full Information

    First Posted
    June 13, 2019
    Last Updated
    September 20, 2022
    Sponsor
    Hospital do Coracao
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04005989
    Brief Title
    Adipose Stromal Cells Injection in the Myocardium for Induction of Revascularization
    Acronym
    ADMIRE
    Official Title
    Adipose Stromal Cells Injection in the Myocardium for Induction of Revascularization
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2021
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Due to logistic issues during COVID-19 pandemic
    Study Start Date
    December 1, 2021 (Anticipated)
    Primary Completion Date
    November 30, 2022 (Anticipated)
    Study Completion Date
    December 20, 2022 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Hospital do Coracao

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    Treatment of ischemic myocardium has been the subject of intense research in recent years and stem cell therapy is one of the great promises. The InCor laboratory has studied cells from different backgrounds as candidates for cell therapy in the context of myocardial infarction. Evidence in preclinical studies of the application of stromal (mesenchymal) adipose tissue (hASC) in the ischemic heart by both the InCor group (in the animal model in rodents and pigs) and others in the literature suggest relevant benefits on the decrease of deterioration post-infarction. More recently it has been demonstrated that it arises mainly from the formation of new vessels due to paracrine factors, which are secreted by the injected cells. There are currently no studies in Brazil in which the safety of injecting different doses of hASC cells into the heart has been particularly evaluated. Recently, two studies have demonstrated the clinical applicability of hASC in patients with peripheral ischemic disease and stroke. Thus, the objective of this work will be to test the hypothesis that the implantation of autologous stromal cells derived from adipose tissue combined with myocardial revascularization surgery in patients with coronary artery disease
    Detailed Description
    To test the hypothesis that the implantation of adipose-derived autologous cells derived from adipose tissue (hASCs) combined with coronary artery bypass grafting in patients with coronary artery disease is safe and well tolerated, besides being able to promote regional perfusion increase in the injected segments.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Ischemic Heart Disease, Myocardial Ischemia, Coronary Artery Disease
    Keywords
    STROMAL CELLS, ADIPOSE STROMAL CELLS, REVASCULARIZATION, MYOCARDIUM REVASCULARIZATION, CARDIAC SURGERY, CORONARY ARTERY DISEASE

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Model Description
    It is a randomized, prospective, double-blind, placebo-controlled clinical study. Eligible patients will be randomly divided into 4 groups (one control group and 3 active treatment groups): 10 PATIENTS EACH ARM Control Group - saline injection Low dose group (BD) - hASC injection (1x106 / kg body weight) Intermediate dose group (DI) - injection of hASC (2x106 / kg body weight) High dose group (AD) - hASC injection (4x106 / kg body weight)
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Masking Description
    DOUBLE BLIND
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    PLACEBO GROUP
    Arm Type
    Placebo Comparator
    Arm Description
    injection of saline solution
    Arm Title
    Low dose group
    Arm Type
    Active Comparator
    Arm Description
    hASC injection (1x10e6 / kg body weight)
    Arm Title
    Intermediate Dose
    Arm Type
    Active Comparator
    Arm Description
    injection of hASC (2x10e6 / kg of body weight)
    Arm Title
    High dose group
    Arm Type
    Active Comparator
    Arm Description
    injection of hASC (4x10e6 / kg body weight)
    Intervention Type
    Biological
    Intervention Name(s)
    Stromal Cells Injection
    Intervention Description
    Adipose stromal cell
    Primary Outcome Measure Information:
    Title
    Cardiovascular Death
    Description
    Death due to stroke, myocardial infarction or other cardiovascular causes
    Time Frame
    12 months
    Title
    Unstable angina
    Description
    Occurence of angina requiring hospitalization
    Time Frame
    12 months
    Title
    Acute myocardial infarction
    Description
    Occurence of acute myocardial infarction (with or without ST segment elevation)
    Time Frame
    12 months after procedure
    Title
    Unplanned myocardial revascularization surgery
    Description
    Need for urgent surgical myocardial revascularization
    Time Frame
    12 months
    Title
    Unplanned myocardial revascularization through angioplasty
    Description
    Need for urgent non-surgical myocardial revascularization
    Time Frame
    12 months
    Secondary Outcome Measure Information:
    Title
    All cause mortality
    Time Frame
    12 months
    Title
    Stroke
    Time Frame
    12 months
    Title
    Cardiogenic shock
    Time Frame
    12 months
    Title
    Occurence of complex ventricular arrhythmia
    Time Frame
    12 months
    Title
    New onset atrial fibrilation
    Time Frame
    12 months
    Title
    Occurence of acute pulmonary edema
    Time Frame
    12 months
    Title
    Pulmonary embolism
    Time Frame
    12 months
    Title
    Acute respiratory failure of any cause
    Time Frame
    12 months
    Title
    Septic shock
    Description
    Disseminated infection requiring vasopressors
    Time Frame
    12 months
    Title
    New onset cancer
    Description
    Diagnosis of any cancer at any stage during study period
    Time Frame
    12 month

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    80 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: signing the Informed Consent Form (TCLE) the patient must be a patient with obstructive atherosclerotic coronary artery disease sex: both men and women are eligible- Age: between 18 and 80 years of age the patient should present clinical evidence (angina pectoris or angina equivalent) OR imaging (stress echocardiography, myocardial perfusion scintigraphy, cardiac magnetic resonance imaging) of myocardial ischemia, invasively stratified with coronary angiography the presence of myocardial ischemia should be confirmed by at least 2 (two) distinct diagnostic methods performed within one year of the patient's inclusion in the study the patient is a candidate for myocardial revascularization surgery but coronary obstructive lesions, in their entirety, are NOT amenable for surgical treatment in the opinion of the surgeon (main surgeon), depending on the anatomical type, extent or distal involvement of the lesions OR, even if they can be treated surgically as a whole, an unsatisfactory surgical outcome is anticipated in terms of functional gain (restoration of myocardial perfusion) Exclusion Criteria: do not meet ALL criteria for inclusion have a concomitant severe disease, at an advanced stage, or with an unquestionable shortening of life expectancy (<1 year), or that prevents complementary examinations and / or attendance at follow-up visits have a confirmed diagnosis, previous history and / or past treatment of neoplasia, of any location and staging, in the last 5 years being in clinical treatment or awaiting surgical treatment of neoplasia, any location and staging present, during the outpatient investigation, unequivocal findings of neoplasia have symptoms attributable exclusively to left ventricular dysfunction, although of ischemic etiology, without the evidence of current myocardial ischemia, by at least two (2) methods of evaluation presented severe left ventricular dysfunction as defined by transthoracic echocardiography due to the finding of a left ventricular ejection fraction <0.25 (Simpson's method) have a history or current diagnosis of severe ventricular arrhythmias such as sustained ventricular tachycardia unless an automatic cardioverter-defibrillator has been implanted previously Concurrent heart diseases of other etiologies (valvular, idiopathic, hypertensive, Chagasic, etc.). have a history of acute coronary syndrome (unstable angina or acute myocardial infarction) in the last 3 months present chronic renal failure in dialysis treatment have participated in other cell therapy studies in the past 2 years Pregnant women patients diagnosed with acquired immunodeficiency syndrome (AIDS)

    12. IPD Sharing Statement

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    Adipose Stromal Cells Injection in the Myocardium for Induction of Revascularization

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