The Effect of Intramyocardial Injection of Mesenchymal Precursor Cells on Myocardial Function in Patients Undergoing LVAD Implantation
Primary Purpose
Heart Failure, Cardiomyopathy, Ventricular Dysfunction
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
MPC Intramyocardial injection
Control Solution
Sponsored by
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Heart Failure, Left Ventricular Assist Device, Heart Transplantation, Cardiomyopathy, Destination Therapy, Cell Therapy
Eligibility Criteria
Inclusion Criteria:
- Signed informed consent, inclusive of release of medical information, and Health Insurance Portability and Accountability Act (HIPAA) documentation;
- Age 18 years or older;
- If the subject or partner is of childbearing potential, he or she must be willing to use adequate contraception (hormonal or barrier method or abstinence) from the time of screening and for a period of at least 16 weeks after procedure;
- Female subjects of childbearing potential must have a negative serum pregnancy test at screening;
- Admitted to the clinical center at the time of randomization;
- Clinical indication and accepted candidate for implantation of an FDA approved implantable, non-pulsatile LVAD as a bridge to transplantation or for destination therapy.
Exclusion Criteria:
- Planned percutaneous LVAD implantation;
- Anticipated requirement for biventricular mechanical support;
- Cardiothoracic surgery within 30 days prior to randomization;
- Myocardial infarction within 30 days prior to randomization;
- Prior cardiac transplantation, LV reduction surgery, or cardiomyoplasty;
- Acute reversible cause of heart failure (e.g. myocarditis, profound hypothyroidism);
- Stroke within 30 days prior to randomization;
- Platelet count < 100,000/ul within 24 hours prior to randomization;
- Active systemic infection within 48 hours prior to randomization;
- Presence of >10% anti-human leukocyte antigen (anti-HLA) antibody titers with known specificity to the MPC donor HLA antigens;
- A known hypersensitivity to dimethyl sulfoxide (DMSO), murine, and/or bovine products;
- History of cancer prior to screening (excluding basal cell carcinoma);
- Acute or chronic infectious disease, including but not limited to human immunodeficiency virus (HIV);
- Received investigational intervention within 30 days prior to randomization;
- Treatment and/or an incompleted follow-up treatment of any investigational cell based therapy within 6 months prior to randomization;
- Active participation in other research therapy for cardiovascular repair/regeneration;
- Prior recipient of stem precursor cell therapy for cardiac repair;
- Pregnant or breastfeeding at time of randomization.
Sites / Locations
- University of Florida
- University of Maryland
- Minneapolis Heart Institute Foundation
- Montefiore Einstein Heart Center
- Columbia University Medical Center
- Duke University
- Cleveland Clinic Foundation
- Ohio State University
- University of Pennsylvania
- Baylor Research Institute
- Texas Heart Institute
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Sham Comparator
Arm Label
MPC Intramyocardial injection
Control Solution
Arm Description
Intramyocardial injections of 25 million Mesenchymal Precursor Cells (MPCs)
Intramyocardial injections of 50% Alpha-MEM/42.5% ProFreeze NAO Freezing Medium/7.5% DMSO
Outcomes
Primary Outcome Measures
Intervention Related Adverse Events
The primary safety endpoint of this study is the incidence of the following potential study-intervention related adverse events within 90 days post intervention (LVAD implantation + intramyocardial injection of study product): infectious myocarditis, myocardial rupture, neoplasm, hypersensitivity reaction, and immune sensitization.
Secondary Outcome Measures
Functional Status and Ventricular Function
The key efficacy endpoint of this study is functional status and ventricular function, while weaned from LVAD support, at 90 days post intervention (LVAD implantation + intramyocardial injection of study product). Functional status is defined by the ability to tolerate wean from LVAD support for 30 minutes without signs or symptoms of hypoperfusion, including, but not limited to symptoms of low output or signs of vascular congestion. Ventricular function will be assessed by transthoracic echocardiogram (TTE) in those patients able to be weaned for 30 minutes from LVAD support.
The number of participants who successfully tolerated the 30 minute wean from LVAD support at 90 days is reported.
Full Information
NCT ID
NCT01442129
First Posted
September 26, 2011
Last Updated
April 10, 2015
Sponsor
Deborah Ascheim
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
1. Study Identification
Unique Protocol Identification Number
NCT01442129
Brief Title
The Effect of Intramyocardial Injection of Mesenchymal Precursor Cells on Myocardial Function in Patients Undergoing LVAD Implantation
Official Title
LVAD Therapy: Exploring the Effect of Intramyocardial Injection of Mesenchymal Precursor Cells on Myocardial Function
Study Type
Interventional
2. Study Status
Record Verification Date
April 2015
Overall Recruitment Status
Completed
Study Start Date
April 2012 (undefined)
Primary Completion Date
March 2013 (Actual)
Study Completion Date
August 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Deborah Ascheim
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The main purpose of this research is to determine whether injecting mesenchymal precursor cells (MPC) into the heart during surgery to implant a left ventricular assist device (LVAD) is safe. MPCs are normally present in human bone marrow, and have been shown to increase the development of blood vessels and new heart muscle cells in the heart. In addition, this research is being done to test whether injecting the MPCs into the heart is effective in improving heart function.
Detailed Description
Intramyocardial injection of mesenchymal precursor cells (MPC) in patients with advanced heart failure who are treated with left ventricular assist device (LVAD) implantation may result in a renewable source of proliferating functional cardiomyocytes, as well as induce development of capillaries and larger size blood vessels to supply oxygen and nutrients to endogenous myocardium and newly-implanted cardiomyocytes, and release factors capable of paracrine signaling. If safety is established and an efficacy signal is observed in this exploratory trial, then the investigators will design a follow-up trial (stage 2) based on an adaptive design. The next trial would randomize patients to active therapy at one of two doses (25 and 75 million MPCs) versus placebo, and based on a predetermined selection criterion drop randomization to one of the dose arms as results accrue. Should this exploratory trial demonstrate safety but no signal of efficacy, then the subsequent trial would be based on a single dose of 75 million MPCs versus placebo.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure, Cardiomyopathy, Ventricular Dysfunction
Keywords
Heart Failure, Left Ventricular Assist Device, Heart Transplantation, Cardiomyopathy, Destination Therapy, Cell Therapy
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
30 (Actual)
8. Arms, Groups, and Interventions
Arm Title
MPC Intramyocardial injection
Arm Type
Experimental
Arm Description
Intramyocardial injections of 25 million Mesenchymal Precursor Cells (MPCs)
Arm Title
Control Solution
Arm Type
Sham Comparator
Arm Description
Intramyocardial injections of 50% Alpha-MEM/42.5% ProFreeze NAO Freezing Medium/7.5% DMSO
Intervention Type
Biological
Intervention Name(s)
MPC Intramyocardial injection
Other Intervention Name(s)
RevascorTM
Intervention Description
Intramyocardial injection of 25 million mesenchymal precursor cells at the time of LVAD implantation
Intervention Type
Biological
Intervention Name(s)
Control Solution
Other Intervention Name(s)
Cryoprotective media
Intervention Description
Injection of control solution during the LVAD implantation.
Primary Outcome Measure Information:
Title
Intervention Related Adverse Events
Description
The primary safety endpoint of this study is the incidence of the following potential study-intervention related adverse events within 90 days post intervention (LVAD implantation + intramyocardial injection of study product): infectious myocarditis, myocardial rupture, neoplasm, hypersensitivity reaction, and immune sensitization.
Time Frame
90 days
Secondary Outcome Measure Information:
Title
Functional Status and Ventricular Function
Description
The key efficacy endpoint of this study is functional status and ventricular function, while weaned from LVAD support, at 90 days post intervention (LVAD implantation + intramyocardial injection of study product). Functional status is defined by the ability to tolerate wean from LVAD support for 30 minutes without signs or symptoms of hypoperfusion, including, but not limited to symptoms of low output or signs of vascular congestion. Ventricular function will be assessed by transthoracic echocardiogram (TTE) in those patients able to be weaned for 30 minutes from LVAD support.
The number of participants who successfully tolerated the 30 minute wean from LVAD support at 90 days is reported.
Time Frame
90 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Signed informed consent, inclusive of release of medical information, and Health Insurance Portability and Accountability Act (HIPAA) documentation;
Age 18 years or older;
If the subject or partner is of childbearing potential, he or she must be willing to use adequate contraception (hormonal or barrier method or abstinence) from the time of screening and for a period of at least 16 weeks after procedure;
Female subjects of childbearing potential must have a negative serum pregnancy test at screening;
Admitted to the clinical center at the time of randomization;
Clinical indication and accepted candidate for implantation of an FDA approved implantable, non-pulsatile LVAD as a bridge to transplantation or for destination therapy.
Exclusion Criteria:
Planned percutaneous LVAD implantation;
Anticipated requirement for biventricular mechanical support;
Cardiothoracic surgery within 30 days prior to randomization;
Myocardial infarction within 30 days prior to randomization;
Prior cardiac transplantation, LV reduction surgery, or cardiomyoplasty;
Acute reversible cause of heart failure (e.g. myocarditis, profound hypothyroidism);
Stroke within 30 days prior to randomization;
Platelet count < 100,000/ul within 24 hours prior to randomization;
Active systemic infection within 48 hours prior to randomization;
Presence of >10% anti-human leukocyte antigen (anti-HLA) antibody titers with known specificity to the MPC donor HLA antigens;
A known hypersensitivity to dimethyl sulfoxide (DMSO), murine, and/or bovine products;
History of cancer prior to screening (excluding basal cell carcinoma);
Acute or chronic infectious disease, including but not limited to human immunodeficiency virus (HIV);
Received investigational intervention within 30 days prior to randomization;
Treatment and/or an incompleted follow-up treatment of any investigational cell based therapy within 6 months prior to randomization;
Active participation in other research therapy for cardiovascular repair/regeneration;
Prior recipient of stem precursor cell therapy for cardiac repair;
Pregnant or breastfeeding at time of randomization.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Timothy Gardner, MD
Organizational Affiliation
Christiana Care Health Services
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Patrick O'Gara, MD
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
University of Florida
City
Gainsville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
University of Maryland
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Minneapolis Heart Institute Foundation
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55407
Country
United States
Facility Name
Montefiore Einstein Heart Center
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States
Facility Name
Columbia University Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Duke University
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Cleveland Clinic Foundation
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
Baylor Research Institute
City
Dallas
State/Province
Texas
ZIP/Postal Code
75230
Country
United States
Facility Name
Texas Heart Institute
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
24682346
Citation
Ascheim DD, Gelijns AC, Goldstein D, Moye LA, Smedira N, Lee S, Klodell CT, Szady A, Parides MK, Jeffries NO, Skerrett D, Taylor DA, Rame JE, Milano C, Rogers JG, Lynch J, Dewey T, Eichhorn E, Sun B, Feldman D, Simari R, O'Gara PT, Taddei-Peters WC, Miller MA, Naka Y, Bagiella E, Rose EA, Woo YJ. Mesenchymal precursor cells as adjunctive therapy in recipients of contemporary left ventricular assist devices. Circulation. 2014 Jun 3;129(22):2287-96. doi: 10.1161/CIRCULATIONAHA.113.007412. Epub 2014 Mar 28.
Results Reference
derived
Links:
URL
http://www.ctsurgerynet.org/
Description
Cardiothoracic Surgical Network Website
Learn more about this trial
The Effect of Intramyocardial Injection of Mesenchymal Precursor Cells on Myocardial Function in Patients Undergoing LVAD Implantation
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