Dilated Cardiomyopathy
Conditions
Brief summary
Clinical evaluation of the CIRCULATE catheter involves intracoronary administration of a typical medical agent (nitroglycerin) and a shown-to-be-safe cell-based agent (CardioCell) in patients with a diagnosis of dilated cardiomyopathy (DCM).
Detailed description
The use of adult stem cells from several sources has been shown to improve cardiac function in acute and chronic cardiac disease. Several sources of adult stem cells have been identified including bone marrow, skeletal muscle, blood and adipose tissue. A number of pilot trials using intramyocardial injection of stem cells have shown promising results in patients with chronic myocardial disease in patients with ischemic heart failure , and in patients after an acute myocardial infarction . The vast majority of research on cell therapies in the treatment of heart diseases focuses mainly on determining the optimal source of cells, their characteristics, and the number of cells in the administered preparation. From a clinical perspective, the method of cell administration is also an important topic. There are several ways of cell administration that can be used in cell therapy for heart muscle disease. In addition to the intramuscular administration systems, such preparations can be administered directly into the circulation in a more or less selective manner. As no dedicated devices were developed, various types of catheters and microcatheters have been used for transcoronary administration. During the procedure of administering cell preparations by means of a catheter directly to the selected coronary vessel, the flow parameters should be adjusted to minimize the risk of damage to the administered cells. The CIRCULATE catheter tested in the experiment was designed to increase the efficacy and safety of the cells delivery. It has a reservoir and holes created through which - as shown in preclinical studies - the cells can be delivered without a risk of their damage during delivery. In addition to the administration of cell therapy, the course of the study is planned to administer the drug - nitroglycerin - one of the most commonly used drugs for coronary administration, recommended during standard angiography of the coronary arteries due to its ability to expand the arterial bed, thus enabling accurate imaging and sizing of the examined arteries.
Interventions
DEVICETranscoronary delivery of a pharmacological agent (nitroglycerin) and cell based agent (Cardiocell) using the CIRCULATE Catheter
Investigated device - the CIRCULATE Catheter will be introduced, using a standard radial or femoral access and a typical guiding catheter and typical coronary wire, first into the right coronary artery. After that the one dose of NTG (200µg) will be administered followed by a typical angiographic recording to visualize the vasodilatatory effect of the medication. Then CardioCell in doses of 10mln cells each (6.7mL) will be administered transcoronary to each of the coronary arteries (right coronary artery (RCA), LAD, left circumflex (Cx)). Angiography will be performed routinely before and after each product administration.
Sponsors
John Paul II Hospital, Krakow
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DEVICE_FEASIBILITY
Masking
NONE
Intervention model description
Clinical evaluation of the CIRCULATE catheter will be performed in a group of 10 patients. Each will receive intracoronary NTG followed by labelled CardioCell. This is a non-randomized study without any requirement for sample size calculation.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of DCM * Left ventricular ejection fraction (LVEF) ≤ 45% by echocardiography * Signed informed consent
Exclusion criteria
* Less than 3 months from any substantial cardiac therapeutic intervention (such as, e.g. CRT/ICD fitting) * Less than 3 months from acute coronary syndrome * BMI lower than 18 or greater than 45kg/m2 * Severe valvular heart disease or left ventricle aneurysm requiring aneurysmectomy or other structural interventions * Present candidate for heart transplantation * Active or any history of malignancy or tumor * Moderate or severe immunodeficiency * Chronic immunosuppressive therapy * Acute or chronic infection * Coagulopathies * Known alcohol or drug dependence * Severe renal dysfunction (eGFR\<20mL/min) * Soft tissue disease or local infection in a place of required artery puncture * Pregnancy or breastfeeding * Females of childbearing potential who do not use a highly effective method of contraception, and in absence of a negative highly sensitive urine or serum pregnancy test * Participation in any other clinical research study that has not reached its primary efficacy endpoint or otherwise would interfere with the patient's participation in this project * Life expectancy \<12 months * Any concurrent disease or condition that, in the opinion of the investigator, would make the patient unsuitable for participation in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Device success | During procedure | Device success, defined as the device introduction, administration of nitroglycerine and cell-based agent, and device removal without complications |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Standardized uptake values (SUVs) of 99mTc-HMPAO radiolabelled CardioCell | 1 hour after application | CardioCell myocardial uptake on a whole-body scan: 50% of cells will be radiolabelled. Standardized uptake values (SUVs) of 99mTc-HMPAO radiolabelled CardioCell in cardiac VOI on a whole-body scan measured using the commercial calculation methods corrected for physical decay and attenuation |
| Freedom from major adverse cardiovascular events | 24 hours or until hospital discharge, whichever time point is first | Freedom from periprocedural (during the procedure and 60 minutes thereafter) major adverse cardiovascular events |
Countries
Poland
Contacts
Primary ContactPiotr Musialek, MD, DPhil
Outcome results
None listed