Administration of Allogeneic-MSC in Patients With Non-Ischemic Dilated Cardiomyopathy (DCMII)

Joshua M Hare

Status and phase: Enrolling; Phase 2

Conditions: Non-ischemic Dilated Cardiomyopathy

Treatments: Biological: allogeneic human mesenchymal stem cells (hMSCs); Other: Placebo

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT04476901

20200566

20-02-134 (Other Identifier)

CDMRP-PR191597 (Other Grant/Funding Number)

Details and patient eligibility

About

The purpose of this study is to evaluate the safety and effectiveness of an experimental drug called human allogeneic mesenchymal stem cell therapy.

Enrollment: 136 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

In order to be eligible to participate in this study, an individual must meet all of the following criteria:

1. Men and women aged 18 to 80 years (inclusive) at the time of signing the informed consent form.
2. Diagnosis of NIDCM with left ventricular ejection fraction ≤45%.
3. Appropriate guideline-directed optimal medical therapy for non-ischemic cardiomyopathy. At a minimum, subjects must be on beta blockers and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) or Angiotensin Receptor Neprilysin Inhibitors (ARNI) or have appropriate medical indication precluding use of one or both of these agents. Subjects must be on a stable regimen for at least 30 days prior to the procedure. Dose titration is allowed.
4. Be a candidate for cardiac catheterization*
5. Be willing to undergo DNA test.

Exclusion criteria

An individual who meets any of the following criteria will be excluded from participation in this study:

1. Be eligible for or require standard-of-care surgical or percutaneous intervention for the treatment of non-ischemic dilated cardiomyopathy

2. Clinical manifestation of coronary artery disease (CAD) (e.g., chest pain and concomitant clinical findings such as electrocardiogram changes suggestive of coronary ischemia, myocardial infarction) or evidence of endocardial or transmural scar on cardiac MRI suggestive of undiagnosed CAD or history of percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Be indicated for or require coronary artery revascularization

3. Documented presence of epicardial stenosis of 70% or greater in one or more major epicardial coronary arteries

4. Valvular heart disease including 1) aortic valve prosthesis, mechanical mitral valve, and mitral valve clip; 2) severe aortic valve insufficiency/regurgitation within 12 months of consent*

5. Aortic stenosis with valve area ≤ 1.5cm2*

6. Cardiomyopathy due to acute Post-partum (within 6 months), Non-compaction*, or Hypertrophic* cardiomyopathy

7. Cardiomyopathy due to known toxin (e.g amyloid) Note: anthracycline induced cardiomyopathy will be allowed

8. QTc interval > 550 ms on baseline electrocardiogram (ECG) (note: QTc interval is the interval between the start of the Q wave and the end of the T wave in the heart's electrical cycle)

9. Automated Implantable Cardioverter Defibrillator (AICD) appropriate firing or anti tachycardia pacing for ventricular tachycardia or ventricular fibrillation within 30 days prior to consent

10. Have an estimated baseline glomerular filtration rate below the clinical site's institutional cutoff

11. A hematologic abnormality during baseline testing as evidenced by hemoglobin < 9 g/dl; hematocrit < 30%; absolute neutrophil count < 2,000 or total WBC count more than 2 times upper limit of normal; or platelet values < 100,000/ul

12. Have liver dysfunction, as evidenced by enzymes Aspartate Transaminase Enzyme (AST) and Alanine Aminotransferase Enzyme (ALT) greater than three times the ULN

13. Have a bleeding diathesis or coagulopathy (International Normalised Ratio (INR) > 1.5), cannot be withdrawn from anticoagulation therapy, or will refuse blood transfusions

14. Be a solid organ transplant recipient. This does not include prior cell based therapy (>12 months prior to enrollment), bone, skin, ligament, tendon or corneal grafting.

15. Have a history of organ or cell transplant rejection

16. Have a clinical history of malignancy within the past 12 months (i.e., subjects with prior malignancy must be disease free for 12 months), except curatively treated basal cell or squamous cell carcinoma or cervical carcinoma

17. Drug and/or alcohol abuse or dependence within the past 9 months

18. Be serum positive for HIV, hepatitis B surface antigen, or viremic hepatitis C

19. Documented presence of a known Left Ventricular (LV) thrombus, aortic dissection, or aortic aneurysm. (Refer to "Guidance to the PI" section with regards to LV thrombus, below)*

20. Blood glucose levels (HbA1c) >10%

21. Severe radiographic contrast allergy

22. Known history of anaphylactic reaction to penicillin or streptomycin

23. Hypersensitivity to dimethyl sulfoxide (DMSO)

24. Non-cardiac condition with life expectancy < 1 year

25. Acute stroke or transient ischemic attack within 3 months of enrollment

26. Be pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods

27. Pacemaker-dependence with an Implantable Cardioverter Defibrillator (ICD) (Note: pacemaker-dependent candidates without an ICD are not excluded)

28. Presence of a pacemaker and/or ICD generator with any of the following limitations/conditions:

    • manufactured before the year 2000
    • leads implanted < 6 weeks prior to consent
    • non-transvenous epicardial or abandoned leads
    • subcutaneous ICDs
    • leadless pacemakers

29. A cardiac resynchronization therapy (CRT) device implanted less than 3 months prior to consent

30. Other MRI contraindications (e.g. subject body habitus incompatible with MRI)

31. Need for advanced heart failure therapy (e.g. IV inotropes)

32. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial

33. Any other condition that in the judgment of the Investigator would be a contraindication to enrollment or follow-up

(*) Applies to subjects receiving product via transendocardial administration only

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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136 participants in 6 patient groups, including a placebo group

Genotype A administered with placebo Group

Placebo Comparator group

Description:

Participants whose blood genotyping resulted with Genotype A (absence of any variant/ presence of benign variant) and randomized to the placebo group will receive the placebo intervention.

Treatment:

Other: Placebo

Genotype A administered with hMSC Group

Experimental group

Description:

Participants whose blood genotyping resulted with Genotype A (absence of any variant/ presence of benign variant) and randomized to the treatment group will receive the hMSC intervention.

Treatment:

Biological: allogeneic human mesenchymal stem cells (hMSCs)

Genotype B administered with placebo Group

Placebo Comparator group

Description:

Participants whose blood genotyping resulted with Genotype B (variants of uncertain significance) and randomized to the placebo group will receive the placebo intervention.

Treatment:

Other: Placebo

Genotype B administered with hMSC Group

Experimental group

Description:

Participants whose blood genotyping resulted with Genotype B (variants of uncertain significance) and randomized to the treatment group will receive the hMSC intervention.

Treatment:

Biological: allogeneic human mesenchymal stem cells (hMSCs)

Genotype C administered with placebo Group

Placebo Comparator group

Description:

Participants whose blood genotyping resulted with Genotype C (pathogenic or likely pathogenic variants) and randomized to the placebo group will receive the placebo intervention.

Treatment:

Other: Placebo

Genotype C administered with hMSC Group

Experimental group

Description:

Participants whose blood genotyping resulted with Genotype C (pathogenic or likely pathogenic variants) and randomized to the treatment group will receive the hMSC intervention.

Treatment:

Biological: allogeneic human mesenchymal stem cells (hMSCs)