Hypoxia and Inflammatory Injury in Human Renovascular Hypertension

Phase 1

Completed

• Conditions: Renal Artery Stenosis; Ischemic Nephropathy; Renovascular Disease; Chronic Kidney Disease
• Interventions: Drug: Mesenchymal stem cell; Procedure: Mesenchymal stem cell delivery with stent placement

• Registration Number: NCT02266394
• Lead Sponsor: Mayo Clinic

Brief Summary

Current treatments for ARAS based on restoring blood flow alone have been unsuccessful at recovering kidney function. For this reason we are studying a stem cell product called "mesenchymal stem cells" or MSC. Mesenchymal stem cells (MSC) are grown from a person's own fat tissue (obtained as a fat biopsy) and infused back into the patient's own kidney.

This study is also being done to determine if the MSC infusion prior to percutaneous transluminal renal angioplasty with stenting (PTRA) further enhances changes in single kidney blood flow and restoration of kidney function, as well as to assess the relationship between MSC dose and measures of kidney function.

Detailed Description

These studies include participation by human subjects using a 3-day inpatient CRU protocol at St. Mary's Hospital. Studies include formal measurement of blood and urinary markers of kidney function, BOLD MR and multidetector CT scanning. Forty-two non-diabetic patients between 40 and 80 years of any race or ethnicity will be recruited. All will have hypertension (defined as BP≥140/90 mmHg or ongoing antihypertensive drug therapy) but will have less than 180 mmHg to be included (with or without drug therapy). These subjects will be free of cardiovascular events within 3 months and will not have implanted electrical devices, such as a pacemaker or defibrillator. All patients will have identified large vessel renovascular disease (RVD) for Aims 1, 2 and 3. At least 10% of these subjects will be of African-American descent (self-identified) and recruited in collaboration with the University of Mississippi under the direction of Dr. Luis Juncos and the University of Alabama under the direction of Dr. David Calhoun. For completion of Aims 2 and 3, a three-day evaluation will be repeated between three and four months later, and ongoing safety and imaging studies will be performed up to 24 months after MSC administration. Participants in these protocols will undergo transvenous kidney biopsy under the direction of Drs. McKusick and Misra and their colleagues in Interventional Radiology. All subjects for these studies will complete the research plan at Mayo Clinic, Rochester, Minnesota.

Study Timeline

• Study First Submitted: 2014-09-18
• Study First Submitted QC: 2014-10-13
• Study First Posted: 2014-10-17
• Study Start: 2014-10-21
• Primary Completion: 2020-09-25
• Study Completion: 2020-09-25
• Status Verified: 2021-01
• Last Update Submitted: 2021-01-25
• Last Update Posted: 2021-01-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 42

Inclusion Criteria

• Creatinine <2.2 mg/dL for Caucasian males, <2.0 Caucasian females,< 2.4 African-American males, <2.1 mg/dL African-American females
• Hypertension (Systolic BP>155 mm Hg) and/or requirement for two or more antihypertensive medications: no restrictions on antihypertensive agents, although loop diuretics will be changed to diluting site agents (e.g. hydrochlorothiazide, indapamide, metolazone) prior to study.
• Angiotensin Converting Enzyme (ACE inhibitor) or Angiotensin Receptor Blocker (ARB) therapy maintained or initiated at usual recommended daily dose (equivalent: 40 mg lisinopril) .

Exclusion Criteria

• Diabetes requiring insulin or oral hypoglycemic medications (see text)
• Known allergy to furosemide or iodinated intravenous contrast
• Pregnancy
• Recent Cardiovascular event: Myocardial infarction, stroke, congestive heart failure within 3 months
• Cardiac ejection fraction less than 30%
• Evidence of hepatitis B or C, or HIV infection
• requirement for potentially nephrotoxic drugs, e.g. non-steroidal anti-inflammatory drugs
• Uncontrolled hypertension: SBP >180 mm Hg, despite antihypertensive therapy
• Kidney transplant
• Pacemaker, implantable defibrillator or other contraindication to Magnetic resonance imaging
• Inability to comply with breath-hold for 30 seconds
• History of deep venous thrombosis within 3 months of enrollment
• contraindications to renal biopsy including artificial valve requiring continuous anticoagulation

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Mesenchymal stem cell delivery	Mesenchymal stem cell	To determine hemodynamic and immunologic changes associated with intra-renal delivery of adipose-derived MSC into human subjects with advanced RVD.
Mesenchymal stem cell delivery with stent placement	Mesenchymal stem cell	To test adjunctive delivery of MSC to individuals with advanced RVD undergoing renal artery stenting.
Mesenchymal stem cell delivery with stent placement	Mesenchymal stem cell delivery with stent placement	To test adjunctive delivery of MSC to individuals with advanced RVD undergoing renal artery stenting.

Primary Outcome Measures

Name	Time	Method
Change in Kidney function	3 months	Renal Tissue oxygenation
Safety of Mesenchymal stem cell infusion	2 years	Number of patients with tissue injury markers

Secondary Outcome Measures

Name	Time	Method
Decrease in Kidney inflammation	3 months	Venous and tissue biomarkers of inflammation

Trial Locations

Locations (3)

University of Alabama; 🇺🇸 Birmingham, Alabama, United States

Mayo Clinic; 🇺🇸 Rochester, Minnesota, United States

University of Mississippi; 🇺🇸 Jackson, Mississippi, United States