Serial Infusions of Allogeneic Mesenchymal Stem Cells in Cardiomyopathy Patients With Left Ventricular Assist Device

Phase 2

Terminated

Conditions: Ischemic Heart Disease
Non-ischemic Cardiomyopathy

Interventions: Other: Placebo
Biological: Human Allogeneic Mesenchymal Bone Marrow Cells (aMBMC)

Registration Number: NCT03925324

Lead Sponsor: Medstar Health Research Institute

Brief Summary: A study to assess the safety and preliminary efficacy of serial intravenous dose of Allogeneic Mesenchymal Bone Marrow Cells in subjects with heart failure and implanted left ventricular assist devices.

Detailed Description: A double-blind, placebo-controlled, single-center, randomized study to assess the safety and preliminary efficacy of a three serial intravenous doses of allogeneic mesenchymal bone marrow cells to subjects with heart failure and implanted left ventricular assist devices.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 4

Inclusion Criteria

Age ≥18 years.
Advanced Heart Failure
Advanced HF defined as HF requiring LVAD implantation and deemed stable on his/her LVAD.
On stable medical therapy (per the discretion of the treating physician) including beta-blockers, ACE-inhibitors, angiotensin receptors blockers, angiotensin receptor neprilysin inhibitor, mineralocorticoid receptor antagonists, isosorbide, hydralazine, and mineralocorticoid receptor antagonists) and optimized pump speed for at least a month prior to randomization.
HS-CRP level≥2 mg/l.
NYHA class II-III symptoms.
Ability to understand and provide signed informed consent.
Reasonable expectation that patient will receive standard post-treatment care and attend all scheduled safety follow-up visits

Exclusion Criteria

Women of childbearing potential. Postmenopausal women or women with permanent contraception method (defined as total hysterectomy) will not be excluded.
History of debilitating stroke (modified Rankin Score > 3) within 3 months.
The likelihood of requirement of cardiac surgery during the study period.
Presence of clinically significant, uncorrected left sided valvular heart disease, active acute myocarditis, or uncontrolled hypertension defined as Persistently elevated mean arterial blood pressure (>100 mmHg). Echocardiography within 12 months of screening. Patients can be re-evaluated, at the discretion of the investigator.
QTc >550 ms (in the absence of bundle branch block, interventricular conduction delay or ventricular pacing). Electrocardiogram (ECG) within 60 days.
History of cardiac arrest within 3 months.
Hypertrophic or infiltrative cardiomyopathy.
Considered or listed for organ transplantation or history of organ transplantation
Illness other than HF with life expectancy less than 12 months.
Enrolled in an interventional trial or received an experimental drug or device within 30 days of randomization.
Left ventricular assist device implantation >2 years prior to enrollment.
Biventricular assist device (Bi-VAD) support.
Severe COPD defined by FEV1<1L, FEV1/FVC<70% within 12 months if known history of COPD, otherwise FEV1<1L, FEV1/FVC<70% within 24 months
Uncontrolled seizure disorder.
Clinically significant hematologic, hepatic, or renal impairment as determined by screening clinical laboratory tests within the last 30 days:

Liver disease = ALT or AST > 3x normal, alkaline phosphatase or bilirubin >2x normal Renal disease = on long term dialysis Hematologic = Unexplained persistent leukocytosis (WBC >11 K/UL) or hemoglobin < 8.5 gm/dl
Presence of any other clinically-significant medical condition, psychiatric condition, or laboratory abnormality, that in the judgment of the investigator or sponsor may affect compliance with the study protocol or pose a safety risk to the subject.
Inability to comply with the conditions of the protocol.
Acute coronary syndrome within 4 weeks (clinical diagnosis, confirmed by electrocardiographic abnormalities and elevation of troponin-I).
Malignancy within the previous five years, except adequately treated basal cell carcinoma, provided that it is neither infiltrating nor sclerosing, and carcinoma in situ of the cervix.
Active uncontrolled systemic infection. Positive blood or deep tissue cultures or clinical or imaging evidence of systemic infection despite complete course of effective antimicrobial therapy as determined by infectious diseases. Localized (non-systemic) infection is not an exclusion criterion. Patients can be re-evaluated, at the discretion of the investigator.
Early postpartum cardiomyopathy (within six months of diagnosis).
Presence of inherited or acquired immune deficiency or human immunodeficiency virus infection (HIV). Negative HIV test within the preceding 12 months is required.
Systemic corticosteroids, immunosuppressive drug therapy (cyclophosphamide, methotrexate, cyclosporine, tacrolimus, azathioprine, mycophenolate, sirolimus, etc.), and DNA depleting or cytotoxic drugs taken within four weeks prior to study treatment.
Known Porphyria.
Allergy to sodium citrate or any caine type of local anesthetic.
Patient enrolled in hospice care.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Three intravenous infusions of 1.5 mL/kg Lactated Ringer's Solution with each infusion 1 month apart.
Human Allogeneic Mesenchymal Bone Marrow Cells (aMBMC)	Human Allogeneic Mesenchymal Bone Marrow Cells (aMBMC)	Three intravenous infusions of 1.5 million (aMBMC) per kg administered at approximately 2mL/min. Maximum dose as for 100kg subject or 150 million cells for any subject 100kg or more with each infusion 1 month apart.

Primary Outcome Measures

Name	Time	Method
Uncontrolled Systemic Infection	up to 12 months post enrollment	Number of admission for uncontrolled systemic infection
Temperature	up to 12 months post enrollment	Temperature
All-cause Mortality	up to 12 months post enrollment	Rate of Death

Secondary Outcome Measures

Name	Time	Method
Gout Flares	Day 90	Count of gout flares
6 Minute Walk Distance Changes	Baseline and day 90 post initial infusion	6 minute walk distance changes
Hospitalizations Due to Right Heart Failure	day 90	Number of hospitalizations for to right heart failure
Change in the Following Cardiac Biomarker	Baseline and day 90 post initial infusion	The change in the lab values N-Terminal Prohormone of Brain Natriuretic Peptide (NT-ProBNP)
Change in RV Systolic Function	Baseline and day 90 post initial infusion	Change in RV systolic function
NK Cell Depletion	Baseline to day 90	percent reduction in NK cells