Phase 2 Study of MP4CO to Treat Vaso-occlusive Sickle Crisis
- Conditions
- Anemia, Sickle CellSickle Cell AnemiaHemoglobin SC DiseaseSickle Cell DiseaseSickle Cell DisordersSickle Cell Hemoglobin C Disease
- Interventions
- Registration Number
- NCT01925001
- Lead Sponsor
- Sangart
- Brief Summary
Sickle Cell disease is caused by an inherited hemoglobin disorder. Healthy red blood cells are discoid and can deform and move through small blood vessels to carry oxygen to all parts of the body. In Sickle Cell disease, as red blood cells circulate and oxygen is released, the deoxygenated abnormal Hemoglobin S can begin to polymerize and cause red cells to become sticky and elongated. These "sickled" red cells are less flexible and will obstruct small blood vessels and prevent normal red cells from circulating freely, which limits oxygen delivery to tissues and organs. This is known as a "sickling crisis" or "vaso-occlusive crisis" and is the leading cause of hospitalization in patients with Sickle Cell disease.
Patients suffering from a sickle crisis experience severe pain and are at risk of stroke, heart attack or even death. Current therapy is limited to hydration and symptomatic pain relief. The administration of MP4CO as an adjunct treatment to standard therapy may alleviate pain associated with a sickling crisis and potentially reduce the severity and duration of a crisis. This may shorten the time in hospital and potentially improve the quality of life for patients with sickle cell anemia.
- Detailed Description
Sickle cell disease (SCD) is an autosomal recessive disorder of the β globin gene of the hemoglobin molecule. To date, no specific agent has been approved to treat a sickle cell crisis, to reduce the severity of a sickling crisis, or to shorten the duration of admission. Current therapy for a crisis is limited to hydration and symptomatic pain relief with opiates when pain is severe enough to cause admission to hospital. Administration of oxygen by inhalation alone has not proven effective. The carbon monoxide (CO) molecule binds to Hb S and, while attached, prevents and reverses polymerization of Hb S chains and the distortion of the red cell. CO at very low doses also acts as a cell-signaling molecule, and may reduce inflammation, decrease oxygen requirements, and prevent programmed cell death (apoptosis).
MP4CO is designed as an ischemic rescue therapy to deliver non-toxic levels of CO, to provide an immediate metabolic signal to cells to help reverse red cell sickling, and to reduce inflammation.
Previously published studies provide a foundation to postulate that MP4CO might have the appropriate properties for treatment or reversal of an acute sickling crisis. The initial release of CO from MP4CO is predicted to have a beneficial effect including immediate stabilization of Hb S to prevent further red cell polymerization and reverse existing sickling, dilation of capillaries to enhance tissue perfusion, and anti-inflammatory cell-signalling properties. The subsequent circulation of the MP4 molecule as an oxygen therapeutic (after converting to MP4OX following oxygenation in the lungs) will help to 1) preferentially oxygenate ischemic tissue, 2) reverse partially sickled red cells, and 3) improve perfusion and oxygenation of local tissues to potentially ameliorate the painful crisis caused by sickling of red cells. In addition, MP4CO has enhanced chemical stability, which enables storage at room temperature.
Recruitment & Eligibility
- Status
- WITHDRAWN
- Sex
- All
- Target Recruitment
- Not specified
- Signed Informed Consent (and assent as required for minors)
- Diagnosis of SCD (known HbSS or HbSß0)
- Sixteen years of age or older
- Prior history of at least one VOC requiring hospitalization within the last 24 months
- ≥ 5 VOCs within the preceding 6 months requiring Emergency Room (ER) visits or hospital admissions
- History of overt stroke or cerebral vascular accident within the previous 12 months
- Remained in the hospital for ≥2 weeks (14 days) for VOC management within the previous 6 months
- Known pulmonary hypertension based on an estimated tricuspid regurgitant jet velocity (TRJV) >2.90 m/s or definitive diagnosis by prior right heart catheterization
- Baseline SaO2 level by pulse oximetry <92% on room air
- Systemic hypertension (baseline systolic pressure ≥ 160 mmHg or diastolic pressure ≥ 90 mmHg)
- History of myocardial infarction, myocardial ischemia, or angina
- On a chronic red blood cell transfusion therapy program (simple or exchange)
- Renal dysfunction presenting with a GFR<60 mL/min/1.73m
- Any diagnosis of a concurrent chronic debilitating disease that may affect the completion of the study or results of the study as determined by the investigator
- Currently enrolled in any other investigational treatment study
- Significant substance abuse.
- Known to have HIV, active hepatitis B, or C infection, or active tuberculosis
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Sodium chloride solution Sodium chloride solution Normal saline (0.9% Sodium Chloride Injection USP)administered intravenously MP4CO MP4CO Escalating doses of MP4CO, administered intravenously
- Primary Outcome Measures
Name Time Method Duration of hospitalization for treatment of painful vaso-occlusive crisis (VOC) Up to 28 days Time from randomization to resolution of the vaso-occlusive crisis, assessed by evaluation of cessation of opioid analgesia, recovery of ambulation, and/or ready for hospital discharge.
- Secondary Outcome Measures
Name Time Method Pain levels Up to 7 days Proportion of subjects with a pre-defined reduction in pain levels assessed using a visual analogue scale (VAS)
Readmission to emergency room (ER) Up to 28 days Proportion of subjects with at least one return visit to ER after hospital discharge
Acute Chest Syndrome (ACS) complications Up to 28 days Proportion of subjects with ACS complications
Re-admission to hospital for treatment of VOC Up to 28 days Proportion of subjects re-admitted to hospital for VOC treatment within 7 days after discharge
Trial Locations
- Locations (14)
Queen Mary Hospital
🇬🇧London, United Kingdom
University Hospital Brugmann
🇧🇪Brussels, Belgium
Univ. Medical Center Rizk Hospital
🇱🇧Beirut, Lebanon
Georges Pompidou European University Hospital
🇫🇷Paris, France
American Univ. of Beirut Medical Center
🇱🇧Beirut, Lebanon
Cornell Medical City
🇶🇦Doha, Qatar
Academic Medical Center
🇳🇱Amsterdam, Netherlands
Cukurova University Medical Facilty
🇹🇷Adana, Turkey
King's College Hospital
🇬🇧London, United Kingdom
Guys Hospital
🇬🇧London, United Kingdom
Mersin University Medical Faculty
🇹🇷Mersin, Turkey
Hôpital Henri Mondor
🇫🇷Créteil, France
Salmaniya Medical Complex
🇧🇭Manama, Bahrain
Rio de Janerio Instituto Estadual de Hematologie
🇧🇷Rio de Janerio, Brazil