Ignite Creation Date:
2024-05-06 @ 6:26 PM
Last Modification Date:
2024-10-26 @ 2:48 PM
Study NCT ID:
NCT05669144
Status:
RECRUITING
Last Update Posted:
2022-12-30
First Post:
2022-12-10
Brief Title:
Co-transplantation of Mesenchymal Stem Cell Derived Exosomes and Autologous Mitochondria for Patients Candidate for CABG Surgery
Sponsor:
Tehran University of Medical Sciences
Organization:
Tehran University of Medical Sciences
Study Overview
Official Title:
Co-transplantation of Mesenchymal Stem Cell Derived Exosomes and Autologous Mitochondria for Patients Candidate for CABG Surgery With EF 25 Clinical Trial Phase
Status:
RECRUITING
Status Verified Date:
2022-12
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Heart failure HF and acute myocardial infarction that often follows are among the main causes of disability and death worldwide As such new treatments and biological drugs are needed to protect the heart against the harmful effects of ischemia and also reperfusion injury IRI preserve cardiac function reduce the zone of myocardial infarction MI and improve patient outcomes In this regard it has been shown that mitochondrial dysfunction has a key role in the pathogenesis of heart ischemia cardiomyopathy and reperfusion injury in this study which includes 4 groups of intervention we try to minimize the damage by transplantation of mitochondria and administration of MSC-derived exosomes MSC-derived exosomes limit inflammatory damage while fresh autologous exosomes limit oxidative stress
Detailed Description:
This research will be performed as a retrospective cohort study at Tehran Heart Center Patients will be selected from CABG candidates with severely low Ejection fraction determined by speckle echocardiography Patients with severe co-morbidities or cerebral damage will be excluded from the study Detailed informed consent will be taken from the patients Patients who refuse to provide consent will receive standard treatment
Criteria
Inclusion Criteria
Patients who are a candidate for CABG due to CADMR
History of Q-wave MI less than one month
Age 35-80
LVEF 25 by any imaging modality echocardiographySPECTLV angiography and Cardiac MRI
Viability study as evidenced by low-dose dobutamine stress echocardiogram andor thallium redistribution nuclear study at least four viable segments
Exclusion Criteria
Severe co-morbidities eg renal failure liver failure etc
Inability to provide informed consent
Cerebral Damage
1 Study groups
The standard treatment performed for all patients is revascularisation by coronary artery bypass grafting surgery Patients will be divided into four groups based on the treatments received in addition to the standard treatment
Mitochondrial and exosome transplantation by intracoronary and intra-myocardial injection Study groups
1 Intracoronary and intra-myocardial injection of exosomes 5 patients
2 Intracoronary and intra-myocardial injection of mitochondria 5 patients
3 Intracoronary and intra-myocardial injection of exosomes and mitochondria 5 patients
4 Placebo 5 patients For the patients in groups b and c mitochondria will be extracted from a muscle tissue specimen extracted at the beginning of the surgery from pectoralis muscles exposed after sternotomy Mitochondria will be extracted from the muscle specimen simultaneously with the surgery When revascularisation is achieved by the bypass grafts The extracted mitochondria will be injected into the heart muscle A 31-gauge insulin syringe will perform injections into ten different sites in the ischemic area of the heart muscle Besides direct injection into the heart muscle one-third of the extracted mitochondria will be injected into the coronary sinus
Patients in groups a and b will receive the extracted exosome from MSC cells described in step 2 The extracted exosome will be injected into the coronary sinus after the placement of the Cardiopulmonary bypass
2 Isolation and characterisation of mesenchymal stem cells from the human umbilical cord UC-MSCs Human umbilical cord mesenchymal stem cells are enzymatically isolated by collagenase in terms of a previous study and cultured in DMEM F12 medium with 10 exosome-depleted FBS GMP grade with penicillin and streptomycin antibiotics and incubated at 37 C and 5 CO2 After the cell confluence reaches 80 the conditioned medium is collected for exosome isolation the cells are used in passage 3
The phenotypic analysis is performed on the third passage Surface antigens are analysed for CD90 CD105 CD73 and CD34 using flow cytometry
3 Extraction of exosomes from UC-MSCs by ultracentrifugation and characterisation
After the cell confluence reaches 80 the conditioned medium is collected for exosome isolation by several ultracentrifuges In brief after 48 h the conditioned medium CM of the cells is centrifuged at 400 g for 10 min to remove cells and at 2500 g for 30 min to eliminate apoptotic bodies and debris Afterwards CM was centrifuged twice at 100 000 g for two h followed by the process of suspending the exosome pellet in PBS
Surface antigens are analysed for CD9 CD63 and CD81 using western blot Furthermore Bradford Colorimetric Assay BCA kit is used to measure exosome production total protein at a wavelength of 570 nm Dynamic light scattering DLS determines the size distribution of exosomes
4 Extraction of mitochondria from US-MSCs and characterisation
5 Short-term evaluation of the safety of clinical trial transplant mitochondria and exosome phase I
The patient will be under close monitoring after the surgery based on clinical symptoms signs arrhythmia echocardiographic evaluations and lab results
6 Short-term evaluations of the patient in terms of blood factors cTnT CK-MB Creatine kinase CK and its isoenzyme CK-MB are critical tools for diagnosing acute myocardial infarction AMI The content of CK-MB relative to total CK in myocardial cells is variable in normal myocardium it is low and enhanced several-fold in hypoxic myocardium and heart stroke
7 SPECT scan Cardiac MRI and Dobutamine stress Speckle Echocardiography before and after 2 months
The evaluation of the patients recovery will be performed one month after the surgery This evaluation is based on patients signs and symptoms Function Class assessments Speckle and Dobutamine stress Eco SPECT Nuclear heart Scan and Cardiac MRI imaging CMR Evaluations will be performed before surgery and one month after the surgery Close Comparison will be performed between evaluation results to report possible improvements in the patients condition
The assessed variables for follow-up evaluation include
Ejection Fraction variables from Eco and CMR LVEF RVEF Global EF
16 Segment viability analysis by SPECT scan and CMR
NYHA Classification assessment based on patient physical examination
8 Data Analysis will be performed by IBM SPSS Statistics Version 25 A p-value of less than 005 will be assessed as significant
Criteria
Inclusion Criteria
Patients who are a candidate for CABG due to CADMR
History of Q-wave MI less than one month
Age 35-80
LVEF 25 by any imaging modality echocardiographySPECTLV angiography and Cardiac MRI
Viability study as evidenced by low-dose dobutamine stress echocardiogram andor thallium redistribution nuclear study at least four viable segments
Exclusion Criteria
Severe co-morbidities eg renal failure liver failure etc
Inability to provide informed consent
Cerebral Damage
1 Study groups
The standard treatment performed for all patients is revascularisation by coronary artery bypass grafting surgery Patients will be divided into four groups based on the treatments received in addition to the standard treatment
Mitochondrial and exosome transplantation by intracoronary and intra-myocardial injection Study groups
1 Intracoronary and intra-myocardial injection of exosomes 5 patients
2 Intracoronary and intra-myocardial injection of mitochondria 5 patients
3 Intracoronary and intra-myocardial injection of exosomes and mitochondria 5 patients
4 Placebo 5 patients For the patients in groups b and c mitochondria will be extracted from a muscle tissue specimen extracted at the beginning of the surgery from pectoralis muscles exposed after sternotomy Mitochondria will be extracted from the muscle specimen simultaneously with the surgery When revascularisation is achieved by the bypass grafts The extracted mitochondria will be injected into the heart muscle A 31-gauge insulin syringe will perform injections into ten different sites in the ischemic area of the heart muscle Besides direct injection into the heart muscle one-third of the extracted mitochondria will be injected into the coronary sinus
Patients in groups a and b will receive the extracted exosome from MSC cells described in step 2 The extracted exosome will be injected into the coronary sinus after the placement of the Cardiopulmonary bypass
2 Isolation and characterisation of mesenchymal stem cells from the human umbilical cord UC-MSCs Human umbilical cord mesenchymal stem cells are enzymatically isolated by collagenase in terms of a previous study and cultured in DMEM F12 medium with 10 exosome-depleted FBS GMP grade with penicillin and streptomycin antibiotics and incubated at 37 C and 5 CO2 After the cell confluence reaches 80 the conditioned medium is collected for exosome isolation the cells are used in passage 3
The phenotypic analysis is performed on the third passage Surface antigens are analysed for CD90 CD105 CD73 and CD34 using flow cytometry
3 Extraction of exosomes from UC-MSCs by ultracentrifugation and characterisation
After the cell confluence reaches 80 the conditioned medium is collected for exosome isolation by several ultracentrifuges In brief after 48 h the conditioned medium CM of the cells is centrifuged at 400 g for 10 min to remove cells and at 2500 g for 30 min to eliminate apoptotic bodies and debris Afterwards CM was centrifuged twice at 100 000 g for two h followed by the process of suspending the exosome pellet in PBS
Surface antigens are analysed for CD9 CD63 and CD81 using western blot Furthermore Bradford Colorimetric Assay BCA kit is used to measure exosome production total protein at a wavelength of 570 nm Dynamic light scattering DLS determines the size distribution of exosomes
4 Extraction of mitochondria from US-MSCs and characterisation
5 Short-term evaluation of the safety of clinical trial transplant mitochondria and exosome phase I
The patient will be under close monitoring after the surgery based on clinical symptoms signs arrhythmia echocardiographic evaluations and lab results
6 Short-term evaluations of the patient in terms of blood factors cTnT CK-MB Creatine kinase CK and its isoenzyme CK-MB are critical tools for diagnosing acute myocardial infarction AMI The content of CK-MB relative to total CK in myocardial cells is variable in normal myocardium it is low and enhanced several-fold in hypoxic myocardium and heart stroke
7 SPECT scan Cardiac MRI and Dobutamine stress Speckle Echocardiography before and after 2 months
The evaluation of the patients recovery will be performed one month after the surgery This evaluation is based on patients signs and symptoms Function Class assessments Speckle and Dobutamine stress Eco SPECT Nuclear heart Scan and Cardiac MRI imaging CMR Evaluations will be performed before surgery and one month after the surgery Close Comparison will be performed between evaluation results to report possible improvements in the patients condition
The assessed variables for follow-up evaluation include
Ejection Fraction variables from Eco and CMR LVEF RVEF Global EF
16 Segment viability analysis by SPECT scan and CMR
NYHA Classification assessment based on patient physical examination
8 Data Analysis will be performed by IBM SPSS Statistics Version 25 A p-value of less than 005 will be assessed as significant
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None