MitoQ to Improve Vascular Funciton in Preeclampsia (MAVEN)
MitoQ (Mitoquinol Mesylate) to Ameliorate Vascular Function in Preeclampsia: a Novel Approach
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Preeclampsia (PreE) impacts ~10% of pregnancies and has severe outcomes both during and after pregnancy. It is a leading cause of pregnancy-related deaths, and has long term cardiovascular consequences for maternal and child health. Despite advances in the understanding of preeclampsia over the past 50 years, the underlying unifying mechanism causing preeclampsia remains elusive. This critical gap not only encompasses lack of understanding of the pathophysiology, but it also includes a lack of therapeutics for prevention or treatment. Success in this study could translate into a clinical trial that could finally offer a treatment for PreE.
The investigators have recently demonstrated that endothelial function in the human placental microcirculation is impacted by excess reactive oxygen and nitrogen species (ROS, RNS) from the mitochondria (MT), which in preeclampsia, impairs vasodilation. Excess ROS causes decreased nitric oxide (NO) bioavailability, increased lipid peroxidation, uncoupled eNOS, peroxynitrite, and exacerbates MT dysfunction and MT DNA damage via alterations in NO. Microvascular function can be improved by mechanisms that rebalance the oxidative stress response. The investigators have shown that MitoTempol, a MT antioxidant, improves vasodilation. Moreover, the investigators have shown that a major part of the cycle of excessive oxidative stress is caused by MT DNA damage and subsequent activation of toll like receptor 9 (TLR9), and that inhibiting TLR9 prevents this dysfunction. The finding that MT antioxidants given ex-vivo can reverse placental vascular damage after delivery gives promise that treatment of patients during pregnancy could restore vasodilation and allow for safer prolongation of pregnancy.
MitoQ (Mitoquinol Mesylate) is a nutritional supplement, and mitochondrial antioxidant. MitoQ has been extensively studied pre- clinically in cell-culture, and pregnant mouse, rat, and sheep models of PreE or oxidative stress and demonstrated beneficial fetal results. It has been used in clinical trials for heart failure, hepatitis C, Parkinson's, and multiple sclerosis with doses from 10mg to 80mg per day.
Overall Hypothesis: The investigators hypothesize that MitoQ (Mitoquinol Mesylate)-treated preeclampsia patients will have improved brachial artery flow-mediated dilation (FMD) and laser Doppler flowmetry assessments of the cutaneous microvasculature, and that placental endothelial function in micro-vessels and placental pathology will be improved in treated patients. To demonstrate this, the investigators will enroll two pilot human cohorts- one of admitted patients with preeclampsia with severe features who will either continue standard in-patient clinical care or be supplemented daily with MitoQ (Mitoquinol Mesylate) and a second outpatient cohort of patients with preeclampsia without severe features who will received standard outpatient care or be supplemented daily with MitoQ
Aim: Test whether with MitoQ (Mitoquinol Mesylate) treatment in preeclamptic patients improves endothelial function Hypothesis: MitoQ (Mitoquinol Mesylate)-treated patients will have improved brachial artery FMD and laser Doppler flowmetry assessments of the cutaneous microvasculature and placental endothelial function in micro-vessels and placental pathology will be improved in treated patients.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Jennifer McIntosh, D.O., M.S.
- Phone Number: 14148059019
- Email: jmcintosh@mcw.edu
Study Locations
-
-
Wisconsin
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Milwaukee, Wisconsin, United States, 53226
- Recruiting
- Froedtert & the Medical College of Wisconsin
-
Contact:
- Jennifer McIntosh
- Phone Number: 4148059019
- Email: jmcintosh@mcw.edu
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Inpatient Cohort
- pregnant patients with a clinical diagnosis of preeclampsia with severe features
- gestational age between 23+0 and 32+0 weeks' gestation
- singleton pregnancy
- age 18-50 years old
- No indication for immediate delivery (e.g. the patient and their physician team have planned expectant management of preeclampsia with severe features
- Able to consent and follow a 2-step commend
- English speaking
Outpatient Cohort
- Pregnant patients with a clinical diagnosis of preeclampsia without severe features
- gestational age between 23+0 and 34+0 weeks' gestation
- singleton pregnancy
- age 18-50 years old
- No indication for immediate delivery
- Planned outpatient management of preeclampsia
- Able to consent and follow a 2-step commend
- English speaking
Exclusion Criteria:
• Unable to stand from chair without physical assistance from another person (able to use assistive device).
- History of blood clots in the extremities or any condition in which compression of the thigh or transient ischemia is contraindicated (i.e., wounds in the leg).
- Chronic lasting symptoms (> 6 months) of severe COVID-19 (i.e., hospitalization)
- History of head trauma or concussion within the past 6 months
- Comorbid neurological disorder
- Peripheral vascular disease
- Diagnosed myocardial infarction or arrhythmia in the previous year
- Resting SBP ≥180 mmHg or DBP ≥ 100 mmHg
- Other significant medical condition likely to influence study or jeopardize safety as assessed by the Primary Investigator
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Preeclampsia with Severe Features taking Mitoquinol Mesylate
Patients allocated to this arm will be inpatients who have preeclampsia with severe features.
They will receive 10mg of Mitoquinol Mesylate daily from enrollment until delivery.
|
Patients randomized to the intervention will receive 10mg of Mitoquinol Mesylate daily from enrollment until delivery.
|
|
Placebo Comparator: Preeclampsia with Severe Features taking placebo
Patients allocated to this arm will be inpatients who have preeclampsia with severe features.
They will receive Placebo daily from enrollment until delivery.
|
Patients randomized to the placebo groups will take 1 placebo capsule daily until delivery.
|
|
Experimental: Preeclampsia without Severe Features taking MitoQ
Patients allocated to this arm will be out-patients who have preeclampsia without severe features.
They will receive 10mg of Mitoquinol Mesylate daily from enrollment until delivery.
|
Patients randomized to the intervention will receive 10mg of Mitoquinol Mesylate daily from enrollment until delivery.
|
|
Placebo Comparator: Preeclampsia without Severe Features taking placebo
Patients allocated to this arm will be out-patients who have preeclampsia without severe features.
They will receive placebo daily from enrollment until delivery.
|
Patients randomized to the placebo groups will take 1 placebo capsule daily until delivery.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Brachial Artery Flow Mediated Dilation (FMD)
Time Frame: 1-2 times per week from enrollment until delivery, up to 10 months
|
We will measure brachial artery vascular health in the arm.
Baseline brachial artery diameter and blood flow velocity through the artery will be measured before and after a pneumatic forearm cuff is inflated to 225 mmHg for five minutes.
|
1-2 times per week from enrollment until delivery, up to 10 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Cutaneous Microvascular Function
Time Frame: 1-2 times per week From enrollment until delivery, up to to months.
|
Laser Doppler Flowmetry (LDF) will measure blood flow flux during local skin heating to examine microvessel vasodilation
|
1-2 times per week From enrollment until delivery, up to to months.
|
|
Placental Microvascular Function
Time Frame: At Delivery
|
After delivery, placental vessels will be isolated from the placenta and a videomicroscopy technique will be used to evaluate flow-mediated dilation in vessels from placebo and MitoQ treated pregnancies.
|
At Delivery
|
|
Time from Enrollment to Delivery
Time Frame: Time in days from enrollment to delivery, up to 10 months
|
Time from diagnosis and initiation of MitoQ or placebo to delivery
|
Time in days from enrollment to delivery, up to 10 months
|
|
Blood Draw
Time Frame: Weekly from enrollment until Delivery, up to 10 months
|
We will collect blood each week.
The blood draw analysis may include but will not be limited to examining sFlt:PlGF ratio, plasma redox and bioenergetic analyses.
|
Weekly from enrollment until Delivery, up to 10 months
|
|
Maternal Preeclampsia Severity
Time Frame: From enrollment until delivery, up to 10 months
|
A composite outcome of Maternal Severity of preeclampsia will be assessed and include laboratory, blood pressure, and ultrasound data relevant to preeclampsia
|
From enrollment until delivery, up to 10 months
|
|
Composite Neonatal Delivery Outcome
Time Frame: Collected from delivery until hospital discharge; up to 1 week after birth.
|
A composite outcome of neonatal delivery information including (but not limited to): cord blood, gestational age, weight, APGARs
|
Collected from delivery until hospital discharge; up to 1 week after birth.
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Jennifer J McIntosh, D.O.,, Medical College of Wisconsin
Publications and helpful links
General Publications
- Weissgerber TL, Milic NM, Milin-Lazovic JS, Garovic VD. Impaired Flow-Mediated Dilation Before, During, and After Preeclampsia: A Systematic Review and Meta-Analysis. Hypertension. 2016 Feb;67(2):415-23. doi: 10.1161/HYPERTENSIONAHA.115.06554. Epub 2015 Dec 28.
- Vangrieken P, Al-Nasiry S, Bast A, Leermakers PA, Tulen CBM, Schiffers PMH, van Schooten FJ, Remels AHV. Placental Mitochondrial Abnormalities in Preeclampsia. Reprod Sci. 2021 Aug;28(8):2186-2199. doi: 10.1007/s43032-021-00464-y. Epub 2021 Feb 1.
- Chekir C, Nakatsuka M, Noguchi S, Konishi H, Kamada Y, Sasaki A, Hao L, Hiramatsu Y. Accumulation of advanced glycation end products in women with preeclampsia: possible involvement of placental oxidative and nitrative stress. Placenta. 2006 Feb-Mar;27(2-3):225-33. doi: 10.1016/j.placenta.2005.02.016. Epub 2005 Apr 22.
- Zsengeller ZK, Rajakumar A, Hunter JT, Salahuddin S, Rana S, Stillman IE, Ananth Karumanchi S. Trophoblast mitochondrial function is impaired in preeclampsia and correlates negatively with the expression of soluble fms-like tyrosine kinase 1. Pregnancy Hypertens. 2016 Oct;6(4):313-319. doi: 10.1016/j.preghy.2016.06.004. Epub 2016 Jun 30.
- Opichka MA, Livergood MC, Balapattabi K, Ritter ML, Brozoski DT, Wackman KK, Lu KT, Kozak KN, Wells C, Fogo AB, Gibson-Corley KN, Kwitek AE, Sigmund CD, McIntosh JJ, Grobe JL. Mitochondrial-targeted antioxidant attenuates preeclampsia-like phenotypes induced by syncytiotrophoblast-specific Galphaq signaling. Sci Adv. 2023 Dec;9(48):eadg8118. doi: 10.1126/sciadv.adg8118. Epub 2023 Dec 1.
- Oyewole AO, Birch-Machin MA. Mitochondria-targeted antioxidants. FASEB J. 2015 Dec;29(12):4766-71. doi: 10.1096/fj.15-275404. Epub 2015 Aug 7.
- Vaka R, Deer E, LaMarca B. Is Mitochondrial Oxidative Stress a Viable Therapeutic Target in Preeclampsia? Antioxidants (Basel). 2022 Jan 22;11(2):210. doi: 10.3390/antiox11020210.
- Teran E, Hernandez I, Nieto B, Tavara R, Ocampo JE, Calle A. Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. Int J Gynaecol Obstet. 2009 Apr;105(1):43-5. doi: 10.1016/j.ijgo.2008.11.033. Epub 2009 Jan 19.
- Stanhewicz AE, Nuckols VR, Pierce GL. Maternal microvascular dysfunction during preeclamptic pregnancy. Clin Sci (Lond). 2021 May 14;135(9):1083-1101. doi: 10.1042/CS20200894.
- Sanchez-Aranguren LC, Prada CE, Riano-Medina CE, Lopez M. Endothelial dysfunction and preeclampsia: role of oxidative stress. Front Physiol. 2014 Oct 10;5:372. doi: 10.3389/fphys.2014.00372. eCollection 2014.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- PRO00056100
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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