Phase I Safety and Feasibility Study of Intracoronary Delivery of Autologous Bone Marrow Derived Mononuclear Cells

Phase I Safety and Feasibility Study of Intracoronary Delivery of Autologous Bone Marrow Derived Mononuclear Cells for Systemic, Single Right Ventricular Failure Due to Congenital Heart Disease

The objective of this study is to determine the safety and feasibility of autologous mononuclear cells (MNC) collected from bone marrow (BM) and intracoronary delivery for individuals with declining performance of their single right ventricle systemic pumps. This procedure has the potential to foster a new strategy for congenital heart patients. This is an open-label study of autologous MNC derived from bone marrow with a 2-year follow-up to document 1) related serious adverse events and 2) monitor changes in cardiac structure and function.

Study Overview

• Status: Completed
• Conditions: Congenital Heart Disease
• Intervention / Treatment: Biological: Autologous Bone Marrow-derived Mononuclear Cells

Detailed Description

This study is an open label Phase I trial to determine the safety and feasibility of bone marrow-derived mononuclear cells delivered into the coronary circulation of subjects with Fontan circulation and right ventricular dysfunction. Subjects will be screened at outpatient clinic visits at Mayo Clinic and interested qualified subjects will be consented and offered participation in this trial. Once informed consent has been obtained; preoperative values will be established and a selection committee will review subjects within three days prior to planned procedure to confirm inclusion and exclusion criteria. This will require a non-study cardiologist to review the clinical case and confirm the baseline cardiac function with evidence of disease progression with right ventricle dysfunction. However, individuals with decreased cardiac function requiring inotropic support and immediate listing for cardiac transplantation will NOT be included such that the risk of this research procedure may not be acceptable. Following cell-based product delivery, subjects will be followed for 6-months according to a pre-determined schedule that includes imaging studies along with questionnaires, electrophysiology and laboratory studies. Subjects will be contacted for an additional 18-months for surveillance by phone.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 2 years to 30 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Individuals with Fontan circulation with right ventricular dysfunction
• Ejection fraction equal to or less than 40% despite optimal outpatient medical management for at least 3 months
• Able to undergo bone marrow aspirate according to clinical consultation with hematology (INR must be maintained at or below 1.5)
• Able to undergo an MRI or CT examination

Exclusion Criteria:

• Individuals or parents of minors unwilling to consent to participation
• Individuals with severe chronic diseases, extra-cardiac syndromes, or cancer
• Females 10 years and older with positive pregnancy test or lack of effective birth control method
• Individuals currently requiring IV inotropes
• Individuals with bleeding disorders or history of thrombosis
• Individuals not eligible for MRI and have elevated serum creatinine level (eGFR less that 45 mL/min) and therefore cannot have a CT examination
• Individuals not eligible for MRI and have a prior significant reaction to intravenous contrast required for CT examination

• Individuals with the following conditions within 60 days prior to procedure:

  • Cardiogenic shock or extracorporeal circulation;
  • New arrhythmia that required medication for control;
  • Documented infection requiring treatment with antibiotics, and/or current infection being treated with antibiotics;
  • Cardiac condition requiring emergency procedure;
  • Cardiovascular surgery;
  • Seizures or history of significant neurological injury;
  • Multi-system organ failure including acute or chronic renal failure

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Single-arm; Intracoronary delivery of autologous bone marrow-derived mononuclear cells using catheterization procedure	Biological: Autologous Bone Marrow-derived Mononuclear Cells; Other Names: MNC

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of related serious adverse events	6 months post cell delivery

Secondary Outcome Measures

Outcome Measure	Time Frame
Number of subjects who died	6 months post cell delivery
Number of subjects with sustained or symptomatic ventricular arrhythmias	6 months post cell delivery
Number of subjects with acute decompensated heart failure	6 months post cell delivery
Number of subjects with myocardial infarction	6 months post cell delivery
Number of subjects with cardiac infection	6 months post cell delivery
Number of subjects with unexpected cardiovascular procedures within 6 months following cellular transplantation	6 months post cell delivery
Percentage of subjects that have cells delivered	6 months post cell delivery
Percentage of subjects completing the 6-month follow-up	6 months post cell delivery
Change in CT/MRI derived right ventricle ejection fraction	Baseline, 6 months post cell delivery
Change in diastolic ventricular volume	Baseline, 6 months post cell delivery
Change in systolic ventricular volume	Baseline, 6 months post cell delivery
Change in echocardiography derived right ventricle ejection fraction	Baseline, 6 months post cell delivery

Collaborators and Investigators

• Sponsor: Timothy J Nelson, MD, PhD
• Collaborators: Mayo Clinic
• Investigators: Principal Investigator: Muhammad Y Qureshi, MBBS, Mayo Clinic; Study Director: Timothy J Nelson, M.D., Ph.D., Mayo Clinic

Publications and helpful links

Helpful Links

• Mayo Clinic Clinical Trials

Study record dates

Study Major Dates

• Study Start: August 1, 2015
• Primary Completion (Actual): November 1, 2020
• Study Completion (Actual): November 1, 2020

Study Registration Dates

• First Submitted: September 10, 2015
• First Submitted That Met QC Criteria: September 11, 2015
• First Posted (Estimate): September 15, 2015

Study Record Updates

• Last Update Posted (Actual): May 14, 2021
• Last Update Submitted That Met QC Criteria: May 12, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Keywords: Single right ventricular failure
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Congenital Abnormalities; Cardiovascular Abnormalities; Heart Diseases; Heart Defects, Congenital
• Other Study ID Numbers: 13-006427

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO