- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03382301
Ciclosporin A Preconditioning for Renal Artery Stenosis (CicloSAAR)
Impact of a Ciclosporin A Preconditioning for Prevention of Ischemia-reperfusion Injury After Renal Artery Stenosis Dilation
Renal artery stenosis is one the leading cause of secondary hypertension. Previous randomized controlled trials in humans have failed to demonstrate an improvement of renal function after stenosis dilation, probably because of a selection bias with more severe patients being excluded from randomization. Renal ischemia-reperfusion injuries have also not been taken into account. Indeed, reperfusion leads to a rapid renal blood flow recovery associated with renal ischemia-reperfusion injuries.
Mitochondrial permeability transition pore (mPTP) is a key player in the occurrence of ischemia reperfusion injuries because its opening leads to mitochondria leakage and cell death. However, preconditioning whether pharmacological or ischemic can prevent mPTP opening and protect cells. Ciclosporin A can prolong mPTP closing during reperfusion and reduce renal and cardiac tissular lesions. Another mPTP blocker (Bendavia) has been associated with an improvement of renal blood flow (RBF) and glomerular filtration rate (GFR) after renal artery stenosis dilation at 6 weeks in pigs. Based on a recent study, dilation overall benefit could be secondary to an improvement of the contralateral kidney GFR and tissue oxygen content, requiring a single kidney evaluation of those renal functional parameters. The investigators previously demonstrated that dose and timing of ciclosporin A preconditioning is key to protect kidneys from ischemia-reperfusion injuries. Previous controlled trials that failed to demonstrate a benefit of ciclosporin A conditioning have used post conditioning on necrotic cells. Considering kidney ischemia-reperfusion injuries, preconditioning have led to more encouraging results compared to ciclosporin A post conditioning in animals. Therefore the investigators aim to conduct the first clinical study of ciclosporin A preconditioning for prevention of kidney ischemia-reperfusion injuries after renal artery stenosis dilation.
Using renal functional imaging and the new PET-MRI (Positron Emission Tomography-Magnetic Resonance Imaging) combined device, the investigators will evaluate kidney perfusion, oxidative metabolism, glomerular filtration rate and oxygen content before and 3 months after renal artery stenosis dilation with or without a ciclosporin A preconditioning.
Study Overview
Status
Conditions
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Sandrine LEMOINE, MD
- Phone Number: +33 472 110 263
- Email: Sandrine.lemoine01@chu-lyon.fr
Study Contact Backup
- Name: Gabrielle Laetitia NORMAND, MD
- Phone Number: +33 472 110 263
- Email: laetitia.normand@chu-lyon.fr
Study Locations
-
-
-
Lyon, France, 69437
- Recruiting
- Service d'Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon
-
Contact:
- Sandrine LEMOINE, MD
- Phone Number: +33 472 110 263
- Email: Sandrine.lemoine01@chu-lyon.fr
-
Contact:
- Gabrielle Laetitia NORMAND, MD
- Phone Number: +33 472 110 263
- Email: laetitia.normand@chu-lyon.fr
-
Principal Investigator:
- Sandrine LEMOINE, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients over 50 years of age
- For women : only menopausal women
- Estimated Glomerular filtration rate ≥ 25 mL/min/1.73m2
- Renal artery stenosis with ≥ 70 % caliber reduction (Doppler or scanner or MRI)
- No controlateral stenosis
- Kidney size ≥ 7 cm
- Only atheromatous renal artery stenosis
- Resistant hypertension and/or rapid loss of kidney function and/or flash pulmonary edema
- Collective decision of dilation after a multidisciplinary meeting
Exclusion Criteria:
- Inclusion in another study
- Protected adults
- Person without a social security coverage
- Imprisoned person
- Systolic blood pressure >180 mmHg and/or diastolic blood pressure > 110 mmHg
- Non atheromatous renal artery stenosis
- Single kidney
- Multiple myeloma
- Iodine contrast agents allergy
- Ciclosporin A hypersensibility
- Severe other medical conditions that could be exacerbated by Iodine injection (cancer, lymphoma, active Hepatitis B, active Hepatitis C, uncontrolled HIV)
- Previous radiation exposure (above 20 mSv (millisievert) in the last 6 months before inclusion)
- MRI contra indications (MRI incompatible pacemaker or insulin pomp, metal clip, MRI incompatible cardiac valve, dental brace, claustrophobia)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ciclosporin A preconditioning
Ciclosporin A preconditioning before renal artery stenosis dilation
|
Ciclosporin A perfusion (2.5 mg/kg) for 1 hour before renal artery dilation
|
Placebo Comparator: NaCl preconditioning
|
NaCl perfusion (Saline perfusion) for 1 hour (2.5 mg/kg) before renal artery dilation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in relative increase (baseline and 3 months after) of global renal perfusion between the two groups
Time Frame: 3 months after renal artery stenosis dilation
|
Global renal perfusion is assessed by 15O labeled water PET (Positron Emission Tomography) imaging
|
3 months after renal artery stenosis dilation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in the relative increase (baseline and 3 months after) of global renal oxidative metabolism between the two groups
Time Frame: 3 months after renal artery stenosis dilation
|
Global renal oxidative metabolism is assessed by 11C labeled acetate PET (Positron Emission Tomography) imaging
|
3 months after renal artery stenosis dilation
|
Difference in the relative increase (baseline and 3 months after) of global renal oxygen content between the two groups
Time Frame: 3 months after renal artery stenosis dilation
|
Global renal oxygen content is assessed by BOLD MRI (Blood-Oxygen-Level Dependent Magnetic Resonance Imaging)
|
3 months after renal artery stenosis dilation
|
Difference in the relative increase (baseline and 3 months after) of global glomerular filtration rate between the two groups
Time Frame: 3 months after renal artery stenosis dilation
|
Global glomerular filtration rate is assessed by Iohexol measured clearance
|
3 months after renal artery stenosis dilation
|
Difference in the relative increase (baseline and 3 months after) of single-kidney perfusion (ischemic versus contralateral kidney) between the two groups
Time Frame: 3 months after renal artery stenosis dilation
|
Kidney perfusion is assessed by 15O labeled water PET (Positron Emission Tomography) imaging
|
3 months after renal artery stenosis dilation
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Arterial Occlusive Diseases
- Kidney Diseases
- Urologic Diseases
- Postoperative Complications
- Pathological Conditions, Anatomical
- Reperfusion Injury
- Constriction, Pathologic
- Renal Artery Obstruction
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Dermatologic Agents
- Antifungal Agents
- Calcineurin Inhibitors
- Cyclosporine
- Cyclosporins
Other Study ID Numbers
- 69HCL16_0823
- 2017-002937-48 (EudraCT Number)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Renal Artery Stenosis
-
Adriano Henrique Pereira BarbosaCompletedTransplant Renal Artery StenosisBrazil
-
Guang'anmen Hospital of China Academy of Chinese...UnknownAtherosclerotic Renal Artery StenosisChina
-
Mayo ClinicCompletedAtherosclerotic Renal Artery Stenosis | Ischemic Nephropathy | Renovascular HypertensionUnited States
-
University of AarhusOdense University Hospital; Aarhus University Hospital; Rigshospitalet, Denmark; Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) and other collaboratorsRecruitingHeart Failure | Percutaneous Transluminal Angioplasty | Renovascular Hypertension | Renal Artery Stenosis Atherosclerotic | Renovascular Hypertension With Renal FailureDenmark
-
Imperial College Healthcare NHS TrustRecruitingTransplant Renal Artery StenosisUnited Kingdom
-
Peking Union Medical College HospitalUnknownA Study of Using Parenchymal Blood Volume(PBV) for Endovascular Treatment of Renal Arterial StenosisRenal Artery Stenosis | Renal Blood PerfusionChina
-
Peking University First HospitalRecruitingRenal Artery Stenosis Atherosclerotic | Secondary Hypertension Renal ArterialChina
-
Chinese Academy of Medical Sciences, Fuwai HospitalNot yet recruitingRenal Artery Obstruction | Hypertension, RenovascularChina
-
Atrium Medical CorporationCompletedHypertension, Renovascular | Renal Artery StenosisUnited States
-
Assistance Publique - Hôpitaux de ParisMinistry of Health, FranceTerminatedHypertension | Hypertension Resistant to Conventional Therapy | Angiographically Proven Grade III Unilateral or Bilateral Atherosclerotic Renal Artery Stenosis (ARAS) Greater Than or Equal to 60 PercentFrance
Clinical Trials on Ciclosporin A preconditioning before renal artery stenosis dilation
-
Julio RamirezUniversity of LouisvilleTerminatedOsteomyelitisUnited States