- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04713657
Beta-blocker Administration for Cardiomyocyte Division
June 5, 2023 updated by: Bernhard Kuhn
Mechanistic Clinical Trial of Beta-Blocker Administration For Reactivating Cardiomyocyte Division In Tetrology of Fallot
Heart failure is a common long-term complication in patients with congenital heart disease (CHD).
Medical treatments to promote regeneration of new healthy heart muscle cells have the potential to provide new heart failure treatments for these patients.
The development of such therapies is limited by the poor understanding of the ways in which heart muscles grow after birth.
Investigators have learned that humans without heart disease generate new heart muscles cells up to the age of 20 years old and that this is decreased in patients with congenital heart disease like Tetralogy of Fallot.
Investigators are trying to determine if treatment with a medicine called Propranolol can increase heart muscle cell proliferation and, with that, normalize heart growth.
Investigators will examine discarded heart muscle tissue that is obtained during surgery for the presence of new heart muscle cells.
Propranolol is approved by the Food and Drug Administration (FDA) to treat a certain kind of benign tumor in infants (hemangioma), but it is not currently approved by the FDA to increase heart muscle growth.
Study Overview
Status
Recruiting
Conditions
Study Type
Interventional
Enrollment (Estimated)
40
Phase
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Shannon Janzef, MSN, RN, CBC
- Phone Number: 412.692.5760
- Email: janzefs@upmc.edu
Study Contact Backup
- Name: Elizabeth Hartigan, RN
- Phone Number: 412-692-7060
- Email: elizabeth.hartigan@chp.edu
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15224
- Recruiting
- UPMC Children's Hospital of Pittsburgh
-
Contact:
- Shannon Janzef, MSN, RN, CBC
- Phone Number: 412-692-5760
- Email: janzefs@upmc.edu
-
Contact:
- Elizabeth Hartigan, RN
- Phone Number: 4126927060
- Email: elizabeth.hartigan@chp.edu
-
Principal Investigator:
- Bernhard Kuhn, MD
-
Sub-Investigator:
- Philip Adams, MD
-
Sub-Investigator:
- Adam Christopher, MD
-
Sub-Investigator:
- Tarek Alsaied, MD
-
Sub-Investigator:
- Jennifer Johnson, DO
-
Sub-Investigator:
- Laura Olivieri, MD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
1 month to 1 month (Child)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Male and female infants < 45 days of age with a diagnosis of tetralogy of Fallot with pulmonary stenosis or double outlet right ventricle, tetralogy type by echocardiogram, who weigh greater than 2 kg at the time of consent and are tolerating enteral feeds.
- DORV variant
Exclusion Criteria:
- congenital atrio-ventricular block on EKG (PR interval > 120 ms),
- concomitant medication administration that interacts with propranolol,
- patient family is, in the opinion of the investigator, unable to comply with the requirements of the study protocol or is unsuitable for the study for any reason,
- gestation age < 35 weeks,
- infants of diabetic mothers, asthma or underlying respiratory disease,
- presence of metal implants in infants.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Propranolol
The target dose of Propranolol hydrochloride for this study target dose for this study will be 4 mg/kg/day divided in 4 doses.
The concentration of propranolol solution is 20 mg/5 mL.
Additionally, labeled syringes will be provided to families for accurate weight-based dosing.
Treatment with propranolol will begin at 1 month of age and continue until surgical repair, which happens usually at 3 - 9 months of age.
|
15N-thymidine will be administered to patients in order to quantify cardiomyocyte proliferation.
15N-thymidine will be administered as 5 separate syringes.
Each syringe will contain the recommended daily dose based on participants weight.
Subjects will be given the labeled thymidine by mouth once a day for 5 consecutive days.
The dosing will begin one week after starting the study drug.The caregiver (parent or nurse) will administer the labeled thymidine by mouth via a syringe once a day for 5 consecutive days.
They will be provided with a diary to keep track of study drug dosing.
Other Names:
Parents will be asked to keep a diary of the child's feeding and diaper changes during the administration of thymidine.
To monitor how the labeled thymidine is processed in the body, investigators will analyze urine from the child's diapers.
Each time a diaper is changed, a cotton ball will be placed in the diaper.
At the next diaper change, this cotton ball will be removed from the diaper, placed in a Ziploc bag, and stored in the freezer.
They will be collected and stored cotton balls starting with the first administration of thymidine until 24 hours after the last administration.
The frozen cotton balls may be collected from the home by a nurse or brought by parent to the next clinic visit.
On Study Day 1 to obtain baseline assessment of cardiac size.
A second research dedicated echocardiogram will be done after being anesthetized for surgery.
Echocardiography is routinely performed to determine right ventricle (RV) structure of the heart and function in ToF/PS and is non-invasive.
A limited study protocol will be performed using the feed-and-bundle technique at the time of study enrollment, The feed and bundle technique is utilized so that the infant will be as comfortable as possible and asleep during the procedure.
This is done to prevent the risk of sedation and allow for a more natural sleep.
The baby is undressed, prepared with ECG-leads and an oxygen saturation probe, and fed.
With this "feed, swaddle, and sleep" technique, scanning times of 30-60 minutes can be achieved, which provides the stillness needed for accurate visualization of the heart.
A second CMR, with the same limited study protocol, will be performed under general anesthesia prior to surgical repair.
It does not pose any risk of radiation exposure and will not require IV placement or contrast administration for a limited assessement of the right ventricle.
For patients who are randomized to receive propranolol, The target dose for this study will be 4 mg/kg/day divided in 4 doses.
The first dose will be given in the Pediatric Clinical and Translational Research Center (PCTRC) at 1mg/kg.
Parents will administer propranolol (1 mg/kg po x 4 doses per day).
Parents will be instructed to administer propranolol with feeding or soon after feeding, but not before feeding.
families will also be given instructions for regarding 15N-thymidine dosing frequency and interval and provided with a log sheet to record administered and missed doses of propranolol and 15N-thymidine.
Other Names:
On Study Day 1; monthly until surgery in conjunction with patient's clinical cardiology appointment; and at the time of surgery.
Will include vital signs.
On the morning of surgery, after IV access is obtained for anesthesia 2 ml of blood will be collected for analysis.
A small piece of heart tissue and fat that has already been removed during surgery will be collected for analysis.
|
Placebo Comparator: Placebo
Placebo will be given in a volume that corresponds to the patient's weight.
Additionally, labeled syringes will be provided to families for accurate weight-based dosing.
Treatment with placebo will begin at 1 month of age and continue until surgical repair, which happens usually at 3 - 9 months of age.
There is no current standard of care for pharmacologic therapy for infants with ToF.
As such, there are no alternative treatments, and the placebo group is standard of care.
|
15N-thymidine will be administered to patients in order to quantify cardiomyocyte proliferation.
15N-thymidine will be administered as 5 separate syringes.
Each syringe will contain the recommended daily dose based on participants weight.
Subjects will be given the labeled thymidine by mouth once a day for 5 consecutive days.
The dosing will begin one week after starting the study drug.The caregiver (parent or nurse) will administer the labeled thymidine by mouth via a syringe once a day for 5 consecutive days.
They will be provided with a diary to keep track of study drug dosing.
Other Names:
Parents will be asked to keep a diary of the child's feeding and diaper changes during the administration of thymidine.
To monitor how the labeled thymidine is processed in the body, investigators will analyze urine from the child's diapers.
Each time a diaper is changed, a cotton ball will be placed in the diaper.
At the next diaper change, this cotton ball will be removed from the diaper, placed in a Ziploc bag, and stored in the freezer.
They will be collected and stored cotton balls starting with the first administration of thymidine until 24 hours after the last administration.
The frozen cotton balls may be collected from the home by a nurse or brought by parent to the next clinic visit.
On Study Day 1 to obtain baseline assessment of cardiac size.
A second research dedicated echocardiogram will be done after being anesthetized for surgery.
Echocardiography is routinely performed to determine right ventricle (RV) structure of the heart and function in ToF/PS and is non-invasive.
A limited study protocol will be performed using the feed-and-bundle technique at the time of study enrollment, The feed and bundle technique is utilized so that the infant will be as comfortable as possible and asleep during the procedure.
This is done to prevent the risk of sedation and allow for a more natural sleep.
The baby is undressed, prepared with ECG-leads and an oxygen saturation probe, and fed.
With this "feed, swaddle, and sleep" technique, scanning times of 30-60 minutes can be achieved, which provides the stillness needed for accurate visualization of the heart.
A second CMR, with the same limited study protocol, will be performed under general anesthesia prior to surgical repair.
It does not pose any risk of radiation exposure and will not require IV placement or contrast administration for a limited assessement of the right ventricle.
On Study Day 1; monthly until surgery in conjunction with patient's clinical cardiology appointment; and at the time of surgery.
Will include vital signs.
On the morning of surgery, after IV access is obtained for anesthesia 2 ml of blood will be collected for analysis.
A small piece of heart tissue and fat that has already been removed during surgery will be collected for analysis.
For patients who are randomized to receive placebo, the first dose will be given in the Pediatric Translational Research Center (PCTRC) and will be based on the patients weight.
Parents will administer placebo 4 doses per day.
Treatment with placebo will begin at 1 month of age and continue until surgical repair, which happens usually at 3 - 9 months of age.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cardiomyocyte Division
Time Frame: At the time of complete surgical repair, at approximately 3-9 months old, it is expected that a piece of RV myocardium will be resected. This tissue will be collected and analyzed using a multiple isotope mass spectrometer.
|
To quantify cardiomyocyte division, investigators will utilize previously established MIMS (membrane introduction mass spectrometry) approach.
Briefly, investigators will administer 5 enteral doses of 15N-thymidine to all patients at 1 month after birth.
Cardiomyocytes that have undergone DNA replication after the intake of 15N-thymidine will incorporate the stable isotope into their DNA.
|
At the time of complete surgical repair, at approximately 3-9 months old, it is expected that a piece of RV myocardium will be resected. This tissue will be collected and analyzed using a multiple isotope mass spectrometer.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hypertrophy as assessed by echocardiography
Time Frame: At 1 month and at time of surgery
|
Analysis of the impact of propranolol on Right Ventricle Myocardial Volume
|
At 1 month and at time of surgery
|
Hypertrophy as assessed by Cardiac MR
Time Frame: At 1 month and at time of surgery
|
Analysis of the impact of propranolol on Right Ventricle Myocardial Volume
|
At 1 month and at time of surgery
|
Hypertrophy assessed by microscopy
Time Frame: At time of Surgery
|
Analysis of the impact of propranolol on cardiomyocytes cross sectional area
|
At time of Surgery
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Bernhard Kuhn, MD, UPMC Children's Hospital of Pittsburgh
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
December 16, 2022
Primary Completion (Estimated)
February 1, 2026
Study Completion (Estimated)
February 1, 2026
Study Registration Dates
First Submitted
January 13, 2021
First Submitted That Met QC Criteria
January 13, 2021
First Posted (Actual)
January 19, 2021
Study Record Updates
Last Update Posted (Actual)
June 6, 2023
Last Update Submitted That Met QC Criteria
June 5, 2023
Last Verified
June 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Heart Diseases
- Cardiovascular Diseases
- Congenital Abnormalities
- Heart Defects, Congenital
- Cardiovascular Abnormalities
- Heart Septal Defects
- Heart Septal Defects, Ventricular
- Transposition of Great Vessels
- Tetralogy of Fallot
- Double Outlet Right Ventricle
- Physiological Effects of Drugs
- Adrenergic beta-Antagonists
- Adrenergic Antagonists
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Antihypertensive Agents
- Vasodilator Agents
- Propranolol
Other Study ID Numbers
- STUDY20020132
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
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.
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