- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06015776
Purinergic Signaling and the Postmenopausal Heart
August 28, 2023 updated by: Robina Matyal, Beth Israel Deaconess Medical Center
PGC-1, Purines and the Postmenopausal Heart
There is an increased risk of diastolic heart failure in post menopausal women.
Estrogen plays a positive role in regulating molecular pathways in heart remodeling.
Such pathways may work through purinergic signaling and its downstream effects on the heart's mitochondrial metabolism and angiogenic response to stress.
Loss of estrogen functionality in post menopausal women may account for the increased risk of diastolic heart failure.
The investigators will explore said pathways using cardiac tissue obtained from patients undergoing cardiac surgery.
Study Overview
Status
Recruiting
Intervention / Treatment
Detailed Description
Cardiovascular disease (CVD) is the leading cause of death of women in the United States, accounting for around 1 of every 3 deaths.
Estrogen deficiency, as seen in aging women or after oophorectomy, has been linked to loss of cardiovascular protection, typically seen during reproductive life.
Up to half of women evaluated for myocardial ischemia have normal appearing coronary arteries.
These women can develop heart failure with a preserved ejection fraction (termed HFpEF) for which the etiology is unclear.
Hormonal replacement therapy (HRT) after menopause remains controversial but current evidence cannot support this for either primary or secondary prevention of CVD.
There are clearly modulatory influences on estrogenic signaling, that could well influence cardiovascular health in later life.
Previous studies have demonstrated that estrogen improves energy production within the heart by increasing 5' adenosine monophosphate-activated protein (AMPK) and mitochondrial biogenesis via upregulation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α); a master switch of mitochondrial function, linked to vascular integrity and angiogenesis.
Estrogen has been also found to modulate purinergic signaling by boosting expression of adenosine receptors and of CD39, the dominant endothelial ecto-ADPase that generates adenosine.
There are also close relationships between purinergic signaling and dipeptidyl peptidase-4 (DPP-4; otherwise known as adenosine deaminase complexing protein 2 or CD26), possibly mediated by adenosine deaminase bioactivity.
Decreased PGC-1α and aberrant purinergic signaling in metabolic syndrome may lead to impaired mitochondrial function, provoking diastolic dysfunction, and also result in impaired angiogenesis.
The investigators hypothesize there are central roles of PGC-1α, purines and DPP-4 linked neuropeptide pathways in the control of angiogenesis and mitochondrial activity.
These become increasingly disordered in setting of estrogen loss provoking development of metabolic syndrome, thereby exacerbating HFpEF and microvascular disease.
Specific Aim 1: To determine how ischemia and cardiometabolic dysfunction in women's heart disease are exacerbated by the loss of puringeric pathways from estrogen deficiency.
The investigators expect to determine that diastolic dysfunction is a functional consequence of this microvascular loss and cardiometabolic dessynchrony.
Specific Aim 2: To evaluate the role of adenosingergic receptor activation and DPPIV inhibition on angiogenesis in a ovariectomized swine model of chronic myocardial ischemia and metabolic syndrome.
Here, the investigators will explore relationships between the regulated and linkages in the exocytosis of nucleotides and neuropeptides, formation of nucleosides (adenosine) and alterations in angiogenic activity secondary to these.
Summary: The investigators will study fundamental mechanisms in heart disease underpinning biological differences in women.
The investigators will also offer new therapeutic strategies that target cardiac metabolism.
Study Type
Observational
Enrollment (Estimated)
100
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: Robina Matyal, MD
- Phone Number: 6176401208
- Email: rmatyal1@bidmc.harvard.edu
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02215
- Recruiting
- Beth Israel Deaconess Medical Center
-
Contact:
- Robina Matyal, MD
- Phone Number: 617-640-1208
- Email: rmatyal1@bidmc.harvard.edu
-
-
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
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Sampling Method
Non-Probability Sample
Study Population
Patients presenting for elective cardiac surgery.
Patients will be enrolled and consented during hospital admission for surgery.
Description
Inclusion Criteria:
- Patients undergoing cardiac surgery under cardiopulmonary bypass.
Exclusion Criteria:
- Refusal to participate
- Emergency surgery
- Pre-existing heart block
- Preexisting atrial fibrillation
- Redo surgery
- Estrogen or hormone replacement therapy
- History of chronic heart failure
- History of major kidney disease
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
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Men
Men who are undergoing cardiac surgery
|
Differences between men and women will be observed
|
Women
Women who are undergoing cardiac surgery
|
Differences between men and women will be observed
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comparative quantification of expression of CD39 and adenosinergic receptors
Time Frame: 6 months
|
Expression of CD39, ADORA2A and ADORA2B in cardiac tissue measured using Western blotting
|
6 months
|
Comparative quantification of expression of PGC-1 alpha, mitochondrial markers
Time Frame: 6 months
|
Expression of PGC-1 alpha, AMPK and mitochondrial markers using Western blot
|
6 months
|
Comparative quantification of expression of angiogenic markers
Time Frame: 6 months
|
Expression of angiogenic markers (PDGF, VEGF, Angiostatin)
|
6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Robina Matyal, MD, Beth Israel Deaconess Medical Center, Professor of Anesthesia
- Principal Investigator: Simon Robson, MD, PhD, Beth Israel Deaconess Medical Center,Vice Chair Research
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)
July 1, 2019
Primary Completion (Estimated)
June 1, 2024
Study Completion (Estimated)
June 1, 2024
Study Registration Dates
First Submitted
August 23, 2023
First Submitted That Met QC Criteria
August 28, 2023
First Posted (Actual)
August 29, 2023
Study Record Updates
Last Update Posted (Actual)
August 29, 2023
Last Update Submitted That Met QC Criteria
August 28, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2008P000151/13
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
No
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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