Trifecta-Heart cfDNA-MMDx undersøgelse
Trifecta-Heart cfDNA-MMDX-undersøgelse: Sammenligning af DD-cfDNA-testen med MMDx Microarray Test og Central HLA Antibody Test
Demonstrate the relationship between DD-cfDNA levels and HLA antibodies in blood transplant recipient and the Molecular Microscope® (MMDx) Diagnostic System results in indication and protocol biopsies from heart transplants.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
The current standard for assessment of rejection in heart transplants is an endomyocardial biopsy (EMB) interpreted by histology according to ISHLT guidelines. This has considerable error rates, many due to the high disagreement among pathologists in assessing lesions and diagnoses. To address the unmet need for precision and accuracy, the Alberta Transplant Applied Genomics Centre (ATAGC, University of Alberta) has developed a new diagnostic system - the Molecular Microscope® Diagnostic System (MMDx), which uses microarrays to define the global gene expression features of rejection and injury. Now a new screening test is being introduced: the monitoring of donor-derived cell-free DNA (DD-cfDNA) released in the blood by the heart during rejection. The Natera Inc DD-cfDNA Prospera® test is based on the massively multiplex polymerase chain reaction that targets 13,392 single nucleotide polymorphisms and targeted sequences are quantified by Next Generation Sequencing. The Prospera® test has been done on kidney transplant recipients and detected "active rejection" and differentiated it from borderline rejection and no rejection. However, Prospera® test was not examined (the DD-cfDNA results) in heart transplant recipients. DD-cf-DNA test for heart transplants must now be calibrated against MMDx that is based on global gene expression, the new standard for biopsy interpretation. The present study will calibrate centrally measured (Natera Inc) DD-cfDNA levels obtained at the time of an indication or protocol biopsy against the MMDx measurements of T cell-mediated rejection (TCMR), antibody-mediated rejection (ABMR) and early and late tissue injury. The present study will compare DD-cfDNA and MMDx in 300 prospectively collected biopsies for clinical indications and protocol, and accompanying 600 blood samples, to calibrate the DD-cfDNA (Natera Inc.) levels against the MMDx biopsy diagnoses of TCMR, ABMR (and its stages), and acute (early) and chronic (late) injury, , as well as central assessment of HLA antibody (One Lambda) in 300 blood samples, interpreted centrally as donor specific antibody (DSA) based on the tissue typing results. Trifecta-Heart collected 718 biopsies, 709 cfDNA samples and 706 One Lambda samples so far. Due to a considerable interest from participation centers, this study aims to collect 300 more biopsies and corresponding blood samples. This study is an extension of the INTERHEART ClinicalTrials.gov Identifier: NCT02670408
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Robert Polakowski, PhD
- Telefonnummer: 1 780 492 5091
- E-mail: polakows@ualberta.ca
Undersøgelse Kontakt Backup
- Navn: Konrad Famulski, PhD
- Telefonnummer: 1 780 782 9463
- E-mail: konrad@ualberta.ca
Studiesteder
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Darlinghurst, Australien, NSW 2010
- Ikke rekrutterer endnu
- Cardiac Transplantation Laboratory, The Victor Chang Cardiac Research Institute
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Ledende efterforsker:
- Peter MacDonald, MD
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Kontakt:
- Carmen Herrera, MD
- E-mail: peter.macdonal@svha.org.au
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Alberta
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Edmonton, Alberta, Canada, T6G 2R7
- Rekruttering
- Division of Cardiology, University of Alberta
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Ledende efterforsker:
- Daniel Kim, MD
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Kontakt:
- Daniel Kim, MD
- E-mail: dk@ualberta.ca
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Arkansas
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Little Rock, Arkansas, Forenede Stater, 72205
- Rekruttering
- Baptist Health Institute for Research and Innovation
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Ledende efterforsker:
- Patrick Campbell, MD
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Kontakt:
- Victoria McIntosh Marren
- E-mail: victoria.mcintosh@baptist-health.org
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Florida
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Tampa, Florida, Forenede Stater, 33606
- Rekruttering
- Tampa General Hospital, 409 Bayshore Blvd.
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Kontakt:
- Kristyn Kuzianik
- E-mail: kkuzianik@tgh.org
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Ledende efterforsker:
- Benjamin Mackie, MD
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New Jersey
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West New York, New Jersey, Forenede Stater, 10032
- Rekruttering
- Columbia University Medical Center, Columbia Interventional Cardiovascular Care
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Ledende efterforsker:
- Gabriel Sayer, MD
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Kontakt:
- Maria Alejandra Muñoz Cifuentes
- E-mail: mam2649@cumc.columbia.edu
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New York
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The Bronx, New York, Forenede Stater, 10467
- Rekruttering
- Montefiore Medical Center, 3319 Rochambeau Avenue, 2nd FL
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Kontakt:
- Renae Robinson
- E-mail: rerobins@montefiore.org
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Kontakt:
- Brandon Johnson
- E-mail: brajohnson@montefiore.org
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Ledende efterforsker:
- Omar Saeed, MD
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Texas
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Dallas, Texas, Forenede Stater, 75246
- Rekruttering
- Annette C. and Harold C. Simmons Transplant Institute, BaylorScott&White Research Institute
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Kontakt:
- Aayla K Jamil, MBBS
- E-mail: Aayla.Jamil@BSWHealth.org
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Ledende efterforsker:
- Shelley Hall, MD
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Utah
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Salt Lake City, Utah, Forenede Stater, 84132
- Rekruttering
- Cardiovascular Medicine, University of Utah Health
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Kontakt:
- Jennifer Hong
- E-mail: Jennifer.Hong@hsc.utah.edu
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Ledende efterforsker:
- Josef Stehlik, MD, PhD
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Bologna, Italien, 40138
- Ikke rekrutterer endnu
- Heart Failure and Heart Transplant Unit, University of Bologna
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Ledende efterforsker:
- Luciano Potena, MD
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Kontakt:
- Laura Borgese
- E-mail: laura.borgese@gmail.com
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Zabrze, Polen, 41-800
- Rekruttering
- Silesian Center for Heart Diseases (Ś!ąskie Centrum Chorób Serca w Zabrzu
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Ledende efterforsker:
- Piotr Przybylowski, Professor
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Kontakt:
- Agnieszka Kuczaj, MD PhD
- E-mail: agnieszka.kuczaj@gmail.com
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A Coruña, Spanien
- Ikke rekrutterer endnu
- Advanced Heart Failure Transplant Unit
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Ledende efterforsker:
- Maria G Crespo-Leiro, MD
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Kontakt:
- Zulaika Grille Cancela
- E-mail: Zulaika.grille.cancela@sergas.es
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Prague, Tjekkiet, 140 21
- Rekruttering
- Institute for Clinical and Experimental Medicine - IKEM Videnska 1958/9
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Kontakt:
- Tereza Novakowa
- E-mail: novt@ikem.cz
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Ledende efterforsker:
- Vojtech Melenovsky, MD PhD
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Barn
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Prøveudtagningsmetode
Studiebefolkning
The study population includes patients with a functioning heart transplant undergoing a biopsy for clinical indications or surveillance (protocol) biopsy.
Beskrivelse
Inclusion Criteria:
- All heart transplant recipients undergoing a biopsy for clinical indications and protocol biopsies, as determined by their physician or surgeon, will be eligible to enroll in the study.
- Patients are enrolled based on standard of care biopsies, including surveillance biopsies in high-risk patients, with informed consent.
Exclusion Criteria:
- Patients will be excluded from the study if they decline participation
- Are unable to give informed consent.
- Recipients of multiple organs.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Observationsmodeller: COHORT
- Tidsperspektiver: PROSPECTIVE
Antal grupper/kohorter
Kohorter og interventioner
Gruppe / kohorteGruppe / kohorte |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Heart transplant protocol and for cause biopsies
The study population includes patients with a functioning heart transplant undergoing a biopsy for clinical indications as standard of care, or protocol biopsies of heart in high-risk patients, or follow-up after treatment. |
Microarray test of gene expression in heart biopsies Donor derived cell-free DNA in patient blood Centralized measurement of HLA antibodies in patient blood |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Calibration of Prospera test for T cell-mediated rejection
Tidsramme: 18 months
|
Set DD-cfDNA test cut-off values against the probability of T cell-mediated rejection in the biopsy as reported by MMDx. Calibration of DD-cfDNA test cut-off values against the probability of T cell-mediated rejection in the biopsy as reported by MMDx. |
18 months
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Calibration of Prospera test for antibody-mediated rejection
Tidsramme: 18 months
|
Set DD-cfDNA test cut-off values against the probability of antibody-mediated rejection in the biopsy as reported by MMDx. |
18 months
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Calibration of Prospera test for heart injury
Tidsramme: 18 month
|
Set DD-cfDNA test cut-off values against the probability of acute and chronic heart injury in the biopsy as reported by MMDx. |
18 month
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Report calibrated Prospera test results for rejection
Tidsramme: 6 months
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Obtain clinicians feedback |
6 months
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Report calibrated Prospera test results for heart injury
Tidsramme: 6 month
|
Obtain clinicians feedback |
6 month
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Determine if Prospera blood test can replace heart biopsy test
Tidsramme: 6 month
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Obtain clinicians feedback |
6 month
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Determine if Prospera blood test can replace follow up heart biopsy
Tidsramme: 6 month
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Determine whether resolution of DD-cfDNA after treatment can monitor response to therapy and avoid follow-up biopsies |
6 month
|
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Assessment of donor-specific antibody status
Tidsramme: 6 months
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Report and compare the DSA status based on centralized and local HLA antibody measurement. |
6 months
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Philip F Halloran, MD PhD, Alberta Transplant Applied Genomics Center, University of Alberta
Publikationer og nyttige links
Generelle publikationer
- Madill-Thomsen KS, Halloran PF. Precision diagnostics in transplanted organs using microarray-assessed gene expression: concepts and technical methods of the Molecular Microscope(R) Diagnostic System (MMDx). Clin Sci (Lond). 2024 Jun 5;138(11):663-685. doi: 10.1042/CS20220530.
- Halloran PF, Reeve J, Mackova M, Madill-Thomsen KS, Demko Z, Olymbios M, Campbell P, Melenovsky V, Gong T, Hall S, Stehlik J. Comparing Plasma Donor-derived Cell-free DNA to Gene Expression in Endomyocardial Biopsies in the Trifecta-Heart Study. Transplantation. 2024 Sep 1;108(9):1931-1942. doi: 10.1097/TP.0000000000004986. Epub 2024 Aug 20.
- Halloran PF, Madill-Thomsen KS. Donor-derived Cell-free DNA: A Step Forward in the Quest for Transplant Truth. Transplantation. 2025 Jun 1;109(6):910-914. doi: 10.1097/TP.0000000000005332. Epub 2025 Jan 28. No abstract available.
- Halloran PF, Madill-Thomsen KS. The Molecular Microscope Diagnostic System: Assessment of Rejection and Injury in Heart Transplant Biopsies. Transplantation. 2023 Jan 1;107(1):27-44. doi: 10.1097/TP.0000000000004323. Epub 2022 Dec 8.
- Madill-Thomsen KS, Hidalgo LG, Mackova M, Campbell P, Demko Z, Felius J, Gong T, Hall S, Kim DH, Kuczaj A, Lowe D, Maliakkal N, Melenovsky V, Olympios M, Patel S, Prewett A, Przybylowski P, Sayer G, Stehlik J, Tseliou E, Uriel N, Halloran PF. Defining the relationships among four tests for assessing antibody-mediated rejection in heart transplants in a prospective, observational study. J Heart Lung Transplant. 2026 Apr;45(4):659-670. doi: 10.1016/j.healun.2025.10.024. Epub 2025 Nov 13.
- Madill-Thomsen KS, Hidalgo LG, Mackova M, Demko Z, Prewett A, Campbell P, Felius J, Gong T, Hall S, Kim DH, Kuczaj A, Lowe D, Maliakkal N, Melenovsky V, Olympios M, Patel S, Przybylowski P, Sayer G, Tseliou E, Uriel N, Stehlik J, Halloran PF; Trifecta-Heart Study Group. Comparing DSA-negative and DSA-positive antibody-mediated rejection in heart transplants: Results from the Trifecta-Heart study. J Heart Lung Transplant. 2026 Jul;45(7):1046-1057. doi: 10.1016/j.healun.2026.03.004. Epub 2026 Mar 13.
- Halloran PF, Madill-Thomsen KS, Biagini DG, Kaur N, Prewett A, Suresh N, Demko ZP, Bhorade S, Olympios M, Gauthier PT, Campbell PT, Gong T, Hall S, Kim DH, Kuczaj A, Przybylowski P, Melenovsky V, Patel SR, Sayer G, Stehlik J, Tseliou E, Uriel N, Mackova M; Trifecta-Heart Investigators. A two-threshold donor-derived cell-free DNA algorithm improves detection of molecular rejection in heart transplantation. J Heart Lung Transplant. 2026 Jun 22:S1053-2498(26)01953-4. doi: 10.1016/j.healun.2026.06.009. Online ahead of print.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- ATAGC06
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Only IPD data will be shared within a participating center.
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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