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ESTRATEGIA PARA MEJORAR LA RESPUESTA AL TRATAMIENTO DEL ACV (SISTER)

13 de octubre de 2026 actualizado por: Translational Sciences, Inc.

SISTER is a Phase-II, prospective, randomized, placebo-controlled, blinded, dose finding trial that aims to determine the safety and preliminary efficacy of TS23, a monoclonal antibody against the alpha-2 antiplasmin (a2-AP), in acute ischemic stroke.

Descripción general del estudio

Estado

Reclutamiento

Condiciones

Intervención / Tratamiento

Descripción detallada

SISTER is a Phase II, Bayesian, adaptive, randomized, dose-finding trial of TS23 in patients with acute ischemic stroke. Patients with an anterior cerebral circulation acute ischemic stroke and present between 4.5 to 24 hours of their last known well with a presenting NIH Stroke Scale Score >/=4 (with the patient having a clearly disabling deficit if the NIHSS is 4 or 5) and an imaging evidence of salvageable brain tissue will be eligible and will be approached for an informed consent for study participation. Patients with an NIHSS of 4-5 must have a new, disabling neuro-logic deficit to be eligible for the study. After informed consent is provided, the study will randomize to 4 doses of TS23 and placebo. The trial will enroll up to 150 subjects at up to 70 participating US sites.

The effects of TS23 will be evaluated on two following primary outcomes using a utility function: 1) primary safety outcome: any intracerebral hemorrhage at 30 (+/-4) hours and 2) primary efficacy outcome: NIH Stroke Scale score at 30 (+/-4) hours after drug administration. The study will follow participants for 90 (+/-7) days.

Primary Objective: To identify a dose of TS23 that is safe and more efficacious than placebo for the treatment of patients from 4.5 to 24 hours of last known well, who have evidence of core-penumbra mismatch on perfusion imaging and are not a candidate for standard of care reperfusion therapies.

Tipo de estudio

Intervencionista

Inscripción (Estimado)

300

Fase

  • Fase 2

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Estudio Contacto

  • Nombre: Pam Plummer, MSN,RN, CCRC
  • Número de teléfono: 5138852437
  • Correo electrónico: plummepa@ucmail.uc.edu

Copia de seguridad de contactos de estudio

  • Nombre: Rebeca Aragon Garcia, BS, CCRC
  • Número de teléfono: 9736688644
  • Correo electrónico: aragonra@ucmail.uc.edu

Ubicaciones de estudio

    • Alabama
      • Birmingham, Alabama, Estados Unidos, 35233
        • Reclutamiento
        • University of Alabama Hospital
        • Contacto:
        • Investigador principal:
          • Felix Guerra Castanon, MD
    • Arizona
      • Phoenix, Arizona, Estados Unidos, 85006
        • Reclutamiento
        • Banner University Medical Center
        • Investigador principal:
          • Savdeep Singh, MD
        • Contacto:
      • Phoenix, Arizona, Estados Unidos, 85054
        • Retirado
        • Mayo Clinic Phoenix
      • Tucson, Arizona, Estados Unidos, 85719
        • Reclutamiento
        • Banner University Medical Center - Tucson
        • Contacto:
        • Investigador principal:
          • Firas Kaddouh, MD, MHS
    • California
      • La Jolla, California, Estados Unidos, 92093
        • Reclutamiento
        • UCSD Health La Jolla
        • Contacto:
        • Investigador principal:
          • Royya Modir, MD
        • Contacto:
      • Los Angeles, California, Estados Unidos, 90027
        • Reclutamiento
        • Kaiser Permanente Los Angeles
        • Contacto:
        • Investigador principal:
          • Navdeep Sangha, MD
      • Sacramento, California, Estados Unidos, 95816
        • Retirado
        • Sutter Medical Center
      • San Diego, California, Estados Unidos, 92103
        • Reclutamiento
        • UCSD Medical Center- Hillcrest Hospital
        • Contacto:
        • Investigador principal:
          • Royya Modir, MD
        • Contacto:
    • Connecticut
      • Hartford, Connecticut, Estados Unidos, 06102
        • Reclutamiento
        • Hartford Hospital
        • Investigador principal:
          • Ajay Tunguturi, MD
        • Contacto:
      • New Haven, Connecticut, Estados Unidos, 06511
        • Reclutamiento
        • Yale New Haven Hospital
        • Contacto:
        • Investigador principal:
          • James Giles, MD, PhD
    • Delaware
      • Newark, Delaware, Estados Unidos, 19718
        • Retirado
        • Christiana Hospital
    • Florida
      • Gainesville, Florida, Estados Unidos, 32608
        • Terminado
        • UF Health Shands Hospital
      • Miami, Florida, Estados Unidos, 33136
        • Reclutamiento
        • Jackson Memorial Hospital
        • Contacto:
        • Contacto:
        • Investigador principal:
          • Gillian Gordon Perue, MD, MBBS, DM
    • Georgia
      • Atlanta, Georgia, Estados Unidos, 30303
        • Reclutamiento
        • Grady Memorial Hospital
        • Contacto:
        • Investigador principal:
          • Nicolas Bianchi, MD
    • Illinois
      • Chicago, Illinois, Estados Unidos, 60637
        • Activo, no reclutando
        • University of Chicago Medical Center
    • Iowa
      • Iowa City, Iowa, Estados Unidos, 52242
        • Retirado
        • University of Iowa Hospitals & Clinics
    • Kentucky
      • Lexington, Kentucky, Estados Unidos, 40503
      • Louisville, Kentucky, Estados Unidos, 40202
        • Reclutamiento
        • University of Louisville Hospital
        • Investigador principal:
          • Isaac Abecassis, MD
        • Contacto:
    • Massachusetts
      • Boston, Massachusetts, Estados Unidos, 02115
        • Reclutamiento
        • Brigham and Women's Hospital
        • Investigador principal:
          • Rahul Mahajan, MD, PhD
        • Contacto:
      • Boston, Massachusetts, Estados Unidos, 02171
        • Reclutamiento
        • Massachusetts General Hospital
        • Investigador principal:
          • Aneesh Singhal, MD, MBBS
        • Contacto:
    • Minnesota
      • Burnsville, Minnesota, Estados Unidos, 55337
        • Reclutamiento
        • M Health Fairview Ridges Hospital
        • Contacto:
        • Contacto:
        • Investigador principal:
          • Muhammad Affan, MD, MBBS
      • Edina, Minnesota, Estados Unidos, 55435
        • Reclutamiento
        • M Health Fairview Southdale Hospital
        • Contacto:
        • Investigador principal:
          • Muhammad Affan, MD, MBBS
        • Contacto:
      • Minneapolis, Minnesota, Estados Unidos, 55455
        • Reclutamiento
        • M Health Fairview University of Minnesota Medical Center
        • Contacto:
        • Contacto:
        • Investigador principal:
          • Muhammad Affan, MD,MBBS
      • Saint Paul, Minnesota, Estados Unidos, 55102
        • Retirado
        • United Hospital
    • Missouri
      • St Louis, Missouri, Estados Unidos, 63110
        • Reclutamiento
        • Barnes Jewish Hospital
        • Investigador principal:
          • Charles Kircher, MD
        • Contacto:
    • New Jersey
      • Edison, New Jersey, Estados Unidos, 08837
        • Reclutamiento
        • JFK Medical Center
        • Investigador principal:
          • Nancy Gadallah, DO
        • Contacto:
    • New York
      • Brooklyn, New York, Estados Unidos, 11220
      • Buffalo, New York, Estados Unidos, 14203
        • Retirado
        • Buffalo General Medical Center
      • Manhasset, New York, Estados Unidos, 11030
      • New York, New York, Estados Unidos, 10029
        • Reclutamiento
        • The Mount Sinai Hospital
        • Contacto:
        • Investigador principal:
          • Laura Stein, MD, MPH
      • New York, New York, Estados Unidos, 10032
      • New York, New York, Estados Unidos, 10029
        • Retirado
        • Mount Sinai West
      • Syracuse, New York, Estados Unidos, 13202
        • Reclutamiento
        • SUNY Upstate Medical University
        • Contacto:
        • Investigador principal:
          • Julius-Gene LaTorre, MD, MPH
        • Contacto:
      • Valhalla, New York, Estados Unidos, 10595
        • Retirado
        • Westchester Medical Center
    • North Carolina
      • Durham, North Carolina, Estados Unidos, 27710
        • Reclutamiento
        • Duke University Hospital
        • Contacto:
        • Investigador principal:
          • Alexander Limkakeng, MD, MHSc
        • Contacto:
      • Winston-Salem, North Carolina, Estados Unidos, 27157
        • Terminado
        • Wake Forest Baptist Medical Center
    • Ohio
      • Cincinnati, Ohio, Estados Unidos, 45267
        • Reclutamiento
        • University of Cincinnati Medical Center
        • Investigador principal:
          • Yasmin Aziz, MD
        • Contacto:
      • Columbus, Ohio, Estados Unidos, 43210
        • Reclutamiento
        • OSU Wexner Medical Center
        • Investigador principal:
          • Jan Bittar, MD
        • Contacto:
    • Oklahoma
      • Tulsa, Oklahoma, Estados Unidos, 74104
        • Reclutamiento
        • Ascension St. John
        • Investigador principal:
          • Rahul Rahangdale, MD
        • Contacto:
    • Oregon
      • Portland, Oregon, Estados Unidos, 97225
        • Reclutamiento
        • Providence St. Vincent Medical Center
        • Investigador principal:
          • Kishan Patel, MD
        • Contacto:
    • Pennsylvania
      • Bethlehem, Pennsylvania, Estados Unidos, 18015
        • Reclutamiento
        • Saint Luke's Hospital of Bethlehem Pennsylvania
        • Investigador principal:
          • Daniel Ackerman, MD
        • Contacto:
      • Philadelphia, Pennsylvania, Estados Unidos, 19140
        • Reclutamiento
        • Temple University Hospital
        • Contacto:
        • Investigador principal:
          • Nina Gentile, MD
    • Rhode Island
      • Providence, Rhode Island, Estados Unidos, 02903
        • Reclutamiento
        • Rhode Island Hospital
        • Investigador principal:
          • Farhan Khan, MD
        • Contacto:
    • South Carolina
      • Charleston, South Carolina, Estados Unidos, 32608
        • Reclutamiento
        • Medical University of South Carolina University Hospital
        • Contacto:
        • Contacto:
        • Investigador principal:
          • Christine Holmstedt, DO
      • Greenville, South Carolina, Estados Unidos, 29605
        • Reclutamiento
        • Prisma Health Greenville Memorial
        • Contacto:
        • Investigador principal:
          • Sanjeev Sivakumar, MD
    • Tennessee
      • Memphis, Tennessee, Estados Unidos, 38104
        • Reclutamiento
        • Methodist University Hospital
        • Contacto:
        • Investigador principal:
          • Balaji Krishnaiah, MD
        • Contacto:
    • Texas
      • Houston, Texas, Estados Unidos, 77030
    • Utah
      • Salt Lake City, Utah, Estados Unidos, 84132
        • Retirado
        • University of Utah Healthcare
    • Virginia
      • Charlottesville, Virginia, Estados Unidos, 22901
        • Reclutamiento
        • UVA Medical Center
        • Investigador principal:
          • Amna Sohail, MBBS, MD
        • Contacto:
      • Richmond, Virginia, Estados Unidos, 23298
        • Retirado
        • VCU Medical Center
    • Washington
      • Seattle, Washington, Estados Unidos, 98104
        • Retirado
        • Harborview Medical Center
    • Wisconsin
      • Milwaukee, Wisconsin, Estados Unidos, 53211

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años y mayores (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria:

  1. Age 18 years and older

  2. Suspected anterior circulation acute ischemic stroke

  3. NIH Stroke Scale score ≥4 prior to randomization

    a. The participant must have a clearly disabling deficit if NIHSS is 4-5.

  4. Favorable baseline neuroimaging consisting of all of the following:

    1. ASPECTS of 6 or more on CT (or ASPECTS of ≥7 on MRI)
    2. Favorable perfusion imaging on CT perfusion (CTP)/MR-perfusion weighted imaging (PWI) consisting of all of the following:

    i. Mismatch ratio of penumbra: core >1.2 ii. Mismatch volume >10 cc iii. Core <70 cc

    c. If CT hypodensity is present, then in the investigator's visual assessment, the total acute infarct volume combined area of (a) the CT hypodensity and (b) the perfusion-based core volume (CBF<30%) should be smaller than perfusion-based volume (area of Tmax>6s minus CBF<30%).

  5. Able to receive assigned study drug within 4.5 to 24 hours of stroke onset or last known well.

  6. Anticipate being able to receive assigned study drug within 120 minutes of qualifying perfusion imaging.

  7. Informed consent for the study participation obtained from participant or their legally authorized representatives.

Exclusion Criteria:

  1. Received endovascular treatment with clot engagement.

    1. Patients who undergo groin puncture but clot engagement is not attempted due to spontaneous distal migration are permitted to be enrolled in the trial if all other eligibility criteria are met.
    2. Patients who undergo groin puncture but clot is not engaged due to reasons other than spontaneous distal migration are NOT permitted.
  2. Received or planned to receive intravenous thrombolysis.

  3. Pre-stroke modified Rankin score >2.

  4. Previous treatment with TS23 or known previous allergy to antibody therapy.

  5. Known pregnancy, women who are breastfeeding or plan to breastfeed within 3 months of receiving TS23 or have a positive urine or serum pregnancy test for women of childbearing potential.

  6. Known previous stroke in the past 90 days.

  7. Known previous intracranial hemorrhage, intracranial neoplasm, subarachnoid hemorrhage, or arterial venous malformation.

  8. Known active diagnosis of intracranial neoplasm.

  9. Clinical presentation suggestive of a subarachnoid hemorrhage, even if initial CT scan was normal.

  10. Surgery or biopsy of parenchymal organ in the past 30 days.

  11. Known trauma with internal injuries or persistent ulcerative wounds in the past 30 days.

  12. Severe head trauma in the past 90 days.

  13. Persistent systolic blood pressure >180mmHg or diastolic blood pressure >105mmHg despite best medical management.

  14. Serious systemic hemorrhage in the past 30 days.

  15. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with International Normalized Ratio (INR) >1.7.

  16. Platelets <100,000/mm3.

  17. Hematocrit <25 %.

  18. Elevated aPTT above laboratory upper limit of normal.

  19. Creatinine > 4 mg/dl, or patients receiving renal dialysis, regardless of creatinine.

  20. Received the following within the previous 24 hours:

    1. If patient received unfractionated heparin within the last 24 hours, the patient must have an aPTT within normal range prior to enrollment.
    2. Low molecular weight heparins such as Dalteparin, enoxaparin, tinzaparin in full dose within the previous 24 hours.
  21. Received Factor Xa inhibitors (such as Fondaparinux, apixaban or rivaroxaban) within the past 48 hours.

  22. Received direct thrombin inhibitors (e.g., argatroban, dabigatran, bivalirudin, desirudin, lepirudin) within 48 hours.

  23. Received glycoprotein IIb/IIIa inhibitors within the past 14 days.

  24. Known pre-existing neurological or psychiatric disease which would confound the neurological/functional evaluations.

  25. Current participation in another research drug treatment protocol (i.e., participants could not start another experimental agent until after 90 days).

  26. Concurrent acute myocardial infarction, pulmonary embolism, deep venous thrombosis or other thrombotic event that requires anticoagulation or anti-platelet treatment.

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación paralela
  • Enmascaramiento: Cuadruplicar

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Comparador de placebos: Placebo

Placebo

Monoclonal antibody

Experimental: Dose 1 TS23

low dose

Monoclonal antibody

Experimental: Dose 2 TS23

next higher dose

Monoclonal antibody

Experimental: Dose 3 TS23

next higher dose

Monoclonal antibody

Experimental: Dose 4 TS23

highest dose

Monoclonal antibody

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
The proportion of patients with ANY intracerebral hemorrhage (ICH)
Periodo de tiempo: At 30 (+/- 4) hours after study drug

Any ICH visualized on the follow-up CT scan

At 30 (+/- 4) hours after study drug
Stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS)
Periodo de tiempo: At 30 (+/- 4) hours after study drug

NIHSS is a stroke severity score that ranges from 0 to 42, with higher numbers indicating a more severe stroke. The NIHSS will be adjusted for the baseline value in analysis.

At 30 (+/- 4) hours after study drug

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Improvement in level of global disability measured by modified Rankin Score (mRS distribution)
Periodo de tiempo: 90 (±7) days

The modified Rankin Score assessment is a 7-level disability scale that measures the degree of disability or dependence in daily activities of people who have suffered a stroke. Range 0= no disability and 6=dead.

90 (±7) days
Frequency of Modified Rankin (mRS) score of 0-1 or returning to pre-stroke mRS.
Periodo de tiempo: Proportion of patients with modified Rankin scale score 0-1 or return to pre-stroke mRS at 90 (+/-7) days.

Proportion of patients with modified Rankin scale score 0-1 or return to pre-stroke mRS.

Proportion of patients with modified Rankin scale score 0-1 or return to pre-stroke mRS at 90 (+/-7) days.
NIHSS
Periodo de tiempo: 72 (±12) hours (or at discharge if sooner) after study drug administration.

NIHSS is a stroke severity score that ranges from 0 to 42, with higher numbers indicating a more severe stroke. The NIHSS will be adjusted for the baseline value in analysis.

72 (±12) hours (or at discharge if sooner) after study drug administration.
α2-antiplasmin (a2AP) level in plasma
Periodo de tiempo: at 3 (±1) h after completion of study drug administration

A serine protease inhibitor responsible for inactivating plasmin.

at 3 (±1) h after completion of study drug administration
Matrix metalloproteinase-9 level in plasma
Periodo de tiempo: 3 (±1) h after completion of study drug

An enzyme that regulates the pathological remodeling process that involve inflammation and fibrosis associated with cardiovascular disease.

3 (±1) h after completion of study drug
% brain tissue reperfusion
Periodo de tiempo: 30 (±4) h after study drug administration

Proportion of brain tissue that is reperfused on the follow-up perfusion scan compared to the baseline, calculated as:

([baseline minus follow up perfusion imaging area of hypoperfusion]/ baseline area of hypoperfusion); hypoperfusion=T max>6 seconds

30 (±4) h after study drug administration
Pharmacokinetic analyses
Periodo de tiempo: 3 (±1) h, 30 (±4) h, 30 (±5) days & 90 (±7) days after study drug administration. At 90 (±7) days for approximately 50 mITT participants. After approximately 50 mITT participants, it will be obtained at 72h(+12 hrs)/discharge visit, whichever comes 1st.

Measure of plasma concentrations of TS23

3 (±1) h, 30 (±4) h, 30 (±5) days & 90 (±7) days after study drug administration. At 90 (±7) days for approximately 50 mITT participants. After approximately 50 mITT participants, it will be obtained at 72h(+12 hrs)/discharge visit, whichever comes 1st.
Evaluation of anti-drug antibodies
Periodo de tiempo: will be measured at baseline and 90 (±7) days follow-up visit for approximately 50 mITT participants.

commonly used for characterization of therapeutic antibodies

will be measured at baseline and 90 (±7) days follow-up visit for approximately 50 mITT participants.
Proportion of patients with symptomatic intracerebral hemorrhage
Periodo de tiempo: 30 (±4) h of study drug administration

a blood clot large enough to cause significant neurological deterioration.

30 (±4) h of study drug administration
Proportion of patients with non-intracerebral hemorrhage major or clinically relevant non-major bleeding
Periodo de tiempo: 30 days of study drug administration.

major and non-major events of bleeding that is not in the brain

30 days of study drug administration.
Plasma fibrinogen level
Periodo de tiempo: 3 (±1) h after completion of study drug

Clotting factor

3 (±1) h after completion of study drug
Proportion of patients with non-bleeding severe adverse events
Periodo de tiempo: 90 (±7) days

Assessment of untoward events

90 (±7) days
Proportion of patients with stroke-related and all-cause deaths
Periodo de tiempo: 90 (±7) days

measure of important patient outcomes

90 (±7) days

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

Colaboradores

Investigadores

  • Investigador principal: Eva Mistry, MBBS, University of Cincinnati

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Actual)

18 de marzo de 2024

Finalización primaria (Estimado)

1 de julio de 2028

Finalización del estudio (Estimado)

1 de diciembre de 2028

Fechas de registro del estudio

Enviado por primera vez

8 de julio de 2023

Primero enviado que cumplió con los criterios de control de calidad

8 de julio de 2023

Publicado por primera vez (Actual)

17 de julio de 2023

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

19 de octubre de 2026

Última actualización enviada que cumplió con los criterios de control de calidad

13 de octubre de 2026

Última verificación

1 de octubre de 2026

Más información

Términos relacionados con este estudio

Otros números de identificación del estudio

  • TS23-U202
  • UH3NS125023 (Subvención/contrato del NIH de EE. UU.)

Plan de datos de participantes individuales (IPD)

¿Planea compartir datos de participantes individuales (IPD)?

SÍ

Descripción del plan IPD

The SISTER trial will comply with the NIH Public Access Policy, which ensures that the public has access to the published results of NIH funded research, and the StrokeNet SOP (ADM 03) regarding results publication. Manuscripts and abstracts that use data from SISTER require approval from the Publication Committee of an original proposal before the concept may proceed. All publications will include this acknowledgement: "Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number [to be determined]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health."

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

Sí

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .