Study of the Use of a Single Dose of Erythropoietin to Treat Acute Myocardial Ischemia

NCT00524901 | Completed Phase 2

• 1 other identifier: WTR-ECG-2
• Study Type: interventional
• Target: 10
• Locations: 1 country
• Sites: 1

Brief Summary

This is a phase 2 study that evaluates the effect of intravenous administration of a bolus EPO on the activation of EPOR-signal transduction cascades and myocardial apoptosis during cardiopulmonary bypass surgery. Human atrial and ventricular tissue will be collected during CABG surgery for 3-vessel disease for the assay of EPOR signaling and apoptosis. Two atrial specimens will be collected before and at the end of cardiopulmonary bypass (CPB). Concomitantly, two transmural ventricular biopsies will be obtained, at the start and at the end of CPB. Immediately after obtaining the first atrial biopsy, one bolus of EPO will be administered intravenously. The atrial tissue will be split and appropriate sections will be frozen for determination of baseline expression or activity of a number of molecules including Erk1/2, STAT5, Akt and caspase-3 or embedded in paraffin for immunohistochemistry. Ventricular tissue will only be processed for immunohistochemistry. Additionally, plasma will be collected before the procedure and for up to 30 days post-procedure to examine release of markers of both myocardial ischemia and stress (CK-MB, Troponin T and NT-proBNP) and renal dysfunction (cystatin C, creatinine for eGFR). Before initializing the randomised study, a pilot study will be performed with 5 subjects that will not be treated to evaluate the feasibility of myocardial sample collection. Initiation of the randomised study will only commence if baseline activity of EPOR-STC can be determined in the atrial tissue and caspase-3 positive cells can be identified in the second ventricular biopsy.

Conditions

CABG; Coronary Artery Disease

Keywords

Apoptosis; CABG; Coronary Artery Disease; Three Vessel Disease; Erythropoietin; EPO-receptor signaling

Outcome Measures

Primary Outcomes (1)

• The increase from baseline between EPO and saline treated subjects in activity of EPOR-STC including but not limited to, phospho Erk1/2, phospho Akt, activated caspase-3, and activated STAT5 in the second atrial biopsy.

  2 hours

Secondary Outcomes (4)

• Difference in apoptosis between atrial and ventricular specimens at the end of CPB, defined as the number of TUNEL and activated caspase-3 positive cells per high power field.

  2 hours

• Difference between EPO- and saline treated subjects in TUNEL and active caspase-3 positive cells in ventricular and atrial biopsies.

  2 hours

• Difference in AUC for CK-MB, Troponin T, NT-proBNP, and cystatin C between EPO- and saline treated patients.

  30 days

• Subject incidence rates of adverse events.

  30 days

Study Arms (2)

1

EXPERIMENTAL

25 patients undergoing CABG for three vessel disease, receiving a single dose of erythropoietin periprocedural.

Drug: Epoetin alpha

2

PLACEBO COMPARATOR

25 patients undergoing CABG for three vessel disease, receiving placebo (NaCl 0.9%) periprocedural.

Drug: NaCl 0.9%

Interventions

Epoetin alpha DRUG

A single dose of epoetin alpha during CABG for three vessel disease, 60.000 IU intravenously.

Also known as: Eprex

1

NaCl 0.9% DRUG

A single dose of NaCl 0.9% during CABG for three vessel disease, 1 ml intravenously.

Also known as: Saline

2

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Before any study-specific procedure, including assessments for screening, the appropriate written informed consent must be obtained.
• Man or woman 18 to 80 years of age .
• Undergoing a planned, elective cardiopulmonary bypass operation for the first time for 3-vessel coronary artery disease with an anticipated aortic cross clamp time of approximately 40 minutes and a total bypass time of approximately 90 minutes.
• Hemoglobin (Hb) concentration ≥7.4 mmol/l and ≤9.9 mmol/l within 7 days prior to CABG surgery and no major acute blood loss since this Hb determination.

You may not qualify if:

• An unstable medical condition, defined as having been hospitalized for a non-cardiac condition within 4 weeks of screening, major surgery within 24 weeks of screening, or otherwise unstable in the judgment of the investigator (e.g., at risk of complications or adverse events unrelated to study participation).
• Left ventricular ejection fraction (LVEF) \< 40%.
• Clinical history of chronic kidney disease (CKD) (at any point prior to registration) defined as serum creatinine \>105 μmol/l for all females, \>130 μmol/l for black males, and \>115 μmol/l for non-black males.
• Atrial fibrillation, paroxysmal atrial fibrillation or atrial flutter.
• Clinically significant abnormality in chemistry, hematology, or urinalysis parameters performed within the screening period.
• Current symptoms of polyurea, polydipsia, or increased thirst.
• Grand mal seizure within 1 year of enrollment.
• Poorly controlled hypertension, defined as systolic blood pressure (SBP) \> 180 mmHg or diastolic blood pressure (DBP) \> 105 mmHg on day of CABG surgery.
• Use of any erythropoietic protein (e.g., rHuEPO; Procrit®, Eprex®, Neorecormon®, Epogen®, Aranesp®) within 12 weeks of enrolment.
• Positive pregnancy test or known to be pregnant at the time of screening.
• Recent (within 3 months) history of alcohol or illicit drug abuse disorder, based on self-report.
• Severe uncorrected valvular disease (including pulmonary and tricuspid) or left ventricular outflow obstruction which, in the opinion of the investigator, requires surgery.
• Pulmonary hypertension, defined as a pulmonary artery pressure \> 30 mmHg at rest.
• Participation in any investigational device or drug trial(s) or receiving other investigational agent(s) within 30 days.
• Known positive for HIV antibodies, hepatitis B surface antigen, or hepatitis C antibodies.

Sponsors & Collaborators

• University Medical Center Groningen: lead

Study Sites (1)

University Medical Center Groningen, Dept. of Cardiology

Groningen, Provincie Groningen, 9700 BD, Netherlands

Location

MeSH Terms

Conditions

Coronary Artery Disease

Interventions

Epoetin Alfa; Sodium Chloride

Condition Hierarchy (Ancestors)

Coronary Disease; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases

Intervention Hierarchy (Ancestors)

Erythropoietin; Colony-Stimulating Factors; Glycoproteins; Glycoconjugates; Carbohydrates; Hematopoietic Cell Growth Factors; Cytokines; Intercellular Signaling Peptides and Proteins; Peptides; Amino Acids, Peptides, and Proteins; Proteins; Biological Factors; Chlorides; Hydrochloric Acid; Chlorine Compounds; Inorganic Chemicals; Sodium Compounds

Study Officials

• W. H. van Gilst, Prof, dr

  University Medical Center Groningen, Dept. of Exprimental Cardiology

  STUDY CHAIR

• W. T. Ruifrok, MD

  University Medical Center Groningen, Dept. of Experimental Cardiology

  PRINCIPAL INVESTIGATOR

• B. D. Westenbrink, MD

  University Medical Center Groningen, Dept. of Experimental Cardiology

  PRINCIPAL INVESTIGATOR

• A. H. Epema, dr, MD

  University Medical Center Groningen, Dept. of Anaesthesiology

  PRINCIPAL INVESTIGATOR

• H. E. Mungroop, dr, MD

  University Medical Center Groningen, Dept. of Anaesthesiology

  PRINCIPAL INVESTIGATOR

• P. W. Boonstra, Prof, dr, MD

  University Medical Center Groningen, Dept. of Cardiothoracic Surgery

  PRINCIPAL INVESTIGATOR

• R. A. de Boer, dr, MD

  University Medical Center Groningen, Dept of Cardiology

  PRINCIPAL INVESTIGATOR

• D. J. van Veldhuisen, Prof, dr, MD

  University Medical Center Groningen, Dept. of Cardiology

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD, PhD

Study Record Dates

• First Submitted: September 4, 2007
• First Posted: September 5, 2007
• Study Start: September 1, 2007
• Primary Completion: January 1, 2011
• Study Completion: April 1, 2011
• Last Updated: February 15, 2013

Record last verified: 2013-02

Locations

NL (1)