Pilot Study of Hemoglobin Based Oxygen Therapeutics in Elective Coronary Revascularization

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

The purpose of this study is to assess the safety and feasibility of a novel oxygen carrying solution, HBOC-201, in the setting of PCI for Acute Coronary Syndromes from randomization til hospital discharge.

Condition or disease	Intervention/treatment	Phase
Angina Pectoris; Unstable Angina; Myocardial Infarction	Procedure: Percutaneous Coronary Revascularization; Drug: Hemoglobin-Based Oxygen Carrier-201 (HBOC-201); Drug: Voluven	Phase 2

Detailed Description:

Acute coronary syndromes are due to an acute or subacute primary reduction of myocardial oxygen supply provoked by disruption of an atherosclerotic plaque associated with inflammation, thrombosis, vasoconstriction and microembolization. Occlusive thrombosis superimposed on a ruptured atheroma in an epicardial coronary artery is firmly established as the immediate cause of an acute ST-segment Elevation Myocardial Infarction (STEMI). Rapid restoration of blood flow (oxygen supply) to jeopardized myocardium limits necrosis and reduces mortality. This can be accomplished medically with a thrombolytic agent, or mechanically, with so-called primary balloon angioplasty or stenting. Primary percutaneous coronary intervention (PCI) has become the preferred therapy for STEMI in most developed countries.

HBOC-201 is a solution belonging to a new class of biologic oxygen therapeutics, hemoglobin based oxygen carriers. HBOC-201 is a crosslinked and glutaraldehyde-polymerized hemoglobin (Hb) extracted from isolated bovine red blood cells. On a gram-for-gram basis, HBOC-201 was calculated to be approximately three times more potent than stored fresh red blood cell hemoglobin at restoring baseline tissue oxygenation following severe acute anemia. Evaluation of this Hemoglobin Based Oxygen Carrier has been undertaken in 57 preclinical studies and 21 human clinical trials. The compound is under review by the US FDA and has been approved in the Republic of South Africa. However, HBOC-201 has not yet been evaluated in the setting of this disease (narrowing of a coronary artery).

Biopure will be studying the safety and feasibility of HBOC-201 in patients with typical symptoms of Unstable Angina or Non ST-segment Elevation Myocardial Infarction eligible to undergo invasive revascularization through a PCI procedure.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	45 participants
Allocation:	Randomized
Intervention Model:	Factorial Assignment
Masking:	Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose:	Treatment
Official Title:	A Multi-Center,Randomized,Double-Blind,Placebo-Controlled,Dose Finding Pilot Study, to Evaluate Safety/Feasibility of HBOC-201 in Elective Percutaneous Coronary Revascularization of Subjects With Acute Coronary Syndromes
Study Start Date :	December 2003
Actual Primary Completion Date :	April 2005
Actual Study Completion Date :	July 2007

Arms and Interventions

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Arm	Intervention/treatment
Active Comparator: 1; Voluven will be administered at 7.7 ml/min over 15 minutes,followed by Voluven at 7.7 ml/min over 15 minutes	Procedure: Percutaneous Coronary Revascularization Drug: Voluven
Active Comparator: 2; HBOC-201 will be administered at 7.7 ml/min over 15 minutes,followed by Voluven at 7.7 ml/min over 15 minutes	Procedure: Percutaneous Coronary Revascularization Drug: Hemoglobin-Based Oxygen Carrier-201 (HBOC-201) Drug: Voluven
Experimental: 3; HBOC-201 will be administered at 7.7 ml/min over 15 minutes,followed by HBOC-201 at 7.7 ml/min over 15 minutes	Procedure: Percutaneous Coronary Revascularization Drug: Hemoglobin-Based Oxygen Carrier-201 (HBOC-201)

Outcome Measures

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Primary Outcome Measures :

1. Safety
2. In hospital thrombotic events
3. Anaphylactic reactions
4. Inflammatory reactions
5. Substantial changes to systemic & coronary hemodynamics
6. Circulatory overload
7. Renal dysfunction
8. Untoward drug interaction effects
9. substantial changes in laboratory parameters
10. Life threatening cardiac arrhythmias
11. Other adverse events
12. Feasibility:
13. Number of subjects requiring premature discontinuation of study drug for clinical or logistical reasons

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 75 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Written informed consent provided before initiation of any study-related procedure, and before any pre-procedural sedation, and agreement to comply with all protocol-specified procedures
• Acute Coronary Syndrome (Stable and unstable angina or non ST segment Elevation Myocardial Infarction (UA/non-STEMI) [Braunwald class I-III Class B], Appendix 1).
• Single vessel disease of the Left Coronary Artery (LCA)
• One vessel disease of the Right Coronary Artery (RCA)
• Have a single de novo lesion
• Older than 18 years and younger than 75 years of age
• Eligible to undergo PCI on the target vessel

Exclusion Criteria:

• Previous Q-wave myocardial infarction
• Congestive heart failure with Left ventricular Ejection Fraction <35%
• Confirmed pregnancy
• Anemia to a hemoglobin level <8.5g/dl
• Systemic mastocytosis
• History of known haemorrhagic stroke at any time or any stroke less than or equal to 30 days prior to randomization
• Severe hypertension (>180/110mmHG) not adequately controlled by antihypertensive therapy at time of study entry
• Need for mechanical ventilation
• Renal impairment: Creatinine > 1.6mg/dl
• Known history of COPD with FEV 1s < 1.0 liter
• Contra-indications to the use of adenosine, i.e.History of bronchospasm and/or ongoing therapy with theophylline derivatives, >1 degree atrioventricular block in the absence of a functioning electronic pacemaker and treatment with dipyridamole within the prior 24 hours
• Patients with significant hemodynamic compromise and/or cardiogenic shock requiring inotropic or pressor support or pulmonary edema
• History of or clinical documentation of severe aortic/mitral valve stenosis, significant aortic valve insufficiency
• Participation in another trial with an investigational drug or device (of other investigations) including the follow-up period, within the last 30 days before enrollment
• Inability or unwillingness to perform 30 day follow up
• Concomitant disease that interferes with prognosis (life expectancy of less than or equal to 6 months
• Contra-indications to standard drugs for coronary intervention and coronary heart disease: aspirin, heparin, low molecular weight heparin, clopidogrel, contrast dye
• Patient weight > 110kg

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

Belgium
Site # 5 Onze Lieve Vrouw Ziekenhuis (OLVZ)
Aalst, Belgium
Site # 6 Antwerpen
Antwerpen, Belgium
Germany
Site # 2 Herzzentrum
Leipzig, Germany
Netherlands
Site # 3 OLVG Amsterdam
Amsterdam, Netherlands
Site # 4 Academisch Medisch Centrum (AMC)
Amsterdam, Netherlands
Site # 1 Erasmus Medical Center
Rotterdam, Netherlands

Sponsors and Collaborators

Biopure Corporation

Investigators

Principal Investigator:	P W Serruys, Professor	University Medical Center Rotterdam

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications of Results:

Serruys PW, Vranckx P, Slagboom T, Regar E, Meliga E, de Winter RJ, Heyndrickx G, Schuler G, van Remortel EA, Dubé GP, Symons J. Haemodynamic effects, safety, and tolerability of haemoglobin-based oxygen carrier-201 in patients undergoing PCI for CAD. EuroIntervention. 2008 Mar;3(5):600-9.

Responsible Party:	Biopure Corporation
ClinicalTrials.gov Identifier:	NCT00317512 History of Changes
Other Study ID Numbers:	COR-0001
First Posted:	April 25, 2006
Last Update Posted:	May 16, 2008
Last Verified:	May 2008

Keywords provided by Biopure Corporation:

Hemoglobin Based Oxygen carrier; HBOC 201; Percutaneous Revascularization; Percutaneous Coronary Intervention	Non ST-segment Elevation Myocardial Infarction; Tissue Oxygenation; Transluminal Percutaneous Coronary Angioplasty

Additional relevant MeSH terms:

Infarction; Myocardial Infarction; Angina Pectoris; Angina, Unstable; Ischemia; Pathologic Processes; Necrosis; Myocardial Ischemia; Heart Diseases	Cardiovascular Diseases; Vascular Diseases; Chest Pain; Pain; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; HBOC 201; Blood Substitutes