Plasmonic Photothermal and Stem Cell Therapy of Atherosclerosis Versus Stenting (NANOM PCI)
Intensive therapy with rosuvastatin 40 mg and ApoA-I Milano reduces the total atheroma volume (TAV) up to 6.38 or 14.1 mm3 respectively. Our previous bench studies PLASMONICS and NANOM First-in-Man trial documented TAV reduction up to unprecedented 79.4 and 60.3 mm3 respectively with high level of safety and feasibility.
The completed randomized two arm (1:1) study (NANOM-PCI) with parallel assignment (n=62) assessed (NCT01436123) the safety and feasibility of the delivery technique for nanoparticles (NP) using micro-injection catheter (with intravascular intramural injection of allogeneous stem cells carrying NP after MSCT-, IVUS- and OCT-guided mapping of the vessel), and plasmonic photothermal therapy of atherosclerosis combined with stenting (Nano group, n=32) versus stenting with Xience V cage (Stenting group, n=30). The primary outcome was TAV at 12 months.
The mean reduction of TAV at 12 months in Nano group was -84.1 mm3 (95% CI: SD 28.3; min -52.4 mm3, max -99.1 mm3; p<0.05) versus +12.4 mm3 in case of stenting (p<0.05 between groups). 42/62 patients (68%) in Nano group passed the Glagov threshold of a 40% plaque burden with mean plaque burden (PB) 36.2% (95% CI: SD 9.3%, min 30.9%, max 44.5%). The increase of the minimal lumen diameter was 61.2 and 63.3% at 12 month follow up in groups respectively. The serial assessment of VH-IVUS showed a significant decrease at 12 months in the dense calcium area, fibrous and fibro-fatty tissue with fulminant necrosis due to thermolysis in Nano-group, whereas an increase of fibrous and fibro-fatty components in stenting arm. We have documented 2 vs 3 cases of the definite thrombosis and 3 vs 5 cases of target lesion revascularization in groups respectively. The analysis of the event-free survival of the ongoing clinical follow-up shows the significantly lower risk of cardiovascular death in Nano group if compare with conventional stenting (93.4% vs 86.7%; p<0.05).
Plasmonic resonance-mediated therapy using noble-metal NP associated with significant regression of coronary atherosclerosis. Tested delivery approach has acceptable safety and efficacy for atheroregression below a 40% PB.
The investigators hypothesize that multistep approach with the use of stent in acute care unit, and then subsequent transcatheter micro-injection with nanoparticles can resolve atherosclerosis, stop and regress atherogenesis, remodulate or even rejuvenate arteries. Stem cells in patch can be good carriers for nanoparticles as well as high-effective metabolic vectors (paracrine-like regulation of alive cells and via bioactive products of cell lysis after detonation of nanoparticles) for the treatment of plaque on site. Gold nanoparticles with silica-iron oxide shells promise high-energy plasmonic photothermic burning or melting effect under the near-infrared laser irradiation onto the lesion. Thus the investigators expect complex two-side effect on the plaque with protected lumen and adventitia.
Novel discoveries in atherogenesis, and development of nanobiotechnologies with potentials for the management of atherosclerosis leads us to the quest of new approaches. The investigators still cannot really effectively treat atherosclerosis.
The investigators management is more symptomatic, and lipid-pool or inflammation-oriented! The investigators cannot manage non-organic part (mineral deposits, calcified necrotic core, partially collagen and fibrotic tissue) and total plaque volume Surgery and invasive procedures is just focused on blood flow restoration (just manipulate the form of plaque) + concerns of clinical and technical restrictions (incl. alien body - stent) + risk of restenosis or subacute 'fatal' in-stent atherothrombosis + graft survival/ occlusion + surgery-related complications High rate of short- and long-term complications and readmissions. Regression of atherosclerosis in fact is still a dream. The investigators offer an alternative to stenting and may be cardiac artery bypass surgery (CABG). Our approach can really allow to rejuvenate arteries, Plasmonic photothermal therapy (PPTT) can burn plaque, but stem cells and bioengineered structures promise restoration of the vessel wall.
Our personal previous data showed that PPTT can 1.6-fold reduce a volume of plaque with most optimal long-term result in subsets with the use of SPCs as a delivery approach. The most optimal delivery systems of NPs into the plaque are the on-artery bioengineered patch and ferro-magnetic approach.
|Coronary Artery Disease Atherosclerosis||Other: Stenting and micro-infusion of NP Device: Implantation of everolimus-eluting stent||Phase 1|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Investigator)
Primary Purpose: Treatment
|Official Title:||Plasmonic Photothermal and Stem Cell Therapy of Atherosclerosis With The Use of Gold Nanoparticles With Iron Oxide-Silica Shells Versus Stenting|
- Total atheroma volume [ Time Frame: at month 12 ]Total plaque volume measured by intravascular ultrasound (IVUS), cubic mm.
- Composite end-point of any MACE (major acute cardiovascular events), all-cause death, any revascularization [ Time Frame: at month 12 ]Composite end-point of all-cause death, all MACE - major cardiovascular events, any revascularization
- Composition of plaque [ Time Frame: at month 12 ]Analysis of IVUS(intravascular ultrasound)-related composition of plaque (calcified deposits, necrotic calcified core), fibro-lipid core and etc.
- Major and minor bleeding [ Time Frame: at month 12 ]Clinical examination of major and minor bleeding under the antithrombotic therapy
- Restenosis rate [ Time Frame: at month 12 ]Restenosis rate verified clinically + IVUS
- Stent thrombosis rate [ Time Frame: at month 12 ]Stent thrombosis rate verified clinically, angiography, IVUS
- Coronary flow-mediated vasodilatation [ Time Frame: at month 12 ]Ultrasound-related examination of coronary flow-mediated vasodilatation
- Coronary intima-media thickness [ Time Frame: at month 12 ]Ultrasound-IVUS-related examination of coronary intima-media thickness
- Minimum diameter stenosis [ Time Frame: at month 12 ]IVUS-related assessment of minimum diameter stenosis
- Minimum lumen diameter [ Time Frame: at month 12 ]IVUS-related assessment of minimum lumen diameter
|Study Start Date:||December 2010|
|Study Completion Date:||October 2012|
|Primary Completion Date:||July 2012 (Final data collection date for primary outcome measure)|
Experimental: Stenting + Micro-infusion
Step 1 - implantation of everolimus-eluting stent with imaging by MSCT, IVUS and OCT; Step 2 - injection of stem cells containing gold nanoparticles with silica-iron oxide shells.
Other: Stenting and micro-infusion of NP
Step 1 - IVUS, OCT-guided put in everolimus-eluting (drug-eluting-DES) stent + intravascular ultrasound (IVUS) mapping + harvesting stem cells with mesenchymal phenotype; Step 2 - culturing of stem cells in medium by gold nanoparticles with silica-iron oxide shells; Step 3 - micro-infusion of stem cells bearing NP into the lesion; Step 4 - detonation of nanoshells after migration of stem cells with NPs inside (until 7-10 days after transplantation). We expect 'melting' and 'burning' effects of PPTT, beneficial effects of bioactive products of stem cells lysis + benefits from further migration of stem cells from patch into the plaque
Active Comparator: Stenting
Put in everolimus-eluting stent
Device: Implantation of everolimus-eluting stent
Put stent in ischemia-related coronary artery by indications for PCI
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01436123
|De Haar Research Foundation|
|Rotterdam, South Holland, Netherlands, 3071PR|
|Ural Center of Modern Nanotechnologies, Institute of Natural Sciences, Ural Federal University|
|Yekaterinburg, Sverdlovsk oblast, Russian Federation, 620000|
|Ural Institute of Cardiology|
|Yekaterinburg, Sverdlovsk oblast, Russian Federation, 620144|
|Principal Investigator:||Alexander Kharlamov, M.D., Ph.D.||Ural Institute of Cardiology|
|Study Chair:||Jan Gabinsky, M.D., Ph.D.||Ural Institute of Cardiology|
|Study Director:||Olga Kovtun, M.D., Ph.D.||Ural Medical University|