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Duengen HD, Kim RJ, Zahger D, Orvin K, Admon D, Kettner J, Shimony A, Otto C, Becka M, Kanefendt F, Iniguez Romo A, Hasin T, Ostadal P, Calvo Rojas G, Senni M. 87Effects of the chymase inhibitor fulacimstat on adverse cardiac remodelling after acute myocardial infarction - Results of the CHIARA MIA 2 trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Adverse cardiac remodelling represents the most important risk factor for the development of heart failure (HF) after myocardial infarction (MI). Chymase is a protease that generates locally pro-fibrotic factors such as angiotensin II, TGFβ, and matrixmetallproteases that contribute to tissue remodelling.
Purpose
This phase IIa study examined the effects of the chymase inhibitor fulacimstat on functional parameters of adverse cardiac remodelling after acute MI.
Methods
A double-blind, multinational, randomized, placebo-controlled study was performed in patients after first STEMI who were treated with primary percutaneous coronary intervention within 24h of symptom onset. To enrich for patients at risk of adverse remodelling, main inclusion criteria were a left-ventricular ejection fraction (LVEF)≤45% and an infarct size>10% on day 5 to 9 post MI as measured by cardiac MRI. On day 6 to 12 post MI, patients were randomized to treatment with either 25 mg fulacimstat (n=54) or placebo (n=53) twice daily on top of standard of care. The changes in LVEF, LVEDVI, and LVESVI from baseline to 6 months of treatment were analyzed by a central blinded cardiac MRI core laboratory.
Results
Fulacimstat was safe and well tolerated, 64.8% of patients treated with fulacimstat and 75.5% of patients treated with placebo reported treatment emergent adverse events. Fulacimstat achieved exposures that were approximately 10-fold higher than those predicted to be required for minimal therapeutic activity. After six months of treatment, there were no effects of fulacimstat compared to placebo on the changes in LVEF, LVEDVI, and LVESVI (see Table).
Analysis of primary efficacy parameters Parameter Placebo Fulacimstat p-value LVEF (%) baseline 37.2±6.1 39.1±5.5 0.15 6 months 41.2±8.4 42.6±8.4 0.45 delta 4.0±5.0 3.5±5.4 0.69 LVEDVI (mL/m2) baseline 80.0±17.1 77.4±18.2 0.51 6 months 85.1±19.1 84.7±23.4 0.94 delta 5.1±18.9 7.3±13.3 0.54 LVESVI (mL/m2) baseline 50.5±13.0 47.3±12.3 0.26 6 months 51.1±16.9 49.6±18.1 0.71 delta 0.6±14.8 2.3±11.2 0.56 Data are given as mean ± standard deviation.
Conclusion
Fulacimstat was safe and well tolerated in patients with left-ventricular dysfunction (LVD) after first STEMI but had no effect on adverse cardiac remodelling in the experimental setting of this study.
Acknowledgement/Funding
The study was funded by its sponsor BAYER AG
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Affiliation(s)
- H D Duengen
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine, Cardiology, Berlin, Germany
| | - R J Kim
- Duke University Medical Center, Duke Cardiovascular Magnetic Resonance Center, Durham, United States of America
| | - D Zahger
- Soroka University Medical Center, Beer Sheva, Israel
| | - K Orvin
- Rabin Medical Center - Beilinson Campus, Cardiology Division, Petah Tikva, Israel
| | - D Admon
- Hadassah Hebrew University Hospital Ein Kerem, Heart Institute, Jerusalem, Israel
| | - J Kettner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - A Shimony
- Soroka University Medical Center, Beer Sheva, Israel
| | - C Otto
- BAYER AG, Experimental Medicine Hematology and Cardiology, Wuppertal, Germany
| | - M Becka
- BAYER AG, Research and Clinical Sciences Statistics, Wuppertal, Germany
| | - F Kanefendt
- BAYER AG, Clinical Pharmacokinetics, Wuppertal, Germany
| | - A Iniguez Romo
- Hospital Alvaro Cunqueiro, Servicio de la Cardiologia, Babio-Beade, Spain
| | - T Hasin
- Shaare Zedek Medical Center, Department of Cardiology, Jerusalem, Israel
| | - P Ostadal
- Nemocnice na Homolce, Prague, Czechia
| | | | - M Senni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Kuranz CC, Park HS, Huntington CM, Miles AR, Remington BA, Plewa T, Trantham MR, Robey HF, Shvarts D, Shimony A, Raman K, MacLaren S, Wan WC, Doss FW, Kline J, Flippo KA, Malamud G, Handy TA, Prisbrey S, Krauland CM, Klein SR, Harding EC, Wallace R, Grosskopf MJ, Marion DC, Kalantar D, Giraldez E, Drake RP. How high energy fluxes may affect Rayleigh-Taylor instability growth in young supernova remnants. Nat Commun 2018; 9:1564. [PMID: 29674695 PMCID: PMC5908785 DOI: 10.1038/s41467-018-03548-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/22/2018] [Indexed: 11/23/2022] Open
Abstract
Energy-transport effects can alter the structure that develops as a supernova evolves into a supernova remnant. The Rayleigh–Taylor instability is thought to produce structure at the interface between the stellar ejecta and the circumstellar matter, based on simple models and hydrodynamic simulations. Here we report experimental results from the National Ignition Facility to explore how large energy fluxes, which are present in supernovae, affect this structure. We observed a reduction in Rayleigh–Taylor growth. In analyzing the comparison with supernova SN1993J, a Type II supernova, we found that the energy fluxes produced by heat conduction appear to be larger than the radiative energy fluxes, and large enough to have dramatic consequences. No reported astrophysical simulations have included radiation and heat conduction self-consistently in modeling supernova remnants and these dynamics should be noted in the understanding of young supernova remnants. Radiation and conduction are generally considered as the main energy transport mechanisms for the evolution of early supernova remnants. Here the authors experimentally show the role of electron heat transfer on the growth of Rayleigh–Taylor instability in young supernova remnants.
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Affiliation(s)
- C C Kuranz
- University of Michigan, Ann Arbor, 48109, Michigan, USA.
| | - H-S Park
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - C M Huntington
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - A R Miles
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - B A Remington
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - T Plewa
- Florida State University, Tallahassee, 32306, Florida, USA
| | - M R Trantham
- University of Michigan, Ann Arbor, 48109, Michigan, USA
| | - H F Robey
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - D Shvarts
- Ben Gurion University of the Negev, Be'er-Sheva, 84015, Israel.,Nuclear Research Center Negev, Be'er Sheva, 84190, Israel
| | - A Shimony
- Ben Gurion University of the Negev, Be'er-Sheva, 84015, Israel.,Nuclear Research Center Negev, Be'er Sheva, 84190, Israel
| | - K Raman
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - S MacLaren
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - W C Wan
- University of Michigan, Ann Arbor, 48109, Michigan, USA.,Los Alamos National Laboratory, Los Alamos, 87545, New Mexico, USA
| | - F W Doss
- Los Alamos National Laboratory, Los Alamos, 87545, New Mexico, USA
| | - J Kline
- Los Alamos National Laboratory, Los Alamos, 87545, New Mexico, USA
| | - K A Flippo
- Los Alamos National Laboratory, Los Alamos, 87545, New Mexico, USA
| | - G Malamud
- University of Michigan, Ann Arbor, 48109, Michigan, USA.,Nuclear Research Center Negev, Be'er Sheva, 84190, Israel
| | - T A Handy
- University of Michigan, Ann Arbor, 48109, Michigan, USA
| | - S Prisbrey
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - C M Krauland
- General Atomics, San Diego, 92186, California, USA
| | - S R Klein
- University of Michigan, Ann Arbor, 48109, Michigan, USA
| | - E C Harding
- Sandia National Laboratory, Albuquerque, 87185, New Mexico, USA
| | - R Wallace
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | | | - D C Marion
- University of Michigan, Ann Arbor, 48109, Michigan, USA
| | - D Kalantar
- Lawrence Livermore National Laboratory, Livermore, 94550, California, USA
| | - E Giraldez
- General Atomics, San Diego, 92186, California, USA
| | - R P Drake
- University of Michigan, Ann Arbor, 48109, Michigan, USA
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Wan WC, Malamud G, Shimony A, Di Stefano CA, Trantham MR, Klein SR, Shvarts D, Kuranz CC, Drake RP. Observation of Single-Mode, Kelvin-Helmholtz Instability in a Supersonic Flow. Phys Rev Lett 2015; 115:145001. [PMID: 26551815 DOI: 10.1103/physrevlett.115.145001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 06/05/2023]
Abstract
We report the first observation, in a supersonic flow, of the evolution of the Kelvin-Helmholtz instability from a single-mode initial condition. To obtain these data, we used a novel experimental system to produce a steady shock wave of unprecedented duration in a laser-driven experiment. The shocked, flowing material creates a shear layer between two plasmas at high energy density. We measured the resulting interface structure using radiography. Hydrodynamic simulations reproduce the large-scale structures very well and the medium-scale structures fairly well, and imply that we observed the expected reduction in growth rate for supersonic shear flow.
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Affiliation(s)
- W C Wan
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - G Malamud
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Nuclear Research Center - Negev, Beer Sheva 84190, Israel
| | - A Shimony
- Nuclear Research Center - Negev, Beer Sheva 84190, Israel
- Department of Physics, Ben Gurion University of the Negev, Beer Sheva 84190, Israel
| | - C A Di Stefano
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - M R Trantham
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - S R Klein
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - D Shvarts
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Nuclear Research Center - Negev, Beer Sheva 84190, Israel
- Department of Physics, Ben Gurion University of the Negev, Beer Sheva 84190, Israel
| | - C C Kuranz
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - R P Drake
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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