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Le Corvoisier P, Gallet R, Lesault PF, Audureau E, Paul M, Ternacle J, Ghostine S, Champagne S, Arrouasse R, Bitari D, Mouillet G, Dubois-Randé JL, Berdeaux A, Ghaleh B, Deux JF, Teiger E. Intra-coronary morphine versus placebo in the treatment of acute ST-segment elevation myocardial infarction: the MIAMI randomized controlled trial. BMC Cardiovasc Disord 2018; 18:193. [PMID: 30340532 PMCID: PMC6194573 DOI: 10.1186/s12872-018-0936-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/09/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Experimental studies suggest that morphine may protect the myocardium against ischemia-reperfusion injury by activating salvage kinase pathways. The objective of this two-center, randomized, double-blind, controlled trial was to assess potential cardioprotective effects of intra-coronary morphine in patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous intervention. METHODS Ninety-one patients with STEMI were randomly assigned to intracoronary morphine (1 mg) or placebo at reperfusion of the culprit coronary artery. The primary endpoint was infarct size/left ventricular mass ratio assessed by magnetic resonance imaging on day 3-5. Secondary endpoints included the areas under the curve (AUC) for troponin T and creatine kinase over three days, left ventricular ejection fraction assessed by echocardiography on days 1 and 6, and clinical outcomes. RESULTS Infarct size/left ventricular mass ratio was not significantly reduced by intracoronary morphine compared to placebo (27.2% ± 15.0% vs. 30.5% ± 10.6%, respectively, p = 0.28). Troponin T and creatine kinase AUCs were similar in the two groups. Morphine did not improve left ventricular ejection fraction on day 1 (49.7 ± 10.3% vs. 49.3 ± 9.3% with placebo, p = 0.84) or day 6 (48.5 ± 10.2% vs. 49.0 ± 8.5% with placebo, p = 0.86). The number of major adverse cardiac events, including stent thrombosis, during the one-year follow-up was similar in the two groups. CONCLUSIONS Intracoronary morphine at reperfusion did not significantly reduce infarct size or improve left ventricular systolic function in patients with STEMI. Presence of comorbidities in some patients may contribute to explain these results. TRIAL REGISTRATION ClinicalTrials.gov, NCT01186445 (date of registration: August 23, 2010).
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Affiliation(s)
- Philippe Le Corvoisier
- Department VERDI, Inserm, CIC1430, AP-HP, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, F-94010, Creteil, France. .,Inserm, U955 team 3, F-94010, Creteil, France.
| | - Romain Gallet
- Inserm, U955 team 3, F-94010, Creteil, France.,Interventional Cardiology Unit, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | | | - Etienne Audureau
- Department of Public Health and CEPIA EA7376, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | - Muriel Paul
- Department of Pharmacy, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | - Julien Ternacle
- Interventional Cardiology Unit, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | - Saïd Ghostine
- Department of Cardiology, Marie-Lannelongue Hospital, F-92350, Le Plessis-Robinson, France
| | - Stéphane Champagne
- Interventional Cardiology Unit, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | - Raphaele Arrouasse
- Department VERDI, Inserm, CIC1430, AP-HP, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, F-94010, Creteil, France
| | - Dalila Bitari
- Department VERDI, Inserm, CIC1430, AP-HP, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, F-94010, Creteil, France
| | - Gauthier Mouillet
- Interventional Cardiology Unit, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | - Jean-Luc Dubois-Randé
- Inserm, U955 team 3, F-94010, Creteil, France.,Department of Cardiology, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | | | | | - Jean-François Deux
- Department of Radiology, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
| | - Emmanuel Teiger
- Inserm, U955 team 3, F-94010, Creteil, France.,Interventional Cardiology Unit, AP-HP, Henri Mondor Hospital, F-94010, Creteil, France
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Yiou R, Hamidou L, Birebent B, Bitari D, Lecorvoisier P, Contremoulins I, Khodari M, Rodriguez AM, Augustin D, Roudot-Thoraval F, de la Taille A, Rouard H. Safety of Intracavernous Bone Marrow-Mononuclear Cells for Postradical Prostatectomy Erectile Dysfunction: An Open Dose-Escalation Pilot Study. Eur Urol 2015; 69:988-91. [PMID: 26439886 DOI: 10.1016/j.eururo.2015.09.026] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/15/2015] [Indexed: 12/24/2022]
Abstract
UNLABELLED Evidence from animal models replicating postradical prostatectomy erectile dysfunction (pRP-ED) suggests intracavernous injection of bone marrow-mononuclear cells (BM-MNCs) as a promising treatment approach for pRP-ED. We conducted a phase 1/2 pilot clinical trial of intracavernous autologous BM-MNC injection to treat pRP-ED (NCT01089387). Twelve patients with localized prostate cancer and vasculogenic pRP-ED refractory to maximal medical treatment were divided into four equal groups treated with escalating BM-MNC doses (2×10(7), 2×10(8), 1×10(9), 2×10(9)). Tolerance was the primary endpoint. Secondary endpoints were the effects on erectile function and penile vascularization at 6 mo, as assessed using the International Index of Erectile Function-15 and Erection Hardness Scale questionnaires, and color duplex Doppler ultrasound. We measured the peak systolic velocity in cavernous arteries and assessed endothelial function using the penile nitric oxide release test. No serious side effects occurred. At 6 mo versus baseline, significant improvements of intercourse satisfaction (6.8±3.6, 3.9±2.5, p=0.044) and erectile function (17.4±8.9, 7.3±4.5, p=0.006) domains of the International Index of Erectile Function-15 and Erection Hardness Scale (2.6±1.1, 1.3±0.8, p=0.008) were observed in the total population. Spontaneous erections showed significantly greater improvement with the higher doses. Clinical benefits were associated with improvement of peak systolic velocity and of % penile nitric oxide release test and sustained after 1 yr. Our results need to be confirmed by phase 2 clinical trials. PATIENT SUMMARY We report a phase 1/2 pilot clinical trial investigating cell therapy with injection of bone marrow mononucleated cells to treat postradical prostatectomy erectile dysfunction. No serious side effects occurred. Improvements of erectile function and penile vascularization were noted. Further studies are required to confirm these preliminary results.
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Affiliation(s)
- René Yiou
- APHP, Urology Department, Henri Mondor Teaching Hospital, Créteil, France.
| | - Leila Hamidou
- APHP, Department of Physiology, Henri Mondor Teaching Hospital, Créteil, France
| | - Brigitte Birebent
- Etablissement Français du Sang, Unité d'Ingénierie et de thérapie cellulaire, Créteil, France
| | - Dalila Bitari
- APHP, CIC-P006, and CIC-BT 504, Henri Mondor Teaching Hospital, Créteil, France
| | | | | | - Muhieddine Khodari
- APHP, Urology Department, Henri Mondor Teaching Hospital, Créteil, France
| | | | - Déborah Augustin
- APHP, Urology Department, Henri Mondor Teaching Hospital, Créteil, France
| | | | | | - Hélène Rouard
- Etablissement Français du Sang, Unité d'Ingénierie et de thérapie cellulaire, Créteil, France
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