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Bartunek J, Terzic A, Davison BA, Behfar A, Sanz-Ruiz R, Wojakowski W, Sherman W, Heyndrickx GR, Metra M, Filippatos GS, Waldman SA, Teerlink JR, Henry TD, Gersh BJ, Hajjar R, Tendera M, Senger S, Cotter G, Povsic TJ, Wijns W. Cardiopoietic stem cell therapy in ischaemic heart failure: long-term clinical outcomes. ESC Heart Fail 2020; 7:3345-3354. [PMID: 33094909 PMCID: PMC7754898 DOI: 10.1002/ehf2.13031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/03/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022] Open
Abstract
Aims This study aims to explore long‐term clinical outcomes of cardiopoiesis‐guided stem cell therapy for ischaemic heart failure assessed in the Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART‐1) trial. Methods and results CHART‐1 is a multinational, randomized, and double‐blind trial conducted in 39 centres in heart failure patients (n = 315) on standard‐of‐care therapy. The ‘active’ group received cardiopoietic stem cells delivered intramyocardially using a retention‐enhanced catheter. The ‘control’ group underwent patient‐level sham procedure. Patients were followed up to 104 weeks. In the entire study population, results of the primary hierarchical composite outcome were maintained neutral at Week 52 [Mann–Whitney estimator 0.52, 95% confidence interval (CI) 0.45–0.59, P = 0.51]. Landmark analyses suggested late clinical benefit in patients with significant left ventricular enlargement receiving adequate dosing. Specifically, beyond 100 days of follow‐up, patients with left ventricular end‐diastolic volume of 200–370 mL treated with ≤19 injections of cardiopoietic stem cells showed reduced risk of death or cardiovascular hospitalization (hazard ratio 0.38, 95% CI 0.16–0.91, P = 0.031) and cardiovascular death or heart failure hospitalization (hazard ratio 0.28, 95% CI 0.09–0.94, P = 0.040). Cardiopoietic stem cell therapy was well tolerated long term with no difference in safety readouts compared with sham at 2 years. Conclusions Longitudinal follow‐up documents that cardiopoietic stem cell therapy is overall safe, and post hoc analyses suggest benefit in an ischaemic heart failure subpopulation defined by advanced left ventricular enlargement on tolerable stem cell dosing. The long‐term clinical follow‐up thus offers guidance for future targeted trials.
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Affiliation(s)
- Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Andre Terzic
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, Aalst, B-9300, Belgium.,Department of Cardiovascular Medicine, Mayo Clinic, Center for Regenerative Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Center for Regenerative Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ricardo Sanz-Ruiz
- Cardiology Department, Hospital General Universitario Gregorio Marañón and CIBERCV (Instituto de Salud Carlos III), Madrid, Spain
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland
| | | | - Guy R Heyndrickx
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, Aalst, B-9300, Belgium
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Spedali Civili, Brescia, Italy
| | - Gerasimos S Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Scott A Waldman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Teerlink
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.,Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Timothy D Henry
- The Carl Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Center for Regenerative Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Roger Hajjar
- Phospholamban Foundation, Amsterdam, Netherlands
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland
| | | | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
| | - Thomas J Povsic
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
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Bartunek J, Terzic A, Davison BA, Filippatos GS, Radovanovic S, Beleslin B, Merkely B, Musialek P, Wojakowski W, Andreka P, Horvath IG, Katz A, Dolatabadi D, El Nakadi B, Arandjelovic A, Edes I, Seferovic PM, Obradovic S, Vanderheyden M, Jagic N, Petrov I, Atar S, Halabi M, Gelev VL, Shochat MK, Kasprzak JD, Sanz-Ruiz R, Heyndrickx GR, Nyolczas N, Legrand V, Guédès A, Heyse A, Moccetti T, Fernandez-Aviles F, Jimenez-Quevedo P, Bayes-Genis A, Hernandez-Garcia JM, Ribichini F, Gruchala M, Waldman SA, Teerlink JR, Gersh BJ, Povsic TJ, Henry TD, Metra M, Hajjar RJ, Tendera M, Behfar A, Alexandre B, Seron A, Stough WG, Sherman W, Cotter G, Wijns W. Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial. Eur Heart J 2017; 38:648-660. [PMID: 28025189 PMCID: PMC5381596 DOI: 10.1093/eurheartj/ehw543] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/22/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. METHODS AND RESULTS This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein-Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann-Whitney estimator 0.54, 95% confidence interval [CI] 0.47-0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200-370 mL (60% of patients) (Mann-Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. CONCLUSION The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.
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Affiliation(s)
- Jozef Bartunek
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
| | - Andre Terzic
- Mayo Clinic, Center for Regenerative Medicine, Department of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 550905, USA
| | | | - Gerasimos S. Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | | | - Branko Beleslin
- Cardiology Clinic, Clinical Centre of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Piotr Musialek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Wojciech Wojakowski
- Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Peter Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Amos Katz
- Department of Cardiology, Barzilai Medical Center, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dariouch Dolatabadi
- Division of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Badih El Nakadi
- Division of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Istvan Edes
- Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Petar M. Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Slobodan Obradovic
- Clinic of Emergency Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Marc Vanderheyden
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
| | | | - Ivo Petrov
- Department of Cardiology, Angiology, and Electrophysiology, City Clinic Heart and Vascular Institute, Sofia University, Sofia, Bulgaria
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Majdi Halabi
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Valeri L. Gelev
- Department of Cardiology, Angiology, and Electrophysiology, City Clinic Heart and Vascular Institute, Sofia University, Sofia, Bulgaria
| | - Michael K. Shochat
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Haifa, Israel, Technion
| | | | | | - Guy R. Heyndrickx
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
| | - Noémi Nyolczas
- Medical Centre, Hungarian Defense Forces, Budapest, Hungary
| | - Victor Legrand
- Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Antoine Guédès
- Department of Cardiology, Universite Catholique de Louvain, CHU UcL Namur, Yvoir, Belgium
| | - Alex Heyse
- Department of Cardiology, AZ Glorieux, Ronse, Belgium
| | | | | | | | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias I Pujol, Universitat Autònoma, Barcelona, Spain
| | | | | | - Marcin Gruchala
- Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Scott A. Waldman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R. Teerlink
- School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Bernard J. Gersh
- Mayo Clinic, Center for Regenerative Medicine, Department of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 550905, USA
| | - Thomas J. Povsic
- Duke Clinical Research Institute and Duke Medicine, Durham, NC, USA
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Spedali Civili, Brescia, Italy
| | | | - Michal Tendera
- Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Atta Behfar
- Mayo Clinic, Center for Regenerative Medicine, Department of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 550905, USA
| | | | | | - Wendy Gattis Stough
- Departments of Clinical Research and Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Cary, NC, USA
| | | | | | - William Wijns
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
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Bartunek J, Davison B, Sherman W, Povsic T, Henry TD, Gersh B, Metra M, Filippatos G, Hajjar R, Behfar A, Homsy C, Cotter G, Wijns W, Tendera M, Terzic A. Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial design. Eur J Heart Fail 2015; 18:160-8. [PMID: 26662998 PMCID: PMC5064644 DOI: 10.1002/ejhf.434] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/14/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022] Open
Abstract
Aims Cardiopoiesis is a conditioning programme that aims to upgrade the cardioregenerative aptitude of patient‐derived stem cells through lineage specification. Cardiopoietic stem cells tested initially for feasibility and safety exhibited signs of clinical benefit in patients with ischaemic heart failure (HF) warranting definitive evaluation. Accordingly, CHART‐1 is designed as a large randomized, sham‐controlled multicentre study aimed to validate cardiopoietic stem cell therapy. Methods Patients (n = 240) with chronic HF secondary to ischaemic heart disease, reduced LVEF (<35%), and at high risk for recurrent HF‐related events, despite optimal medical therapy, will be randomized 1:1 to receive 600 × 106 bone marrow‐derived and lineage‐directed autologous cardiopoietic stem cells administered via a retention‐enhanced intramyocardial injection catheter or a sham procedure. The primary efficacy endpoint is a hierarchical composite of mortality, worsening HF, Minnesota Living with Heart Failure Questionnaire score, 6 min walk test, LV end‐systolic volume, and LVEF at 9 months. The secondary efficacy endpoint is the time to cardiovascular death or worsening HF at 12 months. Safety endpoints include mortality, readmissions, aborted sudden deaths, and serious adverse events at 12 and 24 months. Conclusion The CHART‐1 clinical trial is powered to examine the therapeutic impact of lineage‐directed stem cells as a strategy to achieve cardiac regeneration in HF populations. On completion, CHART‐1 will offer a definitive evaluation of the efficacy and safety of cardiopoietic stem cells in the treatment of chronic ischaemic HF. Trial registration:NCT01768702
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Affiliation(s)
| | | | | | - Thomas Povsic
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Bernard Gersh
- Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Department of Medicine, Rochester, MN, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | | | - Roger Hajjar
- Mount Sinai School of Medicine, New York, NY, USA
| | - Atta Behfar
- Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Department of Medicine, Rochester, MN, USA
| | | | | | | | - Michal Tendera
- 3rd Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andre Terzic
- Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Department of Medicine, Rochester, MN, USA
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