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Allogeneic Induced Pluripotent Stem Cells-Derived Cardiomyocytes And Stromal Cells

A groundbreaking clinical trial is underway to investigate the safety and effectiveness of a novel treatment for terminal heart failure. This trial focuses on using Engineered Human Myocardium (EHM), derived from allogeneic induced pluripotent stem cells, as a biological ventricular assist tissue. This innovative approach aims to improve heart function and quality of life for patients with severe heart failure who have limited treatment options.

Table of Contents

What is Engineered Human Myocardium (EHM)?

Engineered Human Myocardium (EHM) is an innovative medical treatment being developed for patients with terminal heart failure. It is made from allogeneic induced pluripotent stem cells-derived cardiomyocytes and stromal cells. [1]

To break this down:

  • Allogeneic means the cells come from a donor, not the patient themselves.
  • Induced pluripotent stem cells are adult cells that have been reprogrammed to behave like embryonic stem cells, capable of developing into many different cell types.
  • Cardiomyocytes are heart muscle cells.
  • Stromal cells are connective tissue cells that support the function of an organ.

EHM is classified as a cell therapy and is administered as an implant directly into the heart.[1]

How Does EHM Work?

EHM is designed to function as a biological ventricular assist tissue. In simpler terms, it’s meant to help the heart pump blood more effectively. The implanted tissue is intended to integrate with the patient’s existing heart muscle and improve its function.[1]

The goal is to enhance the thickness and function of the heart wall, potentially improving the heart’s ability to pump blood and alleviating symptoms of heart failure.[1]

Who Might Benefit from EHM?

EHM is being developed for patients with terminal heart failure, specifically those with:

  • Heart failure with reduced ejection fraction (HFrEF): This means the heart is not pumping blood as effectively as it should. Specifically, the trial is looking at patients with an ejection fraction of 35% or less.[1]
  • New York Heart Association (NYHA) Class III or IV: These are patients with marked or severe limitations in physical activity due to their heart condition.[1]
  • Age between 18 and 80 years.[1]

Some patients with right ventricular dysfunction may also be considered for this treatment.[1]

Current Clinical Trial

EHM is currently being studied in a combined Phase I/II clinical trial. This means the trial is designed to assess both the safety and the effectiveness of the treatment.[1]

The trial has two main objectives:

  1. Primary Objective: To assess the safety and efficacy of EHM in patients with terminal heart failure.[1]
  2. Secondary Objective: To evaluate the effects of EHM on disease-specific events and symptoms.[1]

The trial is divided into two parts:

  • Part A: This is a dose escalation phase, where researchers will be looking at safety outcomes within the first 28 days after implantation.[1]
  • Part B: This phase will look at safety outcomes over the entire study duration.[1]

Potential Benefits of EHM

While the effectiveness of EHM is still being studied, researchers hope it may provide several benefits for patients with terminal heart failure:

  • Improved heart function, particularly the ability to pump blood more effectively.[1]
  • Enhanced thickness and function of the heart wall.[1]
  • Reduction in heart failure symptoms and improved quality of life.[1]
  • Potential reduction in hospitalizations due to heart failure.[1]
  • Possible improvement in exercise capacity and overall functional status.[1]

Safety Considerations

As with any new medical treatment, safety is a primary concern. The clinical trial is carefully designed to monitor for potential side effects or complications. Some key safety considerations include:

  • Arrhythmic events: The trial will closely monitor for any heart rhythm disturbances.[1]
  • Immune rejection: Since EHM uses cells from a donor, there’s a potential for the body to reject the implant. Patients may need to take immunosuppressive drugs.[1]
  • Procedure-related complications: As EHM requires a surgical procedure to implant, there are risks associated with the surgery itself.[1]
  • Disease progression: The trial will monitor whether EHM affects the progression of heart failure.[1]

It’s important to note that EHM is still in the experimental stage. While it shows promise, more research is needed to fully understand its effectiveness and safety profile. Patients considering participating in the clinical trial should discuss the potential risks and benefits thoroughly with their healthcare providers.[1]

Aspect Details
Study Type Combined Phase I/II clinical trial
Treatment Engineered Human Myocardium (EHM) derived from allogeneic induced pluripotent stem cells
Target Condition Terminal heart failure (HFrEF with EF ≤ 35%)
Primary Objectives Assess safety and efficacy of EHM in patients with terminal heart failure
Secondary Objectives Evaluate effects on disease-specific events, symptoms, and quality of life
Key Inclusion Criteria Adults 18-80 years, HFrEF (EF ≤ 35%), NYHA Class III or IV, ICD or CRT-D implant
Key Exclusion Criteria Contraindications to immunosuppressive drugs, pregnancy, terminal kidney or liver failure
Primary Endpoints Adverse events, evidence of structural and functional muscular augmentation
Secondary Endpoints MACE frequency, arrhythmic events, immune rejection, changes in heart function and quality of life

FAQ

  • What is Engineered Human Myocardium (EHM)? Engineered Human Myocardium (EHM) is a tissue implant made from allogeneic induced pluripotent stem cells-derived cardiomyocytes and stromal cells. It is designed to assist and potentially improve heart function in patients with terminal heart failure.
  • Who is eligible for this clinical trial? Eligible participants are adults aged 18-80 with heart failure with reduced ejection fraction (EF ≤ 35%), at least one hypo- or dyskinetic heart segment, and classified as New York Heart Association (NYHA) Class III or IV under optimal medical therapy. They must also have a previously implanted ICD or CRT-D device.
  • What are the main objectives of the trial? The primary objectives are to assess the safety and efficacy of EHM in patients with terminal heart failure. Secondary objectives include evaluating the effects of EHM-grafts on disease-specific events and symptoms, as well as measuring changes in heart function and quality of life.
  • How is the EHM implanted? The EHM is implanted through a left-lateral mini-thoracotomy for left ventricular applications or open-chest surgery for right ventricular applications. The procedure is performed during a clinically indicated intervention on the heart.
  • What are the potential benefits and risks of this treatment? Potential benefits include improved heart function, reduced symptoms of heart failure, and better quality of life. Risks may include procedure-related complications, arrhythmic events, and possible immune rejection. The trial closely monitors these aspects to ensure patient safety and evaluate the treatment's effectiveness.

Ongoing Clinical Trials on Allogeneic Induced Pluripotent Stem Cells-Derived Cardiomyocytes And Stromal Cells

  • Study on the Safety and Effectiveness of Engineered Human Myocardium for Patients with Terminal Heart Failure

    Recruiting

    2 1 1
    Investigated diseases:
    Investigated drugs:
    Germany

Glossary

  • Allogeneic: Cells or tissues derived from a genetically different donor of the same species.
  • Induced Pluripotent Stem Cells: Adult cells that have been genetically reprogrammed to an embryonic stem cell-like state, capable of developing into different types of cells.
  • Cardiomyocytes: Heart muscle cells responsible for generating contractile force in the heart.
  • Stromal Cells: Connective tissue cells that support the function of an organ or tissue.
  • Ejection Fraction (EF): A measurement of how much blood the left ventricle pumps out with each contraction, used to assess heart function.
  • Heart Failure with Reduced Ejection Fraction (HFrEF): A type of heart failure where the heart's ability to pump blood is reduced, typically with an ejection fraction of 40% or less.
  • New York Heart Association (NYHA) Classification: A system used to classify the severity of heart failure based on symptoms and physical limitations.
  • Implantable Cardioverter-Defibrillator (ICD): A small device implanted in the chest to detect and correct abnormal heart rhythms.
  • Cardiac Resynchronization Therapy Defibrillator (CRT-D): A specialized implantable device that combines the functions of a pacemaker and defibrillator to improve heart function in certain types of heart failure.
  • Hypokinetic: Reduced movement or contraction of a part of the heart muscle.
  • Dyskinetic: Abnormal movement or contraction of a part of the heart muscle.
  • Tricuspid Annular Plane Systolic Excursion (TAPSE): A measure of the movement of the tricuspid valve annulus, used to assess right ventricular function.
  • Major Adverse Cardiac Events (MACE): A composite endpoint in clinical trials that typically includes events such as heart attack, stroke, and cardiovascular death.

References

  1. http://clinicaltrials.eu/trial/study-on-the-safety-and-effectiveness-of-engineered-human-myocardium-for-patients-with-terminal-heart-failure/