Due to multiple factors, time to administration of lytic therapy or emergent percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) may be delayed, resulting in loss of additional myocardial tissue. These delays are virtually impossible to overcome in remote regions, and are associated with increased mortality. Recent small animal studies show the potential for oxygen therapeutic nanoparticles - dodecafluoropentane e m u l s i o n (DDFPe) to reduce both myocardial infarct and stroke size duringprolongedmyocardialischemia.Ourrecentdataina murineacute STEMIm o d e l indicatesthatasingledoseofDDFPedecreasesmyocardialdamageby75%inmodelsthat examineischemiaalone,andbyabout30%inmodelswithischemiawithreperfusion(I/R),alongwith significantreductioninapoptosis.ThedosesusedintheI/Rmodelswereone-thirdthedoseusedinthe ischemiaalonemodel.IVDDFPesignificantlydecreasesbraindamageinanI/Rstrokemodel.However,the efficacyofDDFPehasnotbeentestedinalargeanimalmodel,orinmodelsofprolongedmyocardialischemia followedbyreperfusioninaclinicallyrelevantsettingmimickingatheroscleroticplaquerupture.We hypothesizethatuseofthesenanoparticlesearlyinthecareofacuteSTEMIwilldecreaseoreliminate myocardialdamagefromprolongedmyocardialischemiafollowedbyreperfusion.Firstwewilldemonstratethe abilityofDDFPetoreachtheriskareainacuteischemiaviacollateralflow,andreducetheformationof mitochondrialreactiveoxygenspeciesthataretheprimarymediatorsinischemiareperfusioninjury.Wewill correlateDDFPedeliverywithregionalmyocardialbloodflowusingneutronactivatedmicrospheres(NAM). Secondly,wewilladministerIVDDFPeduringaprolongedfour-hourperiodofmyocardialischemiainan atheroscleroticpigmodel,followedbyreperfusion.DDFPepresencewithintheriskareawillbecorrelatedwith regionalmyocardialbloodflowintheriskarea.AtfourweekspostinfarctionwewillexamineLVejection fractionwithmagneticresonanceimaging(MRI),numberofinfarctedsegmentswithdelayedenhancement MRI,andactualinfarctsizewithpost-mortemEvansBlueandtriphenyltetrazoliumchloridestaining.DDFPe hasatwo-yearshelf-lifeandhasanactiveINDforstroke.Verificationofitseffectivenessinthistrialwouldlead toINDsubmissionforacardioprotectiontrial.DDFPecouldbedeployedintheambulanceoruponarrivalto thehospitaltomaintaintissueoxygenationandreduceI/Rdamagefollowingpercutaneouscoronary revascularization.ThiswouldhaveprofoundimplicationsintheearlymanagementofacuteSTEMI,asthe abilityofthisoxygentherapeutictoreduceischemicdamageduetohypoxiacouldprolongthetime window in which patients would be eligible for percutaneousinterventions, andallowpatientseveninremotelocations toreachdefinitive care. Ultimately we predict this will preserve ejection fraction and prevent heart failure and arrhythmic complications f o l l o w i n g S T E M I that still complicate current state of the art therapies.

Public Health Relevance

Thisprojectwilltestwhetheranultrasoundcontrastagentwhichcancarrylargequantitiesofoxygen (oxygentherapeutic)canbeusedtoreduceheartdamageinheartattackvictims.Thistherapeutic,if proveneffective,mayhaveprofoundimpactontheamountofheartdamagecausedbyaheartattack, andallowpatientstosurviveeveniftheirheartattackoccursinregionsthatarelongdistancesfrom hospitals.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Small Business Innovation Research Grants (SBIR) - Phase I (R43)
Project #
1R43HL137545-01
Application #
9348460
Study Section
Special Emphasis Panel (ZRG1-CVRS-C (10)B)
Program Officer
Schwartz, Lisa
Project Start
2017-04-01
Project End
2018-03-31
Budget Start
2017-04-01
Budget End
2018-03-31
Support Year
1
Fiscal Year
2017
Total Cost
$317,743
Indirect Cost
Name
Nuvox Pharma, LLC
Department
Type
Domestic for-Profits
DUNS #
825136141
City
Tucson
State
AZ
Country
United States
Zip Code
85719