This application to participate in the CCTRN proposes clinical research skills development program and phase l/ll randomized clinical trial evaluating the safety and efficacy of novel cell-based therapeutic strategy for idiopathic dilated cardiomyopathy (IDCM), a leading cause of heart failure (HF), death and disability. This trial will have major impact in the field of cell-baed therapy for IDCM as new approach to produce durable and sustainable improvements in heart function and to cause reverse remodeling. This trial is built on solid foundation of extensive preclinical and clinical work demonstrating that: 1) intramyocardial cell delivery can be safely and effectively performed using catheter based system in HF patients, and 2) bone marrow-derived mesenchymal stem cells (MSCs) are well tolerated, engraft in injured tissues, and stimulate endogenous cardiac stem cell (CSC) proliferation and differentiation. Accordingly, the hypothesis to be tested is that combining CSCs and MSCs will enhance the therapeutic efficacy relative to use of MSCs alone. The mechanism of action at phenotypic level will be assessed using cardiac MRI to measure regional and global LV function, tissue fibrosis, and tissue perfusion. Post-hoc analysis will be performed to test the hypothesis that in vitro assessments of cell morphology, cell surface markers, and cell colony growth potential may predict ability of individual patient's cells to improve cardiac measures. Cellular mechanisms of action of MSC therapy will be assessed by measuring capacity for endogenous CSC proliferation and differentiation. Endomyocardial biopsies will be obtained and tested for their capacity to yield endogenous CSCs. Our group has extensive experience with catheter delivery of MSCs in patients with ischemic and non-ischemic HF. Accordingly, this study is timely, warranted, and may have major health impact by addressing unmet need in IDCM patients. This program will break new ground in field by testing novel therapeutic approach, combining two cell types that together have synergistic properties demonstrated biologically. Together, these aims will advance our understanding of cell-based therapy for IDCM, with specific emphasis placed upon parameters of patient selection, cell delivery strategies, and the impact of novel cell formulations.

Public Health Relevance

This clinical study will address a significant clinical need, namely the investigation of new and promising cellbased therapies for heart dysfunction due to non-ischemic heart failure (Idiopathic Dilated Cardiomyopathy). The proposed phase l/ll randomized clinical trial will elucidate new insights into the clinical role of cell-based therapy for the treatment of this important disorder that is one of the leading causes of cardiovascular death and disability in the USA

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project with Complex Structure Cooperative Agreement (UM1)
Project #
5UM1HL113460-04
Application #
8815331
Study Section
Special Emphasis Panel (ZHL1-CSR-O (F2))
Program Officer
Ebert, Ray F
Project Start
2012-03-23
Project End
2019-02-28
Budget Start
2015-03-01
Budget End
2016-02-29
Support Year
4
Fiscal Year
2015
Total Cost
$574,293
Indirect Cost
$198,938
Name
University of Miami School of Medicine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
052780918
City
Coral Gables
State
FL
Country
United States
Zip Code
33146
Schulman, Ivonne Hernandez; Khan, Aisha; Hare, Joshua M (2018) Interdisciplinary Stem Cell Institute at the University of Miami Miller School of Medicine. Circ Res 123:1030-1032
Schulman, Ivonne Hernandez; Balkan, Wayne; Hare, Joshua M (2018) Mesenchymal Stem Cell Therapy for Aging Frailty. Front Nutr 5:108
Bolli, Roberto; Hare, Joshua (2018) Introduction to a Compendium on Regenerative Cardiology. Circ Res 123:129-131
Arora, Himanshu; Panara, Kush; Kuchakulla, Manish et al. (2018) Alterations of tumor microenvironment by nitric oxide impedes castration-resistant prostate cancer growth. Proc Natl Acad Sci U S A 115:11298-11303
Premer, Courtney; Schulman, Ivonne Hernandez (2018) Predictive Value of Circulating Progenitor Cells in Acute Coronary Syndrome: Implications for Treatment. Circ Res 122:1491-1493
Mayourian, Joshua; Ceholski, Delaine K; Gorski, Przemek A et al. (2018) Exosomal microRNA-21-5p Mediates Mesenchymal Stem Cell Paracrine Effects on Human Cardiac Tissue Contractility. Circ Res 122:933-944
Premer, Courtney; Schulman, Ivonne H (2018) Have We Been Measuring the Wrong Form of Vitamin D? Circ Res 123:934-935
Starke, Robert M; Thompson, John W; Ali, Muhammad S et al. (2018) Cigarette Smoke Initiates Oxidative Stress-Induced Cellular Phenotypic Modulation Leading to Cerebral Aneurysm Pathogenesis. Arterioscler Thromb Vasc Biol 38:610-621
Bagno, Luiza; Hatzistergos, Konstantinos E; Balkan, Wayne et al. (2018) Mesenchymal Stem Cell-Based Therapy for Cardiovascular Disease: Progress and Challenges. Mol Ther 26:1610-1623
Kanelidis, Anthony J; Premer, Courtney; Lopez, Juan et al. (2017) Route of Delivery Modulates the Efficacy of Mesenchymal Stem Cell Therapy for Myocardial Infarction: A Meta-Analysis of Preclinical Studies and Clinical Trials. Circ Res 120:1139-1150

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