Ignite Creation Date:
2024-10-26 @ 3:42 PM
Last Modification Date:
2024-10-26 @ 3:42 PM
Study NCT ID:
NCT06634108
Status:
RECRUITING
Last Update Posted:
None
First Post:
2024-05-29
Brief Title:
Genistein in trAnSthyretin recePtor Amyloid caRdiomyopathy
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Cardiovascular Genistein Therapy for Heart Failure Inflammation
Status:
RECRUITING
Status Verified Date:
2024-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
GASPAR
Brief Summary:
This Phase 1b2a study aims to investigate the safety and efficacy of genistein in patients with Transthyretin TTR Amyloidosis The focus is on its impact on inflammatory and cardiometabolic biomarkers along with the effects on cardiac function and exercise capacity
Blood samples will be collected at baseline following each dose of genistein and after a six-week placebo washout period These samples will undergo extensive analyses including profiling for inflammatory cytokines and novel molecular markers and routine tests like CBC Chem 7 LFT HbA1c NT-proBNP CRP troponin T and serum TTR RNA-seq analyses on peripheral blood mononuclear cells PBMCs and isolation of plasma exosomes for inflammatory biomarkers are also part of the protocol
Following ESCAHA guidelines echocardiography will assess cardiac structure and function focusing on the left and right ventricles and valvular function Additionally exercise capacity will be evaluated through a standardized 6-minute walk test and NT-proBNP levels will be measured as a cardiac stress biomarker
The trial will include an 18-week follow-up period post-enrolment with the primary endpoint being the change in inflammatory markers from baseline to three months Secondary endpoints are cardiac function and exercise capacity changes over the same timeframe This study aims to provide significant insights into genisteins therapeutic potential for TTR Amyloidosis and its broader implications in managing heart failure
Following ethical committee approval and written informed consent the Investigators aim is to enroll 40 participants This is an open-label study Each patient will receive genistein by mouth 250 mg twice a day for 4 weeks 500 mg totalday 500 mg twice a day for 4 weeks 1000 mg totalday and 750 mg twice a day 1500 mg totalday for an additional 4 weeks This will be followed by a 6-week washout period to conclude the study An 18-month study is anticipated based on the average enrollment rates Results from this study are expected to offer critical insights for future larger studies
Blood samples will be collected at baseline following each dose of genistein and after a six-week placebo washout period These samples will undergo extensive analyses including profiling for inflammatory cytokines and novel molecular markers and routine tests like CBC Chem 7 LFT HbA1c NT-proBNP CRP troponin T and serum TTR RNA-seq analyses on peripheral blood mononuclear cells PBMCs and isolation of plasma exosomes for inflammatory biomarkers are also part of the protocol
Following ESCAHA guidelines echocardiography will assess cardiac structure and function focusing on the left and right ventricles and valvular function Additionally exercise capacity will be evaluated through a standardized 6-minute walk test and NT-proBNP levels will be measured as a cardiac stress biomarker
The trial will include an 18-week follow-up period post-enrolment with the primary endpoint being the change in inflammatory markers from baseline to three months Secondary endpoints are cardiac function and exercise capacity changes over the same timeframe This study aims to provide significant insights into genisteins therapeutic potential for TTR Amyloidosis and its broader implications in managing heart failure
Following ethical committee approval and written informed consent the Investigators aim is to enroll 40 participants This is an open-label study Each patient will receive genistein by mouth 250 mg twice a day for 4 weeks 500 mg totalday 500 mg twice a day for 4 weeks 1000 mg totalday and 750 mg twice a day 1500 mg totalday for an additional 4 weeks This will be followed by a 6-week washout period to conclude the study An 18-month study is anticipated based on the average enrollment rates Results from this study are expected to offer critical insights for future larger studies
Detailed Description:
BACKGROUND
Heart Failure HF is a complex clinical syndrome when the heart cannot meet the metabolic demands of the body HF is a growing health and economic burden in the United States Between 2013 to 2017 there were over 12 million hospitalizations per year and costs of over 30 billion per year The prognosis of HF is quite poor with the number of deaths per year increasing from 275000 in 2009 to 310000 in 2014
HF is caused by ischemic cardiomyopathy valvular disease and non-ischemic cardiomyopathy which includes infiltrative cardiac disease such as amyloidosis The link between inflammation and HF is well characterized and plays a significant role in heart failure The immune system is activated in response to myocardial injury decreased peripheral perfusion or neurohormonal activation Cytokines are released from inflammatory cells and destabilize cardiovascular function When a cardiomyocyte is damaged by infarction or stretch from volume or pressure overload the surrounding myocytes secrete inflammatory cytokines that further exacerbate HF
Inflammatory cytokines serve as reliable indicators of HF severity providing prognostic value and a means to assess the effectiveness of therapeutic interventions A host of inflammatory cytokines such as interleukin-6 IL-6 interleukin-8 IL-8 tumor necrosis factor-a TNF-alpha and interferon g IFN-gamma have been identified as key players in the pathogenesis of HF Chronic HF management includes correcting the underlying cause treating symptoms and long-term pharmacological and device therapy In the chronic setting pharmacological interventions such as β-blockers ACE inhibitors aldosterone antagonists and sodium-glucose cotransporter-2 inhibitors SGLT2i combined with implantable cardioverter-defibrillator ICD and cardiac resynchronization therapy CRT can markedly improve symptoms and survival
GENISTEIN
Genistein a soybean derivative can potentially reduce inflammation and oxidative stress as demonstrated in numerous preclinical models It has been studied extensively and has no known adverse side effects Moreover it does not significantly interact with cardiac medications
Genistein has emerged as an interesting compound due to its anti-inflammatory and antioxidant properties Acting as an antagonist to cannabinoid receptor 1 genistein can influence several pathways implicated in the exacerbation of heart failure primarily inflammation and oxidative stress Evidence from preclinical models has highlighted genisteins capacity to modulate immune responses and alleviate oxidative stress which are instrumental in the inflammatory processes underlying heart failure Moreover genistein has demonstrated cardio-protective effects in various in vitro and animal studies suggesting a therapeutic potential that warrants further clinical exploration
ATTR PATHOGENESIS
Transthyretin amyloid cardiomyopathy ATTR-CM is an often-overlooked form of amyloidosis that leads to restrictive cardiomyopathy and progressive heart failure This condition predominantly affects the elderly and patients with hypertrophic cardiomyopathy ATTR-CM results from the aggregation of misfolded transthyretin TTR proteins which form amyloid fibrils that deposit in the cardiac tissue These deposits can disrupt normal cardiac architecture and function precipitating diastolic dysfunction and heart failure
The misfolding and aggregation of TTR a protein responsible for transporting thyroxine and retinol-binding protein can be attributed to genetic mutations or age-related changes genistein has been shown to bind and stabilize TTR potentially inhibiting its misfolding and subsequent fibril formation This stabilization presents a novel approach that could impede the progression of ATTR-CM
STUDY RATIONALE
A notable pathogenic process associated with aging or mutation involves the misfolding of Transthyretin TTR leading to its aberrant assembly into amyloid This misassembly causes conditions such as amyloidosis familial amyloid neuropathy and amyloid cardiomyopathy Small molecules have been found to stabilize the native tetramer by binding to the thyroid hormone binding sites of TTR
The current clinical trial is designed to address a pivotal gap in heart failure treatment by integrating genistein as an adjunct therapy alongside the standard of care tafamidis By targeting both the inflammatory mechanisms implicated in heart failure and the molecular pathogenesis of ATTR-CM the study positions genistein as a potential modifier of disease progression
Recognized for its commendable safety profile and the absence of reported major adverse side effects genistein holds the potential to address ATTR-CM The adjunctive use of genistein could enhance tafamidis therapy offering a dual approach to stabilize TTR and mitigate inflammation This study is poised to contribute significantly to the heart failure therapeutic landscape potentially improving outcomes for patients with ATTR amyloid cardiomyopathy By exploring genisteins role in conjunction with established therapies this research may pave the way for novel more effective treatment regimens for heart failure particularly in those with or at risk for ATTR-CM
Heart Failure HF is a complex clinical syndrome when the heart cannot meet the metabolic demands of the body HF is a growing health and economic burden in the United States Between 2013 to 2017 there were over 12 million hospitalizations per year and costs of over 30 billion per year The prognosis of HF is quite poor with the number of deaths per year increasing from 275000 in 2009 to 310000 in 2014
HF is caused by ischemic cardiomyopathy valvular disease and non-ischemic cardiomyopathy which includes infiltrative cardiac disease such as amyloidosis The link between inflammation and HF is well characterized and plays a significant role in heart failure The immune system is activated in response to myocardial injury decreased peripheral perfusion or neurohormonal activation Cytokines are released from inflammatory cells and destabilize cardiovascular function When a cardiomyocyte is damaged by infarction or stretch from volume or pressure overload the surrounding myocytes secrete inflammatory cytokines that further exacerbate HF
Inflammatory cytokines serve as reliable indicators of HF severity providing prognostic value and a means to assess the effectiveness of therapeutic interventions A host of inflammatory cytokines such as interleukin-6 IL-6 interleukin-8 IL-8 tumor necrosis factor-a TNF-alpha and interferon g IFN-gamma have been identified as key players in the pathogenesis of HF Chronic HF management includes correcting the underlying cause treating symptoms and long-term pharmacological and device therapy In the chronic setting pharmacological interventions such as β-blockers ACE inhibitors aldosterone antagonists and sodium-glucose cotransporter-2 inhibitors SGLT2i combined with implantable cardioverter-defibrillator ICD and cardiac resynchronization therapy CRT can markedly improve symptoms and survival
GENISTEIN
Genistein a soybean derivative can potentially reduce inflammation and oxidative stress as demonstrated in numerous preclinical models It has been studied extensively and has no known adverse side effects Moreover it does not significantly interact with cardiac medications
Genistein has emerged as an interesting compound due to its anti-inflammatory and antioxidant properties Acting as an antagonist to cannabinoid receptor 1 genistein can influence several pathways implicated in the exacerbation of heart failure primarily inflammation and oxidative stress Evidence from preclinical models has highlighted genisteins capacity to modulate immune responses and alleviate oxidative stress which are instrumental in the inflammatory processes underlying heart failure Moreover genistein has demonstrated cardio-protective effects in various in vitro and animal studies suggesting a therapeutic potential that warrants further clinical exploration
ATTR PATHOGENESIS
Transthyretin amyloid cardiomyopathy ATTR-CM is an often-overlooked form of amyloidosis that leads to restrictive cardiomyopathy and progressive heart failure This condition predominantly affects the elderly and patients with hypertrophic cardiomyopathy ATTR-CM results from the aggregation of misfolded transthyretin TTR proteins which form amyloid fibrils that deposit in the cardiac tissue These deposits can disrupt normal cardiac architecture and function precipitating diastolic dysfunction and heart failure
The misfolding and aggregation of TTR a protein responsible for transporting thyroxine and retinol-binding protein can be attributed to genetic mutations or age-related changes genistein has been shown to bind and stabilize TTR potentially inhibiting its misfolding and subsequent fibril formation This stabilization presents a novel approach that could impede the progression of ATTR-CM
STUDY RATIONALE
A notable pathogenic process associated with aging or mutation involves the misfolding of Transthyretin TTR leading to its aberrant assembly into amyloid This misassembly causes conditions such as amyloidosis familial amyloid neuropathy and amyloid cardiomyopathy Small molecules have been found to stabilize the native tetramer by binding to the thyroid hormone binding sites of TTR
The current clinical trial is designed to address a pivotal gap in heart failure treatment by integrating genistein as an adjunct therapy alongside the standard of care tafamidis By targeting both the inflammatory mechanisms implicated in heart failure and the molecular pathogenesis of ATTR-CM the study positions genistein as a potential modifier of disease progression
Recognized for its commendable safety profile and the absence of reported major adverse side effects genistein holds the potential to address ATTR-CM The adjunctive use of genistein could enhance tafamidis therapy offering a dual approach to stabilize TTR and mitigate inflammation This study is poised to contribute significantly to the heart failure therapeutic landscape potentially improving outcomes for patients with ATTR amyloid cardiomyopathy By exploring genisteins role in conjunction with established therapies this research may pave the way for novel more effective treatment regimens for heart failure particularly in those with or at risk for ATTR-CM
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None