Removal of Anti-Angiogenic Proteins in Preeclampsia Before Delivery
Condition: Preeclampsia
MeSH terms: Pre-Eclampsia
Study type: Interventional

Summary: 
      Preeclampsia is a syndrome that occurs in approximately 3% to 8% of pregnancies and is
      associated with considerable maternal and neonatal morbidity and mortality. Except for
      termination of the pregnancy, effective treatments/preventative measures for preeclampsia are
      lacking. Although prolongation of pregnancy benefits the fetus, it is detrimental to the
      mother, and is associated with hypertension, proteinuria, and symptoms that suggest kidney,
      brain, liver and cardiovascular system involvement.

      Placental soluble fms-like tyrosine kinase 1 (sFlt-1) is elevated in women with preeclampsia,
      with levels that fall after delivery. sFlt-1 is a variant of the vascular endothelial growth
      factor (VEGF) receptor Flt-1, and in the circulation, acts as a potent VEGF and placental
      growth factor (PlGF) antagonist. Given that sFlt-1 levels are elevated in preeclampsia, we
      are investigating if removal of sFlt-1 from the plasma of women with preeclampsia can improve
      maternal and fetal outcomes.

      Short-term extracorporeal apheresis with the LIPOSORBER LA-15 System will be the primary
      intervention using methods that have been previously applied in pregnant women with familial
      hypercholesterolemia.
    

Detailed description: 
      The primary objective of this trial is to determine whether short-term apheresis using a
      dextran sulfate adsorption (DSA) column (Liposorber LA-15 System; the Device) leads to a
      reduction in circulating sFLT-1 in the blood of women with pre-term preeclampsia.

      The following secondary objectives are aimed at evaluating the efficacy and safety of the
      Device as well as the impact of removing circulating sFlt-1 on maternal and neonatal
      outcomes:

        1. To determine whether short-term apheresis using the Device in women with pre-term
           preeclampsia leads to:

             -  a prolongation of pregnancy (ie, gestational age)

             -  a reduction in blood pressure (BP) and proteinuria

             -  an increase in fetal birth weight

        2. To determine the safety of reducing maternal sFlt-1 levels using the Device.

      Up to 16 patients will be enrolled. Initially, 4 patients will undergo apheresis UP TO 2
      times in the first week and undergo all protocol-related assessments including PK of sFlt-1
      levels. Based on an assessment of clinical response by the Investigator, these first 4
      patients will be offered the option to continue apheresis treatments (without pharmacokinetic
      [PK] assessments) up to twice weekly until delivery or until 34 weeks gestation, whichever
      comes first. Following complete review of all parameters and outcomes by an independent Data
      Safety Monitoring Board (DSMB), up to 12 additional patients will be enrolled (total of up to
      16).

      UPDATE: The DSMB reviewed data after the first 4 patients and again after 10
      patients/delivered infants had been treated. In the next 6 patients, DSMB review will occur
      after every 3 patients/delivered infants. These remaining 6 patients may undergo apheresis up
      to 3 times per week.
    

Intervention name(s): Apheresis using Liposorber LA-15 System
Intervention type(s): Device
Intervention description(s): The Liposorber LA-15 Device is a dextran sulfate cellulose column, one of several currently approved in Europe and United States for pheresis of lipoproteins in the treatment of familial hypercholesterolemia. Such devices have been in use for over 30 years. Published experience in pregnant women with familial hypercholesterolemia suggests that lipoprotein pheresis can be safely used in pregnancy after appropriate individual benefit/risk assessment for both mother and fetus is considered. The Liposorber LA-15 system selected for this trial has been evaluated for its ability to efficiently and selectively remove sFlt-1 in vitro.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Pregnancy; Preeclampsia; Pre-term; sFlt-1; Apheresis; Hypertension; Proteinuria; VEGF