Safety Evaluation of Intracoronary Infusion of Extracellular Vesicles in Patients Following Coronary Stent Implantation

Study Overview
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Brief Summary
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The purpose of this study is to determine the safety of using a biological drug called PEP in people who have had a coronary stent placed. A biological drug is a substance that is made from a living organism or its products (parts). In this case, PEP is made of certain parts of blood from living blood donors obtained from a certified blood bank. PEP comes in a powder form and is mixed with heparinized saline (a solution used to prevent clots in catheters) to create a solution that can be injected. The investigators want to see if PEP can be used to stop or slow heart damage.

Detailed Description
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Patients who undergo Percutaneous Coronary Intervention (PCI) will be treated with a single dose of PEP within 20 minutes after stent placement or post-dilation (whichever is last). Subjects will be screened at the time of emergency room presentation. Subjects will be treated in the cardiac catheterization laboratory where the PCI will be completed and PEP will be administered. Subjects will be followed for one year after PEP administration through clinic visits.

Official Title
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Safety Evaluation of Intracoronary Infusion of Extracellular Vesicles in Patients Following Coronary Stent Implantation (EV-CSI)

Conditions
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Percutaneous Coronary Intervention

Intervention / Treatment
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* Drug: PEP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Undergoing ≥1 elective, urgent, or emergent coronary stent implantation Angiographic evidence of TIMI 3 flow through the stented vessel after stent placement Angiographic evidence of residual stenosis visually <30% after stent placement Willing and able to provide signed informed consent Lives within 90 mile radius of study site Willing and able to return to study site for all follow-up visits Exclusion Criteria: Prior solid organ transplantation at any time Pregnant or lactating at screening Known presence of chronic systemic inflammatory disorder that requires ongoing therapy with immunosuppressive agents Known immune system compromise including but not limited to human immunodeficiency virus (HIV), hepatitis A, hepatitis B (HBV) or hepatitis C (HCV) infection Known history of malignancy of any type except non-melanoma skin cancer Known serum creatinine >2 mg/dL or GFR ≤30 mL/min within the last twelve months Known AST, ALT, and/or bilirubin (total) elevated twice the upper limit of normal for age & gender within the last twelve months Known Hemoglobin lower than 8.0 g/dL within the last twelve months Known current illicit drug use at screening Other major surgical procedure or major trauma within the previous 14 days prior to enrollment Female of child bearing potential who is unwilling to agree to use acceptable contraception methods for 3 months after receiving the investigational drug Pacemaker/ICD implant in place Adult lacking decision-making capacity Prisoner Non-English speaking English-speaking but illiterate Legally blind Known allergy to heparin or heparin-induced thrombocytopenia Known history of positive SARS-CoV2 testing within the last 30 days DNR/DNI status prior to PCI procedure or planned DNR/DNI status after PCI procedure Homeless or no permanent address at the time of enrollment

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PEP in Coronary Stent Implantation<br>Patients undergoing a percutaneous coronary intervention (PCI) and possible stent placement procedure will receive a one-time intracoronary infusion of PEP within 20 minutes after stent placement or post-dilation (whichever comes last). | Drug: PEP<br>* A biological drug made of certain parts of blood from living blood donors obtained from a certified blood bank. At the time of cardiac catheterization patients will undergo one-time intracoronary infusion of 10 milliliters of PEP dosage consisting of approximately 5%, 10%, or 20% PEP. PEP dose will be infused immediately distal to the newly placed stent over approximately 5 minutes.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dose limiting toxicities (DLTs) and maximum tolerated dose (MTD) of a single dose (10 mL) of PEP at escalating concentrations of extracellular vesicles delivered at a single time point (after PCI). | DLTs are defined as: signs of infection present in the judgement of a reviewing MD, CTCAE Grade 2 or higher bronchial stricture (rhonchi/wheezing), or CTCAE Grade 3 or higher defined as new or reoccurring angina or anginal equivalent after infusion with PEP; elevated ALT, AST, total or direct bilirubin, unless due to procedural complications or complications of ischemic cardiomyopathy (ICM); decreased hemoglobin or platelet level, unless due to procedural complications or complications of ICM; sustained ventricular arrhythmia during PEP infusion; hypersensitivity or anaphylaxis during PEP infusion; any other grade 3 or higher adverse event. | Days 1-14 of the study period for each study participant. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Infarction scar size | Cardiac MRI will be used to assess myocardial infarction scar size. | Day 7 and Day 40 of the study period for each study participant. | 
| Ejection fraction | Cardiac MRI will be used to assess ejection fraction. | Day 7 and Day 40 of the study period for each study participant. | 
| Alloimmune Response | Class I & II Antibody Single Antigen Bead testing will be completed. Changes will be documented and evaluated. | Day 1 (Baseline/Screening) visit, Day 40 and Day 365 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary Stent Placement