Conference Coverage

Cardiosphere-derived cells may reverse Duchenne heart scarring

Key clinical point: One-time infusion of cardiosphere-derived cells (CDCs) into the three major coronary arteries seemed to prevent and perhaps even reverse cardiac scarring, as well as improve arm function, in boys with advanced Duchenne muscular dystrophy.

Major finding: At 12 months, cardiac scarring increased about 5% in the control group, but decreased about 7% in the treatment arm, although with no change in ejection fraction (P = .03).

Study details: HOPE-Duchenne, an open-label, phase 1-2 trial involving 25 boys

Disclosures: The study was funded by Capricor Therapeutics, makers of the CDC preparation tested. Several investigators were Capricor employees. Others were consultants or reported ownership interests. The senior investigator and presenter was on the trial’s steering committee.

Source: Victor R, et al. 2017 AHA Scientific Sessions abstract number S1177.

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Elevated troponin a concern

This is a tough disease, and therapies are desperately needed.

The HOPE-Duchenne data look pretty good, and everything seems to be moving in the same direction, but 13 people treated for even 12 months doesn’t really tell us much about safety.

Catherine Hackett/Frontline Medical News

Dr. Robert M. Califf

There is a signal for atrial fibrillation, and every one of these boys had a troponin elevation. That is a signal of some harm, although not clinical harm.

The pipeline for this disease is filling up, but a lot of therapies are aimed at younger patients with the hopes of keeping them functional for as long as possible. I’m glad to see a treatment aimed at more advanced disease.

In general, when the choice is made to enter a clinical trial, it may mean you can’t enter another clinical trial, and these people are in a desperate situation. We need to sort out what should be tested, not just what can be tested.

Robert M. Califf, MD, is professor of cardiology at Duke University, Durham, N.C. He was the study discussant, and wasn’t involved in the work.


 

REPORTING FROM THE AHA SCIENTIFIC SESSIONS

ANAHEIM, CALIF. – One-time infusion of cardiosphere-derived cells into the three major coronary arteries seemed to prevent and perhaps even reverse cardiac scarring, as well as improve arm function, in the open-label phase 1-2 HOPE-Duchenne trial of 25 boys with advanced Duchenne muscular dystrophy.

“Decreased scarring is really a big deal because this is counter to the natural history of Duchenne, where all the scars progress, senior investigator Ronald G. Victor, MD , said at the American Heart Association scientific sessions. “It was gratifying to see that the changes in scar coincided with improved regional systolic wall thickening, particularly in the inferior wall of the left ventricle, which is the very area disproportionately affected early and thus severely in Duchenne.”

Dr. Ronald G. Victor

The reason for the excitement is that Duchenne muscular dystrophy, a genetic disorder affecting mostly boys, is one of the toughest diagnoses in pediatric medicine. “It’s a devastating muscle-wasting disease leading to progressive fibrosis in both skeletal and cardiac muscle.” Boys lose the ability to walk by age 12-15, and typically die from heart or respiratory failure by age 25, said Dr. Victor, professor of cardiology and chair of cardiology research at Cedars-Sinai Medical Center, Los Angeles.

Glucocorticoids are the only thing that help to date, prolonging ambulation by about 3 years, but with Cushingoid features and other well-known side effects.

Cardiosphere-derived cells (CDCs) – cardiac progenitor cells – have shown some promise for heart failure. They don’t seem to engraft and grow, but rather to release extracellular vesicles packed with proteins, RNA, and other bioactive molecules. “They act as a role model to get endogenous cells to do the right thing. That’s what we think,” Dr. Victor said.

The HOPE-Duchenne trial [Halt Cardiomyopathy Progression in Duchenne] randomized 12 boys with Duchenne to usual care and 13 others to usual care plus a single infusion of 75 million CDCs divided equally among the left anterior descending, circumflex, and right coronary arteries. The cells were derived from donated heart muscle. The specific CDC preparation tested was “CAP-1002” from Capricor Therapeutics , the study’s sponsor.

The boys were aged 12-22 years, with a mean age of 17.8 years. They had left ventricle scarring in at least four MRI segments; their mean left ventricle ejection fraction was just below 50%; 68% were wheel-chair bound, and all were on stable steroid regimens.

At 12 months, cardiac scarring had increased about 5% in the control group, but decreased by about 7% in the treatment arm, although with no change ejection fraction improvement (P = .03).

Skeletal muscle was assessed by mid-level and distal performance of upper limb scoring, a measure of arm function developed specifically for Duchenne. “For patients who have lost ambulation, the ability to use a joystick to drive a scooter, the ability to feed themselves and use a computer and cellphone are absolutely key to quality of life,” he said.

At 12 months, performance of upper limb scores were largely unchanged in the control group, but improved in about half of the treated boys. “A couple were quite dramatic,” Dr. Victor said. The differences were statistically significant (P = .007) when limited to subjects who started with scores below 55 points, with 58 points meaning normal function.

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