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Lyon AR, Babalis D, Morley-Smith AC, Hedger M, Suarez Barrientos A, Foldes G, Couch LS, Chowdhury RA, Tzortzis KN, Peters NS, Rog-Zielinska EA, Yang HY, Welch S, Bowles CT, Rahman Haley S, Bell AR, Rice A, Sasikaran T, Johnson NA, Falaschetti E, Parameshwar J, Lewis C, Tsui S, Simon A, Pepper J, Rudy JJ, Zsebo KM, Macleod KT, Terracciano CM, Hajjar RJ, Banner N, Harding SE. Investigation of the safety and feasibility of AAV1/SERCA2a gene transfer in patients with chronic heart failure supported with a left ventricular assist device - the SERCA-LVAD TRIAL. Gene Ther 2020; 27:579-590. [PMID: 32669717 PMCID: PMC7744277 DOI: 10.1038/s41434-020-0171-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 01/05/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023]
Abstract
The SERCA-LVAD trial was a phase 2a trial assessing the safety and feasibility of delivering an adeno-associated vector 1 carrying the cardiac isoform of the sarcoplasmic reticulum calcium ATPase (AAV1/SERCA2a) to adult chronic heart failure patients implanted with a left ventricular assist device. The SERCA-LVAD trial was one of a program of AAV1/SERCA2a cardiac gene therapy trials including CUPID1, CUPID 2 and AGENT trials. Enroled subjects were randomised to receive a single intracoronary infusion of 1 × 1013 DNase-resistant AAV1/SERCA2a particles or a placebo solution in a double-blinded design, stratified by presence of neutralising antibodies to AAV. Elective endomyocardial biopsy was performed at 6 months unless the subject had undergone cardiac transplantation, with myocardial samples assessed for the presence of exogenous viral DNA from the treatment vector. Safety assessments including ELISPOT were serially performed. Although designed as a 24 subject trial, recruitment was stopped after five subjects had been randomised and received infusion due to the neutral result from the CUPID 2 trial. Here we describe the results from the 5 patients at 3 years follow up, which confirmed that viral DNA was delivered to the failing human heart in 2 patients receiving gene therapy with vector detectable at follow up endomyocardial biopsy or cardiac transplantation. Absolute levels of detectable transgene DNA were low, and no functional benefit was observed. There were no safety concerns in this small cohort. This trial identified some of the challenges of performing gene therapy trials in this LVAD patient cohort which may help guide future trial design.
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Affiliation(s)
- A R Lyon
- National Heart and Lung Institute, Imperial College London, London, UK. .,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK.
| | - D Babalis
- Imperial Clinical Trials Unit (ICTU), School of Public Health, Imperial College London, London, UK
| | - A C Morley-Smith
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - M Hedger
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - A Suarez Barrientos
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - G Foldes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - L S Couch
- National Heart and Lung Institute, Imperial College London, London, UK
| | - R A Chowdhury
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K N Tzortzis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - N S Peters
- National Heart and Lung Institute, Imperial College London, London, UK
| | - E A Rog-Zielinska
- National Heart and Lung Institute, Imperial College London, London, UK.,Institute for Experimental Cardiovascular Medicine, University Heart Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - H-Y Yang
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Welch
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - C T Bowles
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - S Rahman Haley
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - A R Bell
- Department of Histopathology, Royal Brompton and Harefield Hospitals NHS Trust, Freiburg, Germany
| | - A Rice
- Department of Histopathology, Royal Brompton and Harefield Hospitals NHS Trust, Freiburg, Germany
| | - T Sasikaran
- Imperial Clinical Trials Unit (ICTU), School of Public Health, Imperial College London, London, UK
| | - N A Johnson
- Imperial Clinical Trials Unit (ICTU), School of Public Health, Imperial College London, London, UK
| | - E Falaschetti
- Imperial Clinical Trials Unit (ICTU), School of Public Health, Imperial College London, London, UK
| | | | - C Lewis
- Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - S Tsui
- Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - A Simon
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - J Pepper
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - J J Rudy
- Celladon Corporation, San Diego, CA, USA
| | - K M Zsebo
- Celladon Corporation, San Diego, CA, USA
| | - K T Macleod
- National Heart and Lung Institute, Imperial College London, London, UK
| | - C M Terracciano
- National Heart and Lung Institute, Imperial College London, London, UK
| | - R J Hajjar
- Phospholamban Foundation, Amsterdam, Netherlands
| | - N Banner
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
| | - S E Harding
- National Heart and Lung Institute, Imperial College London, London, UK
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