The Enhanced Angiogenic Cell Therapy in Acute Myocardial Infarction (ENACT-AMI) trial

ISRCTN ISRCTN47943321
DOI https://doi.org/10.1186/ISRCTN47943321
ClinicalTrials.gov number NCT00936819
Secondary identifying numbers MCT-90169
Submission date
12/02/2010
Registration date
17/02/2010
Last edited
07/03/2025
Recruitment status
No longer recruiting
Overall study status
Ongoing
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Duncan J Stewart
Scientific

Ottawa Hospital General Campus
Sprott Centre for Stem Cell Research
501 Smyth Road, Critical Care Wing - 5th Floor
Room 5206 - Box 511
Ottawa
K1H 8L6
Canada

Phone +1 613 737 8899 ext. 79017
Email djstewart@toh.ca
Ms Leslie Carlin
Scientific

Regenerative Medicine Clinical Research
Ottawa Hospital Research Institute (OHRI)
1053 Carling Ave.
Admin. Services Bldg, Rm 2-010, Box 693
Ottawa
K1Y 4E9
Canada

Phone +1 (0)819 665 8477
Email lcarlin@ohri.ca

Study information

Study designPhase IIb double-blind parallel randomized placebo-controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleEnhanced Angiogenic Cell Therapy in Acute Myocardial Infarction: a multicentre, phase IIb randomised placebo-controlled trial
Study acronymENACT-AMI
Study objectivesThe primary objectives of this study are to determine whether endothelial-like culture modified mononuclear cell (E-CMM) therapy is effective in improving cardiac function following acute myocardial infarction, and whether eNOS transfected E-CMMs are superior to non-transfected E-CMMs.

A secondary objective is to determine whether the efficacy of E-CMM therapy depends on the timing of cell therapy (5 - 10 days versus 11 - 30 days).
Ethics approval(s)Approved 11/11/2011, Health Canada (Biologics and Genetics Therapies Directorate, Address Locator #0701B, Ottawa, Ontario, K1A 0K9, Canada; +1 (0)613 863 8405; brdd.dgo.enquiries@hc.sc.gc.ca), ref: Control # 150429 / File # 9427-O0476-39C
Health condition(s) or problem(s) studiedAcute myocardial infarction
InterventionAfter providing informed consent, all participants who meet the eligibilty criteria will undergo apheresis. Apheresis is performed to obtain mononuclear cells from the participant's blood. These cells are sent to a site-specific cell manufacturing lab where they will be processed according to the random allocation. The random allocation will be to:
1. Endothelial-like circulating mononuclear cells (E-CMMs)
2. E-CMMs transfected with human eNOS
3. Plasma-lyte A

Approximately 5 days later, the participant will receive the study treatment via intracoronary injection through the distal stent of the IRA during coronary angiography in the catheterisation suite. Study follow-up will include clinic visits the day after cell therapy, at 6 weeks, 3 and 6 months post-injection.
Intervention typeOther
Primary outcome measureChange in global left ventricular ejection fraction (LVEF) from baseline to 6 months after study treatment as determined by magnetic resonance imaging (MRI).
Secondary outcome measuresChanges from baseline to 6 months after study treatment of:
1. Regional wall motion, wall thickening and infarct volume as determined by cardiac MRI
2. Echocardiographic assessment of LVEF and ventricular volumes
3. Time to clinical worsening (death, hospitalisation for angina, reinfarction)
4. Quality of life (36-item short form health survey [SF-36] and Duke Activity Status Index [DASI] questionnaires)
Overall study start date01/05/2010
Completion date18/09/2029

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
Upper age limit75 Years
SexBoth
Target number of participants100
Total final enrolment47
Key inclusion criteria1. Male or female 18 - 75 years of age
2. Clinical diagnosis of ST-elevation myocardial infarction (MI) of greater than 1 mm in two adjacent electrocardiogram (ECG) limb leads, or greater than 2 mm in two adjacent ECG precordial leads, or a new left bundle branch block and an increase in cardiospecific enzymes (creatine kinase [CK] greater than 3 x upper limit of normal [ULN]), and either positive myocardial bands (MB) fraction or increase in troponin compared to institutional laboratory normal ranges
3. Patients who have suffered an acute Q-wave MI within the preceding 30 days prior to inclusion and have undergone percutaneous coronary intervention (PCI) with stent implantation in the infarct-related artery (IRA)
4. Culprit artery must have distal flow greater than thrombolysis in myocardial infarction (TIMI) 1
5. Left ventricular ejection fraction (LVEF) less than or equal to 45% by echocardiography (Simpson's Method) performed at least 2 days after onset of chest pain
6. In the case of previous MI, must have documentation of LVEF greater than 45% prior to index AMI
7. Females who are surgically sterile, or are post-menopausal, or have documented infertility, or are of child-bearing potential using one of the following methods of contraception:
7.1. Barrier-type devices (e.g., condom, diaphragm) used in combination with a spermicide; a double barrier method is recommended
7.2. Intrauterine devices (IUDs)
7.3. Oral or implanted contraceptives, if used in combination with a barrier method
8. Provided written informed consent
Key exclusion criteria1. Significant unprotected left main disease (greater than 50% stenosis) on diagnostic angiography
2. Planned coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) for a coronary stenosis greater than 70% in the non-infarct related artery (IRA)
3. History of sustained ventricular arrhythmias not related to AMI (evidenced by previous holter monitoring +/- medication history for sustained ventricular arrhythmias in the subject's medical chart
4. History of cerebrovascular accident or transient ischaemic attack less than or equal to 6 months
5. Any exclusion to magnetic resonance imaging (MRI) (includes already implanted automatic internal defibrillator or permanent pacemaker). Recent stent implantation is NOT an exclusion to MRI.
6. Persistent haemodynamic instability (need for ongoing pharmacological or mechanical support greater than 24 hours of the onset of chest pain)
7. Mechanical ventilatory support
8. Significant cardiac valvular disease
9. Left ventricular (LV) dysfunction from any other cause (e.g., non-ischaemic cardiomyopathy, collagen diseases)
10. Clinical evidence of persistent heart failure not responding to standard oral therapy
11. Clinical evidence of persistent ischaemia at time of cell therapy
12. Current pregnancy or nursing mothers
13. Known history of human immunodeficiency virus (HIV)
14. Known history of hepatitis B or C (hepatitis B surface antigen [HBsAg], hepatitis B [HB] core, hepatitis C [HC] antibody)
15. History of untreated ethanol (ETOH) or drug abuse
16. Creatinine clearance less than 60 by Cockcroft-Gault calculator (SI units)
17. Contraindications to apheresis (inadequate venous access or haematological exclusions)
18. Evidence of active infection
19. Significant co-morbidity (e.g., immunocompromise, hepatic failure)
20. Known history of malignancy in the past 5 years (except for low-grade and fully resolved non-melanoma skin cancer)
21. Known allergy to gentamycin and amphotericin
22. Patients receiving other investigational drug or device therapy within 30 days of screening
23. Patients who have received gene therapy
24. Inability ot provide informed consent and comply with the follow-up visit schedule
Date of first enrolment01/05/2010
Date of final enrolment15/09/2019

Locations

Countries of recruitment

  • Canada

Study participating centre

Ottawa Hospital General Campus
Ottawa
K1H 8L6
Canada

Sponsor information

Ottawa Hospital Research Institute (OHRI) (Canada)
Research organisation

Ottawa Hospital General Campus
Sprott Centre for Stem Cell Research
501 Smyth Road, Critical Care Wing - 5th floor
Room 5206 - Box 511
Ottawa
K1H 8L6
Canada

Phone +1 613 737 8899 ext. 79017
Email djstewart@ohri.ca
Website http://www.ohri.ca
ROR logo "ROR" https://ror.org/03c62dg59
Canadian Stem Cell Network
Research organisation

501 Smyth Road
Room CCW-6189
Ottawa
K1H 8L6
Canada

Phone +1 (0)613 739 6675
Email info@stemcellnetwork.ca

Funders

Funder type

Research organisation

Canadian Institutes of Health Research (ref: MCT-90169)
Government organisation / National government
Alternative name(s)
Instituts de Recherche en Santé du Canada, Canadian Institutes of Health Research (CIHR), CIHR_IRSC, Canadian Institutes of Health Research | Ottawa ON, CIHR, IRSC
Location
Canada

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planDr Stewart has presented the analysis of the study results to the American Society of Gene and Cell Therapy (ASGCT) at their annual meeting 2021 (virtually) and is preparing his publication of the results which is planned for the near future.
IPD sharing planCurrent IPD sharing plan as of 07/03/2025:
The datasets generated during and/or analysed during the current study are/will be available upon request from Dr Duncan Stewart (djstewart@toh.ca).
The de-identified raw data and clean data set files are housed in OHRI's securely encrypted password-protected Sharepoint folder system and will be maintained there for at least 15 years following trial completion.
Prior to implementing any requests for data sharing (other than from the REB pre-approved ENACT AMI Study team) that are received and approved by Dr Stewart, a Secondary Use of Information Application will be completed and submitted to the OHSN-REB for approval to share data/files. Each of the participants will be approached with a separate signed consent obtained for permission to share their de-identified data. As required, a Data Sharing Agreement will be signed and executed between Dr Stewart and the requesting party prior to any data being shared with that party.




Previous IPD sharing plan:
The datasets generated during and/or analysed during the current study are/will be available upon request from Dr Duncan Stewart (djstewart@toh.ca).
The de-identified raw data and clean data set files are housed in OHRI's securely encrypted password-protected Sharepoint folder system and will be maintained there for 15 years following trial completion.
Prior to implementing any requests for data sharing (other than from the REB pre-approved ENACT AMI Study team) that are received and approved by Dr Stewart, a Secondary Use of Information Application will be completed and submitted to the OHSN-REB for approval to share data/files. Each of the participants will be approached with a separate signed consent obtained for permission to share their de-identified data. As required, a Data Sharing Agreement will be signed and executed between Dr Stewart and the requesting party prior to any data being shared with that party.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 01/03/2010 11/04/2019 Yes No

Editorial Notes

07/03/2025: The individual participant data (IPD) sharing plan was amended.
29/01/2024: Contact details updated.
08/11/2023: Publication and dissemination plan, IPD sharing plan and ethics approval details added.
01/11/2023: Contact details corrected.
14/01/2020: The following changes have been made:
1. The recruitment end date has been changed from 31/12/2019 to 15/09/2019.
2. The overall trial end date has been changed from 31/12/2020 to 18/09/2029.
3. The total final enrolment number has been added.
16/04/2019: The following changes were made:
1. The recruitment end date was updated from 01/12/2013 to 31/12/2019.
2. The overall trial end date was updated from 01/12/2013 to 31/12/2020.
15/04/2019: The scientific contacts were updated.
11/04/2019: Publication reference added.