Phase 2c Dose Comparison Study of MP4OX in Trauma

NCT ID: NCT01973504

Last Updated: 2013-10-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE2

Study Classification

INTERVENTIONAL

Study Start Date

2013-12-31

Study Completion Date

2016-03-31

Brief Summary

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MP4OX is being developed as an ischemic rescue therapy to perfuse and oxygenate tissues at risk during hemorrhagic shock. MP4OX is a pegylated hemoglobin-based colloid designed to improve perfusion and target delivery of oxygen to ischemic tissues. This study will evaluate safety and efficacy of MP4OX treatment, in addition to standard therapy, in trauma patients suffering from lactic acidosis due to severe hemorrhagic shock.

Detailed Description

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Acute trauma, including both blunt and penetrating injury, is often associated with uncontrolled bleeding that leads to hemorrhagic shock. During shock, inadequate blood flow results in local ischemia and tissue hypoxia (insufficient oxygenation) of critical organs with resulting lactic acidosis. More than 10% of trauma victims who reach hospital alive will die, and many will suffer from organ failure. The primary goal when treating traumatic hemorrhage is to control blood loss, support ventilation and oxygenation, and maintain cardiovascular function to maintain organ perfusion.

Despite optimal care, organ dysfunction is present in many patients as evidenced by persistent lactic acidosis. Blood transfusions are intended to improve circulation of oxygen-carrying red blood cells, but are frequently insufficient, even when the hemoglobin level is optimized. The severity of lactic acidosis in trauma victims has also been shown to correlate with worse outcome.

Support for the proposed application for MP4OX as a therapeutic adjunct to standard treatment of severe hemorrhage shock, is based on multiple preclinical studies in different animal models of hemorrhagic shock resuscitation. These preclinical studies demonstrated that survival was greater and restoration of acid-base status and hemodynamics were improved with MP4OX. The benefits of MP4OX in animals were observed with or without co-administration of autologous blood, demonstrating that red cell transfusion alone was insufficient, and that the effects of MP4OX were additive.

The hypothesis for the current study is that MP4OX will enhance perfusion and oxygenation of ischemic organs and thereby prevent and reduce the duration of organ failure and improve morbidity and mortality outcome measures.

Conditions

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Trauma Hemorrhagic Shock Lactic Acidosis

Keywords

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Trauma Hemorrhagic shock Hemorrhage Lactic acidosis Oxygen therapeutics Oxygen carriers Ischemic rescue therapy Hemoglobin solutions PEGylated hemoglobin

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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MP4OX 500-mL

500-mL dose of MP4OX

Group Type EXPERIMENTAL

MP4OX

Intervention Type DRUG

4.3 g/dL pegylated hemoglobin in balanced lactate-electrolyte solution

MP4OX 750-mL

750-mL dose of MP4OX

Group Type EXPERIMENTAL

MP4OX

Intervention Type DRUG

4.3 g/dL pegylated hemoglobin in balanced lactate-electrolyte solution

Control

Standard crystalloid Keep Vein Open (KVO) infusion

Group Type SHAM_COMPARATOR

Control

Intervention Type DRUG

Crystalloid solution IV infusion drip to keep vein open

Interventions

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MP4OX

4.3 g/dL pegylated hemoglobin in balanced lactate-electrolyte solution

Intervention Type DRUG

Control

Crystalloid solution IV infusion drip to keep vein open

Intervention Type DRUG

Other Intervention Names

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Hemoglobin pegylated MalPEG-Hb MP4 PEG-Hb Pegylated-Hb Keep vein open (KVO) infusion Sham infusion

Eligibility Criteria

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Inclusion Criteria

* Trauma injury (blunt and/or penetrating) resulting in lactic acidosis due to hemorrhagic shock
* Acidosis (blood lactate level ≥ 5 mmol/L; equivalent to 45 mg/dL)

Exclusion Criteria

* Massive injury incompatible with life
* Normalization of lactate prior to dosing (≤ 2.2 mmol/L)
* Evidence of severe traumatic brain injury (TBI) as defined by ANY one of the following: Known non-survivable head injury or open brain injury; Known AIS (head region) ≥ 4 by an appropriate imaging methodology; Contemplated CNS surgery; Abnormal physical exam indicative of severe CNS or any spinal cord injury above T5 level; or Glasgow Coma Score (GCS) = 3, 4 or 5.
* Cardiac arrest prior to randomization
* Known age below the legal age for consenting
* Estimated time from injury to randomization \> 4 hours
* Estimated time from hospital admission to randomization \> 2 hours
* Known pregnancy
* Use of any oxygen carrier other than RBCs
* Known previous participation in this study
* Professional or ancillary personnel involved with this study
* Known receipt of any investigational drug(s) within 30 days prior to study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sangart

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Karim Brohi, MD

Role: PRINCIPAL_INVESTIGATOR

The Royal London Hospital

Frank V. Booth, BCh, FACS

Role: STUDY_CHAIR

Sangart, Inc.

Locations

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Liverpool Hospital

Liverpool, , Australia

Site Status

John Hunter Hospital

Newcastle, , Australia

Site Status

Erasme University Hospital

Brussels, , Belgium

Site Status

University Hospital Antwerpen

Edegem, , Belgium

Site Status

Faculdade de Medicina de S. J. Do Rio Preto

São José do Rio Preto, , Brazil

Site Status

Hopital Universitário, Centro de Estudos em Emergências em Saúde, USP Ribeirão Preto

São Paulo, , Brazil

Site Status

Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - FMUSP

São Paulo, , Brazil

Site Status

Hôpital Beaujon

Clichy, , France

Site Status

Hôpital du Kremlin Bicêtre

Le Kremlin-Bicêtre, , France

Site Status

Hôpital Roger Salengro, CHRU Lille

Lille, , France

Site Status

CHU Dupuytren

Limoges, , France

Site Status

Hôpital Edouard Herriot

Lyon, , France

Site Status

Hôpital Pitié-Salpêtrière

Paris, , France

Site Status

Universitätsklinikum der Rheinisch-Westfälische Technische Hochschule Aachen

Aachen, , Germany

Site Status

Campus Virchow Klinikum Charité Berlin

Berlin, , Germany

Site Status

Kliniken der Stadt Köln gGmbH Krankenhaus Merheim

Cologne, , Germany

Site Status

Klinikum der J.-W.-Goethe-Universität Frankfurt a.M.

Franfurt, , Germany

Site Status

BG Klinik Ludwigshafen

Ludwigshafen, , Germany

Site Status

Soroka University Medical Center

Beersheba, , Israel

Site Status

Rambam Health Care Campus

Haifa, , Israel

Site Status

Hadassah Medical Organization, Hadassah University Hospital, Ein-Karem

Jerusalem, , Israel

Site Status

Auckland City Hospital

Auckland, , New Zealand

Site Status

Oslo University Hospital Ullevaal

Oslo, , Norway

Site Status

Netcare Union Hospital

Alberton, , South Africa

Site Status

Vincent Palotti Dr Christiaan Barnard Memorial Hospital

Cape Town, , South Africa

Site Status

Charlotte Maxeke Johannesburg Academic Hospita

Johannesburg, , South Africa

Site Status

Netcare Milpark Hospital

Johannesburg, , South Africa

Site Status

Chris Hani Baragwanath Hospital

Soweto, , South Africa

Site Status

CHU Vaudois

Lausanne, , Switzerland

Site Status

UniversitätsSpital Zürich

Zurich, , Switzerland

Site Status

The Royal London Hospital

London, , United Kingdom

Site Status

Countries

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Australia Belgium Brazil France Germany Israel New Zealand Norway South Africa Switzerland United Kingdom

References

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Cole RH, Vandegriff KD. MP4, a vasodilatory PEGylated hemoglobin. Adv Exp Med Biol. 2011;701:85-90. doi: 10.1007/978-1-4419-7756-4_12.

Reference Type BACKGROUND
PMID: 21445773 (View on PubMed)

Young MA, Lohman J, Malavalli A, Vandegriff KD, Winslow RM. Hemospan improves outcome in a model of perioperative hemodilution and blood loss in the rat: comparison with hydroxyethyl starch. J Cardiothorac Vasc Anesth. 2009 Jun;23(3):339-47. doi: 10.1053/j.jvca.2008.08.006. Epub 2008 Oct 22.

Reference Type BACKGROUND
PMID: 18948027 (View on PubMed)

Vandegriff KD, Winslow RM. Hemospan: design principles for a new class of oxygen therapeutic. Artif Organs. 2009 Feb;33(2):133-8. doi: 10.1111/j.1525-1594.2008.00697.x.

Reference Type BACKGROUND
PMID: 19178457 (View on PubMed)

Vandegriff KD, Malavalli A, Mkrtchyan GM, Spann SN, Baker DA, Winslow RM. Sites of modification of hemospan, a poly(ethylene glycol)-modified human hemoglobin for use as an oxygen therapeutic. Bioconjug Chem. 2008 Nov 19;19(11):2163-70. doi: 10.1021/bc8002666.

Reference Type BACKGROUND
PMID: 18837531 (View on PubMed)

Svergun DI, Ekstrom F, Vandegriff KD, Malavalli A, Baker DA, Nilsson C, Winslow RM. Solution structure of poly(ethylene) glycol-conjugated hemoglobin revealed by small-angle X-ray scattering: implications for a new oxygen therapeutic. Biophys J. 2008 Jan 1;94(1):173-81. doi: 10.1529/biophysj.107.114314. Epub 2007 Sep 7.

Reference Type BACKGROUND
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Cole RH, Vandegriff KD, Szeri AJ, Savas O, Baker DA, Winslow RM. A quantitative framework for the design of acellular hemoglobins as blood substitutes: implications of dynamic flow conditions. Biophys Chem. 2007 Jun;128(1):63-74. doi: 10.1016/j.bpc.2007.03.004. Epub 2007 Mar 13.

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PMID: 17418478 (View on PubMed)

Young MA, Riddez L, Kjellstrom BT, Bursell J, Winslow F, Lohman J, Winslow RM. MalPEG-hemoglobin (MP4) improves hemodynamics, acid-base status, and survival after uncontrolled hemorrhage in anesthetized swine. Crit Care Med. 2005 Aug;33(8):1794-804. doi: 10.1097/01.ccm.0000172648.55309.13.

Reference Type BACKGROUND
PMID: 16096458 (View on PubMed)

Drobin D, Kjellstrom BT, Malm E, Malavalli A, Lohman J, Vandegriff KD, Young MA, Winslow RM. Hemodynamic response and oxygen transport in pigs resuscitated with maleimide-polyethylene glycol-modified hemoglobin (MP4). J Appl Physiol (1985). 2004 May;96(5):1843-53. doi: 10.1152/japplphysiol.00530.2003. Epub 2004 Jan 16.

Reference Type BACKGROUND
PMID: 14729723 (View on PubMed)

Winslow RM, Lohman J, Malavalli A, Vandegriff KD. Comparison of PEG-modified albumin and hemoglobin in extreme hemodilution in the rat. J Appl Physiol (1985). 2004 Oct;97(4):1527-34. doi: 10.1152/japplphysiol.00404.2004. Epub 2004 Jun 18.

Reference Type BACKGROUND
PMID: 15208289 (View on PubMed)

Vandegriff KD, Bellelli A, Samaja M, Malavalli A, Brunori M, Winslow RM. Kinetics of NO and O2 binding to a maleimide poly(ethylene glycol)-conjugated human haemoglobin. Biochem J. 2004 Aug 15;382(Pt 1):183-9. doi: 10.1042/BJ20040156.

Reference Type BACKGROUND
PMID: 15175010 (View on PubMed)

Tsai AG, Vandegriff KD, Intaglietta M, Winslow RM. Targeted O2 delivery by low-P50 hemoglobin: a new basis for O2 therapeutics. Am J Physiol Heart Circ Physiol. 2003 Oct;285(4):H1411-9. doi: 10.1152/ajpheart.00307.2003. Epub 2003 Jun 12.

Reference Type BACKGROUND
PMID: 12805024 (View on PubMed)

Vandegriff KD, Malavalli A, Wooldridge J, Lohman J, Winslow RM. MP4, a new nonvasoactive PEG-Hb conjugate. Transfusion. 2003 Apr;43(4):509-16. doi: 10.1046/j.1537-2995.2003.00341.x.

Reference Type BACKGROUND
PMID: 12662285 (View on PubMed)

McCarthy MR, Vandegriff KD, Winslow RM. The role of facilitated diffusion in oxygen transport by cell-free hemoglobins: implications for the design of hemoglobin-based oxygen carriers. Biophys Chem. 2001 Aug 30;92(1-2):103-17. doi: 10.1016/s0301-4622(01)00194-6.

Reference Type BACKGROUND
PMID: 11527583 (View on PubMed)

Young MA, Riddez L, Kjellstrom BT, Winslow RM. Effect of maleimide-polyethylene glycol hemoglobin (MP4) on hemodynamics and acid-base status after uncontrolled hemorrhage in anesthetized swine: comparison with crystalloid and blood. J Trauma. 2007 Dec;63(6):1234-44. doi: 10.1097/TA.0b013e31815bd7b0.

Reference Type BACKGROUND
PMID: 18212644 (View on PubMed)

Wettstein R, Tsai AG, Erni D, Winslow RM, Intaglietta M. Resuscitation with polyethylene glycol-modified human hemoglobin improves microcirculatory blood flow and tissue oxygenation after hemorrhagic shock in awake hamsters. Crit Care Med. 2003 Jun;31(6):1824-30. doi: 10.1097/01.CCM.0000069340.16319.F2.

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Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003 May;185(5):485-91. doi: 10.1016/s0002-9610(03)00044-8.

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Regnier MA, Raux M, Le Manach Y, Asencio Y, Gaillard J, Devilliers C, Langeron O, Riou B. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012 Dec;117(6):1276-88. doi: 10.1097/ALN.0b013e318273349d.

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McNelis J, Marini CP, Jurkiewicz A, Szomstein S, Simms HH, Ritter G, Nathan IM. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg. 2001 Nov;182(5):481-5. doi: 10.1016/s0002-9610(01)00755-3.

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Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma. 1993 Oct;35(4):584-8; discussion 588-9. doi: 10.1097/00005373-199310000-00014.

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Tsai AG, Cabrales P, Manjula BN, Acharya SA, Winslow RM, Intaglietta M. Dissociation of local nitric oxide concentration and vasoconstriction in the presence of cell-free hemoglobin oxygen carriers. Blood. 2006 Nov 15;108(10):3603-10. doi: 10.1182/blood-2006-02-005272. Epub 2006 Jul 20.

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Related Links

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http://www.sangart.com

Sangart Inc. (San Diego, CA) web site \[Study SPONSOR\]

Other Identifiers

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TRA-207

Identifier Type: -

Identifier Source: org_study_id