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Ischemic Heart DiseasePhase 1/2LILACSNCT03113773

Low Dose Interleukin-2 in Patients With Stable Ischaemic Heart Disease and Acute Coronary Syndromes

A Phase 1/2 study testing Proleukin in people with Ischemic Heart Disease, run by Cambridge University Hospitals NHS Foundation Trust at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The mainstay for treatment for acute coronary syndrome (ACS) focusses on re-establishing and maintaining the patency of vessels following coronary plaque disruption, through the use of anti-platelets and anticoagulants. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Ischemic Heart Disease
What is being tested?
Proleukin
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
41 participants
Where
1 siteUnited Kingdom
Study dates
11 May 2017to 21 Feb 2019
Phase
Phase 1/2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-75 years old inclusive
  • Previous history (≥ 6 months from planned first day of dosing) of coronary artery disease
  • No history of recent (< 6 months from planned first day of dosing) admissions for an unstable cardiovascular event e.g. MI (Myocardial Infarction), unstable angina, ACS
  • Written informed consent for participation in the trial
  • Part A
  • Age 18-85 years old inclusive
Show all 10Show fewer
  • Current admission (on at least screening visit) with an acute coronary syndrome (non-ST elevation myocardial infarction, i.e., NSTEMI, or unstable angina) with symptoms of myocardial ischemia lasting 10 minutes or more with the patient at rest or with minimal effort plus either elevated levels of TnI on admission or dynamic changes in ECG (new ST-T changes) or T-wave inversion
  • Willingness to be dosed within 8 days from initial date of current admission for ACS
  • Written informed consent for participation in the trial
  • Part B

Who cannot join

  • Current presentation with cardiogenic shock (systolic blood pressure <80 mm Hg, unresponsive to fluids, or necessitating catecholamines), severe congestive heart failure and/or pulmonary oedema
  • Known active bleeding or bleeding diatheses
  • Known active infection requiring antibiotic treatment
  • Severe hematologic abnormalities (haematocrit <30% AND platelet cell count of <100 × 10^3/μL AND white blood cell count <3.3 × 10^3/μL )
  • Known malignancies requiring active treatment or follow up (However, patients with current/a history of localised basal or squamous cell skin cancer are not excluded from participation in this trial)
  • Known heart failure with impaired LV function: echocardiographic findings of LV EF < 45%
Show all 63Show fewer
  • Hypotension (Systolic BP<100mm Hg, DBP<50mmHg) at screening
  • Uncontrolled hypertension (>160/100 mmHg) at screening
  • History of recurrent syncope (Electrocardiographic history suggestive of arrhythmia syncope (e.g. bifascicular block, sinus bradycardia < 40 beats per minute in absence of sinoatrial block or medications, pre-excited QRS complex, abnormal QT interval, ST segment elevation leads V1 through V3 [Brugada syndrome], negative T wave in right precordial leads and epsilon wave [arrhythmogenic right ventricular dysplasia/cardiomyopathy]))
  • Known hepatic failure or abnormal LFTs at baseline (ALT > 2 x ULN).
  • Elevated Total Bilirubin Levels, (TBL > 1.5 x ULN) and Alkaline Phosphatase, ALP (ALP > 1.5 x ULN), at baseline
  • Acute kidney injury or chronic kidney disease at Stage > 3B (eGFR < 45)
  • Respiratory failure
  • History of drug induced Stevens Johnson syndrome, Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), toxic epidermal necrolysis, or contrast allergy (requiring steroid treatment)
  • History of recurrent epileptic seizures in the previous 4 years; repetitive or difficult to control seizures, coma or toxic psychosis lasting >48 hours
  • If known diabetic, uncontrolled diabetes defined as HbA1c > 64 mmol/mol
  • Average corrected QT interval (QTc) > 450 msecs using Bazett's formula using triplicate ECGs (or > 480 msecs if bundle branch block)
  • Known chronic active hepatitis (B or C)
  • Known HIV infection
  • Current infection possibly related to recent or on-going immunosuppressive treatment
  • Known autoimmune disease requiring active immunosuppressive therapy
  • History of organ transplantation
  • Any oral or intravenous Immunosuppressive treatment including Prednisolone, hydrocortisone or disease modifying drugs such as Azathioprine, interferon-alpha, Cyclophosphamide or Mycophenolate. [Other immunosuppressive therapies should be discussed with PI. Inhaled or topical steroids are permissible.]
  • Known pregnancy at screening or visit 2 (where applicable)
  • On-going lactation
  • Inability to comply with trial procedures
  • Current participation in the active dosing phase of other interventional clinical trials
  • Contra indication to IL-2 treatment or hypersensitivity to IL-2 or to any of its excipients
  • Unwillingness or inability to provide written informed consent for participation
  • Known hyper- or hypothyroidism
  • Any medical history or clinically relevant abnormality that is deemed by the principal investigator/delegate and/or medical monitor to make the patient ineligible for inclusion because of a safety concern
  • Part B
  • ST elevation myocardial infarction (heart attack) on this admission.
  • Current presentation with cardiogenic shock (systolic blood pressure <80 mm Hg, unresponsive to fluids, or necessitating catecholamines), electrical instability, severe congestive heart failure and/or pulmonary oedema
  • Known active bleeding or bleeding diatheses
  • Known active infection requiring antibiotic treatment
  • Severe hematologic abnormalities (haematocrit <30% AND platelet cell count of <100 × 10^3/μL, white blood AND cell count <3.3 × 10^3/μL)
  • Known malignancies requiring active treatment or follow up (However, patients with current/a history of localised basal or squamous cell skin cancer are not excluded from participation in this trial)
  • Known heart failure with impaired LV function: echocardiographic findings of LV EF < 35%
  • Hypotension (Systolic BP (SBP)<100mm Hg, DBP<50mmHg) at screening
  • Uncontrolled hypertension (>160/100 mmHg) at screening
  • History of recurrent syncope (Electrocardiographic history suggestive of arrhythmia syncope (e.g., bifascicular block, sinus bradycardia < 40 beats per minute in absence of sinoatrial block or medications, pre-excited QRS complex, abnormal QT interval, ST segment elevation leads V1 through V3 [Brugada syndrome], negative T wave in right precordial leads and epsilon wave [arrhythmogenic right ventricular dysplasia/cardiomyopathy]))
  • Known hepatic failure or abnormal LFTs at baseline (ALT > 2 x ULN).
  • Elevated Total Bilirubin Levels, (TBL > 1.5 x ULN) and Alkaline Phosphatase, ALP (ALP > 1.5 x ULN), at baseline
  • Renal impairment at screening (Creatinine clearance [Cockcroft-Gault] <45ml/min)
  • Acute respiratory failure
  • History of drug induced Stevens Johnson syndrome, Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), toxic epidermal necrolysis, or contrast allergy (requiring steroid treatment)
  • History of recurrent epileptic seizures in the previous 4 years; repetitive or difficult to control seizures, coma or toxic psychosis lasting >48 hours
  • Average corrected QT interval (QTc) > 450 msecs using Bazett's formula using triplicate ECGs (or > 480 msecs if bundle branch block)
  • Known chronic active hepatitis (B or C)
  • Known HIV infection
  • Current infection possibly related to recent or on-going immunosuppressive treatment
  • Known autoimmune disease requiring active immunosuppressive therapy
  • History of organ transplantation
  • Any oral or intravenous immunosuppressive treatment including Prednisolone, hydrocortisone or disease modifying drugs such as Azathioprine, interferon-alpha, Cyclophosphamide or Mycophenolate. [Other immunosuppressive therapies should be discussed with PI. Inhaled or topical steroids are permissible.]
  • Known pregnancy at screening (where applicable)
  • On-going lactation
  • Inability to comply with trial procedures
  • Current participation in the active dosing phase of other interventional clinical trials
  • Contra indication to IL-2 treatment or hypersensitivity to IL-2 or to any of its excipients
  • Unwillingness or inability to provide written informed consent for participation
  • Known hyper- or hypothyroidism
  • Any medical history or clinically relevant abnormality that is deemed by the principal investigator/delegate and/or medical monitor to make the patient ineligible for inclusion because of a safety concern

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Addenbrooke's Hospital

    Cambridge, Cambridgeshire, CB20QQ

Other trials in United Kingdom

About this study

The mainstay for treatment for acute coronary syndrome (ACS) focusses on re-establishing and maintaining the patency of vessels following coronary plaque disruption, through the use of anti-platelets and anticoagulants. Despite advances in management ACS still carries a high risk of morbidity and mortality, thus future management is likely to target other pathways.

Recent studies indicate that CD4+ T cells, and more specifically Treg cells, are important for the control of post-ischemic immune responses and the promotion of myocardial healing. The investigators therefore hypothesise that expansion of Treg cells in patients with ACS dampens the activation of the immune response and promotes both plaque and myocardial healing. The investigators hypothesise that this can be achieved through subcutaneous administration of low doses of interleukin-2 (IL-2). IL-2 supplementation appears to be an attractive therapeutic option playing a key role in Treg cell development, expansion, survival and suppressive function.

Read the detailed description

This Phase I/II trial will carefully examine the safety of low-dose IL-2 in cardiovascular patients where it is currently contraindicated. The planned doses will be given to the trial patients once a day, over five days as subcutaneous injections [ i) Part A : Repeated doses will be given in the range of 0.3x10^6 IU up to a maximum of 3.0x10^6 IU (total of 25 completed patients across 5 groups: 3:2 randomisation IL-2:placebo) ii) Part B : Repeated doses will be given at doses not exceeding the maximum dose used in Part A (total of 32 completed patients across 4 groups: 6:2 randomisation IL-2:placebo)].

These doses have been chosen on the basis of safety and tolerability data from published clinical studies. In the low dose IL-2 studies evaluated, there were a low rate of adverse events (AEs) in all of the studies with the most commonly reported AEs being injection site reactions, fatigue, fever, nausea and vomiting. A low percentage of serious adverse events (SAEs) were recorded in a GVHD (graft-versus-host disease)-risk study and these SAEs included haemorrhage (CNS), anorexia, and infection (colitis).

The experimental and clinical background in low-dose IL-2 therapy suggests a potential clinical utility of Treg cell expansion in patients with ACS. Administration of low doses of IL-2 in various clinical settings appears to be safe and remarkably efficacious at promoting selective expansion of Treg cells with preserved suppressive function. This is the first trial to assess the mechanism of action of IL-2 therapy in cardiovascular patients. The aim of Part A of this clinical trial is to assess the safety of low-dose IL-2 as well as the proof of mechanism in patients with stable ischaemic heart disease. Part B aims to assess the safety and efficacy of, and increase in Treg as a result of this drug supplementation, in the setting of ACS.

The investigators hypothesize that low doses of IL-2 in patients with ACS can increase Treg number and function, and ultimately promote plaque stabilisation and myocardial healing (this will be further addressed in future studies). In this context, it may improve patient recovery and limit the occurrence/recurrence of major clinical events.

Being tested
Proleukin, Placebo Injection
Medical subject headings
Myocardial Ischemia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ProleukinDrug

    Patients will be treated with subcutaneous injections of IL-2 (range 0.3 X 10^6 - 3.0 X 10^6 IU) or placebo once daily for five consecutive days during the trial.A maximum dose of 3.0 X 10^6 IU will be allowed per day.

  • Placebo InjectionDrug

    Dextrose 5%

Study groups in NCT03113773
Study groupRoleWhat they receive
Part AExperimentalProleukin/Placebo in patients with stable ischaemic heart disease
Receives: Drug: Proleukin; Drug: Placebo Injection
Part BExperimentalProleukin/Placebo in patients with cute coronary syndromes
Receives: Drug: Proleukin; Drug: Placebo Injection

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Part A - Determination of IL-2 safety and tolerability parameters

    Biochemistry, haematology, ECGs and adverse events will be reviewed throughout the trial

    Measured: Through study completion, average of 24 days

  2. Part B - Change in the mean circulating Treg levels (percentage of CD4+ T regulatory defined as CD3+, CD4+, CD25high, CD127low cells within the CD3+, CD4+ T cell gate) following treatment with IL-2.

    Percentage change of CD4+ T regulatory cells will be reviewed following treatment with IL-2.

    Measured: Measured Days 1 and 6

  3. Part B - Determination of IL-2 safety and tolerability parameters

    Biochemistry, haematology, ECGs and adverse events will be reviewed

    Measured: Through study completion, average of 24 days

Secondary outcomes (3)
  1. Part B - Changes in circulating cardiac biomarkers (including hs-CRP, IL-6, TnI, BNP)

    Circulating cardiac biomarkers (including hs-CRP, IL-6, TnI, BNP)

    Measured: Measured Days 1, 6 and between days 10-24

  2. Part B - Change in lymphocyte subsets

    Change in lymphocyte subsets

    Measured: Measured Days 1 and 6

  3. Part B - Pharmacokinetic analysis of IL-2 levels

    PK analysis of IL-2

    Measured: Measured Days 1 and 6

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Apr 2017
  2. Study start11 May 2017
  3. Primary completion21 Feb 2019
  4. Study completion21 Feb 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1/2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Sequential
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
41 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03113773
Sponsor's protocol ID
LILACS (A093371)
Acronym
LILACS
Status last verified
Sep 2021
First submitted
14 Mar 2017
Last updated
14 Sep 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Zhao TX, Sriranjan RS, Tuong ZK, Lu Y, Sage AP, Nus M, Hubsch A, Kaloyirou F, Vamvaka E, Helmy J, Kostapanos M, Jalaludeen N, Klatzmann D, Tedgui A, Rudd JHF, Horton SJ, Huntly BJP, Hoole SP, Bond SP, Clatworthy MR, Cheriyan J, Mallat Z. Regulatory T-Cell Response to Low-Dose Interleukin-2 in Ischemic Heart Disease. NEJM Evid. 2022 Jan;1(1):EVIDoa2100009. doi: 10.1056/EVIDoa2100009. Epub 2021 Nov 22.

    PubMed 38319239
  • Liu L, Hu J, Lei H, Qin H, Wang C, Gui Y, Xu D. Regulatory T Cells in Pathological Cardiac Hypertrophy: Mechanisms and Therapeutic Potential. Cardiovasc Drugs Ther. 2024 Oct;38(5):999-1015. doi: 10.1007/s10557-023-07463-y. Epub 2023 May 15.

    PubMed 37184744
  • Zhao TX, Kostapanos M, Griffiths C, Arbon EL, Hubsch A, Kaloyirou F, Helmy J, Hoole SP, Rudd JHF, Wood G, Burling K, Bond S, Cheriyan J, Mallat Z. Low-dose interleukin-2 in patients with stable ischaemic heart disease and acute coronary syndromes (LILACS): protocol and study rationale for a randomised, double-blind, placebo-controlled, phase I/II clinical trial. BMJ Open. 2018 Sep 17;8(9):e022452. doi: 10.1136/bmjopen-2018-022452.

    PubMed 30224390

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Proleukin in people with Ischemic Heart Disease, run by Cambridge University Hospitals NHS Foundation Trust at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 63 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Sep 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Part A - Determination of IL-2 safety and tolerability parameters (time frame: Through study completion, average of 24 days). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03113773, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Sep 2021.

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