Cork trial shows protein can repair heart muscles
The benefit of injecting a low dose of growth factor IGF1 straight into the heart has been demonstrated by a Cork researchers. The trial is the first of its kind in the world.
“We identified a new, really low dose of IGF1 that acted like a stem cell and that was effective in causing repair of the heart,” said Prof Noel Caplice, chair of cardiovascular sciences at University College Cork (UCC).
The research involved experimentation on pigs. Muscle in animals injected with IGF1 after a heart attack repaired and recovered better than in animals not given the dose.
For the human clinical trial, 47 patients who had suffered large heart attacks were recruited. Patients received two different, low-dose preparations of IGF1, or a placebo on a randomised basis.
“The patients involved were from around Munster and blue-lighted (by ambulance in an emergency) to Cork University Hospital. They had an artery opened and were stented. They were then injected with IGF1, within half an hour of the artery being opened,” said Prof Caplice.
For those who received the higher dose of IGFI, heart remodelling had improved after eight weeks.
“After a heart attack, scar tissue forms and there can be a big expansion of the chamber of the heart. It balloons out, and that is not good. What you need is something nice and constricted. After the higher dose IGFI, the heart retained its shape much better,” Prof Caplice said.
About one fifth of people who suffer heart attacks have severe ongoing difficulties, because of lasting damage to heart muscle, even after the best current therapies. The result is that patients often develop long-term heart failure, associated with increased morbidity and mortality, Prof Caplice said.
Now that the pilot clinical trial has shown “a hint of efficacy”, the next step is to secure sponsorship for a much bigger, multi-centre trial, involving thousands of patients worldwide. Prof Caplice said they also want to treat “even sicker patients, not ideal for stenting, because the artery is so blocked”.
IGFI is sometimes “abused by body-builders,” Prof Caplice said. When injected in large doses, it causes not only growth in skeletal muscle, but also heart muscle, with potentially negative effects. The protein is used successfully to treat congenital dwarfism. If administered during the growing years, children can “get close to normal height”, said Prof Caplice.
A team of 25 was involved, including 10 cardiologists, nurses, radiologists, and sonographers.
The findings of the trial, funded by a €1m grant under the joint Health Research Board-Science Foundation Ireland Translational Research Award programme, will be presented at the European Society of Cardiology Heart Failure 2017 conference, in Paris, today.
Trial signals breakthrough in cardiac care
When John Nolan from New Ross, Co Wexford arrived at Caredoc after a night made restless by what he thought was heartburn and shortness of breath, the doctor asked him what hospital he’d like to go.
“Waterford or Wexford,” he said.
The next thing he knew an ambulance crew arrived in and told him the choice was Cork or Dublin. The doctor had conducted an echocardiogram and had serious concerns about his health.
“I knew one of the ambulance guys and he told me the helicopter was on its way to New Ross rugby pitch to take me to Cork and that they would be bringing me over. I thought he was kidding,” John says.
He was “hooked up” to various medical devices for the journey and initially “enjoyed the scenery” before losing consciousness.
“I had a heart attack on the way to Cork but the cardiologists were waiting for me and I was operated on straight away.”
Just as doctors concluded the stenting procedure, John was asked if he’d like to take part in a clinical trial: “They said I was a good candidate and I thought, ‘If it helps someone else, I might as well go ahead’.”
The team involved in the pilot trial at Cork University Hospital (CUH) delivered an injection of insulin-related protein, known as IGF1, straight to his heart.
Ultimately, he feels it was of great benefit. The fact that he took part in a trial meant he was guaranteed 12 months’ follow-up.
“It was fantastic really, very reassuring for me and my family. I had regular MRIs and X-rays, plenty of heart monitoring. There was always a doctor at the other end of the phone,” John says.
He had the procedure done in December 2014 and “felt so good” he flew to America for two weeks the following August to spend time with his son: “I really felt I had benefited from taking part in the trial. And really, people shouldn’t be afraid to participate if given the chance.”
John (74), a retired builder, had kept ‘a hand in’ prior to his heart attack. Now he concentrates on gardening and doing odd jobs.
“Thank God for all of these people, the people who carry out the research. Looking back now, I definitely made the right choice.”
His wife, Margaret, says she and their five children are eternally grateful for the aftercare and attention John got as a participant in the trial.
