drugset / Trial / NCT05317806
Metformin Use in Cardiac Fibrosis in PAI-1 Deficiency
Non-randomizedParallel-groupOpen-labelTreatment
Summary
This study will evaluate the efficacy and safety of metformin, in patients 18-65 years of age with homozygous plasminogen activator inhibitor-1 (PAI-1) deficiency, with or without cardiac fibrosis, for a period of 60 months. The starting dose of metformin will be 500 mg up to a maximum dose of 2000 mg for a period of 5 years with the aim to assess the safety and efficacy of metformin on prevention/stabilization or regression of cardiac fibrosis in a Treated population vs. a Comparison population.
Timeline
- Start
- 2022-10-10
- Primary completion
- 2027-10
- Completion
- 2027-10
Publications
- Background Loskutoff DJ, Sawdey M, Mimuro J. Type 1 plasminogen activator inhibitor. Prog Hemost Thromb. 1989;9:87-115. No abstract available.
- Background Chmielewska J, Ranby M, Wiman B. Evidence for a rapid inhibitor to tissue plasminogen activator in plasma. Thromb Res. 1983 Aug 1;31(3):427-36. doi: 10.1016/0049-3848(83)90407-3.
- Background Chmielewska J, Ranby M, Wiman B. Kinetics of the inhibition of plasminogen activators by the plasminogen-activator inhibitor. Evidence for 'second-site' interactions. Biochem J. 1988 Apr 15;251(2):327-32. doi: 10.1042/bj2510327.
- Background Mehta R, Shapiro AD. Plasminogen activator inhibitor type 1 deficiency. Haemophilia. 2008 Nov;14(6):1255-60. doi: 10.1111/j.1365-2516.2008.01834.x.
- Background Fay WP, Parker AC, Condrey LR, Shapiro AD. Human plasminogen activator inhibitor-1 (PAI-1) deficiency: characterization of a large kindred with a null mutation in the PAI-1 gene. Blood. 1997 Jul 1;90(1):204-8.
- Background Fay WP, Shapiro AD, Shih JL, Schleef RR, Ginsburg D. Brief report: complete deficiency of plasminogen-activator inhibitor type 1 due to a frame-shift mutation. N Engl J Med. 1992 Dec 10;327(24):1729-33. doi: 10.1056/NEJM199212103272406. No abstract available.
- Background Iwaki T, Tanaka A, Miyawaki Y, Suzuki A, Kobayashi T, Takamatsu J, Matsushita T, Umemura K, Urano T, Kojima T, Terao T, Kanayama N. Life-threatening hemorrhage and prolonged wound healing are remarkable phenotypes manifested by complete plasminogen activator inhibitor-1 deficiency in humans. J Thromb Haemost. 2011 Jun;9(6):1200-6. doi: 10.1111/j.1538-7836.2011.04288.x.
- Background Iwaki T, Nagahashi K, Kobayashi T, Umemura K, Terao T, Kanayama N. The first report of uncontrollable subchorionic and retroplacental haemorrhage inducing preterm labour in complete PAI-1 deficiency in a human. Thromb Res. 2012 Apr;129(4):e161-3. doi: 10.1016/j.thromres.2011.10.008. Epub 2011 Nov 17. No abstract available.
- Background Iwaki T, Nagahashi K, Takano K, Suzuki-Inoue K, Kanayama N, Umemura K, Urano T. Mutation in a highly conserved glycine residue in strand 5B of plasminogen activator inhibitor 1 causes polymerisation. Thromb Haemost. 2017 May 3;117(5):860-869. doi: 10.1160/TH16-07-0572. Epub 2017 Feb 23.
- Background Angleton P, Chandler WL, Schmer G. Diurnal variation of tissue-type plasminogen activator and its rapid inhibitor (PAI-1). Circulation. 1989 Jan;79(1):101-6. doi: 10.1161/01.cir.79.1.101.
- Background Heiman M, Gupta S, Shapiro AD. The obstetric, gynaecological and fertility implications of homozygous PAI-1 deficiency: single-centre experience. Haemophilia. 2014 May;20(3):407-12. doi: 10.1111/hae.12313. Epub 2013 Nov 22.
- Background Flevaris P, Vaughan D. The Role of Plasminogen Activator Inhibitor Type-1 in Fibrosis. Semin Thromb Hemost. 2017 Mar;43(2):169-177. doi: 10.1055/s-0036-1586228. Epub 2016 Aug 24.
- Background Ghosh AK, Vaughan DE. PAI-1 in tissue fibrosis. J Cell Physiol. 2012 Feb;227(2):493-507. doi: 10.1002/jcp.22783.
- Background Ghosh AK, Bradham WS, Gleaves LA, De Taeye B, Murphy SB, Covington JW, Vaughan DE. Genetic deficiency of plasminogen activator inhibitor-1 promotes cardiac fibrosis in aged mice: involvement of constitutive transforming growth factor-beta signaling and endothelial-to-mesenchymal transition. Circulation. 2010 Sep 21;122(12):1200-9. doi: 10.1161/CIRCULATIONAHA.110.955245. Epub 2010 Sep 7.
- Background Xu Z, Castellino FJ, Ploplis VA. Plasminogen activator inhibitor-1 (PAI-1) is cardioprotective in mice by maintaining microvascular integrity and cardiac architecture. Blood. 2010 Mar 11;115(10):2038-47. doi: 10.1182/blood-2009-09-244962. Epub 2009 Dec 15.
- Background Khan SS, Shah SJ, Strande JL, Baldridge AS, Flevaris P, Puckelwartz MJ, McNally EM, Rasmussen-Torvik LJ, Lee DC, Carr JC, Benefield BC, Afzal MZ, Heiman M, Gupta S, Shapiro AD, Vaughan DE. Identification of Cardiac Fibrosis in Young Adults With a Homozygous Frameshift Variant in SERPINE1. JAMA Cardiol. 2021 Jul 1;6(7):841-846. doi: 10.1001/jamacardio.2020.6909.
- Background Flevaris P, Khan SS, Eren M, Schuldt AJT, Shah SJ, Lee DC, Gupta S, Shapiro AD, Burridge PW, Ghosh AK, Vaughan DE. Plasminogen Activator Inhibitor Type I Controls Cardiomyocyte Transforming Growth Factor-beta and Cardiac Fibrosis. Circulation. 2017 Aug 15;136(7):664-679. doi: 10.1161/CIRCULATIONAHA.117.028145. Epub 2017 Jun 6.
- Background Joshi N, Kopec AK, Towery K, Williams KJ, Luyendyk JP. The antifibrinolytic drug tranexamic acid reduces liver injury and fibrosis in a mouse model of chronic bile duct injury. J Pharmacol Exp Ther. 2014 Jun;349(3):383-92. doi: 10.1124/jpet.113.210880. Epub 2014 Mar 14.
- Background King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999 Nov;48(5):643-8. doi: 10.1046/j.1365-2125.1999.00092.x. No abstract available.
- Background Sasali A, Leahy JL. Is metformin cardioprotective? Diabetes Care. 2003 Jan;26(1):243-4. doi: 10.2337/diacare.26.1.243. No abstract available.
- Background Choi SM, Jang AH, Kim H, Lee KH, Kim YW. Metformin Reduces Bleomycin-induced Pulmonary Fibrosis in Mice. J Korean Med Sci. 2016 Sep;31(9):1419-25. doi: 10.3346/jkms.2016.31.9.1419.
- Background Kita Y, Takamura T, Misu H, Ota T, Kurita S, Takeshita Y, Uno M, Matsuzawa-Nagata N, Kato K, Ando H, Fujimura A, Hayashi K, Kimura T, Ni Y, Otoda T, Miyamoto K, Zen Y, Nakanuma Y, Kaneko S. Metformin prevents and reverses inflammation in a non-diabetic mouse model of nonalcoholic steatohepatitis. PLoS One. 2012;7(9):e43056. doi: 10.1371/journal.pone.0043056. Epub 2012 Sep 18.
- Background Ursini F, Grembiale RD, D'Antona L, Gallo E, D'Angelo S, Citraro R, Visca P, Olivieri I, De Sarro G, Perrotti N, Russo E. Oral Metformin Ameliorates Bleomycin-Induced Skin Fibrosis. J Invest Dermatol. 2016 Sep;136(9):1892-1894. doi: 10.1016/j.jid.2016.05.097. Epub 2016 May 29. No abstract available.
- Background Wang M, Weng X, Guo J, Chen Z, Jiang G, Liu X. Metformin alleviated EMT and fibrosis after renal ischemia-reperfusion injury in rats. Ren Fail. 2016;38(4):614-21. doi: 10.3109/0886022X.2016.1149770. Epub 2016 Feb 26.
- Background Xiao H, Ma X, Feng W, Fu Y, Lu Z, Xu M, Shen Q, Zhu Y, Zhang Y. Metformin attenuates cardiac fibrosis by inhibiting the TGFbeta1-Smad3 signalling pathway. Cardiovasc Res. 2010 Aug 1;87(3):504-13. doi: 10.1093/cvr/cvq066. Epub 2010 Mar 3.
- Background Xu S, Yang Z, Jin P, Yang X, Li X, Wei X, Wang Y, Long S, Zhang T, Chen G, Sun C, Ma D, Gao Q. Metformin Suppresses Tumor Progression by Inactivating Stromal Fibroblasts in Ovarian Cancer. Mol Cancer Ther. 2018 Jun;17(6):1291-1302. doi: 10.1158/1535-7163.MCT-17-0927. Epub 2018 Mar 15.
- Background McCloskey CW, Cook DP, Kelly BS, Azzi F, Allen CH, Forsyth A, Upham J, Rayner KJ, Gray DA, Boyd RW, Murugkar S, Lo B, Trudel D, Senterman MK, Vanderhyden BC. Metformin Abrogates Age-Associated Ovarian Fibrosis. Clin Cancer Res. 2020 Feb 1;26(3):632-642. doi: 10.1158/1078-0432.CCR-19-0603. Epub 2019 Oct 9.
- Background De Souza A, Khawaja KI, Masud F, Saif MW. Metformin and pancreatic cancer: Is there a role? Cancer Chemother Pharmacol. 2016 Feb;77(2):235-42. doi: 10.1007/s00280-015-2948-8. Epub 2016 Jan 6.
- Background Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000 Apr;35(5):1245-55. doi: 10.1016/s0735-1097(00)00531-3.
- Background Liu Q, Li S, Quan H, Li J. Vitamin B12 status in metformin treated patients: systematic review. PLoS One. 2014 Jun 24;9(6):e100379. doi: 10.1371/journal.pone.0100379. eCollection 2014.
- Background Carrizo E, Fernandez V, Connell L, Sandia I, Prieto D, Mogollon J, Valbuena D, Fernandez I, de Baptista EA, Baptista T. Extended release metformin for metabolic control assistance during prolonged clozapine administration: a 14 week, double-blind, parallel group, placebo-controlled study. Schizophr Res. 2009 Aug;113(1):19-26. doi: 10.1016/j.schres.2009.05.007. Epub 2009 Jun 9.
- Background Rado J, von Ammon Cavanaugh S. A Naturalistic Randomized Placebo-Controlled Trial of Extended-Release Metformin to Prevent Weight Gain Associated With Olanzapine in a US Community-Dwelling Population. J Clin Psychopharmacol. 2016 Apr;36(2):163-8. doi: 10.1097/JCP.0000000000000469.
- Background Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care. 2011 Jun;34(6):1431-7. doi: 10.2337/dc10-2361. No abstract available.
- Background Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA. 2014 Dec 24-31;312(24):2668-75. doi: 10.1001/jama.2014.15298.
- Background Kilo C. Metformin: a safe and effective treatment in the management of NIDDM. Mo Med. 1997 Mar;94(3):114-23.
- Background Johnson NP. Metformin use in women with polycystic ovary syndrome. Ann Transl Med. 2014 Jun;2(6):56. doi: 10.3978/j.issn.2305-5839.2014.04.15.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Metformin | Small molecule | 2000 mg | Oral |