Allogeneic Mesenchymal Human Stem Cell Infusion Therapy for Endothelial DySfunctiOn in Diabetic Subjects With Symptomatic Ischemic Heart Disease. (ACESO-IHD)

• 100 million Allogeneic Mesenchymal Human Stem Cells (Drug), also known as allo-human Mesenchymal Stem Cells (hMSCs), stem cells: 1 single intravenous infusion
• Placebo (Other): Placebo delivered via peripheral intravenous infusion

Primary outcomes

• Brachial Artery Flow Mediated Diameter Percentage (FMD%) [Baseline, Week 2, Month 1, Month 3, and Month 6]: FMD% is measured via brachial artery ultrasound. The unit of measure is percent.
• EPC-CFU Counts [Baseline, Week 2, Month 1, Month 3, and Month 6]: Endothelial progenitor cells (EPC)-colony forming units (CFUs) will be assessed from blood samples. The unit of measure is the average number of colonies per well.

Secondary outcomes

• Fractional Flow Reserve (FFR) [Baseline, Month 6]: Fractional Flow Reserve as assessed by during cardiac catheterization angiography. The values are presented as a ratio.
• Coronary Flow Reserve (CFR) [Baseline, Month 6]: Coronary Flow Reserve as assessed by during cardiac catheterization angiography. The values are presented as a ratio.
• Seattle Angina Questionnaire (SAQ) Angina Frequency (AF) [Baseline, Week 2, Month 1, Month 3, and Month 6]: SAQ is a 7 item questionnaire with a total score ranging from 0-100 with the higher scores indicating less physical limitations, less angina, symptom frequency and better quality of life. The unit of measure is score on a scale.
• Seattle Angina Questionnaire (SAQ) Quality of Life (QL) [Baseline, Week 2, Month 1, Month 3, and Month 6]: SAQ is a 7 item questionnaire with a total score ranging from 0-100 with the higher scores indicating less physical limitations, less angina, symptom frequency and better quality of life. The unit of measure is score on a scale.
• Number of Participants With Treatment-Emergent Serious Adverse Events (TE-SAE) [1 month post infusion]: TE-SAEs will be defined as the composite of: death, non-fatal myocardial infarction (MI), stroke, hospitalization for heart failure, sustained ventricular arrhythmias (characterized by ventricular arrhythmias lasting longer than 30 sec or with hemodynamic compromise) or atrial fibrillation at 1 month post-infusion. TE-SAEs will be assessed by treating physician. The unit of measurement is the number of participants who experienced an event.
• Number of Participants With Major Adverse Cardiac Events (MACE) [12 months]: Defined as the composite incidence of (1) death, (2) hospitalization for cardiovascular events or (3) non-fatal myocardial infarction MI at 1 year. MACE will be assessed by treating physician. The unit of measurement is the number of participants who experienced an event.
• Number of Participants With Target Vessel Failure [12 months]: Number of participants with target vessel failure will be reported. Target vessel failure is defined as any participant that encounters revascularization, death, or MI attributed to the target vessel post-PCI (percutaneous coronary intervention). The unit of measure is number of participants.
• Number of Participants With Treatment Emergent Adverse Events [12 months]: The number of participants who experienced a Treatment Emergent Adverse Event (AE), as assessed by study physician, will be reported. The unit of measurement is the number of participants who experienced an event.
• Number of Participants With Abnormal Lab Values [12 months]: Number of participants with clinically significant abnormal serum hematology and clinical chemistry values will be reported. Clinical significance will be assessed by treating physician. The unit of measure is number of participants.
• Circulating Angiogenic Marker - VEGF [Baseline, Month 1, Month 3, Month 6]: Vascular Endothelial Growth Factor (VEGF) levels from serum samples. Results are provided in units of pg/mL. Higher levels of VEGF are associated with better cardiovascular health.
• Circulating Cytokine Biomarker - TNFα [Baseline, Month 1, Month 3, Month 6]: Circulating Tumor necrosis factor alpha (TNFα) levels from serum samples. Results are provided in units of pg/mL. Lower values are associated with reduced inflammation.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. Be ≥ 18 years of age (males and females).
2. Provide written informed consent.
3. Have a diagnosis of symptomatic ischemic heart disease (IHD) and an indication for standard-of-care coronary angiography.
4. Have Diabetes Mellitus (DM) type 2 documented by glycated hemoglobin (HbA1C) > 7%, or on medical therapy for diabetes.

Exclusion Criteria:

1. Be younger than 18 years of age.
2. Have history of prior myocardial Infarction and revascularization.
3. Have a baseline glomerular filtration rate (GFR) <30 ml/min 1.73m2 estimated using the Modification of Diet for Renal Disease (MDRD) formula.
4. Have poorly controlled blood glucose levels with hemoglobin A1C > 8.5% in the previous 3 months.
5. Have a history of proliferative retinopathy or severe neuropathy requiring medical treatment.
6. Have an indication for standard-of-care surgical (including valve surgery, placement of left-ventricular assist device) or percutaneous intervention for the treatment of valvular heart disease (including valvuloplasty).
7. Have known hypersensitivity or contraindication to aspirin; both heparin and bivalirudin; all available P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor); or any zotarolimus, cobalt, chromium, nickel, tungsten, acrylic, or fluoropolymers; or hypersensitivity to contrast media that cannot be adequately premedicated.
8. Have a hematologic abnormality as evidenced by hematocrit < 25%, white blood cell < 2,500/microliter (uL) or platelet values < 100,000/uL without another explanation (per investigator discretion).
9. Have liver dysfunction, as evidenced by enzymes (AST and ALT) greater than three times the upper limit of normal.
10. Have a bleeding diathesis or coagulopathy (INR > 1.3), cannot be withdrawn from anticoagulation therapy, or will refuse blood transfusions.
11. Be an organ transplant recipient or have a history of organ or cell transplant rejection.
12. Have a clinical history of malignancy within the past 5 years (i.e., subjects with prior malignancy must be disease free for 5 years), except curatively-treated basal cell or squamous cell carcinoma, or cervical carcinoma.
13. Have a condition that limits lifespan to < 1 year.
14. Have a history of drug or alcohol abuse within the past 24 months.
15. Be serum positive for HIV, hepatitis B surface antigen (sAg), or viremic hepatitis C.
16. Be currently participating (or participated within the previous 30 days) in an investigational therapeutic or device trial.
17. Be pregnant, nursing, or of childbearing potential and not on contraceptive medications. (May participate if on 2 forms of contraceptives).
18. Any other condition that in the judgment of the Investigator would be a contraindication to enrollment or follow-up.
19. Coronary lesions with restenosis or heavy calcification.

Participant flow

Outcome results

• Brachial Artery Flow Mediated Diameter Percentage (FMD%) (Primary), Mean, percentage: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 5.80 +/- 3.46; Group B: Placebo Group 4.28 +/- 2.10
• EPC-CFU Counts (Primary), Median, CFUs per well: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 4.92 (1.42 to 7.38); Group B: Placebo Group 8.67 (7.33 to 12.33)
• Fractional Flow Reserve (FFR) (Secondary), Mean, ratio: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 0.83 +/- 0.24; Group B: Placebo Group 0.9 +/- 0.07
• Coronary Flow Reserve (CFR) (Secondary), Mean, ratio: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 2.82 +/- 1.22; Group B: Placebo Group 2.64 +/- 1.78
• Seattle Angina Questionnaire (SAQ) Angina Frequency (AF) (Secondary), Mean, score on a scale: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 76.15 +/- 33.55; Group B: Placebo Group 84.62 +/- 25.04
• Seattle Angina Questionnaire (SAQ) Quality of Life (QL) (Secondary), Mean, score on a scale: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 53.85 +/- 35.5; Group B: Placebo Group 54.81 +/- 24.76
• Number of Participants With Treatment-Emergent Serious Adverse Events (TE-SAE) (Secondary), Count of participants, Participants: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 2; Group B: Placebo Group 1
• Number of Participants With Major Adverse Cardiac Events (MACE) (Secondary), Count of participants, Participants: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 2; Group B: Placebo Group 3
• Number of Participants With Target Vessel Failure (Secondary), Count of participants, Participants: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 0; Group B: Placebo Group 2
• Number of Participants With Treatment Emergent Adverse Events (Secondary), Count of participants, Participants: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 2; Group B: Placebo Group 1
• Number of Participants With Abnormal Lab Values (Secondary), Count of participants, Participants: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 1; Group B: Placebo Group 4
• Circulating Angiogenic Marker - VEGF (Secondary), Mean, pg/mL: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 1,169.62 +/- 379.73; Group B: Placebo Group 1,303.36 +/- 604.34
• Circulating Cytokine Biomarker - TNFα (Secondary), Mean, pg/mL: Group A: Allogeneic Mesenchymal Stem Cells (MSCs) Group 14.70 +/- 4.49; Group B: Placebo Group 13.02 +/- 2.96

Adverse events

Time frame: 1 year

Serious adverse events by term

Other adverse events by term

• Study Protocol and Statistical Analysis Plan (PDF, 2025-04-08)
• Informed Consent Form (PDF, 2025-04-08)

• Nikolaos Spilias, MD, Principal investigator, University of Miami

NIH grants: R01HL134558