Deferiprone Therapy for Heart Attack

(MIRON-DFP Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Keyur Vora, MD MS

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Rohan Dharmakumar

Must not be taking: Iron chelators

Disqualifiers: Prior MI, LVEF < 40%, others

Prior Safety Data

Approved in 3 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing Deferiprone, a medication that removes excess iron, in patients with bleeding in the heart muscle. The goal is to see if it can reduce heart damage by getting rid of extra iron. Deferiprone is effective in reducing cardiac iron load and improving cardiac function.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you are using investigational drugs or devices, you must stop them 30 days before joining the trial.

What data supports the effectiveness of the drug Deferiprone for heart attack?

Deferiprone has been shown to be effective in reducing cardiac iron load and improving heart function in patients with thalassemia, which suggests it may offer heart protection. In studies, patients treated with Deferiprone had fewer heart-related events compared to those on another treatment, indicating its potential for heart health benefits. ^{1 2 3 4 5}

What makes the drug Deferiprone unique for treating heart attacks?

Deferiprone is unique for heart attack treatment because it is primarily known as an iron chelator used for conditions like thalassemia, and its application in heart attacks is novel, potentially offering a different mechanism of action compared to standard treatments like thrombolytics or ACE inhibitors. ^{6 7 8 9 10}

Research Team

Rohan Dharmakumar, PhD

Principal Investigator

Krannert Cardiovascular Research Center

Keyur Vora, MD MS

Principal Investigator

Krannert Cardiovascular Research Center

Eligibility Criteria

This trial is for adults who've recently had a specific type of heart attack (anterior wall STEMI) and are about to have a procedure to open their blocked arteries. They must not have had previous heart attacks or procedures, severe kidney issues, known allergies to MRI contrast agents, or be pregnant. Their body weight should be under 309 lbs., and they can't have certain blood disorders or liver problems.

Inclusion Criteria

I had a specific type of heart attack affecting the front wall of my heart, confirmed by symptoms, ECG changes, and high heart markers.

Exclusion Criteria

Any clinically significant abnormality identified prior to randomization that in the judgment of the Sponsor-Investigator or Delegate would preclude safe completion of the study or confound the anticipated benefit of LIPOMED

My body weight is over 309 lbs.

Absolute neutrophil count of ANC < 1.0 x 109 /L

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Deferiprone or placebo to assess its efficacy in reducing free iron in the hemorrhagic zone of myocardial infarction

6 months

Follow-up

Participants are monitored for safety, tolerability, and treatment effects, including clinical outcomes and side effects

6 months

Treatment Details

Interventions

• Deferiprone (Iron Chelator)
• Placebo (Drug)

Trial Overview The study tests if Deferiprone tablets can reduce iron in the damaged area of the heart after a hemorrhagic myocardial infarction. Patients will either receive Deferiprone or a placebo randomly, alongside standard care including an MRI scan to guide treatment.

Participant Groups

Group I: Hemorrhagic Myocardial Infarction - Deferiprone Active Control 1 Intervention

Enrolled patients with CMR confirmed presence of intramyocardial hemorrhage

Group II: Non-hemorrhagic Myocardial Infarction - Deferiprone Active Control 1 Intervention

Enrolled patients with CMR confirmed absence of intramyocardial hemorrhage

Group III: Hemorrhagic Myocardial Infarction - Placebo Placebo Group 1 Intervention

Enrolled patients with CMR confirmed presence of intramyocardial hemorrhage

Group IV: Non-hemorrhagic Myocardial Infarction - Placebo Placebo Group 1 Intervention

Enrolled patients with CMR confirmed absence of intramyocardial hemorrhage

Deferiprone is already approved in Canada for the following indications:

Approved in Canada as Ferriprox for:

• Iron overload in thalassemia syndromes

Who Is Running the Clinical Trial?

Rohan Dharmakumar

Lead Sponsor

Trials

10

Recruited

120,000+

Cardio-theranostics LLC

Collaborator

Trials

1

Recruited

70+

Lipomed AG

Collaborator

Trials

1

Recruited

70+

Findings from Research

Deferiprone appears to be more effective than deferoxamine in protecting the heart from iron overload, as indicated by better myocardial imaging results and a lower risk of developing or worsening cardiac disease in patients on long-term treatment.

Combining deferiprone with deferoxamine may enhance iron excretion and reduce the time needed to treat severe iron overload and reverse heart disease, although these findings need further validation through randomized controlled trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deferiprone: New insight. Piga, A., Roggero, S., Vinciguerra, T., et al.[2018]

In a study of thalassemia major patients, those treated with deferiprone showed no cardiac events during therapy or for at least 18 months after, while 52 cardiac events occurred in patients treated only with deferoxamine (DFO).

Deferiprone therapy was associated with significantly greater cardiac protection compared to DFO, suggesting it may be a safer option for preventing cardiac disease in thalassemia patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major. Borgna-Pignatti, C., Cappellini, MD., De Stefano, P., et al.[2021]

Deferiprone is an effective oral iron-chelating agent that reduces cardiac iron load and improves cardiac function in patients with transfusion-related hemosiderosis, significantly enhancing their prognosis.

While generally well tolerated, deferiprone can cause serious side effects such as agranulocytosis (0.5%) and neutropenia (9%), necessitating regular blood count monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of iron chelation therapy with deferiprone in patients with transfusion-dependent thalassemia. Jamuar, SS., Lai, AH.[2021]

Captopril significantly reduced the occurrence of ventricular fibrillation during reperfusion in isolated rat hearts, with none of the captopril-treated hearts experiencing this arrhythmia, compared to 4 out of 6 enalapril-treated hearts.

Captopril and HOE 498 improved mechanical function after reperfusion, maintaining a pressure-rate index of 124% and 98% of initial values, respectively, while untreated and enalapril-treated hearts showed severe impairment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reduction of reperfusion arrhythmias in the ischemic isolated rat heart by angiotensin converting enzyme inhibitors: a comparison of captopril, enalapril, and HOE 498. van Gilst, WH., de Graeff, PA., Wesseling, H., et al.[2016]

Defibrotide, when administered in doses of 100-800 mg, significantly reduces plasminogen activator inhibitor (PAI) levels and increases tissue plasminogen activator (t-PA) and prostacyclin levels in human venous blood, indicating its potential efficacy in promoting fibrinolysis.

The study also found that defibrotide inhibits neutrophil activation in vitro by reducing calcium entry into cells, suggesting a mechanism of action that may involve interference with adenosine receptors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modulation of venous endothelial activity and transcellular calcium transport by defibrotide: the adenosine hypothesis. Pasini, FL., Frigerio, C., Capecchi, PL., et al.[2014]

In a study of 157 patients with acute myocardial infarction (AMI), defibrase demonstrated effective thrombolytic properties, achieving a recanalization rate of 57% in patients with total occlusion of the infarct-related artery (IRA) shortly after treatment.

Defibrase treatment resulted in a lower mortality and complication rate compared to conventional therapy, with a low incidence of major bleeding complications, indicating it is a safe and effective option for thrombolysis in AMI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defibrase, a purified fibrinolytic protease from snake venom in acute myocardial infarction. Huang, DX., Gai, LY., Wang, SR., et al.[2017]

Captopril, an angiotensin converting enzyme inhibitor, can trigger myocardial ischemic events in patients with coronary artery disease, especially after stopping beta-blockers like propranolol.

In two case studies, one patient experienced multiple angina episodes and another showed signs of a possible acute myocardial infarction after the combination of these treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ischemic cardiovascular complications concurrent with administration of captopril. A clinical note. Baker, KM., Johns, DW., Ayers, CR., et al.[2019]

Defibrase (DF), a fibrinolytic agent, was effective in recanalizing blocked coronary arteries in patients with acute myocardial infarction, achieving a 100% success rate in the DF group compared to only 27% in the control group.

While DF showed a trend towards improved left ventricular function (LVEF of 61% vs 50% in controls), it also caused minor bleeding complications, such as petechiae and gum bleeding, but no serious adverse effects like intracranial hemorrhage.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Coronary thrombolysis with defibrase]. Li, TD., Gai, LY., Wang, SR.[2014]

References

1. United States pubmed.ncbi.nlm.nih.gov

Deferiprone: New insight. [2018]

2. New Zealand pubmed.ncbi.nlm.nih.gov

Deferiprone in the treatment of transfusion-dependent thalassemia: a review and perspective. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Deferiprone does not protect against chronic anthracycline cardiotoxicity in vivo. [2018]

5. England pubmed.ncbi.nlm.nih.gov

Safety and efficacy of iron chelation therapy with deferiprone in patients with transfusion-dependent thalassemia. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Reduction of reperfusion arrhythmias in the ischemic isolated rat heart by angiotensin converting enzyme inhibitors: a comparison of captopril, enalapril, and HOE 498. [2016]

7. United States pubmed.ncbi.nlm.nih.gov

Modulation of venous endothelial activity and transcellular calcium transport by defibrotide: the adenosine hypothesis. [2014]

8. England pubmed.ncbi.nlm.nih.gov

Defibrase, a purified fibrinolytic protease from snake venom in acute myocardial infarction. [2017]

9. United States pubmed.ncbi.nlm.nih.gov

Ischemic cardiovascular complications concurrent with administration of captopril. A clinical note. [2019]

10. China pubmed.ncbi.nlm.nih.gov

[Coronary thrombolysis with defibrase]. [2014]