CHIP in Endothelial Dysfunction Associated With HEpEF

Heart Failure With Preserved Ejection Fraction Clinical Trial

— CHiEF  

Official title:

Role of Clonal Hematopoiesis of Indeterminate Potential in Endothelial Dysfunction Associated With Heart Failure With Preserved Ejection Fraction

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05828888
• Other study ID #: CHUBX 2022/51
• Secondary ID: 2023-A00319-36
• Status: Not yet recruiting
• Start date: May 1, 2023
• Est. completion date: February 1, 2026

Study information

• Verified date: March 2023
• Source: University Hospital, Bordeaux
• Contact: Olivier MANSIER, PharmD,PhD
• Phone: 05 24 54 91 13
• Email: olivier.mansier[@]chu-bordeaux.fr
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This study aims at identifying processes that are deregulated in blood cells by Clonal Hematopoiesis of Indeterminate Potential (CHIP) which are involved in the development of heart failure with preserved ejection fraction (HEpEF).

Description:

Heart failure is responsible of 70,000 deaths every year in France. Heart failure can be divided into 2 categories depend on whether the ejection fraction is reduced (HFrEF) or preserved (HFpEF). Most of the treatments efficient in HFrEF are unable to prevent decompensating or reduce mortality associated with HFpEF. HFpEF pathophysiology remains poorly understood, which represents an obstacle to their management and to reduce cardiovascular events they are associated with. Currently, it is admitted that cardiovascular risk factors (CVRF such as aging, female gender, diabetes mellitus, high blood pressure, hypercholesterolemia, obesity) are responsible of a low grade chronic inflammatory state that causes an endothelial dysfunction that contributes to the development of HFpEF. However, not all patients with these CVRF develop HFpEF. Moreover, the mechanisms linking CVRF to inflammation or alteration of cardiomyocyte function by endothelial dysfunction remain unknown. This suggests that it exists a role for another factor that remains to be identified. Clonal Hematopoiesis of Indeterminate Potential (CHIP) result from the acquisition in hematopoietic stem cells of mutations associated with hematological malignancies, in the absence of any hematological disease. This situation initially described with a frequency of <5% before 60 years and >20% after 80 years old appears to be more frequent (>40% of people over 65 years). CHIP are mainly associated with the occurrence of cardiovascular events such as atherothrombosis and heart failure, possibly due to the induction of a chronic inflammation. Because CHIP are very frequent in the elderly and because CHIP are associated with inflammation and cardiovascular events, they could represent the missing link in the pathophysiology sequence that leads to the appearance of endothelial dysfunction and HFpEF development.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 80
• Est. completion date: February 1, 2026
• Est. primary completion date: May 1, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years to 85 Years

Eligibility

Inclusion Criteria:

• HFpEF group and control group
• male or female
• 50 = age = 85 ans
• Absence of evidence of hematological malignancy (known or obvious by the results of blood counts)
• Subject registered with a social security scheme
• Written informed consent obtained
• HFpEF group
• patients with a diagnosis of HFpEF according to the criteria defined by the European society of cardiology
• Control group
• patients with a neuro-cardiovascular pathology without any link to coronaropathy nor heart failure

Exclusion Criteria:

• Hematological malignancy (known or obvious on the results of blood counts)
• Chronic inflammatory disease (cancer, vasculitis, rheumatism, hepato-gastro-intestinal diseases)
• Long term anti-inflammatory treatments:
• Corticoids
• Nonsteroidal anti-inflammatory drugs
• Aspirin (> 325 mg per day)
• Cyclo-oxygenase II inhibitors
• Persons under judicial safeguards, trustee or curatorship
• Person deprived of judicial or administrative freedom
• Person unable to give her consent
• Non-cooperative person
• Exclusion period after another clinical study or participation to another interventional clinical study testing a drug in the 30 days before inclusion

Related Conditions & MeSH terms

• Heart Failure
• Heart Failure With Preserved Ejection Fraction

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
University Hospital, Bordeaux	INSERM - UMR 1219

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Presence of clonal hematopoiesis indeterminate potential (CHIP)	Presence of CHIP defined as the presence of a mutation with an allele frequency greater than 2%.	Inclusion Visit
Secondary	Diagnosis of heart failure with preserved ejection fraction	Diagnosis based on the European Society of Cardiology diagnostic sequence	Inclusion Visit
Secondary	scRNA-seq analysis	Sixteen patients will be selected for scRNA-seq analysis: 3 patients with HFpEF and TET2 mutation; 3 patients with HFpEF and DNMT3A mutation; 2 patients with HFpEF but without CHIP; 3 patients with TET2 mutation but without HFpEF; 3 patients with DNMT3A mutation but without HFpEF; 2 patients without HFpEF nor CHIP	6 months (+/- 3 months)