Design and rationale of a clinical trial to increase cardiomyocyte division in infants with tetralogy of Fallot.
Samar R El Khoudary, Anthony Fabio, Jessie W Yester...
https://pubmed.ncbi.nlm.nih.gov/34265312/Actively Recruiting
Led by Weill Medical College of Cornell University · Updated on 2025-11-18
40
Participants Needed
3
Research Sites
N/A
Total Duration
Tetralogy of Fallot and double outlet right ventricle are congenital heart conditions that can lead to heart failure. Researchers are studying whether the medicine Propranolol can help increase the growth of new heart muscle cells in infants with these conditions. This study is a phase 1 randomized trial aiming to understand if Propranolol can reactivate heart muscle cell division and support normal heart growth in infants up to about 4 months old undergoing surgical repair. Participants will be randomly assigned to receive either Propranolol or a placebo starting at 1 month of age until 4 months or just before surgery. Propranolol will be given by parents in four daily doses based on the infants weight. Additionally, patients will receive labeled N-thymidine by mouth for five days to help measure heart muscle cell growth. The study includes heart imaging using echocardiogram and cardiac MRI before and at surgery, as well as tissue and blood sample collection during surgery for detailed analysis. During the study, infants will have regular physical exams including vital signs and feeding and diaper diaries to monitor medication processing. Researchers will analyze heart tissue removed during surgery to measure new heart muscle cell growth using isotope mass spectrometry. The main outcome is cardiomyocyte division at surgery. Secondary outcomes include heart muscle size changes assessed by imaging and microscopy. Participants will be monitored from 1 month of age until surgery, with close follow-up and safety assessments during this time.
CONDITIONS
Beta-blocker Administration for Cardiomyocyte Division
R
Rashida Blackwood, BS, MPH
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Weill Medical College of Cornell University
Lead Sponsor
National Heart, Lung, and Blood Institute (NHLBI)
Collaborating Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Propranolol arm | Placebo arm | Propranolol prior to repair (usual care) |
|---|---|---|---|
| What it is | Infants receive propranolol along with 15N‑thymidine labeling, urine collection, echocardiogram, MRI, physical exam, and tissue sampling at surgery per protocol | Infants receive placebo instead of propranolol, plus the same labeling, imaging, diary, exam, and tissue collection procedures | Propranolol is used before surgical repair to reduce hypercyanotic ("Tet") spells in infants with unrepaired Tetralogy of Fallot |
| Role in trial | Tested intervention in randomized arm | Control comparator arm | Represents routine clinical practice outside the trial |
| Primary use | To assess whether propranolol increases cardiomyocyte division using 15N‑thymidine and imaging/urine markers | To serve as control for evaluating propranolol’s effect on cardiomyocyte division | To prevent or reduce hypercyanotic spells before surgical repair |
| How it is given or performed | Propranolol given orally at 4 mg/kg/day in 4 divided doses, starting with 1 mg/kg first dose; 15N‑thymidine given by mouth once daily for 5 days starting one week after study drug; diaries, imaging and urine collection per protocol | Placebo matching propranolol dose schedule and concomitant labeling, imaging, diary and urine collection | Propranolol is typically given orally in divided doses preoperatively to manage cyanotic spells |
| Evidence status | Efficacy for increasing cardiomyocyte division is not yet established; trial is ongoing | No effect expected on cardiomyocyte division aside from natural baseline | Propranolol appears to reduce incidence of hypercyanotic spells in pre‑operative infants (case series data) |
| Important risks | Risks include potential bradycardia, hypotension, hypoglycemia and bronchospasm associated with propranolol in infants | Placebo avoids propranolol‑specific risks but shares procedural risks (thymidine dosing, imaging, blood/tissue sampling) | Propranolol use may be associated with hemodynamic suppression and potential postoperative catecholamine blunting |
| Important limitations | Trial size is limited and only measures cardiomyocyte division at repair, not long‑term clinical outcomes | Placebo control may not address long‑term developmental or functional cardiac outcomes | Evidence for pre‑operative propranolol is based on older case series lacking randomized comparison and guideline endorsement |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
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Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - Approximately 3 months or until 24 hours before surgery
Participants receive either propranolol or placebo starting at 1 month of age until 4 months of age or 24 hours prior to surgical repair, whichever comes first. During treatment, participants will also take 15N-thymidine by mouth once daily for 5 consecutive days beginning one week after starting the study drug. Parents or caregivers administer medications and keep dosing diaries. Urine samples are collected from diapers during thymidine administration to monitor processing of the labeled thymidine.
Monthly visits until surgery
Duration - Day of surgery
Participants undergo surgical repair of Tetralogy of Fallot. Before surgery, blood samples and heart tissue removed during surgery are collected for analysis.
1 visit (in-person, surgical procedure)
Study Type
INTERVENTIONAL
Masking
TRIPLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
2
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Samar R El Khoudary, Anthony Fabio, Jessie W Yester...
https://pubmed.ncbi.nlm.nih.gov/34265312/Weill Medical College of Cornell University
Lead Sponsor
National Heart, Lung, and Blood Institute (NHLBI)
Collaborating Sponsor