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Tetralogy of FallotPhase 1NCT04713657

Beta-blocker Administration for Cardiomyocyte Division

A Phase 1 study testing N-thymidine, Urine Collection and Echocardiogram in people with Tetralogy of Fallot and Double Outlet Right Ventricle, run by Weill Medical College of Cornell University at 4 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Heart failure is a common long-term complication in patients with congenital heart disease (CHD). Medical treatments to promote regeneration of new healthy heart muscle cells have the potential to provide new heart failure treatments for these patients. Read more about this study

Who is it for?
Ages 30 to 100 days
What is being tested?
N-thymidine, Urine Collection and Echocardiogram
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
40 participants
Where
4 sitesUnited States
Study dates
16 Dec 2022to 31 Dec 2030
Phase
Phase 1
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 30 to 100 days
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Male and female infants < 100 days of age with a diagnosis of tetralogy of Fallot (ToF) with pulmonary stenosis (PS) or double outlet right ventricle (DORV), tetralogy type by echocardiogram, who weigh greater than 2 kg at the time of consent and are tolerating enteral feeds.
  • DORV variant

Who cannot join

  • congenital atrio-ventricular block on EKG (PR interval > 120 ms),
  • concomitant medication administration that interacts with propranolol,
  • patient family is, in the opinion of the investigator, unable to comply with the requirements of the study protocol or is unsuitable for the study for any reason,
  • Premature infants with corrected age < 5 weeks,
  • asthma or underlying respiratory disease,
  • presence of metal implants in infants.

Trial locations and contacts

4 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Rashida Blackwood, BS, MPH contact

646-962-9036

rab4029@med.cornell.edu

United States4 sites, 4 recruiting
  • Columbia University Morgan Stanley Children'S Hospital

    New York, New York, 10032

    Maureen McKiernan, MD, mam2682@cumc.columbia.edu

    Katrina Golub, MPH, kg2697@cumc.columbia.edu

    Recruiting
  • Weill Cornell Medicine

    New York, New York, 10065

    Rashida Blackwood, BS, MPH, 6469629036, rab4029@med.cornell.edu

    Bernhard Kuhn, MD

    Recruiting
  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

    Laura Mercer-Rosa, MD, mercerrosal@chop.edu

    Anh Duc Mai, MAIAH@chop.edu

    Recruiting
  • Upmc Children'S Hospital of Pittsburgh

    Pittsburgh, Pennsylvania, 15224

    Shannon Janzef, RN, janzefsl@upmc.edu

    Mousumi Moulik, MD

    Recruiting

Other trials in United States

About this study

Official title: Mechanistic Clinical Trial of Beta-Blocker Administration For Reactivating Cardiomyocyte Division In Tetralogy of Fallot

Heart failure is a common long-term complication in patients with congenital heart disease (CHD). Medical treatments to promote regeneration of new healthy heart muscle cells have the potential to provide new heart failure treatments for these patients. The development of such therapies is limited by the poor understanding of the ways in which heart muscles grow after birth. Investigators have learned that humans without heart disease generate new heart muscles cells up to the age of 20 years old and that this is decreased in patients with congenital heart disease like Tetralogy of Fallot. Investigators are trying to determine if treatment with a medicine called Propranolol can increase heart muscle cell proliferation and, with that, normalize heart growth. Investigators will examine discarded heart muscle tissue that is obtained during surgery for the presence of new heart muscle cells. Propranolol is approved by the Food and Drug Administration (FDA) to treat a certain kind of benign tumor in infants (hemangioma), but it is not currently approved by the FDA to increase heart muscle growth.

Being tested
N-thymidine, Urine Collection, Echocardiogram, Cardiac MRI (CMR), Propranolol Hydrochloride
Keywords
Tetralogy of Fallot, Double Outlet Right Ventricle
Medical subject headings
Tetralogy of Fallot, Double Outlet Right Ventricle

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • N-thymidineOther

    Also called Thymidine

    15N-thymidine will be administered to patients in order to quantify cardiomyocyte proliferation. 15N-thymidine will be administered as 5 separate syringes. Each syringe will contain the recommended daily dose based on participants weight. Subjects will be given the labeled thymidine by mouth once a day for 5 consecutive days. The dosing will begin one week after starting the study drug.The caregiver (parent or nurse) will administer the labeled thymidine by mouth via a syringe once a day for 5 consecutive days. They will be provided with a diary to keep track of study drug dosing.

  • Urine CollectionOther

    Parents will be asked to keep a diary of the child's feeding and diaper changes during the administration of thymidine. To monitor how the labeled thymidine is processed in the body, investigators will analyze urine from the child's diapers. Each time a diaper is changed, a cotton ball will be placed in the diaper. At the next diaper change, this cotton ball will be removed from the diaper, placed in a Ziploc bag, and stored in the freezer. They will be collected and stored cotton balls starting with the first administration of thymidine until 24 hours after the last administration. The frozen cotton balls may be collected from the home by a nurse or brought by parent to the next clinic visit.

  • EchocardiogramProcedure or surgery

    On Study Day 1 to obtain baseline assessment of cardiac size. A second research dedicated echocardiogram will be done after being anesthetized for surgery. Echocardiography is routinely performed to determine right ventricle (RV) structure of the heart and function in Tetrology of Fallot/ Pulmonary Stenosis (ToF/PS) and is non-invasive.

  • Cardiac MRI (CMR)Procedure or surgery

    A limited study protocol will be performed using the feed-and-bundle technique at the time of study enrollment, The feed and bundle technique is utilized so that the infant will be as comfortable as possible and asleep during the procedure. This is done to prevent the risk of sedation and allow for a more natural sleep. The baby is undressed, prepared with ECG-leads and an oxygen saturation probe, and fed. With this "feed, swaddle, and sleep" technique, scanning times of 30-60 minutes can be achieved, which provides the stillness needed for accurate visualization of the heart. A second CMR, with the same limited study protocol, will be performed under general anesthesia prior to surgical repair. It does not pose any risk of radiation exposure and will not require IV placement or contrast administration for a limited assessement of the right ventricle.

  • Propranolol HydrochlorideDrug

    Also called Propranolol

    For patients who are randomized to receive propranolol, The target dose for this study will be 3 mg/kg/day divided in 3 doses. The first dose will be given in the Pediatric Clinical and Translational Research Center (PCTRC) at 1mg/kg. Parents will administer propranolol (1 mg/kg po x 3 doses per day). Parents will be instructed to administer propranolol with feeding or soon after feeding, but not before feeding. families will also be given instructions for regarding 15N-thymidine dosing frequency and interval and provided with a log sheet to record administered and missed doses of propranolol and 15N-thymidine.

  • PlaceboDrug

    For patients who are randomized to receive placebo, the first dose will be given in the Pediatric Translational Research Center (PCTRC) and will be based on the patients weight. Parents will administer placebo 3 doses per day. Treatment with placebo will begin at 1 month of age and continue until 4 months of age or 24hrs prior to surgical repair, whichever comes first.

  • Physical ExamProcedure or surgery

    On Study Day 1; monthly until surgery in conjunction with patient's clinical cardiology appointment; and at the time of surgery. Will include vital signs.

  • Specimen CollectionOther

    On the morning of surgery, after IV access is obtained for anesthesia 2 ml of blood will be collected for analysis. A small piece of heart tissue and fat that has already been removed during surgery will be collected for analysis.

Study groups in NCT04713657
Study groupRoleWhat they receive
PropranololActive comparatorThe target dose of Propranolol hydrochloride for this study target dose for this study will be 1mg/kg PO x 3 doses per day. The concentration of propranolol solution is 20 mg/5 mL. Additionally, labeled syringes will be provided to families for accurate weight-based dosing. Treatment with propranolol will begin at 1 month of age and continue until 4 months of age or 24hrs prior to surgical repair, whichever comes first.
Receives: Other: N-thymidine; Other: Urine Collection; Procedure: Echocardiogram; Procedure: Cardiac MRI (CMR); Drug: Propranolol Hydrochloride; Procedure: Physical Exam; Other: Specimen Collection
PlaceboPlacebo comparatorPlacebo will be given in a volume that corresponds to the patient's weight. Additionally, labeled syringes will be provided to families for accurate weight-based dosing. Treatment with placebo will begin at 1 month of age and continue until 4 months of age or 24hrs prior to surgical repair, whichever comes first. There is no current standard of care for pharmacologic therapy for infants with Tetralogy of Fallot (ToF). As such, there are no alternative treatments, and the placebo group is standard of care.
Receives: Other: N-thymidine; Other: Urine Collection; Procedure: Echocardiogram; Procedure: Cardiac MRI (CMR); Drug: Placebo; Procedure: Physical Exam; Other: Specimen Collection

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Cardiomyocyte Division

    To quantify cardiomyocyte division, investigators will utilize previously established MIMS (membrane introduction mass spectrometry) approach. Briefly, investigators will administer 5 enteral doses of 15N-thymidine to all patients at 1 month after birth. Cardiomyocytes that have undergone DNA replication after the intake of 15N-thymidine will incorporate the stable isotope into their DNA.

    Measured: At the time of complete surgical repair, at approximately 3-9 months old, it is expected that a piece of RV myocardium will be resected. This tissue will be collected and analyzed using a multiple isotope mass spectrometer.

Secondary outcomes (3)
  1. Hypertrophy as assessed by echocardiography

    Analysis of the impact of propranolol on Right Ventricle Myocardial Volume

    Measured: At 1 month and at time of surgery

  2. Hypertrophy as assessed by Cardiac MRI

    Analysis of the impact of propranolol on Right Ventricle Myocardial Volume

    Measured: At 1 month and at time of surgery

  3. Hypertrophy assessed by microscopy

    Analysis of the impact of propranolol on cardiomyocytes cross sectional area

    Measured: At time of Surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Jan 2021
  2. Study start16 Dec 2022
  3. Primary completion31 Dec 2030 (estimated)
  4. Study completion31 Dec 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
double-blinded, placebo-controlled (1:1) randomized, single-center trial
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04713657
Sponsor's protocol ID
23-12026881
Other IDs
R01HL155597
Status last verified
Oct 2026
First submitted
13 Jan 2021
Last updated
26 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • El Khoudary SR, Fabio A, Yester JW, Steinhauser ML, Christopher AB, Gyngard F, Adams PS, Morell VO, Viegas M, Da Silva JP, Da Silva LF, Castro-Medina M, McCormick A, Reyes-Mugica M, Barlas M, Liu H, Thomas D, Ammanamanchi N, Sada R, Cuda M, Hartigan E, Groscost DK, Kuhn B. Design and rationale of a clinical trial to increase cardiomyocyte division in infants with tetralogy of Fallot. Int J Cardiol. 2021 Sep 15;339:36-42. doi: 10.1016/j.ijcard.2021.07.020. Epub 2021 Jul 12.

    PubMed 34265312

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing N-thymidine, Urine Collection and Echocardiogram in people with Tetralogy of Fallot and Double Outlet Right Ventricle, run by Weill Medical College of Cornell University at 4 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 26 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Rashida Blackwood, BS, MPH (646-962-9036, rab4029@med.cornell.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cardiomyocyte Division (time frame: At the time of complete surgical repair, at approximately 3-9 months old, it is expected that a piece of RV myocardium will be resected. This tissue will be collected and analyzed using a multiple isotope mass spectrometer.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04713657, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Oct 2026.

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