Nitric Oxide, GeNO Nitrosyl Delivery System



Status:Archived
Conditions:High Blood Pressure (Hypertension)
Therapuetic Areas:Cardiology / Vascular Diseases
Healthy:No
Age Range:Any
Updated:7/1/2011
Start Date:September 2010
End Date:June 2011

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An Open Label, Non-Randomized Pilot Study to Evaluate the Safety and Performance of the GeNO Nitrosyl Delivery System in Subjects Being Evaluated for Orthotopic Heart Transplantation (OHT), or Left Ventricular Assist Device (LVAD) Implantation


The primary aim of the study is to evaluate the safety, tolerability and device performance
of the GeNO nitrosyl delivery system during RHC. Secondary considerations are to confirm
that inhaled NO generated by the GeNO nitrosyl delivery system, reduces PVR in patients with
reversible PH, contains levels of NO2 well below the upper level of acceptable exposure.
Further, the study aims to demonstrate that patient response to inhaled NO can be used as a
diagnostic tool with which to determine the proper course of medical action in patients with
chronic heart failure.

Patients with chronic heart failure accompanied by pulmonary hypertension and increased
pulmonary vascular resistance have a number of possible medical therapies available to them.
The least invasive, and therefore most appealing, option is standard management with
medication and observation. Alternatively, implantation of a left ventricular assist device
(LVAD) may be considered, either as a permanent solution or as a bridging strategy to the
final option, orthotopic heart transplantation (OHT). It is often unclear which route is
the best medical choice, and a tool to help physicians and patients choose between these
alternatives would be greatly beneficial.

It has been shown that chronic heart failure patients that demonstrate irreversible
pulmonary hypertension, even in the presence of vasodilators, exhibit adverse outcomes after
OHT (Tsai et al., 2002; Ericson et al., 1990; Murali et al., 1996). It follows that
patient response to pulmonary vasodilators can, and should be used to classify patients as
potential candidates for OHT. In particular, patient response to inhaled NO, a known
pulmonary vasodilator, can be used as a diagnostic tool to assist in deciding which medical
route to take.

With this in mind, the current study aims to demonstrate whether or not NO generated by the
GeNO nitrosyl delivery system effects a reduction in pulmonary hypertension due to increased
pulmonary vascular resistance in patients with chronic heart failure. Any demonstrated
ability of inhaled NO to decrease PVR in patients with reversible PH will support the use of
patient response to inhaled NO as a diagnostic tool to assist in choosing the most
appropriate medical therapy for patients with chronic heart failure.


Investigational product will be administered by qualified study staff in accordance with the
procedures described in the protocol and in accordance with the detailed set of instructions
supplied with the initial shipment of investigational product.

Nitric oxide, 80 ppm in air or oxygen will be administered using the GeNO nitrosyl delivery
system with a standard nasal cannula at a flow rate of 4 LPM.

In order to reliably measure trace levels of NO2 in the presence of a large excess of NO, it
is essential to use a technique with extremely high accuracy in situations of low levels of
NO2. The GeNO nitrosyl delivery system delivers a fixed concentration of 80ppm NO with low
levels of NO2 which current technology cannot measure with accuracy at levels below 3ppm.

The investigational product is the GeNO nitrosyl delivery system which consists of a
drug/device combination product with all the components necessary to deliver the
investigational drug; the nitric oxide gas. The investigational drug, nitric oxide, is
generated at the time of use when the NO2 input gas flows through the cartridge, the
antioxidant reduces the NO2 to NO.

The input gas is supplied as either nitric oxide in air or nitric oxide in oxygen. The
Investigator will determine whether air or oxygen is used as the balance gas, on the basis
of the participant's clinical needs for supplemental oxygen.


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Milwaukee, WI
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