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(Circulation. 2004;110:II-274 – II-279.)
© 2004 American Heart Association, Inc.

Myocardial Protection and Vascular Biology

Soluble Human Complement Receptor 1 Limits Ischemic Damage in Cardiac Surgery Patients at High Risk Requiring Cardiopulmonary Bypass

Harold L. Lazar, MD; Paula M. Bokesch, MD; Frederick van Lenta, PhD; Carmel Fitzgerald, RN MS; Constance Emmett, MS; Henry C. Marsh, Jr, PhD; Una Ryan, PhD; OBE and the TP10 Cardiac Surgery Study Group

From Department of Cardiothoracic Surgery (H.L.L., C.F.), Boston University School of Medicine and Boston Medical Center, Boston, Mass; Department of Anesthesiology (P.M.B.), Emory University, Atlanta, Ga; Department of Laboratory Medicine (F.v.L.), Boston Medical Center, Boston, Mass; AVANT Immunotherapeutics, Inc (C.E., H.C.M., U.R.), Needham, Mass.

Correspondence to Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Boston Medical Center, 88 East Newton Street, Boston, MA 02118. E-mail harold.lazar{at}bmc.org

Background— This study was undertaken to determine whether soluble human complement receptor type 1 (TP10), a potent inhibitor of complement activation, would reduce morbidity and mortality in high-risk patients undergoing cardiac surgery on cardiopulmonary bypass (CPB).

Methods— This was a randomized multicenter, prospective, placebo-controlled, double-blind study in which 564 high-risk patients undergoing cardiac surgery on CPB received an intravenous bolus of TP10 (1, 3, 5, 10 mg/kg) or placebo immediately before CPB. The primary endpoint was the composite events of death, myocardial infarction (MI), prolonged (24 hours) intra-aortic balloon pump support (IABP), and prolonged intubation.

Results— TP10 significantly inhibited complement activity after 10 to 15 minutes of CPB and this inhibition persisted for 3 days postoperatively. However, there was no difference in the primary endpoint between the 2 groups (33.7% placebo versus 31.4% TP10; P=0.31). The primary composite endpoint was, however, reduced in all male TP10 patients by 30% (P=0.025). TP10 reduced the incidence of death or MI in males by 36% (P=0.026), the incidence of death or MI in CABG males by 43% (P=0.043) and the need for prolonged IABP support in male CABG and valve patients by 100% (P=0.019). There was, however, no improvement seen in female TP10 patients. There were no significant differences in adverse events between the groups.

Conclusion— TP10 effectively inhibits complement activation during CPB; however, this was not associated with an improvement in the primary endpoint of the study. Nevertheless, TP10 did significantly decrease the incidence of mortality and MI in male patients.

Key Words: complement • cardiopulmonary bypass • myocardial ischemia