Safety Study of Gene Therapy for Ischemic Heart Disease in Korea

The purpose of this study is to evaluate the safety of VM202RY direct injection into the cardiac muscles of the coronary artery territory where complete revascularization could not be done even through Coronary Artery Bypass Graft.

All the patients expected to undergo Coronary Artery Bypass Graft will screen for the participation in the clinical study. Subjects who signed the informed consent will receive all the screening tests within 21 days before surgery (Day 0). VM202RY will be injected into 4 sites or 8 sites on the coronary artery where complete revascularization was not done since vascular anastomosis could not be performed due to the bad vascular condition during surgery. VM202RY will be administered to Group1 (0.5mg), Group 2 (1mg) and Group 3 (2mg) at different concentrations. Subjects will be scheduled to get inpatient treatment during the gene therapy period (7 days) and follow-up tests at Week 2, 4, 8, 12 and 24 based on surgery day (Day 0). Adverse events and concomitant drugs will be checked.

• Biological: VM202RY
  0.5mg intramuscular injection
• Biological: VM202RY
  1mg intramuscular injection
• Biological: VM202RY
  2mg intramuscular injection

• Experimental: Cohort I
  0.5mg/1mL of VM202RY was intramuscularly injected into 4 sites
  Intervention: Biological: VM202RY
• Experimental: Cohort II
  1mg/2mL of VM202RY was intramuscularly injected into 8 sites
  Intervention: Biological: VM202RY
• Experimental: Cohort III
  2mg/4mL of VM202RY was intramuscularly injected into 8 sites
  Intervention: Biological: VM202RY

Inclusion Criteria:

1. Patients aged ≥ 19 and ≤ 75 years
2. Patients in whom decrease of myocardial perfusion in coronary artery territories (rest perfusion - stress perfusion: ≥ 7%) was observed by myocardial SPECT
3. Patients judged to have possibly incomplete revascularization based on the observation of the coronary artery's internal diameter of ≤ 1 mm, diffuse atherosclerosis or severe calcification on coronary angiography, or patients judged to have some myocardial perfusion territories that could not be performed Coronary Artery Bypass Graft
4. Patients who or whose legal representative can write the informed consent before the initiation of the clinical study and comply with the requirements

Exclusion Criteria:

1. Patients with progressive or present heart failure
2. Patients with uncontrolled ventricular arrhythmia on electrocardiogram, or who have been treated for ventricular arrhythmia
3. Patients with current or history of malignant tumor
4. Patients with severe infectious disease
5. Patients with uncontrolled hematologic disorders
6. Patients requiring surgery for the accompanying valve diseases or left ventricular volume reduction surgery
7. Patients with current or history of proliferative retinopathy
8. Patients with remaining life of less than 1 year and severe accompanying diseases enough to die during the clinical follow-up period
9. Patients with history of drug or alcohol abuse within the recent 3 months
10. Women who are pregnant or breast feeding or premenopausal women of childbearing age. However, women who underwent surgical sterilization including hysterectomy or bilateral tubal ligation can participate in this clinical trial. Even though they consent to the contraception, they cannot be enrolled.
11. Patients in inappropriate condition judged by investigators
12. Patients with cerebrovascular diseases (cerebral infarction, cerebral bleeding or transient ischemic attack that are currently occurring or occurred within 6 months)
13. Patients with idiopathic hypertension who are not controlled with drugs
14. Patients with severe hepatic disorders
15. Patients with severe renal disorders
16. Patients who underwent Coronary Artery Bypass Graft
17. Patients who underwent angioplasty within 1 year before their enrollment in the study