MICA: Developmental clinical studies- Effect of elafin on myocardial injury and inflammation in coronary artery bypass surgery

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Heart muscle cells are susceptible to injury and death following interruption of blood flow (myocardial ischaemia). A mild form of injury occurs during coronary artery bypass surgey and can be measured using a sensitive blood marker (troponin) providing a helpful model to study drugs that may reduce ischaemic injury. Neutrophils are circulating blood cells that contribute to ischaemic injury by releasing destructive enzymes (elastases). Humans produce a protein called elafin that reduces neutrophil elastase injury. Extensive preclinical work from different international centres indicates that elafin has a therapeutic role in diseases of the arteries and heart characterised by neutrophil mediated injury. We believe that administering elafin to patients undergoing bypass surgery will reduce neutrophil mediated myocardial injury and the rise in post-operative inflammatory activity. The degree of heart muscle damage occurring during ischaemia determines clinical outcomes. No therapies are available to address neutrophil mediated heart muscle injury and development of a drug to reduce this offers substantial clinical benefit.