A Dose Ranging Phase IIa Study of 6 Hour Intravenous Dosages of CXL-1427 in Patients Hospitalized With Heart Failure

This is a dose finding, randomized, double-blinded, placebo-controlled study of continuous
6-hour IV infusions of CXL-1427 in hospitalized patients with systolic heart failure which
will first evaluate up to four ascending dose levels of CXL-1427 in up to four cohorts of 8
patients each (the "Dose Escalation" cohorts). Subsequently, up to three of the initial dose
levels of CXL-1427 may be assessed in the additional "Expansion" cohorts of up to
approximately 16 patients to gain further confidence in the results at these dose levels.
The CXL-1427 dose that will be evaluated in the first cohort will be 3µg/kg/min. The dose
levels for the next three sequential Dose Escalation cohorts will be dependent on clinical
safety and tolerability, as well as the results of the invasive hemodynamic measurements.

Inclusion Criteria:

- Inclusion Criteria -In order to be eligible for study participation, a patient MUST:

- Be ≥ 18 and ≤ 85 years of age;

- Have a left ventricular ejection fraction (LVEF) ≤40%, as assessed by
echocardiography, a multigated acquisition (MUGA) scan or magnetic resonance imaging
(MRI) within 3 months prior to or during the current hospitalization;

- Be hospitalized with a primary heart failure or heart failure-related reason, e.g.,
acute decompensation of heart failure, transplant evaluation, hemodynamic
optimization prior to ambulatory inotropes or left ventricular assist device
placement;

- Have an indwelling pulmonary artery (PA) catheter in place for assessment of central
hemodynamic parameters; [Note: The indwelling catheter may already be in place for
medically-indicated reasons, OR be placed for the primary purpose of monitoring the
hemodynamic effects of the study drug. If the pulmonary artery catheter is to be
placed for the sole purpose of monitoring the hemodynamic effect of the study drug,
the patient must have a cardiac index (CI) ≤ 2.2L/min•m2 as measured by a
non-invasive cardiac output monitor (NICaS device) ≤6 hours prior to placement of the
catheter. In this setting, Exclusion Criteria 3 below also applies.]

- Have a Fick and/or thermodilution determination of cardiac index ≤2.5L/min•m2 at
screening, i.e., ≤4 hours before the intended start of the study drug infusion;
[Note: For determinations of CI using the thermodilution method, a mean of three
consecutive values measured approximately 5 minutes apart, none of which differs from
the mean value by more than 15%, should be used.]

- Have a screening and baseline PCWP (or PAD, if a PCWP waveform cannot be reliably
obtained) of ≥20 mmHg if systolic blood pressure is ≥100mmHg OR ≥22mmHg if systolic
blood pressure is between 95-99mmHg (inclusive);

- Be considered sufficiently stable to be expected not to require administration of any
IV or oral vasoactive medications, including diuretics, for at least ~10 hours, i.e.,
from 4 hours before performing baseline hemodynamic assessments until after the
completion of the 6-hour study drug infusion;

- Have a body weight of at least 50kg (110 pounds), but not more than 125kg (275
pounds), and have a body mass index (BMI) <40kg/m2;

- Have adequate peripheral forearm vein access or an available central line port for
administration of study drug;

- Be capable of understanding the nature of the trial; be willing and able to comply
with the inpatient and outpatient study protocol requirements for the duration of the
study (screening period, treatment period, and 30-day post-infusion follow-up
period); and be willing to participate in the study, as documented by written
informed consent.

Exclusion Criteria- - In order to be eligible for study participation, a patient MUST NOT:

- Have a heart rate <50 or >110 beats per minute (bpm) at baseline;

- Have a screening OR baseline systolic blood pressure (SBP) of >150mmHg or <100mmHg,
if PCWP ≥ 20mmHg, but <22mmHg OR <95mmHg, if PCWP ≥ 22mmHg;

- Have tricuspid or pulmonary valve prosthesis or endocarditis, right heart mass, a
history of pneumothorax or hemothorax, a bleeding diathesis that would preclude
placement of a PAL, or a history of complications from previous pulmonary artery
catheter placement, when a pulmonary artery catheter is to be placed solely for the
purposes of monitoring the hemodynamic effects of the study drug; In this setting,
patients with multiple intracardiac leads and/or left bundle branch block should have
such elective pulmonary artery catheter placement performed under radiologic guidance
by experienced personnel, e.g. in the cardiac catheterization laboratory. [Note:
Other pertinent history, such as trauma, vascular injury or previous surgery should
guide selection of the vessel for PAL placement.]

- Have a primary HF etiology attributable to either restrictive/obstructive
cardiomyopathy, idiopathic hypertrophic cardiomyopathy (as defined by any wall
thickness > 1.8cm) or uncorrected severe valvular disease as defined by AHA/ACC/ESC
criteria;

- Have been treated with dopamine, dobutamine, enoximone, nesiritide, nitroglycerine or
nitroprusside within 4 hours, or with levosimendan, amrinone or milrinone within 8
hours, prior to performing baseline hemodynamic assessments, or have an anticipated
need to be treated with any of these agents before the completion of the 6-hour study
drug infusion;

- Be receiving concomitant parenteral therapy with any antiarrhythmic drugs (oral
therapy is allowed);

- Be in atrial fibrillation/flutter with an uncontrolled rate (≥100bpm) at the time of
randomization; [Note: Patients with a history of A-fib/flutter are eligible, if heart
rate is controlled with a ventricular rate not exceeding 100bpm.]

- Have non-sustained ventricular tachycardia (NSVT) of 10 beats or more during any
bedside monitoring within 2 hours prior to randomization, or have excessive premature
ventricular contractions (PVCs) or complex multifocal ventricular ectopy exceeding 10
beats per minute on a 2-minute rhythm strip taken within 2 hours prior to
randomization;

- Require, or be expected to require, any alteration of settings to an implantable
cardioverter-defibrillator (ICD), single chamber or biventricular pacemaker, if
applicable, from 2 hours before the intended start of the study drug infusion, until
after the completion of the study drug infusion;

- Have a history of sudden cardiac death/resuscitation or other appropriate ICD firing
within the past 1 year. (Inappropriate ICD firings are not exclusionary);

- Be hospitalized with acute coronary syndrome or acute myocardial infarction during
the previous 90 days prior to randomization;

- Have a history of a cerebral vascular accident (CVA or stroke) or of a transient
ischemic attack (TIA) within 6 months prior to randomization;

- Have a digoxin level above 1ng/ml (1.281nmol/L) within 8 hours before initiation of
the study drug infusion;

- Have persistent abnormal serum electrolytes at baseline, as defined by: a Na+
concentration <130 or >145 mEq/L, or a K+ or Mg2+ concentration outside the normal
range (according to the local laboratory); [Note: Any observed electrolyte
abnormalities during screening or earlier should be corrected by electrolyte
supplementation and within normal acceptable concentrations should be confirmed prior
to dosing. Any serum electrolyte abnormalities with associated clinical instability
within 8 hours before initiation of the study drug infusion is exclusionary.]

- Have an ALT or AST >3 times the upper normal limit or a hemoglobin <10g/dl (100g/L)
within 8 hours before initiation of the study drug infusion;

- Have a serum creatinine >2.5mg/dl (221µmol/L) or severe renal insufficiency [based on
any standard limit and equation employed by the local lab, such as a GFR <
30mL/min/1.73m2 according to the Modification of Diet in Renal Disease (MDRD)
equation] within 8 hours before initiation of the study drug infusion;

- Have taken an oral phosphodiesterase type 5 inhibitor (PDE5) inhibitor within 96
hours before initiation of the study drug infusion;

- If female, be pregnant or of child-bearing potential (i.e., female patients must be
post-menopausal or surgically sterilized);

- Be receiving a drug which is expected to possess a potential for a clinically
significant pharmacokinetic interaction with CXL-1427, as defined in the CXL-1427
Investigator's Brochure;

- Be the recipient of a myocardial restraint device or flap;

- Have an anticipated survival of less than 90 days, for any reason;

- Have received an investigational drug, device or biologic product within 30 days (or
if longer, 5 half-lives for a drug or biologic agent) prior to randomization, or be
planning to receive an investigational agent at any time throughout the full duration
of the study until at least 30 days after discontinuation of study drug;

- Have any other clinically significant laboratory abnormality, medical condition or
social circumstance that, in the investigator's opinion, makes it inappropriate for
the patient to participate in this clinical trial.