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Investigation of Thermal Injury on Intestinal Permeability in Both Thermal Injury and Healthy Participants

Primary Purpose

Burns

Status
Terminated
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
Lactulose and Mannitol solution
Sucralose
Sponsored by
GlaxoSmithKline
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Burns focused on measuring Mannitol, Intestinal permeability, Thermal injury, HESTIA, Sucralose, Lactulose

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

For Healthy participants:

  • Males or females must be greater than or equal to 18 years of age at the time of signing informed consent.
  • Participants who are healthy as determined by the investigator following medical evaluation including medical history, physical examination, and laboratory tests.
  • A female participant is eligible to participate if she is not pregnant (negative pregnancy testing at screening or Day 1 as needed) and not breastfeeding.
  • Capable of giving signed informed consent.

For Thermally injured participants:

  • Participants must be greater than or equal to 18 years of age.
  • Participants who have sustained a burn (thermal injury) with a Total Burn Surface Area (TBSA) greater than or equal to 15 percent.
  • Admission to the burn center (study site) less than or equal to 24 hours following injury.
  • Able to take enteral fluids either orally or via a nasogastric tube (depends on facial burn damage).
  • A female participant is eligible to participate if she is not pregnant (negative pregnancy testing at study entry) and not breastfeeding.

Exclusion Criteria

For Healthy participants:

  • Healthy participants are excluded from this study if they are receiving anti-coagulation therapy.
  • Pregnancy or breastfeeding.
  • A body mass index greater than 34 kilogram per meter square (kg/m^2).
  • An active history of alcohol dependency.
  • History of sensitivity to any of the STM, or components thereof or a history of drug or other allergy that, in the opinion of the Investigator and/or GlaxoSmithKline (GSK) Medical Monitor, contraindicates their participation.
  • A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody and confirmatory Hepatitis C Polymerase Chain Reaction (PCR) result within 3 months of screening.
  • A positive pre-study urine drug/alcohol screen.
  • A positive test for Human Immuno-deficiency Virus (HIV) antibody.
  • Participants unable to swallow large capsules (the capsules will be shown to participants at screening).
  • Galactosaemia or severe lactose intolerance.
  • Use of an antibiotic 2 weeks prior to study start (administration of the STM).
  • Gastroenteritis in the 2 weeks prior to study start (administration of the STM).

For thermally injured participants:

  • Chemical or electrical burn.
  • Multiple traumatic injuries with an Injury Severity Score (ISS) more than or equal to 16.
  • Participants received substantial undocumented management prior to arrival at the study site (burn center) e.g. from paramedics or in a local accident and emergency department.
  • Systemic corticoidsteroid use.
  • Intravenous (IV) Mannitol use.
  • HIV infection.
  • Viral Hepatitis B or C infection.
  • Gastrointestinal disease (e.g. inflammatory bowel disease) which may affect intestinal permeability.
  • Previous bowel resection (e.g. hemicolectomy, small bowel resection).
  • Galactosaemia or severe lactose intolerance.
  • Bowel obstruction.
  • Renal dysfunction requiring renal replacement therapy (end-stage renal failure prior to thermal injury).
  • Active autoimmune disease and receiving immunomodulatory therapy e.g. rheumatoid arthritis anti-Tumor Necrosis Factor (TNF).
  • Active chemotherapy for cancers or immunoremittive therapies (prednisolone, Adalimumab) within 60 days of thermal injury.
  • Premorbid conditions of malignancy currently under treatment.
  • Previous bilateral lower extremity amputation.
  • Decision not to treat the participant due to futility.

Sites / Locations

  • GSK Investigational Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Healthy controls

Thermal injury participants

Arm Description

Approximately 15 healthy participants of age 18 years or above will be included in the study and will receive STM intermittently via oral route. The total duration of study for healthy participants will be approximately 2 weeks.

Approximately 25 thermally injured participants having TBSA more than or equal to 15 percent and who are co-consented to the SIFTI-2 and HESTIA studies will be included in the study and will receive STM intermittently via oral route. The total duration of study for thermal injury participants will be approximately 6 months.

Outcomes

Primary Outcome Measures

Change From 0 to 5 Hours, and 0 to 24 Hours in the Ratio of Lactulose/Mannitol on Day 1
Urine samples were collected at indicated time-points to determine the impact of thermal injury on the magnitude of small intestine permeability following the injury. As, L/M does not get metabolized, it gets filtered in the kidney and excreted in the urine. The impact of injury in thermal injury participants was compared with healthy participants using L/M ratio in urine.
Change From 0 to 5 Hours, and 0 to 24 Hours in the Ratio of Lactulose/Mannitol Over Time for Healthy Participants
Urine samples were collected at indicated time-points to determine the impact of thermal injury on the magnitude of small intestine permeability following the injury. As, L/M does not get metabolized, it gets filtered in the kidney and excreted in the urine. Baseline value was considered as Day 1 for both the groups. Change from Baseline is equal to post-Baseline visit value minus Baseline value.
Change From 0 to 5 Hours, and 0 to 24 Hours in the Ratio of Lactulose/Mannitol Over Time for Thermal Injury Participants
Urine samples were collected at indicated time-points to determine the impact of thermal injury on the magnitude of small intestine permeability following the injury. As, L/M does not get metabolized, it gets filtered in the kidney and excreted in the urine. Baseline value was considered as Day 1 for both the groups. Change from Baseline is equal to post-Baseline visit value minus Baseline value.

Secondary Outcome Measures

Full Information

First Posted
August 3, 2017
Last Updated
July 11, 2019
Sponsor
GlaxoSmithKline
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1. Study Identification

Unique Protocol Identification Number
NCT03242434
Brief Title
Investigation of Thermal Injury on Intestinal Permeability in Both Thermal Injury and Healthy Participants
Official Title
A Prospective, Longitudinal Study to Investigate the Effect of Thermal Injury on Intestinal Permeability and Systemic Inflammation (HESTIA)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Terminated
Why Stopped
This trial was supporting the development of an asset which was terminated, thus the data from the study were no longer required.
Study Start Date
January 29, 2018 (Actual)
Primary Completion Date
March 26, 2018 (Actual)
Study Completion Date
March 26, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GlaxoSmithKline

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This longitudinal, prospective study aims to establish the magnitude and time course of changes in intestinal permeability; establish the optimal method for assessment of intestinal permeability in thermally injured participants: describe the participant population most likely to benefit from a new medicinal product which could prevent changes in intestinal permeability; and improve our understanding of the links between intestinal damage, changes in the gut microbiome and microbial translocation to the systemic circulation following thermal injury. The key factors of interest in this study are to understand the impact of thermal injury on intestinal permeability in thermally injured participants compared to healthy participants; and to understand the changes in intestinal permeability over time. Approximately 15 eligible healthy participants and 25 thermally injury participants will be included. The sugar test material (STM) comprises of Lactulose, Mannitol and Sucralose and will be intermittently administered enterally to all the participants. The full duration of the study for healthy participants will be approximately two weeks and 6 months for thermally injured participants. In order to enter this study thermally injured participants will be required to co-enroll in this study and an allied study entitled: A Multi-center, Prospective Study to Examine the Relationship between Neutrophil Function and Sepsis in Adults and Children with Severe Thermal Injury (SIFTI-2). (reference number IRAS ID: 200366).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Burns
Keywords
Mannitol, Intestinal permeability, Thermal injury, HESTIA, Sucralose, Lactulose

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Healthy controls
Arm Type
Other
Arm Description
Approximately 15 healthy participants of age 18 years or above will be included in the study and will receive STM intermittently via oral route. The total duration of study for healthy participants will be approximately 2 weeks.
Arm Title
Thermal injury participants
Arm Type
Other
Arm Description
Approximately 25 thermally injured participants having TBSA more than or equal to 15 percent and who are co-consented to the SIFTI-2 and HESTIA studies will be included in the study and will receive STM intermittently via oral route. The total duration of study for thermal injury participants will be approximately 6 months.
Intervention Type
Other
Intervention Name(s)
Lactulose and Mannitol solution
Intervention Description
Participants will receive 100 milliliter (mL) oral solution of Lactulose [5 grams (g)]/ Mannitol (2g), a non-investigational medicinal product, by oral route to measure intestinal permeability.
Intervention Type
Other
Intervention Name(s)
Sucralose
Intervention Description
Participants will receive 3 capsules of Sucralose (2g), a non-investigational medicinal product, by oral route to measure intestinal permeability.
Primary Outcome Measure Information:
Title
Change From 0 to 5 Hours, and 0 to 24 Hours in the Ratio of Lactulose/Mannitol on Day 1
Description
Urine samples were collected at indicated time-points to determine the impact of thermal injury on the magnitude of small intestine permeability following the injury. As, L/M does not get metabolized, it gets filtered in the kidney and excreted in the urine. The impact of injury in thermal injury participants was compared with healthy participants using L/M ratio in urine.
Time Frame
0 to 5 hours and 0 to 24 hours on Day 1
Title
Change From 0 to 5 Hours, and 0 to 24 Hours in the Ratio of Lactulose/Mannitol Over Time for Healthy Participants
Description
Urine samples were collected at indicated time-points to determine the impact of thermal injury on the magnitude of small intestine permeability following the injury. As, L/M does not get metabolized, it gets filtered in the kidney and excreted in the urine. Baseline value was considered as Day 1 for both the groups. Change from Baseline is equal to post-Baseline visit value minus Baseline value.
Time Frame
0 to 5 hours and 0 to 24 hours on Day 8 and Day 15
Title
Change From 0 to 5 Hours, and 0 to 24 Hours in the Ratio of Lactulose/Mannitol Over Time for Thermal Injury Participants
Description
Urine samples were collected at indicated time-points to determine the impact of thermal injury on the magnitude of small intestine permeability following the injury. As, L/M does not get metabolized, it gets filtered in the kidney and excreted in the urine. Baseline value was considered as Day 1 for both the groups. Change from Baseline is equal to post-Baseline visit value minus Baseline value.
Time Frame
0 to 5 hours on Days 3, 5, 7, 11, 13 and 0 to 24 hours on Days 3, 5, 7, 9, 11 and 13

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: For Healthy participants: Males or females must be greater than or equal to 18 years of age at the time of signing informed consent. Participants who are healthy as determined by the investigator following medical evaluation including medical history, physical examination, and laboratory tests. A female participant is eligible to participate if she is not pregnant (negative pregnancy testing at screening or Day 1 as needed) and not breastfeeding. Capable of giving signed informed consent. For Thermally injured participants: Participants must be greater than or equal to 18 years of age. Participants who have sustained a burn (thermal injury) with a Total Burn Surface Area (TBSA) greater than or equal to 15 percent. Admission to the burn center (study site) less than or equal to 24 hours following injury. Able to take enteral fluids either orally or via a nasogastric tube (depends on facial burn damage). A female participant is eligible to participate if she is not pregnant (negative pregnancy testing at study entry) and not breastfeeding. Exclusion Criteria For Healthy participants: Healthy participants are excluded from this study if they are receiving anti-coagulation therapy. Pregnancy or breastfeeding. A body mass index greater than 34 kilogram per meter square (kg/m^2). An active history of alcohol dependency. History of sensitivity to any of the STM, or components thereof or a history of drug or other allergy that, in the opinion of the Investigator and/or GlaxoSmithKline (GSK) Medical Monitor, contraindicates their participation. A positive pre-study Hepatitis B surface antigen or positive Hepatitis C antibody and confirmatory Hepatitis C Polymerase Chain Reaction (PCR) result within 3 months of screening. A positive pre-study urine drug/alcohol screen. A positive test for Human Immuno-deficiency Virus (HIV) antibody. Participants unable to swallow large capsules (the capsules will be shown to participants at screening). Galactosaemia or severe lactose intolerance. Use of an antibiotic 2 weeks prior to study start (administration of the STM). Gastroenteritis in the 2 weeks prior to study start (administration of the STM). For thermally injured participants: Chemical or electrical burn. Multiple traumatic injuries with an Injury Severity Score (ISS) more than or equal to 16. Participants received substantial undocumented management prior to arrival at the study site (burn center) e.g. from paramedics or in a local accident and emergency department. Systemic corticoidsteroid use. Intravenous (IV) Mannitol use. HIV infection. Viral Hepatitis B or C infection. Gastrointestinal disease (e.g. inflammatory bowel disease) which may affect intestinal permeability. Previous bowel resection (e.g. hemicolectomy, small bowel resection). Galactosaemia or severe lactose intolerance. Bowel obstruction. Renal dysfunction requiring renal replacement therapy (end-stage renal failure prior to thermal injury). Active autoimmune disease and receiving immunomodulatory therapy e.g. rheumatoid arthritis anti-Tumor Necrosis Factor (TNF). Active chemotherapy for cancers or immunoremittive therapies (prednisolone, Adalimumab) within 60 days of thermal injury. Premorbid conditions of malignancy currently under treatment. Previous bilateral lower extremity amputation. Decision not to treat the participant due to futility.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
GSK Clinical Trials
Organizational Affiliation
GlaxoSmithKline
Official's Role
Study Director
Facility Information:
Facility Name
GSK Investigational Site
City
Birmingham
ZIP/Postal Code
B15 2TH
Country
United Kingdom

12. IPD Sharing Statement

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Investigation of Thermal Injury on Intestinal Permeability in Both Thermal Injury and Healthy Participants

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