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Pharmacological Countermeasures for High Altitude

Primary Purpose

Hypobaric Hypoxia

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Acetazolamide
Erythropoietin
Sponsored by
United States Army Research Institute of Environmental Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Hypobaric Hypoxia

Eligibility Criteria

18 Years - 40 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Age 18-40 years
  • In good health as determined by the Office of Medical Support & Oversight (OMSO) General Medical Clearance
  • Runs at least 3 times per week and able to complete a two mile run in ≤ 21 minutes (Civilian Volunteers) or passed his/her most recent Army Combat Fitness Test (ACFT) (Military Volunteers Only)
  • Willing to not exercise, or drink alcoholic and/or caffeinated beverages 24 hours prior to each testing session or the acute altitude exposure to 3,000 m
  • Abstain from alcoholic beverages during the 15 day residence at the summit of Pikes Peak
  • Abstain from drinking alcohol or caffeine at least 24 hours before a testing session during Phases 1 and 3
  • Willing to stay and exercise in an altitude chamber (the size of a dorm room) for ~2.5 hours
  • Wiling to reside at the summit of Pikes Peak (4,300 m altitude) and share dormitory area (bunk area, shower, and bathroom), potentially with people of the opposite sex for 15 days
  • Up to date on COVID-19 vaccination

Exclusion Criteria:

  • Women who are pregnant or planning to become pregnant during the study
  • Taking prescription medication, or over-the-counter medications other than contraceptives, unless approved by OMSO & PI
  • Born at altitudes greater than 2,100 m (7,000 ft)
  • Living in areas that are more than 1,200 m (4,000 ft) or have traveled to areas that are more than 1,200 m for five days or more within the last 2 months
  • Prior diagnosis of High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE)
  • Musculoskeletal injuries that compromise the ability to walk/run on a treadmill or hike steep terrain
  • Abnormal blood count in accordance with OMSO - Normal Hb men: 12.6-17.7 g·dL-1 and women: 11.1-15.9 g·dL-1 or Normal Hct men: 37.5-48% and women: 34.0-45%, or presence of abnormal blood chemicals (hemoglobin S or Sickle Cell Trait)
  • Any history of malignancy
  • Personal or family history of blood clots
  • Abnormal prothrombin time/partial thromboplastin time (PT/PTT) test or problems with blood clotting
  • History of thromboembolic disease, hypertension, and known risk factors of cardiovascular disease
  • Blood donation within 8 weeks of beginning the study
  • History of seizures
  • History of inflammatory bowel disease
  • Any recent (within 4-6 weeks) and or expected history of prolonged periods of immobility or limited activity (including recent or upcoming surgery)
  • No evidence of iron deficiency (ferritin < 45 ng/ml)
  • Smokers or tobacco/nicotine (unless quit > 1 month prior to study orientation)
  • History of asthma
  • Experience recent (< 1 month of starting the study) cold, coughs, or respiratory tract infections
  • Allergy to skin adhesive
  • Known allergy to sulfa drugs
  • Evidence of apnea or sleeping disorder
  • Present condition of alcoholism, use of anabolic steroids, other substance abuse issues
  • Inability to tolerate iron supplement

Sites / Locations

  • USARIEMRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Acetazolamide

Erythropoietin and Acetazolamide

Arm Description

Acetazolamide (orally) 250 mg twice a day for 3 1/2 days.

Erythropoietin (subcutaneously) 50 IU /kg three times a week for 4 weeks. After the 4 week Erythropoietin, acetazolamide (orally) 250 mg twice a day for 3 1/2 days.

Outcomes

Primary Outcome Measures

3.2 km self-paced treadmill time trial performance
Time to complete self-paced 3.2 km treadmill time trial (min:sec)

Secondary Outcome Measures

VO2peak
Peak aerobic capacity will be assessed using a metabolic cart.
Lake Louise Acute Mountain Sickness Score
Acute mountain sickness and severity will be assessed using the Lake Louise acute mountain sickness questionnaire. This Likert scale assess acute mountain sickness with scores ranging from 0 to 12. Zero indicates no acute mountain sickness and 12 indicates severe acute mountain sickness.
Ventilation rate
Ventilation rate will be assessed using a pneumotachometer.
Percent body fat
Percent body fat will be assessed using Dual Energy X-ray Absorptiometry.
Oxygen Saturation
Oxygen saturation will be assessed using a finger pulse oximeter.
Erythropoietin
Erythropoietin will be assessed using an ELISA.
Hematocrit
Hematocrit will be assessed using manual hematocrit method.
Reticulocyte
Reticulocyte will be assessed using a hematology analyzer.
Ferritin
Ferritin will be assessed using an ELISA.
C-reactive protein
C-reactive protein will be assessed using an ELISA.
Soluble transferrin
Soluble transferrin will be assessed using an ELISA.
Arterialized capillary PO2
Arterialized capillary PO2 will be assessed using a blood gas analyzer.
Arterialized capillary PCO2
Arterialized capillary PCO2 will be assessed using a blood gas analyzer.
Arterialized capillary pH
Arterialized capillary pH will be assessed using a blood gas analyzer.
Hbmass
Hbmass will be assessed using the CO-rebreathing procedure.
Muscle tissue oxygenation
Muscle tissue oxygenation will be assessed using a non-invasive near-infrared spectroscopy.
Lung Diffusion of carbon monoxide
Lung Diffusion of carbon monoxide will be assessed using a spirometer.

Full Information

First Posted
March 17, 2022
Last Updated
March 28, 2022
Sponsor
United States Army Research Institute of Environmental Medicine
Collaborators
University of Puget Sound
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1. Study Identification

Unique Protocol Identification Number
NCT05300477
Brief Title
Pharmacological Countermeasures for High Altitude
Official Title
Augmentation of Medical Readiness and Physical Performance at High Altitude Using Pharmacological Countermeasures
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
May 27, 2022 (Anticipated)
Primary Completion Date
August 30, 2022 (Anticipated)
Study Completion Date
August 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
United States Army Research Institute of Environmental Medicine
Collaborators
University of Puget Sound

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of this randomized, double-blind study is to determine whether erythropoietin (Procrit) and acetazolamide: 1) mitigates altitude-induced decrements in performance at moderate altitude (3,000 m) and 2) mitigates altitude-induced decrements in performance and reduce acute mountain sickness during prolonged exposure to high altitude (4,300 m; 15 days). Volunteers will complete 5 study phases: Phase 1) sea level baseline testing and a moderate altitude exposure; Phase 2) 4 week study intervention - randomly assigned to receive erythropoietin or placebo); Phase 3) 3 1/2 days of acetazolamide and a moderate altitude exposure; Phase 4) high altitude acclimatization - 15 days at Pikes Peak; and Phase 5) two week deacclimatization. Test battery include VO2peak, 3.2 km treadmill time trial, measures of gas exchange and ventilation during rest and exercise, and blood collection.
Detailed Description
This study will use a double-blind randomized study design in which one group will receive erythropoietin and the other a placebo (saline) for 4 weeks, then both groups will receive acetazolamide. Eighteen men and women volunteers will complete 5 study phases: Phase 1) two week sea level baseline testing (orientation, two VO2peak assessments, three 3.2 km treadmill time-trial, assessment of resting ventilation, venipuncture and capillary blood collection, and Hbmass assessment), and a VO2peak and 3.2 km treadmill time-trial moderate altitude (3,000 m); Phase 2) 4 week intervention to receive subcutaneously erythropoietin or placebo. The erythropoietin (Procrit) dosing regimen will consist of 50 IU/kg three times a week (M-W-F); Phase 3) a second moderate altitude exposure (VO2peak and 3.2 km treadmill time-trial with acetazolamide administered (orally; 250 mg b.i.d) for 3 1/2 nights starting the day before the altitude exposure; Phase 4) high altitude acclimatization in which volunteers will reside for 15 days at 4,300 m altitude (Pikes Peak, Colorado Springs) completing multiple VO2peak assessments and 3.2 km treadmill time-trials, resting ventilation, venipuncture and capillary blood collection; and Phase 5) deacclimatization phase to assess changes in hematological biomarkers after returning from Pikes Peak. This study consists of 41 visits over a ~10 week time period. Visits will take place in Natick, MA and the Pikes Peak High Altitude Research Laboratory at Colorado Springs. Additional assessments that will be completed multiple times during the study include: acute mountain sickness questionnaire, lung gas diffusion at rest and during exercise, oxygen saturation, arterialized blood gases (PO2, PCO2, pH, HCO3) and heart rate during rest, exercise, and sleep, and muscle tissue oxygenation. The primary outcome is 3.2 km treadmill time-trial performance. Secondary outcomes include: incidence and severity of acute mountain sickness, ventilation and gas exchange, Hbmass, Hb concentration, Hct, arterialized blood gases, lung diffusion at rest and during exercise, oxygen saturation and heart rate during rest, exercise, and sleep.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypobaric Hypoxia

7. Study Design

Primary Purpose
Other
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
This study will use a double-blind randomized study design in which one group will receive erythropoietin and the other group will receive the placebo for 4 weeks. After the 4 weeks, both groups will receive acetazolamide.
Masking
ParticipantInvestigator
Masking Description
Participants and Investigators will be blinded to who receives erythropoietin and placebo. Medical providers and a subset of staff will be aware of participants receiving erythropoietin and placebo. Participants, Investigators, and Medical Providers will all be aware of participants administered acetazolamide.
Allocation
Randomized
Enrollment
18 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Acetazolamide
Arm Type
Experimental
Arm Description
Acetazolamide (orally) 250 mg twice a day for 3 1/2 days.
Arm Title
Erythropoietin and Acetazolamide
Arm Type
Experimental
Arm Description
Erythropoietin (subcutaneously) 50 IU /kg three times a week for 4 weeks. After the 4 week Erythropoietin, acetazolamide (orally) 250 mg twice a day for 3 1/2 days.
Intervention Type
Drug
Intervention Name(s)
Acetazolamide
Other Intervention Name(s)
Diamox
Intervention Description
Carbonic Anhydrase Inhibitor
Intervention Type
Drug
Intervention Name(s)
Erythropoietin
Other Intervention Name(s)
Procrit
Intervention Description
Hormone for red blood cell
Primary Outcome Measure Information:
Title
3.2 km self-paced treadmill time trial performance
Description
Time to complete self-paced 3.2 km treadmill time trial (min:sec)
Time Frame
35 minutes
Secondary Outcome Measure Information:
Title
VO2peak
Description
Peak aerobic capacity will be assessed using a metabolic cart.
Time Frame
30 minutes
Title
Lake Louise Acute Mountain Sickness Score
Description
Acute mountain sickness and severity will be assessed using the Lake Louise acute mountain sickness questionnaire. This Likert scale assess acute mountain sickness with scores ranging from 0 to 12. Zero indicates no acute mountain sickness and 12 indicates severe acute mountain sickness.
Time Frame
10 minutes
Title
Ventilation rate
Description
Ventilation rate will be assessed using a pneumotachometer.
Time Frame
20 minutes
Title
Percent body fat
Description
Percent body fat will be assessed using Dual Energy X-ray Absorptiometry.
Time Frame
10 minutes
Title
Oxygen Saturation
Description
Oxygen saturation will be assessed using a finger pulse oximeter.
Time Frame
35 minutes
Title
Erythropoietin
Description
Erythropoietin will be assessed using an ELISA.
Time Frame
4 hours
Title
Hematocrit
Description
Hematocrit will be assessed using manual hematocrit method.
Time Frame
5 minutes
Title
Reticulocyte
Description
Reticulocyte will be assessed using a hematology analyzer.
Time Frame
2 hours
Title
Ferritin
Description
Ferritin will be assessed using an ELISA.
Time Frame
2 hours
Title
C-reactive protein
Description
C-reactive protein will be assessed using an ELISA.
Time Frame
2 hours
Title
Soluble transferrin
Description
Soluble transferrin will be assessed using an ELISA.
Time Frame
2 hours
Title
Arterialized capillary PO2
Description
Arterialized capillary PO2 will be assessed using a blood gas analyzer.
Time Frame
5 minutes
Title
Arterialized capillary PCO2
Description
Arterialized capillary PCO2 will be assessed using a blood gas analyzer.
Time Frame
5 minutes
Title
Arterialized capillary pH
Description
Arterialized capillary pH will be assessed using a blood gas analyzer.
Time Frame
5 minutes
Title
Hbmass
Description
Hbmass will be assessed using the CO-rebreathing procedure.
Time Frame
20 minutes
Title
Muscle tissue oxygenation
Description
Muscle tissue oxygenation will be assessed using a non-invasive near-infrared spectroscopy.
Time Frame
35 minutes
Title
Lung Diffusion of carbon monoxide
Description
Lung Diffusion of carbon monoxide will be assessed using a spirometer.
Time Frame
35 minutes

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age 18-40 years In good health as determined by the Office of Medical Support & Oversight (OMSO) General Medical Clearance Runs at least 3 times per week and able to complete a two mile run in ≤ 21 minutes (Civilian Volunteers) or passed his/her most recent Army Combat Fitness Test (ACFT) (Military Volunteers Only) Willing to not exercise, or drink alcoholic and/or caffeinated beverages 24 hours prior to each testing session or the acute altitude exposure to 3,000 m Abstain from alcoholic beverages during the 15 day residence at the summit of Pikes Peak Abstain from drinking alcohol or caffeine at least 24 hours before a testing session during Phases 1 and 3 Willing to stay and exercise in an altitude chamber (the size of a dorm room) for ~2.5 hours Wiling to reside at the summit of Pikes Peak (4,300 m altitude) and share dormitory area (bunk area, shower, and bathroom), potentially with people of the opposite sex for 15 days Up to date on COVID-19 vaccination Exclusion Criteria: Women who are pregnant or planning to become pregnant during the study Taking prescription medication, or over-the-counter medications other than contraceptives, unless approved by OMSO & PI Born at altitudes greater than 2,100 m (7,000 ft) Living in areas that are more than 1,200 m (4,000 ft) or have traveled to areas that are more than 1,200 m for five days or more within the last 2 months Prior diagnosis of High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE) Musculoskeletal injuries that compromise the ability to walk/run on a treadmill or hike steep terrain Abnormal blood count in accordance with OMSO - Normal Hb men: 12.6-17.7 g·dL-1 and women: 11.1-15.9 g·dL-1 or Normal Hct men: 37.5-48% and women: 34.0-45%, or presence of abnormal blood chemicals (hemoglobin S or Sickle Cell Trait) Any history of malignancy Personal or family history of blood clots Abnormal prothrombin time/partial thromboplastin time (PT/PTT) test or problems with blood clotting History of thromboembolic disease, hypertension, and known risk factors of cardiovascular disease Blood donation within 8 weeks of beginning the study History of seizures History of inflammatory bowel disease Any recent (within 4-6 weeks) and or expected history of prolonged periods of immobility or limited activity (including recent or upcoming surgery) No evidence of iron deficiency (ferritin < 45 ng/ml) Smokers or tobacco/nicotine (unless quit > 1 month prior to study orientation) History of asthma Experience recent (< 1 month of starting the study) cold, coughs, or respiratory tract infections Allergy to skin adhesive Known allergy to sulfa drugs Evidence of apnea or sleeping disorder Present condition of alcoholism, use of anabolic steroids, other substance abuse issues Inability to tolerate iron supplement
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Roy M Salgado, Ph.D.
Phone
508-206-2375
Email
roy.m.salgado.civ@mail.mil
Facility Information:
Facility Name
USARIEM
City
Natick
State/Province
Massachusetts
ZIP/Postal Code
01760
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Roy M Salgado, Ph.D.
Phone
508-206-2375
Email
roy.m.salgado.civ@mail.mil

12. IPD Sharing Statement

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Pharmacological Countermeasures for High Altitude

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