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Peripheral Neuroimmune Mechanisms of Hyperthermia

Primary Purpose

Hyperthermia, Major Depressive Disorder, Inflammation

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
WBH
Sham
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Hyperthermia focused on measuring Depression, Major Depressive Disorder, Inflammation, Hyperthermia, Mood Disorders

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Females and Males ages 18-65
  2. English language proficiency
  3. Ability to provide informed consent
  4. Have a current primary psychiatric diagnosis of major depressive disorder (MDD) of at least 4 weeks duration, as defined by Diagnostic & Statistical Manual, 5th Edition (DSM-5) criteria using the MINI.
  5. Score of ≥ 24 on the Inventory of Depressive Symptomatology - Clinician Rated (IDS-CR)
  6. Individuals of childbearing potential must use an acceptable form of birth control.

Exclusion Criteria:

  1. Pregnancy or planned pregnancy during study
  2. Current breastfeeding
  3. History of psychiatric hospitalization within the past year
  4. Active suicidal intent ("yes" on item 4 or 5 on the Columbia-Suicide Severity Rating Scale)
  5. History of bipolar disorder, psychotic disorders, eating disorders, and/or substance abuse or dependence (within the last year), as per the Mini-International Neuropsychiatric Interview (MINI)
  6. Meeting DSM-5 criteria at screening for current obsessive compulsive disorder
  7. A ≥25% drop in IDS-CR score from screen (V1) to baseline (V1b)
  8. Positive urine toxicology screen due to illicit drug use or other exclusionary medications. (Potential false positives will be addressed on a case-by-case basis at the discretion of the investigator)
  9. Serious unstable medical condition including cardiovascular, neurological, neoplastic, autoimmune, infectious or endocrine.
  10. Morbid obesity (BMI > 40) and/or body shape that might increase the risk of cutaneous burning from the Heckel hyperthermia device (because of truncal skin being too close to the infrared lights).
  11. Any history of or current diagnosis of thrombosis or thrombophilia; if it is unclear whether a subject has received this diagnosis, a signed release will be obtained to contact the subject's treating physician and obtain accurate diagnostic information. Depending on the recommendation of the treating physician, the subject may undergo appropriate testing with the treating physician to verify the diagnosis, and if the tests produce negative findings, the subject may be allowed to enter the study
  12. Has a history of or an increased risk for gastrointestinal perforation such as a history of diverticulitis, stomach or intestinal ulcers or abdominal pain that does not go away
  13. Using medication that might impact thermoregulatory capacity within 3 days of receiving WBH treatment, including: diuretics, barbiturates, beta-blockers, antipsychotic agents, anti-cholinergic agents or chronic use of antihistamines, aspirin (other than low-dose for prophylactic purposes), non-steroidal anti-inflammatory drugs (NSAIDs), systemic corticosteroids, or cytokine antagonists.
  14. Use of any medication that could interact in such a way as to potentiate the sedative effect of lorazepam or ondansetron, or otherwise deemed unsafe per physician judgment.
  15. Fever (Temp > 99) of unknown origin at the time of screen
  16. Breast Implants
  17. Unsafe cardiac status as defined by abnormal ECG reading at screening visit as determined by medical monitor, study doctor, or subject's primary care physician or cardiologist
  18. Claustrophobia of sufficient severity to interfere with ability to enter/remain in Heckel device
  19. A subject who in the opinion of the Principal Investigator would not be able to safely complete the study or would jeopardize study integrity

Sites / Locations

  • Massachusetts General Hospital Depression Clinical & Research ProgramRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Whole Body Hyperthermia (WBH)

Sham

Arm Description

A single treatment of Whole Body Hyperthermia will be administered using the Heckel Hyperthermia device. During this procedure, participants' core body temperature will be elevated to 38.5 degrees Celsius.

Under the sham condition, participants will enter the Heckel Hyperthermia device as in the active treatment condition, but will not receive the whole body hyperthermia treatment, and will instead only receive mild heating.

Outcomes

Primary Outcome Measures

Changes in serum levels of Interleukin-6 from baseline to post-treatment
Changes in serum levels of Interleukin-6 from baseline to post-treatment, measured by immunoassay
Decreases in depressive severity, as measured by the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-CR)
The Inventory of Depressive Symptomatology is a valid and reliable 30-item measure that is designed to assess severity of depression. The questions focus on neurovegetative and other depressive symptoms experienced over the past seven days. Possible values range from 0 to 84, with lower scores indicating lower depressive severity. A decrease of 50% or more in the IDS-CR score is considered to be a positive response to treatment, while a final score of 11 or less is considered typical remission. Depressive severity will be measured at baseline and at three timepoints post-intervention using the IDS-CR.
Decreases in depressive severity, as measured by the Symptoms of Depression Questionnaire (SDQ)
The Symptoms of Depression Questionnaire (SDQ) assesses irritability, anger attacks, and anxiety symptoms together with the commonly considered symptoms of depression. Depressive severity will be measured at baseline and at four timepoints post-intervention using the SDQ. Possible values range from 44 to 264, with lower scores indicating lower depressive severity.

Secondary Outcome Measures

Changes in mental and physical functioning, as measured by the Patient Rated Outcome Measure Information System, 29-Item (PROMIS-29)
The PROMIS-29 is a short form assessment containing four items from each of seven domains (Depression, Anxiety, Physical Function, Pain Interference, Fatigue, Sleep Disturbance, and Ability to Participate in Social Roles and Activities) plus one pain intensity question (0-10 numeric rating scale). Possible values range from 4 to 20, with lower scores indicating better functioning.
Changes in mood, as measured by the Positive and Negative Affect Schedule (PANAS)
The Positive and Negative Affect Schedule (PANAS) is a self-report measure that is made up of two mood scales, one measuring positive affect and the other measuring negative affect. Number of items: 10-items measuring positive affect, 10-items measuring negative affect. Scoring is broken down into a positive affect score and a negative affect score; possible values range from 10 to 50, with higher positive scores indicating higher positive affect, and higher negative scores indicating higher negative affect.
Changes to quality of life, as measured by the World Health Organization Wellbeing Index (WHO-5)
The World Health Organization-Five Well-Being Index (WHO-5) is a short self-reported measure of current mental wellbeing. Possible values range from 0 to 25, with lower scores indicating lower quality of life.
Changes to quality of life, as measured by the Quality of Life, Enjoyment, and Satisfaction Questionnaire
The Quality of Life Enjoyment and Satisfaction Questionnaire is a self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. Possible values range from 14 to 70, with lower scores indicating lower quality of life.
Reduction in perceived stress, as measured by the Perceived Stress Scale (PSS)
The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one's life are appraised as stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. Possible values range from 0 to 40, with lower scores indicating lower levels of perceived stress.
Decreases in depressive severity, as measured by the Hamilton Depression Rating Scale 6-Item Self-Report (HAMD-6)
The Hamilton Depression Rating scale (self-report, 6-item) is specific to the core depressive symptoms of depressed mood, guilt, work and activities, psychomotor retardation, psychic anxiety, and general somatic symptoms (energy and physical pain), and it is unidimensional. Possible values range from 0 to 22, with lower scores indicating lower levels of depressive severity.

Full Information

First Posted
April 18, 2022
Last Updated
March 8, 2023
Sponsor
Massachusetts General Hospital
Collaborators
National Institute of General Medical Sciences (NIGMS)
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1. Study Identification

Unique Protocol Identification Number
NCT05366270
Brief Title
Peripheral Neuroimmune Mechanisms of Hyperthermia
Official Title
Peripheral Neuroimmune Mechanisms of Hyperthermia
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 1, 2022 (Actual)
Primary Completion Date
June 2024 (Anticipated)
Study Completion Date
June 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
National Institute of General Medical Sciences (NIGMS)

4. Oversight

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

5. Study Description

Brief Summary
The goal of this study is to examine how whole-body hyperthermia affects the thermoinflammatory profile, which includes the combined immune and heat shock response, in patients with depression and whether these changes correlate with decreased depression in individuals with Major Depressive Disorder.
Detailed Description
The study is a maximum of 42-day randomized controlled trial (RCT) of Whole Body Hyperthermia (WBH) vs. Sham for subjects with depressive symptoms at the Depression Clinical Research Program (DCRP) at Massachusetts General Hospital (MGH). 60 subjects with Major Depressive Disorder (MDD), males and females, between the ages of 18 and 65 years will be recruited and undergo a screening visit prior to being randomized to receive a single treatment of WBH or sham. The primary endpoint will be measurement of Interleukin-6 (IL-6) and other inflammation associated proteins (cytokines and heat shock proteins) in the plasma at one hour, 24h and one-week post WBH. A further endpoint is treatment response defined by a decrease of 50% or more in the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-CR) score at 7 days post-intervention, 2 weeks post-intervention, and 4 weeks post-intervention.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hyperthermia, Major Depressive Disorder, Inflammation
Keywords
Depression, Major Depressive Disorder, Inflammation, Hyperthermia, Mood Disorders

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Subjects are randomized to Control/Sham and Intervention groups
Masking
ParticipantInvestigatorOutcomes Assessor
Masking Description
Participant and clinician assessors will be blinded until study completion. The PI will only be unblinded in the event of an adverse event.
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Whole Body Hyperthermia (WBH)
Arm Type
Experimental
Arm Description
A single treatment of Whole Body Hyperthermia will be administered using the Heckel Hyperthermia device. During this procedure, participants' core body temperature will be elevated to 38.5 degrees Celsius.
Arm Title
Sham
Arm Type
Sham Comparator
Arm Description
Under the sham condition, participants will enter the Heckel Hyperthermia device as in the active treatment condition, but will not receive the whole body hyperthermia treatment, and will instead only receive mild heating.
Intervention Type
Device
Intervention Name(s)
WBH
Other Intervention Name(s)
Whole Body Hyperthermia
Intervention Description
Hyperthermia exposure using Heckel Hyperthermia Device
Intervention Type
Device
Intervention Name(s)
Sham
Intervention Description
Sham (mild heating) using Heckel Hyperthermia Device
Primary Outcome Measure Information:
Title
Changes in serum levels of Interleukin-6 from baseline to post-treatment
Description
Changes in serum levels of Interleukin-6 from baseline to post-treatment, measured by immunoassay
Time Frame
baseline (pre-intervention), one hour post-intervention, 24 hours post-intervention, one week post-intervention
Title
Decreases in depressive severity, as measured by the Inventory of Depressive Symptomatology, Clinician-Rated (IDS-CR)
Description
The Inventory of Depressive Symptomatology is a valid and reliable 30-item measure that is designed to assess severity of depression. The questions focus on neurovegetative and other depressive symptoms experienced over the past seven days. Possible values range from 0 to 84, with lower scores indicating lower depressive severity. A decrease of 50% or more in the IDS-CR score is considered to be a positive response to treatment, while a final score of 11 or less is considered typical remission. Depressive severity will be measured at baseline and at three timepoints post-intervention using the IDS-CR.
Time Frame
baseline (pre-intervention), one week post-intervention, two weeks post-intervention, four weeks post-intervention
Title
Decreases in depressive severity, as measured by the Symptoms of Depression Questionnaire (SDQ)
Description
The Symptoms of Depression Questionnaire (SDQ) assesses irritability, anger attacks, and anxiety symptoms together with the commonly considered symptoms of depression. Depressive severity will be measured at baseline and at four timepoints post-intervention using the SDQ. Possible values range from 44 to 264, with lower scores indicating lower depressive severity.
Time Frame
baseline (pre-intervention), 24 hours post-intervention, one week post-intervention, two weeks post-intervention, four weeks post-intervention
Secondary Outcome Measure Information:
Title
Changes in mental and physical functioning, as measured by the Patient Rated Outcome Measure Information System, 29-Item (PROMIS-29)
Description
The PROMIS-29 is a short form assessment containing four items from each of seven domains (Depression, Anxiety, Physical Function, Pain Interference, Fatigue, Sleep Disturbance, and Ability to Participate in Social Roles and Activities) plus one pain intensity question (0-10 numeric rating scale). Possible values range from 4 to 20, with lower scores indicating better functioning.
Time Frame
baseline (pre-intervention), one week post-intervention, two weeks post-intervention, four weeks post-intervention
Title
Changes in mood, as measured by the Positive and Negative Affect Schedule (PANAS)
Description
The Positive and Negative Affect Schedule (PANAS) is a self-report measure that is made up of two mood scales, one measuring positive affect and the other measuring negative affect. Number of items: 10-items measuring positive affect, 10-items measuring negative affect. Scoring is broken down into a positive affect score and a negative affect score; possible values range from 10 to 50, with higher positive scores indicating higher positive affect, and higher negative scores indicating higher negative affect.
Time Frame
baseline (pre-intervention), 24 hours post-intervention, one week post-intervention, two weeks post-intervention, four weeks post-intervention
Title
Changes to quality of life, as measured by the World Health Organization Wellbeing Index (WHO-5)
Description
The World Health Organization-Five Well-Being Index (WHO-5) is a short self-reported measure of current mental wellbeing. Possible values range from 0 to 25, with lower scores indicating lower quality of life.
Time Frame
baseline (pre-intervention), one week post-intervention, two weeks post-intervention, four weeks post-intervention
Title
Changes to quality of life, as measured by the Quality of Life, Enjoyment, and Satisfaction Questionnaire
Description
The Quality of Life Enjoyment and Satisfaction Questionnaire is a self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. Possible values range from 14 to 70, with lower scores indicating lower quality of life.
Time Frame
baseline (pre-intervention), one week post-intervention, two weeks post-intervention, four weeks post-intervention
Title
Reduction in perceived stress, as measured by the Perceived Stress Scale (PSS)
Description
The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one's life are appraised as stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. Possible values range from 0 to 40, with lower scores indicating lower levels of perceived stress.
Time Frame
baseline (pre-intervention), one week post-intervention, two weeks post-intervention, four weeks post-intervention
Title
Decreases in depressive severity, as measured by the Hamilton Depression Rating Scale 6-Item Self-Report (HAMD-6)
Description
The Hamilton Depression Rating scale (self-report, 6-item) is specific to the core depressive symptoms of depressed mood, guilt, work and activities, psychomotor retardation, psychic anxiety, and general somatic symptoms (energy and physical pain), and it is unidimensional. Possible values range from 0 to 22, with lower scores indicating lower levels of depressive severity.
Time Frame
baseline (pre-intervention), 24 hours post-intervention, one week post-intervention, two weeks post-intervention, four weeks post-intervention

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Females and Males ages 18-65 English language proficiency Ability to provide informed consent Have a current primary psychiatric diagnosis of major depressive disorder (MDD) of at least 4 weeks duration, as defined by Diagnostic & Statistical Manual, 5th Edition (DSM-5) criteria using the MINI. Score of ≥ 24 on the Inventory of Depressive Symptomatology - Clinician Rated (IDS-CR) Individuals of childbearing potential must use an acceptable form of birth control. Exclusion Criteria: Pregnancy or planned pregnancy during study Current breastfeeding History of psychiatric hospitalization within the past year Active suicidal intent ("yes" on item 4 or 5 on the Columbia-Suicide Severity Rating Scale) History of bipolar disorder, psychotic disorders, eating disorders, and/or substance abuse or dependence (within the last year), as per the Mini-International Neuropsychiatric Interview (MINI) Meeting DSM-5 criteria at screening for current obsessive compulsive disorder A ≥25% drop in IDS-CR score from screen (V1) to baseline (V1b) Positive urine toxicology screen due to illicit drug use or other exclusionary medications. (Potential false positives will be addressed on a case-by-case basis at the discretion of the investigator) Serious unstable medical condition including cardiovascular, neurological, neoplastic, autoimmune, infectious or endocrine. Morbid obesity (BMI > 40) and/or body shape that might increase the risk of cutaneous burning from the Heckel hyperthermia device (because of truncal skin being too close to the infrared lights). Any history of or current diagnosis of thrombosis or thrombophilia; if it is unclear whether a subject has received this diagnosis, a signed release will be obtained to contact the subject's treating physician and obtain accurate diagnostic information. Depending on the recommendation of the treating physician, the subject may undergo appropriate testing with the treating physician to verify the diagnosis, and if the tests produce negative findings, the subject may be allowed to enter the study Has a history of or an increased risk for gastrointestinal perforation such as a history of diverticulitis, stomach or intestinal ulcers or abdominal pain that does not go away Using medication that might impact thermoregulatory capacity within 3 days of receiving WBH treatment, including: diuretics, barbiturates, beta-blockers, antipsychotic agents, anti-cholinergic agents or chronic use of antihistamines, aspirin (other than low-dose for prophylactic purposes), non-steroidal anti-inflammatory drugs (NSAIDs), systemic corticosteroids, or cytokine antagonists. Use of any medication that could interact in such a way as to potentiate the sedative effect of lorazepam or ondansetron, or otherwise deemed unsafe per physician judgment. Fever (Temp > 99) of unknown origin at the time of screen Breast Implants Unsafe cardiac status as defined by abnormal ECG reading at screening visit as determined by medical monitor, study doctor, or subject's primary care physician or cardiologist Claustrophobia of sufficient severity to interfere with ability to enter/remain in Heckel device A subject who in the opinion of the Principal Investigator would not be able to safely complete the study or would jeopardize study integrity
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Simmie Foster, MD PhD
Phone
617-643-7427
Email
sfoster4@partners.org
First Name & Middle Initial & Last Name or Official Title & Degree
Maren Nyer, PhD
Phone
617-643-4897
Email
mnyer@mgh.harvard.edu
Facility Information:
Facility Name
Massachusetts General Hospital Depression Clinical & Research Program
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Study Coordinator
Phone
617-724-3222
Email
mgh-wbh@partners.org
First Name & Middle Initial & Last Name & Degree
Simmie Foster, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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Peripheral Neuroimmune Mechanisms of Hyperthermia

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