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Safety and Efficacy of Inhaled Alpha-1 Antitrypsin in Preventing Bronchiolitis Obliterable Syndrome in Lung Transplant Recipients

Primary Purpose

Lung Transplantation, Bronchiolitis Obliterable Syndrome

Status
Unknown status
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Alpha -1 Antitrypsin
Alpha-1 Antitrypsin
AAT
Sponsored by
Rabin Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lung Transplantation focused on measuring Patient after lung transplantation

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:• Patients aged ≥18 years

  • Signature of informed consent
  • Lung transplant recipient in the past 6 months.
  • Stable concomitant therapy >2 weeks prior to visit 1
  • Non-tobacco user of any kind
  • No significant abnormalities in serum hematology, serum chemistry to the Principal Investigator's judgment((Hg>8g/dL ,Creatinine<2mg/dl,Liver enzymes<3*ULN)
  • Non-pregnant, non-lactating female subjects, whose screening pregnancy test is negative and who are using contraceptive methods deemed reliable by the investigator, or who are more than 5 years post-menopausal or surgically sterilized or whose way-of-life excludes sexual activity.
  • Sexually active female subjects of child-bearing potential, as well as male subjects, must use a medically acceptable effective contraceptive method (for male - method such us condoms; for female - methods such as oral contraceptive medication used for at least two weeks before study start, or a combination of any two of the following: diaphragm, cervical cap, condom or spermicide), before study start and throughout the entire duration of the study.

Exclusion Criteria:• Diagnosis of BOS with according to Estenne M. et al.

  • Hospitalization within 1 month before study entry, not due to an airway disease
  • Severe liver cirrhosis with ascites
  • Hypersplenism
  • Grade III/IV esophageal varices;
  • Active pulmonary exacerbation within the 4 weeks prior to screening
  • History of massive hemoptysis: greater than 200 cc in a 24 hour period
  • Pregnancy or breastfeeding
  • Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would interfere with patient treatment, assessment, or compliance with the protocol.
  • Fever at the time of the start of first (day #1) inhalation (oral temperature >38ºC)
  • Evidence of uncontrolled hypertension
  • Pulse >120/min (prior to study drug administration)
  • Any serious malignancy except for basal and squamous (scaly or plate-like) cell skin cancer within the previous 3 years prior to study start
  • Receipt of exogenous AAT within the last 6 months
  • Previous enrolment in this study (subject can not be enrolled twice into the study)
  • Evidence of congestive heart failure or other clinically significant cardiovascular conditions: myocardial infarction during the last year, arrhythmia requiring drug treatment during the last year, uncontrolled hypertension
  • Current smoker (someone who has smoked within 4 weeks prior to screening)
  • Subjects with an additional clinically significant inter-current illness (beside lung disease) (e.g., cardiac, hepatic, renal, endocrine, respiratory, neurological, hematological, neoplastic, immunological and skeletal) that the investigator determines that it could interfere with the safety or other assessments of this study
  • Any evidence of alcohol abuse or history of abuse of illegal and/or legally prescribed drugs such as barbiturates, benzodiazepines, amphetamines, cocaine, opioids, and cannabinoids
  • Being a sexually active female of child-bearing age without adequate contraception
  • Any other factor that, in the opinion of the investigator, would prevent the subject form complying with the requirements of the protocol

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Alpha -1 Antitrypsin

    Arm Description

    Outcomes

    Primary Outcome Measures

    Clinical diagnosis of BOS according to Estenne M. et al Treatment of lung transplant recipients to prevent BOS Clinical diagnosis of BOS according to Estenne M. et al. Adverse events and conc
    Adverse events and concomitant medication recording and follow up. Safety/tolerability parameters at baseline (Day #1) will be compared with values generated at the following visits every 6 weeks (+/- 10 days). At all visits, AEs and concomitant medications will be recorded. Additionally, the study coordinator will check occurrence of AE and concomitant medications by a telephone visit

    Secondary Outcome Measures

    Change in lung function test
    Change in lung function FEV%, FEV1, FVC Baseline (Day #1) values of FEV1 and FVC (and FEV%) will be compared to the following visits every 6 weeks (+/- 10 days). Incidence of Acute cellular rejection. Incidence of respiratory infection leading to antibiotics administration according to the decision of the investigator.

    Full Information

    First Posted
    July 5, 2011
    Last Updated
    July 13, 2011
    Sponsor
    Rabin Medical Center
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01394835
    Brief Title
    Safety and Efficacy of Inhaled Alpha-1 Antitrypsin in Preventing Bronchiolitis Obliterable Syndrome in Lung Transplant Recipients
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2011
    Overall Recruitment Status
    Unknown status
    Study Start Date
    September 2011 (undefined)
    Primary Completion Date
    September 2012 (Anticipated)
    Study Completion Date
    September 2013 (Anticipated)

    3. Sponsor/Collaborators

    Name of the Sponsor
    Rabin Medical Center

    4. Oversight

    5. Study Description

    Brief Summary
    Bronchiolitis obliterable syndrome (BOS) is the most common cause of death in long-term survivors after lung transplantation and refractory to most interventions. Many risk factor for BOS were identified in previous studies such as acute cellular rejection, lymphocytic bronchiolitis, cytomegalovirus (CMV) and non-CMV respiratory infections, injury to the allograft or airways, Primary graft dysfunction, HLA mismatching, and organizing pneumonia. (Belperio JA. et al.). Neutrophils and their released products may be involved in the development of BOS. Neutrophilia was repeatedly observed in the bronchoalveolar lavage fluid of patients after lung transplantation. In addition, infiltration of neutrophils into the bronchial epithelium has been detected in patients with higher degrees of active airway damage. Neutrophils are capable of causing severe damage to the lung tissue by releasing toxic proteases and reactive oxygen species if not counterbalanced by the antiprotease/ antioxidant screen of the lung. Based on this background, a causal relationship between neutrophilia and the development of BOS has been proposed. (Hirsch J. et al.) Detection of unopposed Neutrophile elastase (NE) activity in BAL appears to correlate with poor outcome due to refractory BOS. Unopposed NE in these subjects may not only serve as a marker of evolving graft dysfunction but also participate in damaging the airways of the allograft and inhibit adequate bacterial clearance. Prevention of neutrophil sequestration or inhibition of NE may prevent or attenuate airway damage and improve bacterial clearance mechanisms. (Nutley D et al.) These data demonstrate the importance of neutrophils and unopposed NE in the pathogenesis of BOS and call for new approach to prevent or modulate BOS targeting this mechanism. AAT is the main inhibitor of neutrophil elastase in the lower airways and patients with AAT deficiency have low concentrations of the protein in this region of the lung. This explains the proteinase/antiproteinase theory of the development of emphysema in deficient patients in which the amount of elastase released in the lung exceeds the amount of AAT. The net result is persistence of elastase activity leading to lung destruction and the pathological changes of emphysema. (Abusriwil H. et al.) The administration of the AAT is to address proteinase/antiproteinase imbalance. Administration of AAT will help to prevent further destruction of the lung architecture and reduce the inflammatory dysregulation that causes pulmonary dysfunction. It is expected that by attacking a specific and previously untreated key component part of the pathophysiological cycle of BOS, AAT therapy would decrease the prevalence of BOS in lung transplant recipients and prolong life expectancy of these patients.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Lung Transplantation, Bronchiolitis Obliterable Syndrome
    Keywords
    Patient after lung transplantation

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    Non-Randomized
    Enrollment
    40 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Alpha -1 Antitrypsin
    Arm Type
    Experimental
    Intervention Type
    Drug
    Intervention Name(s)
    Alpha -1 Antitrypsin
    Intervention Description
    Inhalation twice daily of 160mg
    Intervention Type
    Drug
    Intervention Name(s)
    Alpha-1 Antitrypsin
    Intervention Description
    Inhalation twice daily .Dosage 160mg
    Intervention Type
    Drug
    Intervention Name(s)
    AAT
    Intervention Description
    Inhalation twice daily' 160mg
    Primary Outcome Measure Information:
    Title
    Clinical diagnosis of BOS according to Estenne M. et al Treatment of lung transplant recipients to prevent BOS Clinical diagnosis of BOS according to Estenne M. et al. Adverse events and conc
    Description
    Adverse events and concomitant medication recording and follow up. Safety/tolerability parameters at baseline (Day #1) will be compared with values generated at the following visits every 6 weeks (+/- 10 days). At all visits, AEs and concomitant medications will be recorded. Additionally, the study coordinator will check occurrence of AE and concomitant medications by a telephone visit
    Time Frame
    12 Month
    Secondary Outcome Measure Information:
    Title
    Change in lung function test
    Description
    Change in lung function FEV%, FEV1, FVC Baseline (Day #1) values of FEV1 and FVC (and FEV%) will be compared to the following visits every 6 weeks (+/- 10 days). Incidence of Acute cellular rejection. Incidence of respiratory infection leading to antibiotics administration according to the decision of the investigator.
    Time Frame
    12 month

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    70 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria:• Patients aged ≥18 years Signature of informed consent Lung transplant recipient in the past 6 months. Stable concomitant therapy >2 weeks prior to visit 1 Non-tobacco user of any kind No significant abnormalities in serum hematology, serum chemistry to the Principal Investigator's judgment((Hg>8g/dL ,Creatinine<2mg/dl,Liver enzymes<3*ULN) Non-pregnant, non-lactating female subjects, whose screening pregnancy test is negative and who are using contraceptive methods deemed reliable by the investigator, or who are more than 5 years post-menopausal or surgically sterilized or whose way-of-life excludes sexual activity. Sexually active female subjects of child-bearing potential, as well as male subjects, must use a medically acceptable effective contraceptive method (for male - method such us condoms; for female - methods such as oral contraceptive medication used for at least two weeks before study start, or a combination of any two of the following: diaphragm, cervical cap, condom or spermicide), before study start and throughout the entire duration of the study. Exclusion Criteria:• Diagnosis of BOS with according to Estenne M. et al. Hospitalization within 1 month before study entry, not due to an airway disease Severe liver cirrhosis with ascites Hypersplenism Grade III/IV esophageal varices; Active pulmonary exacerbation within the 4 weeks prior to screening History of massive hemoptysis: greater than 200 cc in a 24 hour period Pregnancy or breastfeeding Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would interfere with patient treatment, assessment, or compliance with the protocol. Fever at the time of the start of first (day #1) inhalation (oral temperature >38ºC) Evidence of uncontrolled hypertension Pulse >120/min (prior to study drug administration) Any serious malignancy except for basal and squamous (scaly or plate-like) cell skin cancer within the previous 3 years prior to study start Receipt of exogenous AAT within the last 6 months Previous enrolment in this study (subject can not be enrolled twice into the study) Evidence of congestive heart failure or other clinically significant cardiovascular conditions: myocardial infarction during the last year, arrhythmia requiring drug treatment during the last year, uncontrolled hypertension Current smoker (someone who has smoked within 4 weeks prior to screening) Subjects with an additional clinically significant inter-current illness (beside lung disease) (e.g., cardiac, hepatic, renal, endocrine, respiratory, neurological, hematological, neoplastic, immunological and skeletal) that the investigator determines that it could interfere with the safety or other assessments of this study Any evidence of alcohol abuse or history of abuse of illegal and/or legally prescribed drugs such as barbiturates, benzodiazepines, amphetamines, cocaine, opioids, and cannabinoids Being a sexually active female of child-bearing age without adequate contraception Any other factor that, in the opinion of the investigator, would prevent the subject form complying with the requirements of the protocol
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Mordechai Kramer, MD
    Phone
    972-39377221
    Email
    kremerm@clalit.org.il
    First Name & Middle Initial & Last Name or Official Title & Degree
    Liora Yehoshua, Bsc
    Phone
    972-39377214
    Email
    lioray@clalit.org.il
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Mordechai R Kramer, M.D
    Organizational Affiliation
    Rabin Medical Center
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Safety and Efficacy of Inhaled Alpha-1 Antitrypsin in Preventing Bronchiolitis Obliterable Syndrome in Lung Transplant Recipients

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