Broccoli Sprout Extracts Trial to See if NRF2 is Enhanced by Sulforaphane Treatment in Patients With COPD (BEST)

Enhancing Nrf2 by Sulforaphane Treatment in COPD

Evidence from investigators' group has shown that chronic obstructive pulmonary disease (COPD) patients have impairment of antioxidant defenses which are caused by a defect in activity of Nrf2. This trial focuses on sulforaphane, a derivative of cruciferous vegetables, which is a potent stimulator of Nrf2 activity. The investigators want to investigate whether ingestion of sulforaphane by COPD patients will increase Nrf2 activity and expression of downstream antioxidants. Accordingly, the investigators are conducting a placebo-controlled randomized proof of principle trial of two oral doses of sulforaphane, 25 and 150 micromoles, for 4 weeks in 90 COPD patients. The investigators' goal is to establish a safe and tolerable dose of sulforaphane that effects in vivo antioxidants via Nrf2, then the investigators will have a novel candidate treatment for longer-term efficacy trials.

Study Overview

• Status: Completed
• Conditions: COPD
• Intervention / Treatment: Drug: Sulforaphane 25; Dietary supplement: Sulforaphane 150; Other: Placebo

Detailed Description

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in the United States and is a growing cause of chronic disease internationally. Presently, there are limited treatment options for this disease to modify the progression of airflow obstruction and decrease periodic exacerbations. Recent evidence has emphasized the central role of oxidative stress as a mechanism of COPD pathobiology. Evidence from investigators' group has shown that COPD patients and animals exposed to cigarette smoke have impairment of antioxidant defenses which are caused by a defect in activity of nuclear factor erythroid 2 like 2 (Nrf2), a prolific regulator of anti-oxidant enzymes, glutathione homeostasis, and cytoprotective proteins. Activation of Nrf2 protects mice with chronic smoke exposure from developing emphysema, decreases oxidative stress, increases proteasomal anti-apoptotic cytoprotective responses, improves bacterial phagocytosis and killing, and reverses tobacco-smoke induced corticosteroid resistance. Similarly, in vitro Nrf2 activation in human COPD lung cells has shown improved cytoprotection, improved bacterial clearance, and restoration of steroid sensitivity. This trial focuses on sulforaphane, a derivative of cruciferous vegetables, which is a potent in vitro and in vivo stimulator of Nrf2 activity. The investigators want to investigate whether ingestion of sulforaphane by chronic obstructive pulmonary disease (COPD) patients will increase Nrf2 activity and expression of downstream antioxidants in alveolar macrophages and bronchial epithelial cells. Accordingly, the investigators are conducting a placebo-controlled randomized proof of principle trial of two oral doses of sulforaphane, 25 and 150 micromoles, for 4 weeks in 90 COPD patients. Collections of alveolar macrophages by Bronchoalveolar lavage (BAL), bronchial epithelial cells by endobronchial brushings will be performed at baseline and 4 weeks. Other bio-specimens will include nasal epithelial cells, Peripheral Blood Monocyte Collection (PBMCs), and expired breath condensate (EBC). The investigators' goal is to establish a safe and tolerable dose of sulforaphane that effects in vivo antioxidants via Nrf2, then the investigators will have a novel candidate treatment for longer-term efficacy trials. Ancillary studies are proposed to explore the efficacy and mechanisms of sulforaphane to increase bacterial clearance and to restore steroid sensitivity in COPD lung cells.

• Study Type: Interventional
• Enrollment (Actual): 89
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21224
      • Johns Hopkins School of Medicine
  • New York
    • Buffalo, New York, United States, 14215
      • University at Baffalo, The State University of New York
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19122
      • Temple University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age 40 years or greater, either sex
• 10 or more pack-years smoking history
• Physician diagnosed COPD
• Post bronchodilator Forced expiratory volume in 1 second (FEV1)/ forced expiratory vital capacity (FVC) ratio < 0.70
• FEV1 40-80 % predicted
• Willingness to ingest no more than 1 serving of cruciferous vegetables per week during run-in and treatment periods
• Ability and willingness to provide informed consent

Exclusion Criteria:

• COPD exacerbation within preceding 6 weeks requiring treatment
• Significant respiratory (other than COPD), cardiovascular, neuropsychiatric, renal, gastrointestinal, or genitourinary disease that would interfere with participation in the study or interpretation of the results.
• Acute Myocardial infarction (MI) or Acute Coronary syndrome within 6 prior months
• Cancer (other than skin or localized prostate) within preceding 5 years
• Child-bearing potential with lack of adequate contraception, Pregnancy or lactation. Acceptable forms of birth control include abstinence, hysterectomy, tubal ligation, two of the following: vasectomy, condom, diaphragm, intrauterine device, oral or implanted contraceptives, or spermicide.
• Allergy to local anesthesia
• Resting hypoxemia (O2 saturation < 90%)
• Glomerular Filtration Rate (GFR) < 30
• Liver enzymes four times upper normal
• Current use of warfarin for any indication

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Sulforaphane 25; 25 micromoles (4.4 mg) sulforaphane daily by mouth	Drug: Sulforaphane 25; 25 micromoles (4.4 mg) sulforaphane daily by mouth; Other Names: This is derived from broccoli sprouts.
Active Comparator: Sulforaphane 150; 150 micromoles (26.6 mg) sulforaphane daily by mouth	Dietary supplement: Sulforaphane 150; 150 micromoles (26.6 mg) sulforaphane daily by mouth
Placebo Comparator: Placebo; Microcrystalline cellulose	Other: Placebo; Microcrystalline cellulose once daily by mouth

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Alveolar Macrophage Expression of Nrf2 and Associated Genes at 4 Weeks	The first primary design variable is the change from baseline in nuclear factor erythroid 2 like 2 (Nrf2) expression in alveolar macrophages (AM) at 4 weeks by analysing Nrf2 protein and expression of a panel of Nrf2 regulated genes.Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage for primary outcome data.	Baseline and 4 weeks
Change From Baseline in Bronchial Epithelial Cell Expression of Nrf2 at 4 Weeks	The second primary design variable is the change from baseline in nuclear factor erythroid 2 like 2 (Nrf2) expression in bronchial epithelial cells (BEC) at 4 weeks by analysing Nrf2 protein. Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage for primary outcome data.	Baseline and 4 weeks
Change From Baseline in Bronchial Epithelial Cell Expression of NQ01 and Keap1 at 4 Weeks	The third primary design variable is the change from baseline in NAD(P)H Quinone Dehydrogenase 1 (NQ01) and Kelch Like ECH Associated Protein 1 (Keap1) expression in bronchial epithelial cells (BEC) at 4 weeks. Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage for primary outcome data.	Baseline and 4 weeks
Change From Baseline in Bronchial Epithelial Cell Expression of HO1 at 4 Weeks	The fourth primary design variable is the change from baseline in expression of Heme Oxygenase 1 (HO1) in bronchial epithelial cells (BEC) at 4 weeks. Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage for primary outcome data.	Baseline and 4 weeks
Change From Baseline in Bronchial Epithelial Cell Expression of AKR1C1 at 4 Weeks	The fifth primary design variable is the change from baseline in expression of Aldo-Keto Reductase Family 1 Member C1 (AKR1C1) in bronchial epithelial cells (BEC) at 4 weeks. Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage for primary outcome data.	Baseline and 4 weeks
Change From Baseline in Bronchial Epithelial Cell Expression of AKR1C3 at 4 Weeks	The sixth primary design variable is the change from baseline in expression of Aldo-Keto Reductase Family 1 Member C3 (AKR1C3) in bronchial epithelial cells (BEC) at 4 weeks. Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage for primary outcome data.	Baseline and 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fold-change in Isoprostane Concentrations (Follow-up to Baseline)	Isoprostane, an oxidant stress indicator, was measured in expired breath condensate at baseline and 4 weeks.	Baseline and 4 weeks
Fold-change in Serum Inflammatory Marker Concentrations (Follow-up to Baseline)	Inflammatory markers were measured in serum samples derived from venipuncture at baseline and 4 weeks in the serum of the participants of the trial.	Baseline and 4 weeks
Fold-change in Inflammatory Marker Concentrations in Bronchial Alveolar Lavage (Follow-up to Baseline) by Treatment Group	Inflammatory markers were measured in bronchial alveolar lavage samples at baseline and 4 weeks in the participants of this trial who had bronchoalveolar lavage samples obtained.Three participants - one from each treatment group - were unable to complete follow-up bronchoalveolar lavage.	Baseline and 4 weeks
Fold-change in Plasma Inflammatory Marker Concentrations (Follow-up to Baseline)	Inflammatory markers were measured in plasma at baseline and 4 weeks. Thiobarbituric acid reactive substances were measured in nmol malondialdehyde (MDA)/mL.	Baseline and 4 weeks

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Collaborators: Temple University; State University of New York at Buffalo
• Investigators: Principal Investigator: Janet T Holbrook, PhD, MPH, Johns Hopkins Bloomberg School of Public Health

Publications and helpful links

General Publications

• Sidhaye VK, Holbrook JT, Burke A, Sudini KR, Sethi S, Criner GJ, Fahey JW, Berenson CS, Jacobs MR, Thimmulappa R, Wise RA, Biswal S. Compartmentalization of anti-oxidant and anti-inflammatory gene expression in current and former smokers with COPD. Respir Res. 2019 Aug 20;20(1):190. doi: 10.1186/s12931-019-1164-1.
• Wise RA, Holbrook JT, Criner G, Sethi S, Rayapudi S, Sudini KR, Sugar EA, Burke A, Thimmulappa R, Singh A, Talalay P, Fahey JW, Berenson CS, Jacobs MR, Biswal S; Broccoli Sprout Extract Trial Research Group. Lack of Effect of Oral Sulforaphane Administration on Nrf2 Expression in COPD: A Randomized, Double-Blind, Placebo Controlled Trial. PLoS One. 2016 Nov 10;11(11):e0163716. doi: 10.1371/journal.pone.0163716. eCollection 2016. Erratum In: PLoS One. 2017 Mar 28;12 (3):e0175077.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2010
• Primary Completion (Actual): July 1, 2013
• Study Completion (Actual): June 1, 2015

Study Registration Dates

• First Submitted: April 8, 2011
• First Submitted That Met QC Criteria: April 14, 2011
• First Posted (Estimate): April 15, 2011

Study Record Updates

• Last Update Posted (Actual): May 19, 2017
• Last Update Submitted That Met QC Criteria: April 11, 2017
• Last Verified: April 1, 2017

More Information

Terms related to this study

• Keywords: COPD; Nrf2; Sulforaphane
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Antineoplastic Agents; Protective Agents; Anticarcinogenic Agents; Sulforaphane
• Other Study ID Numbers: 1U01HL105569 (U.S. NIH Grant/Contract); RFA-HL-10-003 (Other Identifier: NHLBI)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: The primary method of data-sharing will be through the traditional mechanism of publication of results in the peer-reviewed medical literature. Following publication of the main results, in accordance with NIH policy, a de-identified, HIPAA-compliant limited use dataset will be made available to qualified investigators who have Institutional Review Board approval and sign a data-use agreement. De-identified specimens collected in the study that are not analyzed for the main study will be made available to qualified investigators along with a limited use dataset in line with University and Office of Human Research Protections guidelines with a materials transfer agreement and/or data-use agreement as applicable. The Center for Clinical Trials has extensive experience in preparation of limited use datasets, and maintains policies and model agreements for data-use agreements and materials-transfer agreements.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No