Bronchial Thermoplasty: Effect on Neuronal and Chemosensitive Component of the Bronchial Mucosa (BT-ASMN)

Treatment of Bronchial Severe Asthma With Bronchial Thermoplasty. Assessment of Efficacy and Safety of Treatment, Study of Effects on Neuronal and Chemosensitive Component of the Bronchial Mucosa Pre and Post Treatment

In severe bronchial asthma the mechanism of inflammation and bronchospasm is complex and still not clarified. The smooth muscle cells play an important role from the mechanical point of view, as a culmination of neurogenic stimuli and inflammatory cytokines that determine as final effect the bronchospasm and over time a hypertrophy of the muscular coat. There are some other hypothesis that the smooth muscle cells may play a role as central regulator of chemical mediators that cause bronchospasm and inflammation, although there are currently no firm conclusions 2 According to other studies3,the nerve receptors TRANSIENT RECEPTOR POTENTIAL VANILLOID TYPE 1 have a great importance in the complex mechanism of airway inflammation too. (There are at least 4)

These receptors would intervene according to the following mechanism:

1. Irritants on the bronchial mucosa stimulate the TRANSIENT RECEPTOR POTENTIAL VANILLOID TYPE 1 present on afferent endings of sensory fibers, unmyelinated C (chemiosensitive neurons)
2. On the same afferent axon acting factors with the activation effect (lowering the activation threshold, increase the expression, promote the translocation of TRPV1 receptor on the membrane). Among these factors the neurotrophins of which the most important NERVE GROWTH FACTOR (NGF)

3. The activation of TRPV1 (through release of Ca2 + +) determines two efferent responses:

   1. CENTRALLY-MEDIATED
   2. LOCAL AXON Reflex

Investigators hypothesized that BT may have a strong influence on the destruction of nerve receptors TRPV1 and unmyelinated nerve fibers located in the mucosa going to stop reflections both central and local authorities responsible for the activation of bronchospasm. In support of this hypothesis, there are some anatomical studies4, which show that these receptors are more numerous at the level of main bronchi which are the main target of BT. Please note in this context that it is already known that in thermoablations commonly used in cardiology it is used a radio frequency with development of heat controlled to 65 °, as in the BT, able to interrupt the circuit nervous responsible for the activation of the circuit causing the abnormal 'arrhythmia.

Study Overview

• Status: Unknown
• Conditions: Severe Persistent Asthma
• Intervention / Treatment: Device: catheter ALAIR

Detailed Description

The mechanism of action the bronchial thermoplasty exerts the positive action demonstrated by the studies through is not yet well understood yet. The only action on the denaturation and destruction of the smooth muscle layer of the bronchi at intermediate and high caliber perhaps not fully explain its action, taking into account that most of the smooth muscle loading of the small airways is minimally altered by the procedure. From the premises outlined in the section on the mechanism of inflammation we hypothesized that BT may have a strong influence on the destruction of nerve receptors TRPV1 and unmyelinated nerve fibers located in the mucosa going to stop reflections both central and local authorities responsible for the activation of bronchospasm. In support of this hypothesis, there are some anatomical studies4, which show that these receptors are more numerous at the level of main bronchi which are the main target of BT. Please note in this context that it is already known that in thermoablations commonly used in cardiology it is used a radio frequency with development of heat controlled to 65 °, as in the BT, able to interrupt the circuit nervous responsible for the activation of the circuit causing the abnormal 'arrhythmia.

• Study Type: Interventional
• Enrollment (Anticipated): 12
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nicola Facciolongo NF Facciolongo, M D; Phone Number: +39 0522-295956; Email: nicola.facciolongo@asmn.re.it
• Study Contact Backup: Name: Carla CG Galeone, phD; Email: carla.galeone@asmn.re.it

Study Locations

• Italy
  • Reggio Emilia, Italy, 42024
    • Recruiting
    • REGGIO EMILIA IRCCS, Santa Maria Nuova Hospital
    • Contact: Nicola NF Facciolongo, MD; Phone Number: +39 0522-295956; Email: nicola.facciolongo@asmn.re.it
    • Principal Investigator: Nicola NF Facciolongo, MD
    • Sub-Investigator: Roberto RP Piro, MD
    • Sub-Investigator: Gianluigi GB Bajocchi, MD
    • Sub-Investigator: Francesco FM Menzella, MD
    • Sub-Investigator: Claudia CC Castagnetti, MD
    • Sub-Investigator: Alberto AC Cavazza, MD
    • Sub-Investigator: Vladimiro VP Pietrini, MD
    • Sub-Investigator: Luisa LS Savoldi, Statistics
    • Sub-Investigator: Carla CG Galeone, Biologist

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patient with severe persistent asthma uncontrolled found in stable for at least 3 weeks
2. Patient receiving regular treatment with inhaled corticosteroids (beclomethason> 1000 mcg or equivalent) and LABA (salmeterol> = 100 mcg or equivalent)
3. AQLQ score <6.25
4. FEV1> = 60% predicted
5. Patients not smoking for at least one year

Exclusion Criteria:

1. acute asthma with life threatening
2. concomitant respiratory diseases (eg, COPD or emphysema)
3. use of ß-blocker drugs
4. severe active infection in the last 2 weeks
5. Pacemaker, internal defibrillator or other implanted electronic device.
6. Known sensitivity to medications used to perform bronchoscopy, including lidocaine, atropine and benzodiazepines.
7. Currently known bleeding disorder is not well controlled.
8. Inability to stop prior to the procedure taking anticoagulants, antiplatelet agents, aspirin or non-steroidal anti-inflammatory drugs
9. 18 years
10. Pregnant women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Bronchial Thermoplasty; bronchoscopy bronchial thermoplasty catheter ALAIR Boston SCientific asthma	Device: catheter ALAIR; Catheter ALAIR Radiofrequency 65°; Other Names: Catheter ALAIR Boston Scientific; M005ATS25010 MOd ATS 2-5

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
analysis of the risk and benefit profile with questionnaire ACT and AQLQ	Evaluation of symptom control through the questionnaire ACT (ASTHMA CONTROL TEST) and AQLQ (Asthma quality life Questionaire) according to GINA criteria. The questionnaires AQLQ and ACT will be collected 3 months before the TB, the day before the procedure, and 3, 6, 12 months after the end of the procedure.	Change from Baseline in ACT and AQLQ Questionaire one year after the end of the procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Analyze the changes in the state of innervation and nerve receptors before and after BT on histological samples of the bronchial mucosa	first biopsies in left lower lobe non yet treated; second biopsies in right lower lobe already treated; third biopsies in upper lobe already treated;	biopsies every 4 weeks( during the treatment)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluate the effect of BT on the run neurogenic inflammation by analysis of the chemical mediators of inflammation on histological samples of the bronchial mucosa.	first biopsies in left lower lobe non yet treated; second biopsies in right lower lobe already treated; third biopsies in upper lobe already treated;	biopsies every 4 weeks (during the treatment)

Collaborators and Investigators

• Sponsor: Arcispedale Santa Maria Nuova-IRCCS
• Investigators: Principal Investigator: Nicola NF Facciolongo, M.D.

Publications and helpful links

General Publications

• Facciolongo N, Di Stefano A, Pietrini V, Galeone C, Bellanova F, Menzella F, Scichilone N, Piro R, Bajocchi GL, Balbi B, Agostini L, Salsi PP, Formisano D, Lusuardi M. Nerve ablation after bronchial thermoplasty and sustained improvement in severe asthma. BMC Pulm Med. 2018 Feb 8;18(1):29. doi: 10.1186/s12890-017-0554-8.

Study record dates

Study Major Dates

• Study Start: March 1, 2013
• Primary Completion (Anticipated): April 1, 2015
• Study Completion (Anticipated): December 1, 2015

Study Registration Dates

• First Submitted: April 2, 2013
• First Submitted That Met QC Criteria: April 22, 2013
• First Posted (Estimate): April 25, 2013

Study Record Updates

• Last Update Posted (Estimate): April 1, 2014
• Last Update Submitted That Met QC Criteria: March 31, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Immune System Diseases; Lung Diseases; Hypersensitivity, Immediate; Bronchial Diseases; Lung Diseases, Obstructive; Respiratory Hypersensitivity; Hypersensitivity; Asthma
• Other Study ID Numbers: BT-01-ASMN

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