Haemodynamic Effects of Apelin Agonists and Antagonists in Man in COPD With Raised Pulmonary Artery Pressures

Haemodynamic Effects of Apelin Agonists and Antagonists in Man in COPD With Raised Pulmonary Artery Pressures.

The investigators are interested in studying how Pulmonary Hypertension occurs. A substance called 'apelin', that naturally occurs in the body has been shown to have an important role in heart disease. Previous studies have shown that it can make blood vessels get wider, and help blood flow around the body and thus improve the way the heart and lungs work.

The investigators are looking to recruit both healthy and COPD pulmonary hypertension patients to study 3 types of apelin. The purpose of this study is to help the investigators understand how Pulmonary Hypertension occurs which may will help with the development of future treatments.

Study Overview

• Status: Completed
• Conditions: Pulmonary Hypertension; COPD
• Intervention / Treatment: Procedure: Haemodynamic studies; Procedure: Forearm plethysmography

Detailed Description

The purpose of this study:

To investigate the physiological role of apelin in the cardiovascular system in patients with COPD with raised pulmonary artery pressures.

Study Aim and hypotheses:

The primary objective is to test the above hypotheses using forearm blood flow and systemic infusions of apelin peptides.

Hypotheses:

1. Apelin agonists are vasodilators in human resistance vessels and this effect will be altered in patients with pulmonary hypertension.
2. Apelin peptides improve right ventricular and pulmonary haemodynamics in patients with elevated pulmonary artery pressures.

Study 1a - A validation dose study of 3 apelin agonists performed in healthy volunteers and COPD patients with elevated pulmonary artery pressures.

Study 1b- A validation dose study of apelin receptor antagonist, in healthy volunteers and COPD patients with elevated pulmonary artery pressures.

Study 2a - To define the haemodynamic response to apelin agonists in healthy volunteers and evaluate the response.

Study 2b - To investigate the haemodynamic response to 3 apelin agonists in COPD patients with elevated pulmonary artery pressures.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Cambridge, United Kingdom, CB2 0QQ
    • Vascular Research Unit, Clinical Pharmacology Unit, ACCI, Level 3, Addenbrooke's Hospital, Hills Road

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Healthy volunteers

  • Aged 18 to 70 years
  • Non-smoker (<1 cigarette per week)
  • If female, postmenopausal or on days 2-9 of menstrual cycle and negative pregnancy test COPD patients with estimated Pulmonary Artery Pressure (PAP) on echo >25mmHg
  • Clinical diagnosis of COPD as per standard criteria
  • Between 18 and 70 years
  • If female, postmenopausal or on days 2-9 of menstrual cycle and negative pregnancy test

Exclusion Criteria:

• pre-existing:

  • Systemic Hypertension (sustained BP >160/100mmHg)
  • Ischaemic Heart Disease
  • Primary valvular heart disease
  • Significant left ventricular failure
  • Active malignancy
  • Renal disease (Creatinine >180 µmol/L)
  • Neurological disease
  • Diabetes mellitus
  • BMI >35, BMI <17
  • Pregnancy
  • Use of vasoactive medication or NSAIDS/aspirin within 48 hours of study.
  • Current involvement in other research studies, other than observational/non-interventional
  • Known HIV

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Systemic Apelin infusion; Study 2a - Haemodynamic studies to investigate the response to systemic infusions of 3 apelin agonists in healthy volunteers Study 2b - Haemodynamic studies to investigate the response to 3 apelin agonists in COPD patients with elevated pulmonary artery pressures	Procedure: Haemodynamic studies; Dose response study; Other Names: Echocardiography; Innocor; Bioimpedance
Experimental: Apelin infusion - forearm; Study 1a - A validation dose study of 3 apelin agonists using forearm plethysmography to evaluate changes in forearm blood flow: performed in healthy volunteers and COPD patients with elevated pulmonary artery pressures. Study 1b- A validation dose study of apelin receptor antagonist using forearm plethysmography to evaluate changes in forearm blood flow, in healthy volunteers and COPD patients with elevated pulmonary artery pressures.	Procedure: Forearm plethysmography; Dose response study

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Percentage change in forearm blood flow in the infused arm. Forearm blood flow ratio in each arm, blood pressure and heart rate will also be reported.	12 months
Cardiac output and stroke volume, pulmonary vascular resistance, mean arterial pressure and heart rate.	12 months

Other Outcome Measures

Outcome Measure	Time Frame
Exploratory endpoints in Study 2 are systolic and diastolic blood pressure.	12 months

Collaborators and Investigators

• Sponsor: Cambridge University Hospitals NHS Foundation Trust
• Collaborators: Wellcome Trust; University of Cambridge
• Investigators: Principal Investigator: Dr. Joseph Cheriyan, MD, Cambridge University Hospitals NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start: June 1, 2014
• Primary Completion (Actual): December 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: April 28, 2014
• First Submitted That Met QC Criteria: April 30, 2014
• First Posted (Estimate): May 2, 2014

Study Record Updates

• Last Update Posted (Estimate): June 25, 2015
• Last Update Submitted That Met QC Criteria: June 23, 2015
• Last Verified: January 1, 2015

More Information

Terms related to this study

• Keywords: COPD; Apelin; agonist; antagonist
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Lung Diseases; Hypertension; Hypertension, Pulmonary
• Other Study ID Numbers: ALPHa-COPD