- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02595346
Study of the Efficiency of Hydroxychloroquine on the Endothelial Dysfunction and Its Vascular Consequences During the Antiphospholipid Syndrome (APLAQUINE)
Efficiency of Hydroxychloroquine on the Endothelial Dysfunction in Antiphospholipid Syndrome (APLAQUINE)
This study evaluates the benefits of hydroxychloroquine on arterial function in antiphospholipid syndrome.
Briefly, the patients will be randomized in two groups, one will receive hydroxychloroquine and standard treatment, the other will receive placebo in addition of standard treatment.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by recurrent thrombotic events and miscarriages, with persistently positive antiphospholipid antibodies (aPL). APS may be isolated (primary APS) or associated to a connective tissue disease, most often systemic lupus erythematous (SLE).
Pathogenic effects of aPL were first described by the demonstration that in vitro incubation of endothelial cells or monocytes with aPL induce an endothelial dysfunction characterized by pro-coagulant (overexpression of tissue factor and modulation of protein C and S), pro-inflammatory (increased level of IL-6(interleukin 6) , IL-1β and TNFα) and pro-adhesive (increased levels of ICAM-1(intercellular adhesion molecule ), VCAM-1 (vascular endothelial cell adhesion molecule) and E-selectin) phenotypes. In parallel the investigators and others reported that endothelial function, assessed by flow mediated dilatation, is altered in patients with primary and secondary forms of APS. Although a role for TLR (toll-like receptor )-mediated NFkB translocation has been advanced, the pathogenic mechanisms that lead to in vivo endothelial injury in APS are incompletely understood.
In an experimental model, the investigators demonstrated that passive transfer of human aPL to mice induced a marked endothelial dysfunction assessed ex vivo in small resistance arteries, and an increase in TNFα levels. Moreover, the investigators group have demonstrated that patients with primary arterial APS display endothelial dysfunction and structural arterial changes, associated with a pro-oxidative and pro-coagulant state and with activation of the TLR2 and TLR4 signalling pathways.
Recently, in a preliminary study the investigators have found that endothelial glycocalyx which is an important part of the vascular barrier and which is intimately linked to the homeostatic functions of the endothelium was altered in APL patients.
Hydroxychloroquine (HCQ) is an antimalarial drug, also used to treat rheumatic diseases such as SLE. There is experimental evidence to suggest a direct role of hydroxychloroquine on the pathophysiology of APS: it directly reduces the binding of antibodies on the phospholipid bilayers, protects the annexin A5 anticoagulant shield and it reverses platelet adhesion induced by aPL.
Furthermore it is known to decrease the expression of lysosomal TLRs, but also extra lysosomal TLR2 and TLR4.
The aim of this study is to investigate whether treatment with hydroxychloroquine modulates vascular endothelial function in patients.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Sébastien MIRANDA, MD
- Email: sebastien.miranda@chu-rouen.fr
Study Locations
-
-
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Rouen, France, 76031
- Recruiting
- ROUEN university hospital
-
Sub-Investigator:
- Ygal BENHAMOU, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients who fulfilled Sidney criteria for APS (antiphospholipid Syndrome
- Women of childbearing potential must have a contraceptive method
- Written informed consent
- no severe, progressive, or uncontrolled kidney, liver, blood, stomach, lung, heart, or brain disease.
Exclusion Criteria:
- secondary antiphospholipid syndrome
- Pregnancy and breastfeeding
- Patients with a history of severe depression, psychosis, or suicidal ideation
- story of intolerance or contra-indication to hydroxychloroquine, lactose, trinitrin
- Prior use of hydroxychloroquine in the last 6 months
- Chronic heart failure
- atrial fibrillation
- severe pulmonary hypertension
- severe kidney failure clearance < 30ml/mn
- uncontrolled arterial hypertension
- secondary arterial hypertension
- diabetes mellitus diagnosed in the last 3 months
- body mass index > 35
- Patient has been committed to an institution by legal or regulatory order
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: hydroxychlorquine
hydroxychloroquine 200 mg twice a day for 6 months
|
endothelial function is assessed by measuring the flow mediated dilatation of humeral artery in response to ischemia. the dilatation is evaluated by echotracking. glycocalyx thickness is measured by the study of sublingual microcirculation with SDF imaging. oxydative, inflammatory and coagulation parameters is assessed on plasma samples.
Other Names:
|
Placebo Comparator: control
placebo 2 pills a day for 6 months
|
endothelial function is assessed by measuring the flow mediated dilatation of humeral artery in response to ischemia. the dilatation is evaluated by echotracking. glycocalyx thickness is measured by the study of sublingual microcirculation with SDF imaging. oxydative, inflammatory and coagulation parameters is assessed on plasma samples. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline flow mediated dilatation of brachial artery
Time Frame: 6 months
|
The brachial artery diameter and blood flow are measured by echotracking and Doppler before and just after and ischemic test.
Result expressed in percentage of diameter variation.
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change from baseline in endothelial glycocalyx thickness
Time Frame: 6 months
|
indirect measure of the glycocalyx thickness by using sublingual SDF (sidestream dark field) imaging
|
6 months
|
change from baseline in oxydative stress
Time Frame: 6 months
|
plasma levels of nitrites and TBARS (thiobarbituric acid reactive substance)
|
6 months
|
change from baseline in systemic inflammation
Time Frame: 6 months
|
plasma levels of TNFalpha
|
6 months
|
change from baseline in coagulation parameter
Time Frame: 6 months
|
Tissue factor plasmatic level
|
6 months
|
change from baseline in plasmatic level in hydroxychloroquine
Time Frame: 6 months
|
plasma level of hydroxychloroquine
|
6 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Sébastien MIRANDA, MD, ROUEN university hospital
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2015/074/HP
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