Sphingosine-1-phosphate and Pneumonia (SOPN)

July 2, 2019 updated by: Taipei Medical University WanFang Hospital

To Assess the Role of Sphingosine-1-phosphate in the Pathobiology of Pneumonia: Generate a New Strategy for Treatment of Severe Community-acquired Pneumonia

Pneumonia is a major infectious cause of death worldwide and imposes a considerable burden on healthcare resources. Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid and involved in many physiological processes including immune responses and endothelial barrier integrity. In term of endothelial barrier integrity, S1P plays a crucial role in protecting lungs from pulmonary leak and lung injury. Because of the involvement in lung injury, S1P could be the potential biomarker of pneumonia. Recently, our pilot study suggested that patients with CAP have significantly higher plasma S1P levels than healthy individuals. Interestingly, our observational study also showed significantly elevated S1P level in the patients who were treated with methylprednisolone during the hospitalization. Based on the above evidence, we hypothesize that S1P plays an important role in the pathobiology of pneumonia. Moreover, S1P is not only a useful biomarker for diagnosis of CAP, but also can be an indicator for using corticosteroids adjuvant therapy.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Lower respiratory tract infections are the most frequent infectious cause of death worldwide[1] and impose a considerable burden on healthcare resources. Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid and has both extracellular and intracellular effects in mammalian cells[2-5]. S1P is involved in many physiological processes including immune responses and endothelial barrier integrity[6-9]. In the context of endothelial barrier integrity, S1P plays a crucial role in protecting the lungs from the pulmonary leak and lung injury. [10-13] Previous research suggests that, at low concentrations, S1P signaling through S1PR1 is crucial for enhancing endothelial barrier function. [13,14] The S1P induces actin polymerization and results in the spreading of endothelial cells, which fill the intercellular gaps. Also, the S1P signaling can stabilize the endothelial cell-cell junctions, such as adherens junction and tight junction. [15-17] Both actin-dependent outward spreading of endothelial cells and cell junction stabilization enhance the endothelial barrier function. However, S1P at higher concentration (> 5 µM) causes endothelial barrier disruption through binding of S1PR2[13]. Thus, exact maintenance of physiologic S1P concentrations and homeostasis of S1PRs and S1P synthesis and degradation seem to be crucial for the preservation of lung endothelial barrier integrity, particularly in inflammatory lung diseases.

Because of the involvement in lung injury and endothelial barrier function, S1P may be a potential biomarker of pneumonia. Moreover, a recent study proposed that targeting the S1P/S1P receptor 2-signaling pathway in the lung may provide a novel therapeutic perspective in pneumonia for the prevention of acute lung injury [18]. Recently, our pilot study suggests that the patients with CAP (N= 137) have significantly higher plasma S1P levels than controls (N= 78). Further, the S1P levels, but not CRP, were found to be inversely correlated with PSI score, CURB-65 score and hospital length of stay (LOS) in patients with CAP. Our initial findings suggest that plasma S1P is a potential biomarker for predicting prognosis in CAP.

Although corticosteroids adjuvant therapy for CAP is still controversial, a recent meta-analysis study showed that corticosteroids adjuvant therapy in patients with the severe CAP could reduce the rate of in-hospital mortality and reduce the length of hospital stay[19]. Recently, the long-standing dogma of cytokine repression by the glucocorticoid was challenged. Vettorazzi et al. proposed a new mechanism of glucocorticoid action. They suggested that increased circulating sphingosine 1-phosphate levels resulting from the induction of sphingosine kinase 1 (SphK1) by glucocorticoids were essential for the inhibition of pulmonary inflammation[20]. Interestingly, our observational study also showed significantly elevated S1P levels in patients who were treated with methylprednisolone during hospitalization.

Several studies have suggested that S1P can enhance pulmonary endothelial cell barrier function, suggesting that higher S1P levels could be potentially beneficial. Hence, the patients, who are unable to produce sufficient S1P, might have a poor prognosis. However, in most of the studies, CAP was not considered as a disease model, and those results were based on cell lines and mouse models. Therefore, further clinical studies focusing on the role of S1P in the pathophysiology of pneumonia is needed.

Study Type

Interventional

Enrollment (Anticipated)

400

Phase

  • Phase 2
  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Taiwan
      • Taipei City, Taiwan, 11696
        • Recruiting
        • Wan Fang Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

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:

  • Clinical symptoms suggestive community-acquired pneumonia and pneumonia severe index (PSI) > 90, Age 18 years or older and Written informed consent obtained

Exclusion Criteria:

  • Presence of severe immunosuppression (HIV infection, use of immunosuppressants), malignancy, pregnancy or breastfeeding, patient with uncontrol diabetes, current use of antibiotics or corticosteroids, any likely infection other than CAP, or pneumonia that developed within 3 days after hospital discharge

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: SINGLE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: methylprednisolone
20 mg of methylprednisolone IV Q12H for 5 days
Drug: Methylprednisolone Sodium Succinate
methylprednisolone vial
PLACEBO_COMPARATOR: Placebo
normal saline IV Q12H for 5 days
Drug: Placebo
Normal saline manufactured to mimic methylprednisolone vial

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mortality
Time Frame: up to 4 months
In hospital mortality
up to 4 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
ICU Admission
Time Frame: up to 4 months
If the patient has any Intensive Care Unit (ICU) Admission?
up to 4 months
Length of ICU stay
Time Frame: up to 4 months
Length of ICU stay (day)
up to 4 months
length of hospital stay
Time Frame: up to 4 months
length of hospital stay (day)
up to 4 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Taipei Medical University WanFang Hospital

Investigators

  • Principal Investigator: Ching-Wang Hsu, MD, Wan Fang Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

June 15, 2019

Primary Completion (ANTICIPATED)

April 1, 2021

Study Completion (ANTICIPATED)

November 1, 2025

Study Registration Dates

First Submitted

April 23, 2019

First Submitted That Met QC Criteria

July 2, 2019

First Posted (ACTUAL)

July 5, 2019

Study Record Updates

Last Update Posted (ACTUAL)

July 5, 2019

Last Update Submitted That Met QC Criteria

July 2, 2019

Last Verified

July 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • N201812054

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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