The CASCADE Study - Measures of Complement Activation and Inflammation in Patients With Covid-19

The CASCADE Study - Measures of Complement Activation and Inflammation in Patients With Coronavirus Disease 2019

COVID-19 is a new disease and therefore it is still not clear exactly how the virus affects the body and why people are affected so differently. It causes infection in the lungs and the virus can then attack blood vessels in the lungs and other organs to spark off an inflammatory process that can make a person very ill. It also can cause damage within tiny blood vessels that makes a person's blood thicken up and stop flow in vital organs. The investigators believe complement (which is a chemical in the body which can be harmful in excess) orchestrates the inflammation and thickening of the blood that can make a person sick. The investigators now need to know which of these complement chemicals are elevated in COVID-19 and compare to healthy volunteers, and assess whether the levels are higher in people with severe lung disease. The investigators believe that if levels are increased there are special treatments that can counteract them and potentially be an effective treatment for COVID-19.

In this study the investigators will measure different parts of the inflammation process to better understand what may be causing severe disease and to see if there may be benefits from a new treatment to reduce inflammation

Study Overview

• Status: Completed
• Conditions: Coronavirus

Detailed Description

This study is an observational cross-sectional and cohort study to assess whether there is evidence of increased complement activation and/or LTB4 levels and other parameters of inflammation and a pro-coagulative state in adult patients hospitalised with COVID-19 compared to healthy controls and also whether these measures differ with increasing severity of respiratory failure.

Blood samples (serum and plasma) will be obtained from each participant at the time of recruitment into the trial, to assess the profile of complement activation, cytokines/ chemokines, leukotrienes (specifically leukotriene B4) and markers of coagulation and inflammation in patients with COVID-19.

Participants within the cohort study will be recruited at the point of admission or as close to it as possible. Baseline sampling will be performed at time of recruitment. There will be up to 2 additional sampling points (with not more than one sample per day) if there is any worsening of the participants respiratory failure (i.e. deteriorating from mild to moderate or moderate to severe disease).

Patients just admitted to hospital will be asked to consent for both the case control and the cohort study

Data will be collected at baseline for all participants and then again at each further sampling point for the participants within the cohort study.

Patient status will be measured at 14 days from the last point of sampling.

• Study Type: Observational
• Enrollment (Actual): 72

Contacts and Locations

Study Locations

• United Kingdom
  • Portsmouth, United Kingdom, PO6 3LY
    • Portsmouth Hospitals NHS Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Participants with Covid 19 and Healthy Volunteers

Description

Inclusion Criteria:

- 1. Adults ≥18 years old requiring hospital admission for COVID-19

2. COVID-19 confirmed by either*:

• A positive swab (using RT-PCR)
• OR based on a high level of clinical probability confirmed by the presence of typical symptoms and compatible radiological findings on imaging with no alternative cause for these findings identified by the treating physician.

Exclusion Criteria:

• 1. Renal replacement therapy on ITU

  2. Significant trauma (including an acute fracture or significant head injury)

  3. Massive transfusion of blood products

  4. Confirmed bacteraemia with pathogenic organism on blood cultures or other severe bacterial infections (including abscess/empyema) which persist despite broad-spectrum antibiotics and are thought to be significantly contributing to the patient's symptoms and clinical state. Recruitment will not be delayed however pending a negative culture.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Complement Activation	C5a, C5, C3, sC5b9, Bb concentration from serum	14 days sampling time period
Leukotrienes Measure	LTB4 concentration from plasma	14 days sampling time period
Coagulation Measure	Level of platelets, INR, APTS, D-Dimer, Fibrinogen, thrombin antithrombin complex (TAT), from citrate plasma	14 days sampling time period
Hyperinflammation Measure	• CRP, Ferritin, PCT, LDH, Troponin, ALT from plasma	14 days sampling time period
Cell Count	Total White Blood Cell count (including lymphocytes, monocytes and neutrophils)	14 days sampling time period
Cytokines and Chemokine Measure	Level of • Pro-inflammatory - IL-1α, IL-1β, IL-2, IL-5, IL-6, IL-7, IL-8, IL-17, GCSF, GMCSF, IFN γ, IP10, MCP-1, MIP1α, TNFα and anti inflammatory IL-4, IL-10, IL-13, IL-22, TGF-α from plasma	14 days sampling time period
Endothelial dysfunction measures:	VEGF, tissue factor and PAI-1, from plasma	14 days sampling time period

Collaborators and Investigators

• Sponsor: Portsmouth Hospitals NHS Trust
• Collaborators: Akari Therapuetics

Study record dates

Study Major Dates

• Study Start (Actual): May 28, 2020
• Primary Completion (Actual): May 30, 2021
• Study Completion (Actual): May 30, 2021

Study Registration Dates

• First Submitted: June 25, 2020
• First Submitted That Met QC Criteria: June 30, 2020
• First Posted (Actual): July 1, 2020

Study Record Updates

• Last Update Posted (Actual): April 7, 2023
• Last Update Submitted That Met QC Criteria: April 6, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Coronavirus Infections; Inflammation
• Other Study ID Numbers: PHT/2020/37

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