Development of Airway Absorption Sampling Methods (FIBRO-SAM)

Development of Airway Absorption Sampling Methods for Biomarker Assessment in Probable Idiopathic Pulmonary Fibrosis (IPF) Patients

The study will measure airway inflammation in probable idiopathic pulmonary fibrosis (IPF) and sarcoidosis as well as in healthy volunteers. This can help understand the molecular basis of these diseases, why these diseases happen, and what makes patients develop lung fibrosis. These insights should one day help to monitor patients and aid in their diagnosis and treatment.

Study Overview

• Status: Withdrawn
• Conditions: Idiopathic Pulmonary Fibrosis; Sarcoidosis
• Intervention / Treatment: Procedure: Bronchoscopy for Probable Idiopathic Pulmonary Fibrosis and Sarcoidosis

Detailed Description

IPF is a progressive disease caused by irreversible scarring of the lung, and disease trajectory is not easily predicted based on clinical measurements. Biomarkers reflective of molecular pathways involved in IPF may help inform patient trajectory, but have been difficult to identify in circulation due to the disease manifesting in the lung. The study team will measure biomarkers from Probable IPF patients, sarcoidosis patients, and healthy volunteers using novel sampling methods involving absorption of upper and lower airway fluids. These novel sampling methods may enable less invasive and potentially more sensitive methods to detect disease activity and will be performed in IPF and sarcoidosis patients during a routine bronchoscopy procedure. The study team will compare the levels of biomarkers that have been shown to be predictive of disease course in airway fluids of probable IPF patients versus sarcoidosis and healthy controls. This study may help understand the molecular basis of IPF, and improve the understanding of diagnosis and treatment.

• Study Type: Observational

Contacts and Locations

• Study Contact: Name: Melissa Wickremasinghe; Phone Number: 02033121344; Email: melissa.wickremasinghe@nhs.net
• Study Contact Backup: Name: Trevor Hansel; Phone Number: 00442033125733; Email: t.hansel@imperial.ac.uk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with probable IPF and Sarcoidosis will be included. Patients with probable IPF and Sarcoidosis will be selected from clinic lists for patients undergoing bronchoscopy as part of their clinical assessment, and they will be invited to participate in this study that involves additional sampling for clinical research purposes.

Probable IPF patients must have Usual Interstitial Pneumonitis (UIP) on CT scan and will be sub classified by gas transfer (DLco corrected for haemoglobin as detailed below;

• Mild (DLco>60)
• Moderate (DLco 40-60)
• Severe (DLco<40)

Healthy volunteers (age/sex matched, non-smoking, without a clinical history of atopy).

The patient populations will include:

• Probable Idiopathic Pulmonary Fibrosis (IPF), n=30
• Sarcoidosis patients, n=15
• Healthy Volunteers n=15

Description

Inclusion Criteria:

• Inclusion Criteria for Probable Idiopathic Pulmonary Fibrosis (IPF)
• Adult male or female patients aged 40 to 85 years
• Women of childbearing age should not be pregnant, planning to get pregnant or breast-feeding.
• Command of the English language to be able to give informed consent.
• Probable IPF requiring bronchoscopy to confirm the diagnosis, agreed within the local multi-disciplinary team (MDT).,according to the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/ American Latin Thoracic Association (ATS/ERS/JRS/ALAT) guidelines (2018) (3)
• IPF disease diagnosis within the past 5 years
• Usual Interstitial Pneumonia (UIP) on HRCT scan.

• Recent lung function criteria:

  • Forced vital capacity (FVC) >40% of predicted value.
  • Carbon monoxide diffusing lung capacity (DLco) corrected for haemoglobin >30% of predicted value

Inclusion criteria for Sarcoidosis

• Adult male or female patients aged 18 years and over
• Women of childbearing age should not be pregnant, planning to get pregnant or breast-feeding.
• Clinical symptoms, CT scan and biopsy diagnosis of sarcoidosis
• Patients with lung parenchymal disease and pulmonary stage II or more

• Recent lung function criteria

  • FVC>50% predicted
  • DLCO >40% predicted

Inclusion criteria for Healthy Volunteers

• Age between 40 to 85 years, age and sex to match the group with IPF
• Healthy subjects without any diseases that may cause inflammation
• Women of childbearing age should not be pregnant, planning to get pregnant or breast-feeding.
• Currently non-smokers: see exclusion criteria

Exclusion Criteria:Exclusion Criteria for probable IPF and Sarcoidosis Patients

Respiratory Conditions other than IPF or sarcoidosis:

• Confirmed diagnosis of occupational lung disease
• Drug-induced lung disease or hypersensitivity pneumonitis
• Lung and systemic autoimmune disease including connective tissue disease. Patients with an auto-immune profile considered diagnostic for a specific connective tissue disease will be excluded, even in the absence of systemic symptoms. Non-specific rises in auto antibodies e.g. rheumatoid factor; anti-nuclear antibody etc. will not be used to exclude individuals from the study.
• Asbestosis or other asbestos related disease (pleural plaques, mesothelioma, asbestos pleural effusions)
• Granulomatous lung disease.
• Pulmonary artery hypertension (PAH) requiring a specific treatment.
• Predominant chronic obstructive pulmonary disease (COPD) with forced expiratory volume in 1 second /forced vital capacity (FEV1/FVC) <0.70.
• Patients with active tuberculosis or incompletely treated latent tuberculosis infection
• Lung cancer
• Upper respiratory tract infections in the past 6 weeks.

Systemic Conditions

• History of vasculitis, autoimmune or connective tissue disease
• Known human immunodeficiency virus (HIV) or chronic viral hepatitis
• Clinically significant diseases (other than IPF or sarcoidosis) that may alter respiratory biomarkers: including other respiratory, gastrointestinal, endocrine, haematological, cardiovascular, genitourinary, skin or neurological diseases.
• Recent or ongoing malignant diseases.
• Significant nasal anatomical defects preventing nasal sampling: including hypertrophy of turbinates, major septum deviation, nasal polyposis or recurrent sinusitis and nasal mucosal defects

Bronchoscopy Contraindications

Any contra-indication to bronchoscopy as set out in British Thoracic Society guidelines (34)

Smoking

A detailed smoking history will be taken from all participants: to include total pack years, smoking in the past year, and smoking in the past 2 weeks.

The history will include cigarettes, pipe smoking, cigars, vaping, and shisha. Any form of smoking is not permitted within 2 weeks of bronchoscopy.

5.4.2 Exclusion Criteria for Healthy Volunteers

• Current inflammatory/ immunological conditions. Any clinically significant diseases that may alter respiratory biomarkers: including respiratory, gastrointestinal, endocrine, haematological, cardiovascular, genitourinary, skin or neurological diseases.
• Recent or ongoing malignant diseases.
• Significant nasal anatomical defects preventing nasal sampling: including hypertrophy of turbinates, major septum deviation, nasal polyposis or recurrent sinusitis and nasal mucosal defects
• Upper respiratory tract infections in the past 6 weeks.
• Cigarette smoking:

no cigarettes in the last 2 weeks not more than 10 cigarettes in the past year <10 year lifetime pack history of smoking

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Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Healthy Volunteers; These will be age matched healthy volunteers (n=15) who will not undergo bronchoscopy
Probable Idiopathic Pulmonary Fibrosis; Patients with probable IPF, who will be having bronchoscopy as part of their clinical diagnostic work up	Procedure: Bronchoscopy for Probable Idiopathic Pulmonary Fibrosis and Sarcoidosis; Blood samples and Nasosorption sampling
Sarcoidosis,; Patients with sarcoidosis who will be having bronchoscopy as part of their clinical diagnostic work up	Procedure: Bronchoscopy for Probable Idiopathic Pulmonary Fibrosis and Sarcoidosis; Blood samples and Nasosorption sampling

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Levels of the of biomarker/mediator surfactant protein D (SPD) in bronchial Lining fluid in IPF and sarcoidosis patients	Comparisons will be made of bronchial lining fluid levels of biomarker/mediator surfactant protein D (SPD), in patients with IPF and sarcoidosis.	Baseline Bronchoscopy visit
Levels of the biomarker/mediator CCL18 in bronchial Lining fluid in IPF and sarcoidosis patients.	Comparisons will be made of bronchial lining fluid levels of biomarker/mediator CCL18 in patients with IPF and sarcoidosis	Baseline Bronchoscopy visit
Levels of the biomarker/mediator CXCL13 in bronchial Lining fluid in IPF and sarcoidosis patients.	Comparisons will be made of bronchial lining fluid levels of biomarker/mediator CXCL13 in patients with IPF and sarcoidosis.	Baseline Bronchoscopy visit
Levels of the of biomarker/mediator periostin in bronchial Lining fluid in IPF and sarcoidosis patients.	Comparisons will be made of bronchial lining fluid levels of biomarker/mediator periostin in patients with IPF and sarcoidosis.	Baseline Bronchoscopy visit

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Levels of Periostin in nasosorption samples within and across the 3 groups of participants	Comparisons will be made of airways levels of biomarker/mediator periostin between patients with IPF and sarcoidosis and health volunteers.	Through study completion, an average of 1 year
Levels of surfactant protein (SPD) in nasosorption samples within and across the 3 groups	Comparisons will be made of airways levels of biomarker/mediator surfactant protein D (SPD) between patients with IPF and sarcoidosis and health volunteers.	Through study completion, an average of 1 year
Levels of CCL18 in nasosorption samples within and across the 3 groups	Comparisons will be made of airways levels of biomarker/mediator CCL18 between patients with IPF and sarcoidosis and health volunteers.	Through study completion, an average of 1 year
Levels of CXCL13 in nasosorption samples within and across the 3 groups	Comparisons will be made of airways levels of biomarker/mediator CXCL13 between patients with IPF and sarcoidosis and health volunteers.	Through study completion, an average of 1 year
Levels of periostin in blood within and across the 3 groups of participants	Comparison will be made of periostin levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.	Through study completion, an average of 1 year
Levels of surfactant protein D (SPD in blood within and across the 3 groups of participants	Comparison will be made of surfactant protein D (SPD levels in blood with nasosorption and bronchosorption levels across the 3 participant groups	Through study completion, an average of 1 year
Levels of CCL18 in blood within and across the 3 groups of participants	Comparison will be made of CCL18 levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.	Through study completion, an average of 1 year
Levels of CXCL13 in blood within and across the 3 groups of participants	Comparison will be made of CXCL13 levels in blood with nasosorption and bronchosorption levels across the 3 participant groups.	Through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: Imperial College London
• Collaborators: Genentech, Inc.
• Investigators: Principal Investigator: Melissa Wickremasinghe, Physician

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2022
• Primary Completion (Actual): January 1, 2022
• Study Completion (Actual): January 1, 2022

Study Registration Dates

• First Submitted: June 9, 2020
• First Submitted That Met QC Criteria: July 29, 2020
• First Posted (Actual): July 31, 2020

Study Record Updates

• Last Update Posted (Actual): September 15, 2023
• Last Update Submitted That Met QC Criteria: September 13, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Immune System Diseases; Lymphoproliferative Disorders; Lymphatic Diseases; Lung Diseases; Hypersensitivity; Lung Diseases, Interstitial; Hypersensitivity, Delayed; Fibrosis; Pulmonary Fibrosis; Idiopathic Pulmonary Fibrosis; Sarcoidosis
• Other Study ID Numbers: 19SM5398; 239911 (Other Identifier: IRAS)

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