Long-term Aspirin Therapy as a Predictor of Decreased Susceptibility to SARS-CoV-2 Infection in Aspirin-Exacerbated Respiratory Disease (AERD-CoV19)

Aspirin-exacerbated respiratory disease (AERD) is characterized by the presence of asthma, chronic rhinosinusitis with nasal polyposis (CRwNP), and acute respiratory reactions induced by aspirin and other cyclooxygenase-1 inhibitors. One of the well-established therapeutic options is aspirin desensitization followed by daily aspirin therapy. The potential mechanisms underlying the clinical benefit of this approach include the downregulation of CysLT1 receptor, inhibition of PGD2 and interleukin IL-4 via the signal transducer and activator of transcription 6, global (blood, urine) activation of type 2 (T2) inflammation as well as local (sputum) reduction of T2 asthma inflammation. Indeed, among current aspirin-treated patients with AERD (n=37), no one had severe acute respiratory syndrome coronavirus clade 2 (SARS CoV-2) infection and most importantly, none of them developed COVID19 during pandemic. WHY? Notably, patients with AERD did not have asthma and nasal polyps exacerbation on aspirin, which is in line with other studies. Respiratory infections, such as the current COVID-19 pandemic, target epithelial cells in the respiratory tract. SARS-CoV-2 spike (S) protein binds angiotensin-converting enzyme 2 (ACE2), and in concert with host proteases, principally transmembrane serine protease 2 (TMPRSS2), promotes cellular entry. Nasal and bronchial epithelium play a key role in the early phases of an immune response to respiratory viruses. Induced sputum (IS) and nasal lavage (NL) cells are likely the first immune cells to encounter SARS CoV-2 during an infection, and their reaction to the virus will have a profound impact on the outcome of the infection. Interferons (IFNs) are antiviral cytokines and among the first mediators produced upon viral infection. IFNs are divided into three groups based on their receptor usage; type I IFNs (IFN-α and IFN-β), type II IFN (IFN-γ), and type III IFNs (IFN-λ1 and 2). Both production of IFN and cellular response to IFN are critical steps for the restriction of viral dissemination. An interferon-stimulated gene (ISG) is a gene whose expression is stimulated by interferon. Specifically, type I and type III interferons are antiviral cytokines, triggering ISGs that combat viral infections. The type II interferon class only has one cytokine (IFN-γ), which has some antiviral activity. To conclude, the assessment of gene expression for interferon α1 (IFNA1), interferon β1 (IFNB1), interferon γ (IFNG), interferon λ1 and λ2 (IFNL1 and IFNL2) as well as for ACE2 and TMPRSS2 in sputum and nasal cells may shed new light on the course of this infection in patient with AERD during long term aspirin therapy.

Study Overview

• Status: Recruiting
• Conditions: AERD - Aspirin Exacerbated Respiratory Disease
• Intervention / Treatment: Drug: Aspirin 300 Mg Oral Tablet; Drug: Placebo

• Study Type: Interventional
• Enrollment (Anticipated): 76
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Lucyna Mastalerz, prof.; Phone Number: 12 40 03 050; Email: lucyna.mastalerz@uj.edu.pl

Study Locations

• Poland
  • Kraków, Poland, 30-688
    • Recruiting
    • University Hospital, Pulmunology Clinic
    • Contact: Lucyna Mastalerz, prof.; Phone Number: 12 40 03 050; Email: lucyna.mastalerz@uj.edu.pl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

INCLUSION CRITERIA FOR AERD PATIENTS:

• signed informed consent form
• 18-70 years old AERD patients with baseline FEV1 of at least 70% of the predicted value on the challenge/desensitization day
• no pregnancy, higly effective contraception must be used

INCLUSION CRITERIA FOR HEALTHY CONTROL:

• signed informed consent form
• 18-70 years old and healthy condition
• no asthma

Exclusion Criteria:

• failure of the circulatory and respiratory system, liver, kidneys and other vital organs
• diabetes, cancer, systemic diseases of connective tissue, infectious diseases, coagulation disorders, active peptic ulcer disease, any active bleeding process.
• Use of drugs that interact with aspirin

• use of intoxicants, alcohol abuse, active and passive smoking,

  • pregnancy, lactation.
  • hypersensitivity to the active substance or any of the excipients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Aspirin; Acard 300 mg (Acidum acetylsalicylicum). 1 tablet (300 mg) twice a day	Drug: Aspirin 300 Mg Oral Tablet; 8-week treatment of aspirin, then after 2-weeks washout the next treatment arm is placebo for 8 weeks
Placebo Comparator: Placebo; Placebo 1 tablet twice a day	Drug: Placebo; 8-week treatment of placebo, then after 2-weeks washout the next treatment arm is aspirin for 8 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of Participants with two-fold decrease in gene expression of ACE2, TMPRSS2, BSG, PPIA, PPIB, DPP4, IFNA1, IFNB1 IFNG, IFNL1, IFNL2 and ISG in sputum and nasal cells after 8 weeks of placebo/aspirin therapy compared to the baseline value.	8 weeks

Collaborators and Investigators

• Sponsor: Lucyna Mastalerz
• Investigators: Principal Investigator: Lucyna Mastalerz, prof., Jagiellonian University

Study record dates

Study Major Dates

• Study Start (Actual): December 7, 2022
• Primary Completion (Anticipated): February 28, 2025
• Study Completion (Anticipated): February 28, 2025

Study Registration Dates

• First Submitted: March 1, 2023
• First Submitted That Met QC Criteria: March 28, 2023
• First Posted (Actual): April 4, 2023

Study Record Updates

• Last Update Posted (Actual): April 6, 2023
• Last Update Submitted That Met QC Criteria: April 4, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19; Respiration Disorders; Respiratory Tract Diseases; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Enzyme Inhibitors; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Fibrinolytic Agents; Fibrin Modulating Agents; Platelet Aggregation Inhibitors; Cyclooxygenase Inhibitors; Antipyretics; Aspirin
• Other Study ID Numbers: AERD-CoV19

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No