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Testing of HIV Protease Inhibitors to Suppress Inflammation and Improve Cardio Pulmonary Hemodynamics in Subjects With Pulmonary Arterial Hypertension

4. september 2014 opdateret af: Yuan Hong, The Third Xiangya Hospital of Central South University

Study Rationale:There is recent evidence that HIV protease inhibitors (HIV-PI) can improve pulmonary hemodynamics in experimental models of pulmonary arterial hypertension (PAH). There is also experimental evidence that both TLR4 and high mobility group box 1 (HMGB1) participate in the pathogenesis of experimental pulmonary hypertension. A recent high throughput screen for inhibitors of HMGB1 induced macrophage activation yielded HIV-protease inhibitors (PIs) as potent inhibitors of HMGB1 induced cytokine production. Based on the experimental evidence we propose a trial to determine whether HIV-PIs will alter the pathobiology of PAH.

Study Objectives:The main objective of this study is to determine whether saquinavir and ritonavir (SQV+RIT) which have a well-characterized safety profile in humans will reduce bio markers of inflammation and pulmonary artery pressures in patients with PAH.

Study Hypothesis:We hypothesize that the HIV-PI, SQV+RIT, will reduce circulating parameters of inflammation including HMGB1, IL1-beta, IL-6, IL-8, IL-10, TNF-alpha and CRP. Our end points will be changes in these parameters from baseline over the duration of the study.We hypothesize that treatment with SQV+RIT will reduce pulmonary artery(PA) pressure of patients with PAH as measured by echocardiography.

Study Design:This is a single center open label phase 0 study to evaluate the effect of SQV +RIT in patients with IPAH. Subjects with IPAH(N=20) will be enrolled into a study, which will be divided into 3 cohorts and entail the administration of HIV protease inhibitors in three doses. The first cohort (n=3) will receive a starting dose of SQV 0.3 mg/kg twice daily in combination with RIT 0.03 mg/kg twice daily. If the first dose is well-tolerated, the second cohort (n= 3 ) with IPAH will be given doses of SQV 3 mg/kg and RIT 0.3 mg/kg twice daily. If the second dose is well-tolerated, the last cohort (n= 14 ) with IPAH will be given doses of SQV 15 mg/kg and RIT 1.5 mg/kg twice daily.

Studieoversigt

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

20

Fase

  • Tidlig fase 1

Kontakter og lokationer

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Studiesteder

    • Hunan
      • Changsha, Hunan, Kina
        • Rekruttering
        • Xiangya Hospital
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 60 år (Voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • Age 18-60
  • Idiopathic pulmonary arterial hypertension
  • Evidence of a personally signed and dated informed consent document indicating that the subject (or a legally acceptable representative) has been informed of all pertinent aspects of the study
  • Had the diagnosis of PAH confirmed by a cardiac catheterization:Mean pulmonary artery pressure (mPAP) ≥ 25 mm Hg (at rest),a pulmonary capillary wedge pressure equal or less than 15mmHg, and a normal or reduced cardiac output
  • Stable PAH therapy for at least 3 months

Exclusion Criteria:

  • Baseline systemic hypotension, defined as MAP less than 50 mmHg
  • Required intravenous inotropes within 30 days prior to study participation
  • Has uncontrolled systemic hypertension as evidenced by sitting systolic blood pressure >160 mm Hg or sitting diastolic blood pressure >100 mm Hg at screening
  • Has a history of portal hypertension or chronic liver disease, including cirrhosis, chronic alcoholism, hepatitis B and/or hepatitis C (with evidence of recent infection and/or active virus replication) defined as moderate to severe hepatic impairment (Child-Pugh Class B-C)
  • Has chronic renal insufficiency as defined by serum creatinine >2.5 mg/dL at screening or requires dialysis support
  • Has a hemoglobin concentration <9 g/dL at Screening
  • History of atrial septostomy
  • Repaired or unrepaired congenital heart disease (CHD)
  • Pericardial constriction
  • Restrictive or congestive cardiomyopathy
  • Left ventricular ejection fraction 40% by multiple gated acquisition scan (MUGA), angiography or echocardiography
  • Symptomatic coronary disease with demonstrable ischemia
  • Other severe acute or chronic medical or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study
  • Has a psychiatric, addictive or other disorder that compromises the ability to give informed consent for participating in this study. This includes subjects with a recent history of abusing alcohol or illicit drugs 30 days prior to study screening Day 1 and for the duration of the study
  • Poorly controlled asthma defined by active wheezing and/or cough with FEV1 < 70% predicted, responsive to inhaled BD (>15% increase in FEV1 with BD)
  • Clinically significant intercurrent illness (including lower respiratory tract infection) or clinically significant surgery within 4 weeks before the administration of study drug
  • History of hypersensitivity or idiosyncratic reaction to drugs from multiple drug classes
  • Receipt of an investigational product or device, or participation in a drug research study within a period of 15 days (or 5 half lives of the drug, whichever is longer) before the first dose of study drug
  • Blood loss or blood donation >550mL within 90 days or plasma donation >500 mL within 14 days before administration of study drug;
  • Patients with a QTc interval > 450 msec
  • Has diabetes mellitus as defined by symptoms of hyperglycemia and serum fasting plasma glucose level≥7.0mmol/l or casual plasma glucose≥11.1mmol/l at screen
  • Has a hyperlipidemia as TC≥6.22 mmol/L, LDL-C ≥4.14 mmol/L or TG ≥2.26 mmol/L
  • History of crohn's disease, ulcerative colitis (UC) and etc. Inflammatory bowel disease (IBD)
  • Patients who are not willing to take contraceptive measures during the study
  • Patients who are taking certain other medication will need to be evaluated for possible exclusion based on the potential for adverse drug interactions

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: micro/low dose saquinavir and ritonavir
To determine if micro dose and low dose SQV+RIT mediates parameters of chronic inflammation in patients with IPAH.
micro and low dose
standard dose
Eksperimentel: standard dose saquinavir and ritonavir
To determine if short-term use of SQV+RIT reduces parameters of chronic inflammation and PA pressure of IPAH based on echocardiographic parameters. Safety issue also evaluated at the same time.
micro and low dose
standard dose

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
HMGB1 level
Tidsramme: 14 days
14 days

Sekundære resultatmål

Resultatmål
Tidsramme
TNF、IL-1Β、IL-6、NT-ProBNP and CRP level
Tidsramme: 14 days
14 days
NYHA/WHO functional class
Tidsramme: 14 days
14 days
Brog respiration class
Tidsramme: 14 days
14 days
PA pressure and total right heart function measured by echocardiography
Tidsramme: 14 days
14 days

Andre resultatmål

Resultatmål
Tidsramme
6 minute walk distance
Tidsramme: 14 days
14 days

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. december 2013

Primær færdiggørelse (Forventet)

1. december 2014

Studieafslutning (Forventet)

1. juli 2015

Datoer for studieregistrering

Først indsendt

23. december 2013

Først indsendt, der opfyldte QC-kriterier

23. december 2013

Først opslået (Skøn)

30. december 2013

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

8. september 2014

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

4. september 2014

Sidst verificeret

1. september 2014

Mere information

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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