- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT04813471
Managing Endothelial Dysfunction in Critically Ill COVID-19 Patients at LAUMCRH
Managing Endothelial Dysfunction in Critically Ill COVID-19 Patients at the Lebanese American University Medical Center- Rizk Hospital
연구 개요
상세 설명
Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the novel pathogen responsible for coronavirus disease 2019 (COVID-19) first discovered in Wuhan, China [1]. Since its emergence in late December 2019, many pathophysiological mechanisms have been proposed with multiple pathways that involve various organ systems [2, 3]. Although considered at its emergence as a respiratory infection with manifestations ranging from lower respiratory tract infection to pneumonia and advancing to acute respiratory disease syndrome (ARDS) in its final stages, recent evidence has highlighted how disseminated the virus can be affecting almost every organ be it the heart, kidneys, or blood vessels . Recent trends in research have focused on elucidating the cardiovascular dysfunction in COVID-19 patients especially following studies showing that cardiovascular risk factors are among the most common presenting comorbidities and that cardiovascular complications of SARS-CoV-2 are among the most lethal [4-11] . Initial research revealed that the virus makes use of the angiotensin-converting enzyme 2 (ACE-2) receptor, a widely expressed receptor found in multiple cells lining the lung, heart, gastrointestinal tract, kidneys and endothelial cells to infiltrate host cells. Another prominent mechanism of infection is immune system dysregulation manifesting as a cytokine storm and inflammatory response over-activation [12, 13].
Attempts at laying out a comprehensive or unifying pathogenesis of a COVID-19 infection have singled out endothelial dysfunction as a core pathway [14]. The endothelium is a monolayer of squamous endothelial cells lining the inner surface of arteries, veins and microvasculature. The endothelium hence plays a major role in homeostasis with interactive roles in blood pressure regulation, anti-coagulation and immune protection. Moreover, it is relevant to note that the most common comorbidities that present with COVID-19 such as hypertension, diabetes, obesity and old age are all underlined by pre-existing endothelial damage or dysfunction. As such, endothelial dysfunction and oxidative stress and their relation to the manifestation and progression of COVID-19 infections has gained significant traction in recent publications [15]. This breakthrough exposes several causes of endothelial dysfunction which include direct lining attack, hypoxia, cytokine storm and suppressed endothelial nitric oxide synthase (eNOS) with concomitant nitric oxide deficiency [15]. Several studies have emphasized the role of Nitric Oxide (NO) signaling as a major regulator of vascular tone with its antioxidant, anti-inflammatory and antithrombotic activity. For example, augmenting the production of NO and its bioavailability by Nicorandil has been proposed as a potential treatment in patients with COVID 19. Nicorandil is a vasodilatory agent composed of N-[2-hydroxyethyl]-Nicotinamide Nitrate) used among patients with acute heart failure emergencies. However, it has never been tested in patients with cardiovascular complications resulting from COVID 19 [16]. Moreover, statins are cardio-protective in nature with recent reports showing that they can be beneficial in COVID-19 [17]. An important mechanism via which Statins may improve endothelial function include increasing the production of NO and subsequent vasodilation effect, along with its established major anti-inflammatory and anti-oxidant properties [17]. Vitamin B complex will be used because of the role it plays in cell functioning, energy metabolism, and proper immune function. In addition of its assistance in proper activation of the immune response, reducing pro-inflammatory cytokine levels, improving respiratory function, maintaining endothelial integrity, preventing hypercoagulability and reducing the length of stay in hospital. [18-19-20] Furthermore, eNOS overexpression leads to an increase in NO formation only when the BH4 synthase GTP-cyclohydrolase 1 (GCH-1) is also up-regulated. So, Folic Acid and L-arginine will be given to supplement our patients with BH4 (Tetrahydrobiopterin) [21]. We hypothesize that its administration along with the other previously mentioned agents would improve endothelial function in patients suffering from COVID 19 via a cumulative increase in the bioavailability of NO, and thus improving patients' outcomes
연구 유형
등록 (예상)
단계
- 3단계
연락처 및 위치
연구 연락처
- 이름: Kamal Matli, MD
- 전화번호: +9613439675
- 이메일: matlikamal@gmail.com
연구 장소
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Beirut, 레바논, 000000
- 모병
- LAUMCRH
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연락하다:
- Georges Ghanem, MD
- 전화번호: 9611200800
- 이메일: georges.ghanem@laumcrh.com
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- Participants must be 18 years of age or older
- Participants must have a PCR confirming COVID 19 status
- Participants must be classified as critical as per the FDA evidence of critical illness, which is defined as respiratory failure requiring at least one of the following: Endotracheal intubation and mechanical ventilation, oxygen delivered by high- flow nasal cannula (heated, humidified, oxygen delivered via reinforced nasal cannula at flow rates > 20 L/min with fraction of delivered oxygen ≥ 0.5), noninvasive positive pressure ventilation, ECMO, or clinical diagnosis of respiratory failure (i.e., clinical need for one of the preceding therapies, but preceding therapies not able to be administered in setting of resource limitation)
- Eligible for or already taking Statin
Exclusion Criteria:
- Patients who are already on statins or Nicorandil.
- Patients labeled as having mild, moderate or severe COVID-19 infection as per the FDA definitions.
- Patients with shock as defined by SBP<90 for more than 30 minutes not responding to IV fluids with evidence of end organ damage.
- Severe hepatic impairment (Child-Pugh class C) or active liver disease are absolute reasons not to be included especially those with unexplained persistent elevations of serum transaminases.
- Pregnancy or breastfeeding
- Hypersensitivity to any of the above-mentioned medications
- On Levodopa.
- Patients on PDE5 inhibitors, Riociguat
- Acute pulmonary edema
- Hypovolemia
- Leber's disease
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
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실험적: Endothelial Dysfunction Protocol
Experimental: Endothelial Dysfunction Protocol Our study will evaluate the impact of the endothelial treatment protocol (atorvastatin(or home statin), nicorandil, l-arginine, folic acid and vitamin B complex) in critically Ill patients already on optimal medical therapy for the treatment of COVID-19 virus. Protocol will be given for a total of 14 days or until discharge from the hospital Patients already on home statin will continue their medication or if the are eligible for statins they will recieve 40 mg tablet to be given PO once daily. Nicorandil Nicorandil 10 mg PO BID for the first 7 days and then if no contraindications escalated to 20 mg PO BID for the remaining 7 days Folic Acid Folic Acid 5 mg po once daily L-Arginine L-Arginine 1 g po TID Vitamin B complex (Becozyme) 1 ampoule IV daily |
Endothelial Protocol
다른 이름들:
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간섭 없음: Standard of care
Standard of Care
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
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Clinical Improvement
기간: will followed up for a total of 28 days
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Clinical improvement was defined as improvement of at least two points from the baseline from date of intervention administration until the date of discharge from hospital or date of death from any cause, whichever came first, assessed up to 1-month status on the six-category ordinal scale.
This scale contains the subsequent categories: (1) death (2) hospital admission requiring invasive mechanical ventilation (3) hospital admission, requiring non-invasive positive pressure ventilation (4) hospital admission, requiring oxygen (5) hospital admission, not requiring oxygen (6) discharge
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will followed up for a total of 28 days
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2차 결과 측정
결과 측정 |
기간 |
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Need for invasive mechanical ventilation
기간: F/up for 28 days
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F/up for 28 days
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Length of ICU stay
기간: F/up for 28 days
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F/up for 28 days
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Length of hospital Stay
기간: F/up for 28 days
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F/up for 28 days
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Length of need of mechanical ventilation
기간: F/up for 28 days
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F/up for 28 days
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All cause mortality
기간: F/up for 28 days
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F/up for 28 days
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Occurrence of side effects
기간: F/up for 28 days
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F/up for 28 days
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공동 작업자 및 조사자
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
기본 완료 (예상)
연구 완료 (예상)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- LAUMCRH
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
미국에서 제조되어 미국에서 수출되는 제품
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .
코로나19에 대한 임상 시험
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Texas Woman's UniversityNational Institutes of Health (NIH)아직 모집하지 않음COVID19 테스트
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Cairo UniversityKasr El Aini Hospital알려지지 않은
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Assistance Publique - Hôpitaux de Paris알려지지 않은
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Brugmann University Hospital모병
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Istituti Clinici Scientifici Maugeri SpAIstituto Auxologico Italiano; Azienda Ospedaliera Bolognini di Seriate Bergamo; Azienda Socio... 그리고 다른 협력자들완전한
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Abderrahmane Mami HospitalDacima Consulting; Eshmoun Clinical Research Center빼는
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Aarhus University HospitalUniversity of Aarhus; Pharma Nord완전한
Endothelial Protocol에 대한 임상 시험
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Hadassah Medical OrganizationHebrew University of Jerusalem모병
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TC Erciyes University알려지지 않은
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Roswell Park Cancer InstituteGlaxoSmithKline모집하지 않고 적극적으로
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National Cancer Institute (NCI)완전한투명 세포 신장 세포 암종 | 재발성 신장 세포 암종 | 4기 신세포암 | 1형 유두상 신장 세포 암종 | 2형 유두상 신장 세포 암종미국, 대만, 호주
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National Cancer Institute (NCI)완전한성인 역형성 성상세포종 | 성인 역형성 핍지교종 | 성인 거대 세포 교모세포종 | 성인 교모세포종 | 성인 교육종 | 성인 혼합 신경아교종 | 재발성 성인 뇌종양미국
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Northwestern UniversityNational Cancer Institute (NCI); NovoCure Ltd.모병비정형 수막종 | 등급 III 수막종 | 재발성 수막종 | 역형성(악성) 수막종 | 등급 II 수막종 | 천막상 수막종미국
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National Cancer Institute (NCI)완전한