AATD Clinical Trial
— GRADS Alpha-1Official title:
Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS) - Alpha-1 Protocol
This project is designed to examine the interaction between the microflora in the lower
airway and the concentration of a serum protein called alpha-1 antitrypsin. The hypothesis
is that alpha-1 antitrypsin impacts the diversity and content of the lower airway
microflora, resulting in a less inflammatory airway.
The Specific Aims are:
1. To compare the lower respiratory tract microbiome and virome population diversity and
content in age and GOLD stage matched PiZZ individuals not receiving augmentation
therapy, PiZZ individuals on augmentation therapy, PiMZ individuals not receiving
augmentation therapy, and PiMM individuals with chronic obstructive pulmonary disease
(COPD).
2. Determine correlations between bronchoalveolar lavage (BAL) and peripheral blood gene
expression patterns and patterns in lung microbial and viral populations across all
cohorts.
3. Correlate the presence or absence of computed tomography (CT) bronchiectasis and
bronchiolectasis with patterns in the microbiome population diversity and content.
4. To identify and define novel molecular phenotypes of Alpha-1 Antitrypsin Deficiency
(AATD) based on computational integration of clinical, transcriptomic, and microbiome
data.
Status | Completed |
Enrollment | 140 |
Est. completion date | September 2015 |
Est. primary completion date | June 2015 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 40 Years to 80 Years |
Eligibility |
Inclusion Criteria: 1. Age between age 40 and 80 (inclusive) at Baseline Visit 2. Alpha-1 Antitrypsin genotype PiZZ or PiMZ 3. Able to tolerate and willing to undergo study procedures 4. Signed informed consent Exclusion Criteria: 1. History of comorbid condition severe enough to significantly increase risks based on investigator discretion 2. Diagnosis of unstable cardiovascular disease including myocardial infarction in the past 6 weeks, uncontrolled congestive heart failure, or uncontrolled arrhythmia 3. Partial pressure of oxygen in the blood (PaO2) on room air at rest <50 mmHg or saturation level of oxygen in hemoglobin(SaO2) on room air at rest <85% 4. Post bronchodilator Forced Expiratory Volume in One Second (FEV1)<30% predicted 5. Use of anticoagulation (patients on warfarin or clopidogrel will be excluded; patients on aspirin alone can be studied even with concurrent use) 6. Dementia or other cognitive dysfunction which in the opinion of the investigator would prevent the participant from consenting to the study or completing study procedures 7. Active pulmonary infection with tuberculosis 8. History of pulmonary embolism in the past 2 years 9. Non-COPD obstructive disease (various bronchiolitides, sarcoid, LAM, histiocytosis X) or parenchymal lung disease, pulmonary vascular disease, pleural disease, severe kyphoscoliosis, neuromuscular weakness, or other cardiovascular and pulmonary disease, that, in the opinion of the investigator, limit the interpretability of the pulmonary function measures 10. Prior significant difficulties with pulmonary function testing 11. Hypersensitivity to or intolerance of albuterol sulfate or ipratropium bromide or propellants or excipients of the inhalers 12. Hypersensitivity to or intolerance of all drugs required for sedation during conscious sedation bronchoscopy. 13. History of Lung volume reduction surgery, lung resection or bronchoscopic lung volume reduction in any form 14. History of lung or other organ transplant 15. History of large thoracic metal implants (e.g., Automatic Implantable Cardioverter Defibrillators (AICD) and/or pacemaker) that in the opinion of the investigator limit the interpretability of CT scans 16. Currently taking >=10mg a day/20mg every other day of prednisone or equivalent systemic corticosteroid 17. Currently taking any immunosuppressive agent excepting systemic corticosteroids 18. History of lung cancer or any cancer that spread to multiple locations in the body 19. Current illicit substance abuse, excluding marijuana 20. Known HIV/AIDS infection 21. History of or current exposure to chemotherapy or radiation treatments that, in the opinion of the investigator, limits the interpretability of the pulmonary function measures. 22. Has a BMI > 40 kg/m2 at baseline exam 23. Current or planned pregnancy within the study course. 24. Currently institutionalized (e.g., prisons, long-term care facilities) 25. Have a genotype of PiMZ and ever received intravenous or inhaled alpha-1 augmentation therapy (Alpha-1 Proteinase Inhibitor, A1PI) Conditional Exclusions 1. Participants who present with an upper respiratory infection or pulmonary exacerbation, either solely participant-identified or that has been clinically treated, in the last six weeks can be rescreened for the study once the six-week window has passed. 2. Participants who present with current use of acute antibiotics or steroids can be rescreened for the study =30 days after discontinuing acute antibiotics/steroids. This does not apply to participants who are on chronic prednisone therapy of <10 mg per day or <20 mg every other day. 3. Participants who present with a myocardial infarction or eye, chest, or abdominal surgery within six weeks can be rescreened after the six week window has passed. Study coordinators should consult with the site principal investigator prior to rescreening these participants. 4. Female participants who present <3 months after giving birth will be asked to reschedule their visit until three months have passed since the birth. 5. Individuals who are PiZZ receiving alpha-1 augmentation therapy (Alpha-1 Proteinase Inhibitor, A1PI) must be off augmentation therapy for >6 months to qualify for stratified enrollment in the PiZZ group not receiving augmentation therapy. |
Observational Model: Case-Only, Time Perspective: Cross-Sectional
Country | Name | City | State |
---|---|---|---|
United States | Johns Hopkins University | Baltimore | Maryland |
United States | Medical University of South Carolina | Charleston | South Carolina |
United States | National Jewish Health | Denver | Colorado |
United States | Vanderbilt University | Nashville | Tennessee |
United States | Yale University | New Haven | Connecticut |
United States | University of Pennsylvania | Philadelphia | Pennsylvania |
United States | University of Pittsburgh | Pittsburgh | Pennsylvania |
United States | University of California - San Francisco | San Francisco | California |
United States | Arizona Health Sciences Center | Tucson | Arizona |
Lead Sponsor | Collaborator |
---|---|
University of Pittsburgh | National Heart, Lung, and Blood Institute (NHLBI) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number and diversity of lower respiratory tract (LRT) microbes | Presenting characteristics (e.g., sex) will be compared among those with and without augmentation therapy using the appropriate test for continuous (e.g., t-test, Wilcoxon) or discrete (e.g., chi-square) data. Paired t-test will be used to compare the diversity, as measured by the number of microbes, and McNemar's test will be used to compare the lower respiratory tract (LRT) microbiome and virome, assessed by the presence or absence of specific organisms (e.g., viral, gram negative bacteria). Conditional logistic regression will be used to determine if there is an independent association with the use of augmentation therapy after controlling for presenting characteristics that differed between the two populations. The primary analysis will determine if the PiZZ individuals on augmentation therapy have a difference in the number and diversity of LRT microbes identified than matched PiZZ individuals who are not on augmentation therapy. |
Single time point split into 2 visits over 1 month | No |
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