Clinical Trials Logo

Clinical Trial Summary

The goal of this clinical trial is to learn about the safety and effectiveness of LAM-001 in patients who have developed bronchiolitis obliterans syndrome (BOS), a form of chronic rejection, after lung transplantation. The main questions it aims to answer are: - Is LAM-001 safe in these patients? - Is LAM-001 effective in slowing BOS progression? Participants will: - Be randomly assigned to inhale either LAM-001 or placebo (a look-alike substance that contains no active drug) daily for 48 weeks - Attend 10 study visits (mixture of in-person and telehealth) over the 48 week period - Undergo pulmonary function testing, bronchoscopy, lab testing, and physical examination - Submit weekly home spirometry monitoring Researchers will compare participants assigned to LAM-001 versus placebo to see if LAM-001 is safely tolerated and to assess the effectiveness of LAM-001 on slowing BOS progression.


Clinical Trial Description

Chronic rejection, commonly denoted as bronchiolitis obliterans (BO), obliterative bronchiolitis (OB), or bronchiolitis obliterans syndrome (BOS), is the leading cause of death beyond the first year after lung transplantation. Whereas the development of BOS is rare within the first year after lung transplantation, annual increments of approximately 10% are recorded in subsequent years, resulting in a cumulative incidence range of 40-50% within the first five years and 70-80% within 10 years of transplantation. No current effective treatment for BOS exists. BOS represents the leading cause of morbidity and mortality after lung transplantation, limiting 5-year survival to well below other solid organ transplants. BOS is characterized by an inexorable lung function decline despite currently available immunomodulatory treatments. Sirolimus has been shown to block T-cell proliferative effects induced by cytokines, alloantigens, and mitogens in a dose-dependent manner(4, 5). Oral sirolimus has been shown in small studies to have a beneficial impact on rapidly progressive BOS; however, administration in this patient population has been challenged by a high degree of intolerance with the side effects. The development of LAM-001 for lung transplant related BOS, conceptually a T-cell driven process against transplanted alloantigen, is based on the principal hypothesis that administration of a sirolimus dose to the rejecting lung allograft(s) by inhalation will result in improved efficacy by depositing higher drug concentrations directly within the allograft by inhalation than would be achieved by oral administration due to systemic toxicities associated with oral sirolimus. Because of known reduced systemic bioavailability of LAM-001 compared to oral sirolimus dosing, amelioration of the substantial adverse event profile compared to oral drug is expected. LAM-001 is also expected to reduce serious complication risks by obviating requirements for maintenance and augmented immune drugs used to treat BOS. The primary objective is to assess the clinical efficacy of LAM-001 in lung transplant recipients with bronchiolitis obliterans syndrome as measured by progression free survival and change in forced expiratory volume in one second (FEV1) over a 48-week period. Another primary objective is to assess the safety and tolerability of LAM-001 in lung transplant recipients with bronchiolitis obliterans syndrome. Secondary objectives are: - To determine the impact of LAM-001 on genetic markers of bronchiolitis obliterans syndrome and activation of the mammalian target of rapamycin (mTOR) pathway by measuring chronic lung allograft dysfunction signature gene profiling and mTOR pathway activation in bronchoalveolar lavage fluid - To determine whether donor-derived cell-free DNA (%ddcfDNA) will predict ongoing injury (versus cessation of BOS progression) by measuring %ddcfDNA in randomized subjects. % ddcfDNA will be correlated with clinical outcome measures of FEV1 change, death, and re-transplantation for both randomized groups. - To determine the levels of sirolimus in the blood and bronchoalveolar lavage (BAL) fluid, the BAL as a surrogate for levels in the lung. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT06018766
Study type Interventional
Source University of California, San Francisco
Contact Steven Hays, MD
Phone 415-336-4141
Email steven.hays@ucsf.edu
Status Recruiting
Phase Phase 2
Start date August 17, 2023
Completion date December 2025

See also
  Status Clinical Trial Phase
Completed NCT02581111 - Naloxone for Optimizing Hypoxemia Of Lung Donors Phase 2/Phase 3
Recruiting NCT02177916 - Patient Education Study to Determine Knowledge Acquisition in Patients Preparing to Undergo Lung Transplantation N/A
Not yet recruiting NCT01394835 - Safety and Efficacy of Inhaled Alpha-1 Antitrypsin in Preventing Bronchiolitis Obliterable Syndrome in Lung Transplant Recipients Phase 2
Not yet recruiting NCT01162148 - Pulmonary Rehabilitation and Inspiratory Muscle Training (IMT) for Patients Following Lung Transplantation N/A
Completed NCT01204970 - Confocal Laser Micro-endoscopy in Chronic Obstructive Pulmonary Disease (COPD) and Lung Transplant Recipients N/A
Active, not recruiting NCT00980967 - Predictive Factors for Chronic Rejection in Lung Transplant Recipients: COLT Study N/A
Completed NCT00531921 - Effects of Donor and Recipient Genetic Expression on Heart, Lung, Liver, or Kidney Transplant Survival N/A
Recruiting NCT00163696 - Multi Breath Nitrogen Washout (MBNW) as a Measure of Small Airway Function in Patients With Respiratory Disease N/A
Completed NCT00177684 - Pharmacokinetic Profiles of Inhaled Lipid Complex Amphotericin B (Abelcet ®) Phase 3
Completed NCT00163891 - Comparison of Two Chest Physiotherapy Protocols in Lung Transplant Recipients N/A
Completed NCT03668483 - Relation Between Muscle Strength With Exercise Capacity and Dyspnea in LTx N/A
Not yet recruiting NCT02855372 - Impact of the Age Difference Between the Donor and Recipient on the Morbidity and Mortality After Lung Transplantation. Study on a National Multicenter Cohort (COLT) N/A
Completed NCT01212406 - Vitamin D in Bronchiolitis Obliterans Syndrome Phase 4
Completed NCT01211509 - Montelukast in Bronchiolitis Obliterans Syndrome Phase 4
Not yet recruiting NCT00808600 - Empowerment of Lung and Heart-lung Transplant Patients N/A
Completed NCT00553397 - Live Lung Donor Retrospective Study N/A
Completed NCT00402805 - Improving the Humoral Response to Influenza Vaccine in Lung Transplant Recipients by an Intradermal Strategy Phase 4
Terminated NCT00235651 - Abelcet Radiotagging Protocol: Inhaled Lipid Complex Abelcet® in Lung Transplant Recipients Phase 3
Completed NCT00701922 - Surveillance Study of Viral Infections Following Lung Transplantation N/A
Active, not recruiting NCT02936505 - Clinical Study Evaluating Two Treatment Protocols for Immunosuppressive Drugs. Looking at 3-year Incidence of CLAD. N/A