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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03887169
Other study ID # DC20180338
Secondary ID 2018-004140-28
Status Completed
Phase Phase 1/Phase 2
First received
Last updated
Start date September 16, 2019
Est. completion date June 1, 2020

Study information

Verified date November 2020
Source Assistance Publique - Hôpitaux de Paris
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of this study is to determine the safety and tolerance of an oral administration of methionine in the treatment of pulmonary alveolar proteinosis due to the double mutation Ala393Thr / Ser567Leu in the MARS gene. This disease is very severe and especially leads to chronic respiratory insufficiency. There is no curative treatment for this disease. The MARS gene encodes the methionine tRNA synthetase (MetRS). Mutations in this gene leads to a defect in MetRS function. In cultured mutated yeast, addition of methionine in culture medium restores MetRS function. Therefore, the investigators hypothesized that treatment of patients with methionine could have beneficial effects on the disease.


Description:

Pulmonary alveolar proteinosis (PAP) is a rare respiratory disorder. Recently, a genetic cause has been identified for a specific form of PAP predominant on La Reunion Island. This form is characterized by a multisystem phenotype including PAP, failure to thrive, hepatic involvement and chronic inflammation. This is a severe disease without any specific treatment and a high rate of mortality related to end-stage respiratory insufficiency. Two recurrent mutations were isolated in the MARS gene that encodes the methionine tRNA synthetase (MetRS). This enzyme catalyzes the ligation of methionine to tRNA and is critical for protein biosynthesis. Functional studies on mutated yeast show an altered growth and protein synthesis as compared to control yeast. Addition of methionine in culture medium corrects these defects. Complementary experiments on human purified MetRS show altered enzymatic catalytic parameters in mutated forms. Increasing blood concentration of methionine in patients could correct these parameters and potentially improve patients' phenotype in this severe disorder where no curative treatment exists. The main objective of this protocol is to determine the tolerance of a prolonged daily supplementation of methionine in patients presenting a MARS related PAP. The secondary objectives are to determine the efficiency of such treatment on respiratory, hepatic, inflammatory and growth status. To meet the objectives of the study, enrolled patients will receive daily oral or enteral methionine administration at increasing doses, under surveillance of plasma levels of methionine and homocysteine, and possible clinical side effects, until determining the "ideal" dose for each patient. Once daily dosage determined for each patient, this dosage will be continued for a total of 2 months with daily clinical monitoring of tolerance and bi-monthly plasma levels surveillance of methionine and homocysteine.


Recruitment information / eligibility

Status Completed
Enrollment 3
Est. completion date June 1, 2020
Est. primary completion date June 1, 2020
Accepts healthy volunteers No
Gender All
Age group N/A to 18 Years
Eligibility Inclusion Criteria: - Minor Patient with alveolar proteinosis by double mutation Ala393Thr and SER567LEU of the MARS gene, genetically proven. - Patient in need of prolonged hospitalization in Necker for treatment of bronchial-alveolar washes in the context of care. - Patient for which methionine can be administered orally or by enteral probe (Nasogastric or gastrostomy probe) - Signed Informed consent form by parents / legal guardian Exclusion Criteria: - Patient with alveolar proteinosis by other mutations of the MARS gene - Patient with alveolar proteinosis secondary to another etiology or without identified cause - Refusal to participate in the study - High blood pressure requiring drug treatment - Heart failure - Known hypersensitivity to one of the substances used or potentially used in the study: methionine, vitamins B6, B12, B9 and C - Pre-Hypermethioninemia (Methioninemia > + 2 DS of normal for age) whatever the cause

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Methionine
Administration of methionine from D1 to D60
Vitamin B12, B9, B6, C supplementation
In case of hyperhomocysteinemia
Diagnostic Test:
Methionine/homocysteine Dosage
Plasma concentration control of methionine and homocysteine from D0 to D75
Thoracic CT scan
At D60
Abdominal and liver ultrasound.
At D60
Brain MRI
In case of abnormal neurological examination

Locations

Country Name City State
France Hôpital Necker-Enfants Malades Paris Ile De France

Sponsors (1)

Lead Sponsor Collaborator
Assistance Publique - Hôpitaux de Paris

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Tolerance Assessment No adverse event from day 0 to day 75. From day 0 to day 75
Secondary Respiratory rate (cycles /min) number of cycles per minute At day 0, day 15, day 30, day 45, day 60, day 75
Secondary Oxygen need (L/min) Flow in L/min At day 0, day 15, day 30, day 45, day 60, day 75
Secondary Respiratory signs of struggle Presence or absence of signs At day 0, day 15, day 30, day 45, day 60, day 75
Secondary Lung lesions Lesions appearance on thoracic CT scan, scored form 0 to 4 At Day 60
Secondary Lipo-proteinaceous material Fluid examination At each bronchial-alveolar washes during the 2,5 months
Secondary Weight To evaluate Nutritional status At Day 15, Day 30, Day 45, Day 60, Day 75
Secondary mid upper arm circumference / head circumference rapport To evaluate Nutritional status At Day 15, Day 30, Day 45, Day 60, Day 75
Secondary Hepatomegaly liver damage evaluate by physician during clinical examination At Day 0, Day 15, Day 30, Day 45, Day 60, Day 75
Secondary cholestasis and hepatic cytolysis liver damage evaluate by biological parameters : ASAT, ALAT, GGT, PAL, Bilirubin At Day 0, Day 15, Day 30, Day 60, Day 75
Secondary Hepatomegaly liver damage evaluate by echography At Day 0 and Day 60
Secondary C reactive protein Biological parameters to evaluate Systemic inflammation At Day 0, Day 30, Day 60
Secondary sedimentation rate Biological parameters to evaluate Systemic inflammation At Day 0, Day 30, Day 60
Secondary Immunoglobulin G level Biological parameters to evaluate Systemic inflammation At Day 0, Day 30, Day 60
Secondary Haemoglobin level Biological parameters to evaluate inflammatory anaemia At Day 0, Day 30, Day 60
Secondary Plasma concentration of methionine Variation of the concentration for each patient From Day 0 to Day 75
Secondary Plasma concentration of homocysteine Variation of the concentration for each patient From Day 0 to Day 75
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