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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT03783091
Other study ID # 32950
Secondary ID
Status Recruiting
Phase Phase 2
First received
Last updated
Start date August 5, 2019
Est. completion date December 2025

Study information

Verified date November 2021
Source Medical College of Wisconsin
Contact Jayshil J Patel, MD
Phone 414-955-7040
Email jpatel2@mcw.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study will randomize 20 septic shock patients to receive either a single 5 gram dose of IV vitamin B12 (Cyanokit® Meridian Medical Technologies, Columbia, MD) versus placebo in addition to standard of care to test the feasibility of completing clinical and laboratory protocols.


Description:

Following informed consent from patient's legally authorized representative, patients will be randomized to hydroxocobalamin or saline. Patients will have blood samples drawn up to 3 hours pre-dose and 3 hours post-dose to measure for hydrogen sulfide levels. Patients will also be followed for 3 hours after study drug infusion to monitor and record vasopressor dependence in norepinephrine-equivalent dose. Patients will then be followed through their medical record for 28 days to determine persistent organ dysfunction syndrome (PODS).


Recruitment information / eligibility

Status Recruiting
Enrollment 20
Est. completion date December 2025
Est. primary completion date December 2023
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Adult patients at least 18 years of age - Admitted to the Medical Intensive Care Unit (MICU) service at Froedtert Hospital - Diagnosis of septic shock, as defined by sepsis-3 criteria Exclusion Criteria: - History of calcium oxaluria

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Hydroxocobalamin
Single IV administration of Vitamin B12
Placebo
Single IV administration of saline

Locations

Country Name City State
United States Medical College of Wisconsin Milwaukee Wisconsin

Sponsors (1)

Lead Sponsor Collaborator
Medical College of Wisconsin

Country where clinical trial is conducted

United States, 

References & Publications (32)

Abraham E, Reinhart K, Svoboda P, Seibert A, Olthoff D, Dal Nogare A, Postier R, Hempelmann G, Butler T, Martin E, Zwingelstein C, Percell S, Shu V, Leighton A, Creasey AA. Assessment of the safety of recombinant tissue factor pathway inhibitor in patients with severe sepsis: a multicenter, randomized, placebo-controlled, single-blind, dose escalation study. Crit Care Med. 2001 Nov;29(11):2081-9. — View Citation

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Boettcher BT, Woehlck HJ, Reck SE, Hong JC, Zimmerman MA, Kim J, Zundel MT, Freed JK, Pagel PS. Treatment of Vasoplegic Syndrome With Intravenous Hydroxocobalamin During Liver Transplantation. J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1381-1384. doi: 10.1053/j.jvca.2016.10.011. Epub 2016 Oct 14. — View Citation

Brenner M, Benavides S, Mahon SB, Lee J, Yoon D, Mukai D, Viseroi M, Chan A, Jiang J, Narula N, Azer SM, Alexander C, Boss GR. The vitamin B12 analog cobinamide is an effective hydrogen sulfide antidote in a lethal rabbit model. Clin Toxicol (Phila). 2014 Jun;52(5):490-7. doi: 10.3109/15563650.2014.904045. Epub 2014 Apr 9. Erratum in: Clin Toxicol (Phila). 2015 Jan;53(1):77. — View Citation

Burnes ML, Boettcher BT, Woehlck HJ, Zundel MT, Iqbal Z, Pagel PS. Hydroxocobalamin as a Rescue Treatment for Refractory Vasoplegic Syndrome After Prolonged Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. 2017 Jun;31(3):1012-1014. doi: 10.1053/j.jvca.2016.08.019. Epub 2016 Aug 18. — View Citation

Eckstein M. Enhancing public health preparedness for a terrorist attack involving cyanide. J Emerg Med. 2008 Jul;35(1):59-65. Epub 2007 Aug 29. Review. — View Citation

Goslar T, Marš T, Podbregar M. Total plasma sulfide as a marker of shock severity in nonsurgical adult patients. Shock. 2011 Oct;36(4):350-5. doi: 10.1097/SHK.0b013e31822bcfd0. — View Citation

Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, Busse LW, Altaweel L, Albertson TE, Mackey C, McCurdy MT, Boldt DW, Chock S, Young PJ, Krell K, Wunderink RG, Ostermann M, Murugan R, Gong MN, Panwar R, Hästbacka J, Favory R, Venkatesh B, Thompson BT, Bellomo R, Jensen J, Kroll S, Chawla LS, Tidmarsh GF, Deane AM; ATHOS-3 Investigators. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med. 2017 Aug 3;377(5):419-430. doi: 10.1056/NEJMoa1704154. Epub 2017 May 21. — View Citation

Košir M, Podbregar M. Advances in the Diagnosis of Sepsis: Hydrogen Sulfide as a Prognostic Marker of Septic Shock Severity. EJIFCC. 2017 May 1;28(2):134-141. eCollection 2017 May. — View Citation

Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and pathophysiology of vasoplegic shock. Crit Care. 2018 Jul 6;22(1):174. doi: 10.1186/s13054-018-2102-1. Review. — View Citation

Li L, Bhatia M, Zhu YZ, Zhu YC, Ramnath RD, Wang ZJ, Anuar FB, Whiteman M, Salto-Tellez M, Moore PK. Hydrogen sulfide is a novel mediator of lipopolysaccharide-induced inflammation in the mouse. FASEB J. 2005 Jul;19(9):1196-8. Epub 2005 Apr 29. — View Citation

López A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, Silverman MS, Takala J, Donaldson J, Arneson C, Grove G, Grossman S, Grover R. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med. 2004 Jan;32(1):21-30. — View Citation

Lorente JA, Landín L, De Pablo R, Renes E, Liste D. L-arginine pathway in the sepsis syndrome. Crit Care Med. 1993 Sep;21(9):1287-95. — View Citation

Módis K, Bos EM, Calzia E, van Goor H, Coletta C, Papapetropoulos A, Hellmich MR, Radermacher P, Bouillaud F, Szabo C. Regulation of mitochondrial bioenergetic function by hydrogen sulfide. Part II. Pathophysiological and therapeutic aspects. Br J Pharmacol. 2014 Apr;171(8):2123-46. doi: 10.1111/bph.12368. Review. — View Citation

Ng PC, Hendry-Hofer TB, Garrett N, Brenner M, Mahon SB, Maddry JK, Haouzi P, Boss GR, Gibbons TF, Araña AA, Bebarta VS. Intramuscular cobinamide versus saline for treatment of severe hydrogen sulfide toxicity in swine. Clin Toxicol (Phila). 2019 Mar;57(3):189-196. doi: 10.1080/15563650.2018.1504955. Epub 2018 Nov 15. — View Citation

Ozaki KS, Kimura S, Murase N. Use of carbon monoxide in minimizing ischemia/reperfusion injury in transplantation. Transplant Rev (Orlando). 2012 Apr;26(2):125-39. doi: 10.1016/j.trre.2011.01.004. Epub 2011 Oct 13. Review. — View Citation

Puskarich MA, Kline JA, Watts JA, Shirey K, Hosler J, Jones AE. Early alterations in platelet mitochondrial function are associated with survival and organ failure in patients with septic shock. J Crit Care. 2016 Feb;31(1):63-7. doi: 10.1016/j.jcrc.2015.10.005. Epub 2015 Oct 26. — View Citation

Shah PR, Reynolds PS, Pal N, Tang D, McCarthy H, Spiess BD. Hydroxocobalamin for the treatment of cardiac surgery-associated vasoplegia: a case series. Can J Anaesth. 2018 May;65(5):560-568. doi: 10.1007/s12630-017-1029-3. Epub 2017 Dec 5. — View Citation

Shatalin K, Shatalina E, Mironov A, Nudler E. H2S: a universal defense against antibiotics in bacteria. Science. 2011 Nov 18;334(6058):986-90. doi: 10.1126/science.1209855. — View Citation

Shen X, Peter EA, Bir S, Wang R, Kevil CG. Analytical measurement of discrete hydrogen sulfide pools in biological specimens. Free Radic Biol Med. 2012 Jun 1-15;52(11-12):2276-83. doi: 10.1016/j.freeradbiomed.2012.04.007. Epub 2012 Apr 19. — View Citation

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287. — View Citation

Szakmany T, Hauser B, Radermacher P. N-acetylcysteine for sepsis and systemic inflammatory response in adults. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD006616. doi: 10.1002/14651858.CD006616.pub2. Review. — View Citation

Takala J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, Vundelinckx G, Hinds CJ. Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med. 1999 Sep 9;341(11):785-92. — View Citation

Truong DH, Mihajlovic A, Gunness P, Hindmarsh W, O'Brien PJ. Prevention of hydrogen sulfide (H2S)-induced mouse lethality and cytotoxicity by hydroxocobalamin (vitamin B(12a)). Toxicology. 2007 Dec 5;242(1-3):16-22. Epub 2007 Sep 15. — View Citation

Weinberg JB, Chen Y, Jiang N, Beasley BE, Salerno JC, Ghosh DK. Inhibition of nitric oxide synthase by cobalamins and cobinamides. Free Radic Biol Med. 2009 Jun 15;46(12):1626-32. doi: 10.1016/j.freeradbiomed.2009.03.017. Epub 2009 Mar 27. Erratum in: Free Radic Biol Med. 2011 Oct 1;51(7):1471. — View Citation

Woehlck HJ, Boettcher BT, Lauer KK, Cronin DC, Hong JC, Zimmerman MA, Kim J, Selim M. Hydroxocobalamin for Vasoplegic Syndrome in Liver Transplantation: Restoration of Blood Pressure Without Vasospasm. A A Case Rep. 2016 Dec 15;7(12):247-250. — View Citation

Zhang H, Moochhala SM, Bhatia M. Endogenous hydrogen sulfide regulates inflammatory response by activating the ERK pathway in polymicrobial sepsis. J Immunol. 2008 Sep 15;181(6):4320-31. — View Citation

Zhang H, Zhi L, Moochhala S, Moore PK, Bhatia M. Hydrogen sulfide acts as an inflammatory mediator in cecal ligation and puncture-induced sepsis in mice by upregulating the production of cytokines and chemokines via NF-kappaB. Am J Physiol Lung Cell Mol Physiol. 2007 Apr;292(4):L960-71. Epub 2007 Jan 5. — View Citation

Zundel MT, Feih JT, Rinka JRG, Boettcher BT, Freed JK, Kaiser M, Ghadiali HY, Tawil JN, Woehlck HJ, Pagel PS. Hydroxocobalamin With or Without Methylene Blue May Improve Fluid Balance in Critically Ill Patients With Vasoplegic Syndrome After Cardiac Surgery: A Report of Two Cases. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):452-457. doi: 10.1053/j.jvca.2017.04.002. Epub 2017 Apr 5. — View Citation

* Note: There are 32 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Feasibility of completing clinical and laboratory protocols Feasibility of completing clinical and laboratory protocols 28 days
Secondary Hydrogen Sulfide Concentration Difference between pre- and post-dose hydrogen sulfide levels 3 hours
Secondary Persistent Organ Dysfunction Syndrome (PODS) Prevalence of Persistent organ dysfunction syndrome (PODS) 28 days
Secondary Change in vasopressor dose Vasopressor dose in mcg/kg/min (norepinephrine equivelents) 3, 24, and 48 hours
Secondary Mortality Intensive care unit and hospital mortality 28 days
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