Hyperoxia Induced Pulmonary Inflammation and Organ Injury: a Human in Vivo Model

Study Overview
=================
Brief Summary
-----------------
Oxygen is the most commonly administered therapy in critical illness. Accumulating evidence suggests that patients often achieve supra-physiological levels of oxygenation in the critical care environment. Furthermore, hyperoxia related complications following cardiac arrest, myocardial infarction and stroke have also been reported. The underlying mechanisms of hyperoxia mediated injury remain poorly understood and there are currently no human in vivo studies exploring the relationship between hyperoxia and direct pulmonary injury and inflammation as well as distant organ injury. The current trial is a mechanistic study designed to evaluate the effects of prolonged administration of high-flow oxygen (hyperoxia) on pulmonary and systemic inflammation. The study is a randomised, double-blind, placebo-controlled trial of high-flow nasal oxygen therapy versus matching placebo (synthetic medical air). We will also incorporate a model of acute lung injury induced by inhaled endotoxin (LPS) in healthy human volunteers. Healthy volunteers will undergo bronchoalveolar lavage (BAL) at 6 hours post-intervention to enable measurement of pulmonary and systemic markers of inflammation, oxidative stress and cellular injury.

Official Title
-----------------
Effects of Hyperoxia Induced Pulmonary Inflammation and Organ Injury in a Human in Vivo Model

Conditions
-----------------
Oxygen Toxicity, Pulmonary Injury, Acute Lung Injury

Intervention / Treatment
-----------------
* Drug: Liquid oxygen
* Drug: medical air


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: 1. Healthy non-smoking subjects less than 45 years of age and BMI < 29 kg/m² Exclusion Criteria: Age < 18 years On concomitant medications including over the counter medications excluding oral contraception and paracetamol Previous adverse reactions to LPS, lignocaine or sedative agents Pregnant or Breast-Feeding Participation in a clinical trial of an investigational medicinal product within 30 days Consent declined History of asthma or other respiratory conditions Smoking/ e cigarette use Marijuana use or other inhaled products with or without nicotine in the last 3 months Alcohol abuse, as defined by the Alcohol Use Disorders Identification Test (AUDIT) Subjects with history of prior conventional cigarette (> 100 cigarettes lifetime and smoking within 6 months) or electronic cigarette use.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Liquid medical oxygen<br>Liquid medical oxygen will be administered using high-flow nasal cannula delivery system. | Drug: Liquid oxygen<br>* Liquid medical oxygen will be administered for 6 hours using high-flow nasal cannula delivery system with an Fi02 of 100% and flow rate of 60 litres per minute.<br>* Other names: Liquid medical oxygen;|
| Placebo Comparator: Synthetic medical air<br>Synthetic medical air will be administered using high-flow nasal cannula delivery system. | Drug: medical air<br>* Synthetic medical air will be administered for 6 hours using high-flow nasal cannula delivery system with a flow rate of 60 litres per minute.<br>* Other names: Synthetic medical air;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bronchoalveolar lavage Interleukin-8 concentration | To determine the effects of hyperoxia on alveolar inflammatory response | 6 hours post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Bronchoalveolar lavage cytokines including but not limited to tumour necrosis factor alpha, IL-1 beta and IL-6 | To determine the effects of hyperoxia on alveolar inflammatory response biomarkers | 6 hours post-intervention | 
| Bronchoalveolar lavage proteases and anti-proteases including but not limited to Matrix Metalloproteinases (MMP-2, MMP-8, MMP-9 and MMP-11), Tissue Inhibitors of Metalloproteinase (TIMPs 1-2) and neutrophil elastase | To determine the effects of hyperoxia on alveolar protease and antiprotease activity | 6 hours post-intervention | 
| Bronchoalveolar lavage white cell differential counts (total cell count, neutrophils, macrophages and lymphocytes) | To determine the effects of hyperoxia on alveolar cell populations | 6 hours post-intervention | 
| Plasma cytokines including but not limited to IL-8, tumour necrosis factor alpha, IL-1 beta and IL-6 | To determine the effects of hyperoxia on plasma inflammatory response biomarkers | 6 and 24 hours post-intervention | 
| Bronchoalveolar lavage soluble programmed cell death receptor (SP-D) | To determine the effects of hyperoxia on alveolar epithelial and endothelial function | 6 hours post-intervention | 
| Bronchoalveolar lavage total protein | To determine the effects of hyperoxia on alveolar epithelial and endothelial function | 6 hours post-intervention | 
| Bronchoalveolar lavage receptor for advanced glycation end-products (RAGE) | To determine the effects of hyperoxia on alveolar epithelial and endothelial function | 6 hours post-intervention | 
| Bronchoalveolar lavage 4-hydroxy-2-nonenal (4-HNE) | To determine the effects of hyperoxia on oxidative stress | 6 hours post-intervention | 
| Bronchoalveolar lavage oxidised low density lipoprotein (oxLDL) | To determine the effects of hyperoxia on oxidative stress | 6 hours post-intervention | 
| Plasma advanced glycation end products (AGE) | To determine the effects of hyperoxia on oxidative stress | 6 and 24 hours post-intervention | 
| Plasma oxidised low density lipoprotein (oxLDL) | To determine the effects of hyperoxia on oxidative stress | 6 and 24 hours post-intervention | 
| Plasma 4-hydroxy-2-nonenal (4-HNE) | To determine the effects of hyperoxia on oxidative stress | 6 and 24 hours post-intervention |