Pulmonary Hypertension SOLAR

Study Overview
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Brief Summary
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The main goal of this study is to develop a noninvasive signature for pulmonary vascular remodeling in Group 3 PH patients, using hyperpolarized 129Xe magnetic resonance imaging (129Xe MRI). Such a signature may identify Group 3 PH responders to PAH-specific therapies. PAH's unique 129Xe MRI signature has been shown in previous studies. Past studies have lacked a pathologic ground truth correlate of these signatures, which could be provided by comparing them with the pathology of lung explant tissue from patients who have undergone a lung transplant. This signature could be validated in a cohort of patients with Group 3 PH in future studies.

Detailed Description
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The objective of this study is to identify a 129Xe MRI signature associated with PAH-like pulmonary vascular remodeling, consisting of plexiform arteriopathy, smooth muscle cell proliferation, and vascular fibrosis, in IPF and COPD that could be used to identify potential responders vs non-responders to PAH-specific therapies. The central hypothesis is that similar mechanisms and pathways underlie pulmonary vascular remodeling in IPF-PH, COPD-PH, and PAH. However, only a subset of Group 3 PH patients display remodeling consistent with PAH, resulting in responder vs. non-responder phenotypes when treated with PAH-specific therapies. In preliminary studies of subjects treated with Tyvaso, The study team has observed distinct 129Xe MRI signatures at baseline and with therapy depending on patients' underlying lung function. Consistent with this, recent studies using single-cell RNA sequencing (scRNAseq) of the pulmonary vasculature in IPF have demonstrated changes consistent with vascular remodeling.

Official Title
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Defining a Noninvasive Signature for Pulmonary Vascular Remodeling in Group 3 PH

Conditions
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Interstitial Lung Disease, COPD, Pulmonary Arterial Hypertension

Intervention / Treatment
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* Drug: Hyperpolarized 129Xe


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years' old Be on the lung transplant waiting list at Duke University Medical Center. PH as defined by RHC - mPAP > 20 mmHg, PVR > 3 WU, PCWP < 15 mmHg Groups defined as: PAH: Clinical diagnosis of PAH (Group 1 PH) in the absence of severe chronic lung disease, left heart disease, chronic thromboembolism, sarcoidosis, sickle cell disease, or other causes of non-Group 1 PH. COPD-noPH: Clinical diagnosis of COPD in the absence of precapillary PH. COPD-PH: Clinical diagnosis of COPD with precapillary PH. IPF-noPH: Clinical diagnosis of IPF in the absence of precapillary PH. IPF-PH: Clinical diagnosis of IPF with precapillary PH. Willing and able to give informed consent and adhere to visit/protocol schedules (consent must be given before any study procedures are performed). Exclusion Criteria: Moderate to severe heart disease (LVEF < 45% or severe LV Hypertrophy). Sarcoidosis. Active cancer. Sickle cell anemia. Liver disease (Childs-Pugh class C). Prisoners and pregnant women will not be approached for the study. Inability to obtain consent. Conditions that will prohibit MRI scanning (metal in eye, claustrophobia, inability to lie supine). Medical or psychological conditions which, in the opinion of the investigator, might create undue risk to the subject or interfere with the subject's ability to comply with the protocol requirements

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PAH:<br>Clinical diagnosis of PAH (Group 1 PH) in the absence of severe chronic lung disease, left heart disease, chronic thromboembolism, sarcoidosis, sickle cell disease or other causes of non-Group 1 PH. | Drug: Hyperpolarized 129Xe<br>* Each xenon dose will be limited to a volume less than 25% of subject lung capacity (TLC),<br>* Other names: Xe MRI;|
| Experimental: COPD-noPH<br>Clinical diagnosis of COPD in the absence of precapillary PH. | Drug: Hyperpolarized 129Xe<br>* Each xenon dose will be limited to a volume less than 25% of subject lung capacity (TLC),<br>* Other names: Xe MRI;|
| Experimental: COPD-PH<br>Clinical diagnosis of COPD with precapillary PH | Drug: Hyperpolarized 129Xe<br>* Each xenon dose will be limited to a volume less than 25% of subject lung capacity (TLC),<br>* Other names: Xe MRI;|
| Experimental: IPF-noPH<br>Clinical diagnosis of IPF in the absence of precapillary PH | Drug: Hyperpolarized 129Xe<br>* Each xenon dose will be limited to a volume less than 25% of subject lung capacity (TLC),<br>* Other names: Xe MRI;|
| Experimental: IPF-PH<br>Clinical diagnosis of IPF with precapillary PH | Drug: Hyperpolarized 129Xe<br>* Each xenon dose will be limited to a volume less than 25% of subject lung capacity (TLC),<br>* Other names: Xe MRI;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| a pathology-based 129Xe MRI noninvasive signature of pulmonary vascular remodeling that could be validated in a larger cohort of Group 3 PH patients | Such a signature could then be tested in clinical trials in Group 3 PH. These studies will have an important positive impact because they lay the foundation for a precision medicine strategy in Group 3 PH through the identification of potential responders and non-responders to PAH-specific therapies | 2 yrs | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lung Transplant, Group 3 PH