Clinical trial NCT01450267: Inhaled Glutathione (GSH) Versus Placebo in Cystic Fibrosis
Official title: Randomized, Single Blind, Controlled Trial of Inhaled Glutathione Versus Placebo in Patients With Cystic Fibrosis
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE3
Conditions: Cystic Fibrosis
Keywords: Cystic Fibrosis
Glutathione
Lead sponsor: University of Campania Luigi Vanvitelli
Sponsor class: OTHER
Collaborators: name: Federico II University
First posted: 2011-10-12
Enrollment: 150
Sex: ALL
Minimum age (years): 6
Maximum age (years): 45
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Cystic fibrosis (CF) is the most common inherited disease among the Caucasian population with considerable morbidity and reduced life expectancy.

Excessive oxidants released by activated inflammatory cells and persisting infections are considered the main mechanism of damage of respiratory epithelium in CF.Glutathione (GSH) represents the first-line defence of the lung against oxidative stress-induced cell injury; however, a depletion of its levels has been observed in the airways of patients affected by CF. In vitro studies have showed that CFTR protein plays a pivotal role in transmembrane glutathione transport. Therapeutic approaches with inhaled GSH could improve the reduced lung antioxidant capacity in order to counterbalance the oxidant stress linked to the chronic airway inflammation and bacterial infection.

Primary objective of the study is to investigate whether a 12 months treatment with inhaled GSH can improve airway obstruction in CF patients. Secondary objectives include the effects of GSH therapy on exercise capacity, body mass index (BMI), respiratory symptoms, quality of life, frequency of pulmonary exacerbations, hospital admissions, and antibiotic administration. Moreover the study will evaluate the effect of GSH therapy on markers of oxidative stress in exhaled breath condensate (EBC) and in serum, and on inflammatory markers on brushed nasal epithelial cells.

Detailed description: 150 eligible patients will be enrolled on the basis of inclusion criteria. Patients will be divided in two groups: 1) Group 1 age between 6 and 18 years; 2) Group 2 older than 18 years. Patients will be randomly assigned to the treatment or placebo arm.Patients randomized in the GSH arm will receive a dosage of 10 mg/kg bid over a 12 months period.

Clinical visits will take place at the beginning (visit 0, enrolment visit) and after one month (visit 1), three months (visit 2), six months (visit 3) nine months (visit 4), and twelve months (visit 5, end of treatments).

Follow-up clinical visits will take place one month (visit 6), three months (visit 7), six months (visit 8) after the end of treatments.

At visit 0, all eligible patients will inhale GSH (10 mg/Kg) and a dynamic spirometry will be performed before, 10 and 60 minutes after inhalation. Patients showing a decrease in FEV1 greater than 15% after GSH inhalation will be excluded from the study.

At visit 0 and at each following visits (visit 1, 2, 3, 4, 5, 6, 7 and 8) will be performed and evaluated:

* Physical examination, measurement of vital signs, body temperature,BMI,and Spirometry;
* 6 minute walking test;
* MMRC dyspnoea scale;
* Chronic cough impact questionnaire;
* Cystic Fibrosis Quality of Life Questionnaire;
* Number of pulmonary exacerbations;
* Number and duration of hospital admissions for pulmonary exacerbations;
* Number, duration and route of administration of antibiotics;
* Blood sampling for haematological and biochemical analysis;
* Brushing of nasal epithelial cell, exhaled breath condensate with evaluation of markers of oxidative stress (H2O2), and blood sample for the measurement of markers of oxidative stress in serum will be performed in a subgroup of patients at visits 0, 3, and 5.

Eligibility criteria: Inclusion Criteria:

* a confirmed diagnosis of cystic fibrosis documented by sweat chloride test over 60 mmol/L and/or genotype analysis;
* male and female aged older than 6 years;
* stable clinical condition;
* written informed consent.

Exclusion Criteria:

* pregnancy and fertile women taking oral contraceptives;
* cigarette smoking;
* positive culture for Burkholderia Cepacia;
* history of haemoptysis or pneumothorax;
* FEV1\<= 40% of the predicted value;
* hyperresponsiveness to GSH inhalation test.

Primary outcomes:
measure: Forced expiratory volume in one second (FEV1) percent
timeFrame: 12 months
Secondary outcomes:
measure: Small airway function
timeFrame: 12 months
measure: Exercise Capacity
timeFrame: 12 months
measure: BMI
timeFrame: 12 months
measure: Dyspnoea
timeFrame: 12 months
measure: Cough
timeFrame: 12 months
measure: Quality of life
timeFrame: 12 months
measure: Pulmonary exacerbations
timeFrame: 12 months
measure: Markers of oxidative stress (H2O2)in serum and in exhaled breath condensate (EBC)
timeFrame: 12 months
measure: Epithelial inflammatory markers on brushed nasal epithelial cells
timeFrame: 12 months
Other outcomes:
Locations:
city: Naples
country: Italy
facility: Ospedale Monaldi, Azienda Ospedaliera Universitaria Federico II
Study officials:
affiliation: University of Campania Luigi Vanvitelli
name: Serafino A Marsico, PROF
role: PRINCIPAL_INVESTIGATOR
References:
citation: Griese M, Ramakers J, Krasselt A, Starosta V, Van Koningsbruggen S, Fischer R, Ratjen F, Mullinger B, Huber RM, Maier K, Rietschel E, Scheuch G. Improvement of alveolar glutathione and lung function but not oxidative state in cystic fibrosis. Am J Respir Crit Care Med. 2004 Apr 1;169(7):822-8. doi: 10.1164/rccm.200308-1104OC. Epub 2004 Jan 15.
citation: Bishop C, Hudson VM, Hilton SC, Wilde C. A pilot study of the effect of inhaled buffered reduced glutathione on the clinical status of patients with cystic fibrosis. Chest. 2005 Jan;127(1):308-17. doi: 10.1378/chest.127.1.308.
citation: Raia V, Maiuri L, Ciacci C, Ricciardelli I, Vacca L, Auricchio S, Cimmino M, Cavaliere M, Nardone M, Cesaro A, Malcolm J, Quaratino S, Londei M. Inhibition of p38 mitogen activated protein kinase controls airway inflammation in cystic fibrosis. Thorax. 2005 Sep;60(9):773-80. doi: 10.1136/thx.2005.042564. Epub 2005 Jun 30.
citation: Calabrese C, Tosco A, Abete P, Carnovale V, Basile C, Magliocca A, Quattrucci S, De Sanctis S, Alatri F, Mazzarella G, De Pietro L, Turino C, Melillo E, Buonpensiero P, Di Pasqua A, Raia V. Randomized, single blind, controlled trial of inhaled glutathione vs placebo in patients with cystic fibrosis. J Cyst Fibros. 2015 Mar;14(2):203-10. doi: 10.1016/j.jcf.2014.09.014. Epub 2014 Nov 4.