Clinical trial NCT01208792: Auto-immunity and Pulmonary Arterial Hypertension
Official title: Auto-immunity and Prognosis of Pulmonary Arterial Hypertension
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Pulmonary Arterial Hypertension
HIV Infection
Congenital Heart Defect
Systemic Sclerosis
Connective Tissue Disease
Keywords: Auto antibodies
Target antigens
2D-immunoblot
Reactive oxygen species
Pulmonary arterial hypertension
Systemic sclerosis
Human immunodeficiency virus infection
Porto pulmonary hypertension
Congenital heart defect
Systemic lupus erythematosus
Mixed connective tissue disease
Sjögren's syndrome
Lead sponsor: Assistance Publique - Hôpitaux de Paris
Sponsor class: OTHER
First posted: 2010-09-24
Enrollment: 629
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: DIAGNOSTIC

Brief summary: The investigators have recently evidenced the presence of antibodies to endothelial cells and fibroblasts in patients with idiopathic or SSc-associated PAH. The investigators also have identified several target antigens of anti-fibroblasts antibodies.

The objective of this study is to further investigate for the presence of antibodies to endothelial cells and fibroblasts in patients and characterize the antigen specificity of autoantibodies in patients with different types of non idiopathic and non SSc-associated PAH, such as PAH associated with HIV infection, porto-pulmonary hypertension, congenital heart diseases, systemic lupus erythematosus, mixed connective tissue disease and Sjögren's syndrome

Detailed description: Two hundred and fifty patients with PAH will be included: 65 patients with idiopathic PAH (iPAH), 20 with PAH associated with HIV infection, 20 with porto-pulmonary hypertension, 20 with PAH secondary to congenital heart disorders, 40 with SSc, 20 with SLE, 20 with MCTD and 10 with a PAH associated with a Sjögren's syndrome.

Two hundred patients without PAH will also be included: 80 patients with SSc and 20 in each of the following groups: HIV infection, porto-pulmonary hypertension, SLE, congenital heart disorders, MCTD and with Sjögren's syndrome.

Twenty patients with proximal chronic thromboembolic pulmonary hypertension (CTPH) will also be included in a control arm of the study.

Two hundred and fifty healthy blood donors age and sex-matched with patients with PAH, will be included as controls.

By using 2D-immunoblotting techniques, we will evidence IgG antibodies to fibroblasts, EC, vascular smooth muscle cells (SMC) in multiple groups of patients and we will characterize target antigens of these autoantibodies. We will also assess the production of ROS: nitric oxide (NO), hydrogen peroxide (H2O2) and the effect of the whole serum (and the IgG particularly) on in VITRO proliferation of EC, fibroblasts and vascular SMC. For sera that will induce the production of ROS, we will study the effect of different vasodilatator (prostacycline, endothelin receptor antagonist, type 5 phosphodiesterase inhibitors) and anti-oxidant therapies.

Expected results We will characterize target antigens of autoantibodies of patients with non-idiopathic and non SSc-associated PAH. We will compare these target to those previously identified in idiopathic or SSc-associated PAH. We will then, distinguish subpopulations of PAH patients whose serum or purified IgG (possibly specific for a given antigen) are able to induce ROS production or cell proliferation. For the population of ROS-producer patients, we will correlate the clinical response to vasodilatator therapy to results of in VITRO inhibition experiments with vasodilatators and anti-oxidant molecules.

Perspectives The characterization of target antigens of EC, fibroblasts and vascular SMC specifically

Eligibility criteria: Inclusion Criteria:

age over 18

* for PAH patients: pre-capillary PAH evidenced by right-heart catheterization
* no associated systemic disease for idiopathic PAH patients
* for HIV patients, HIV1 infection confirmed by ELISA and western blot
* for patients with porto pulmonary hypertension: evidence by endoscopy of esophageal varices, confirmation of hepatic venous pressure gradient over 5 mmHg by catheterization of the hepatic veins
* for patients with congenital heart defect: evidence by imaging of atrial or ventricular septal defect, or patent ductus arterious and confirmed by heart catheterization
* patients with SSc will fulfill the American College of Rheumatology (ACR) and the LEROY and MEDSGER criteria
* patients with MCTD will fulfill the criteria for MCTD
* patients with SLE will fulfill the updated and revised ACR criteria
* patients with Sjögren's syndrome will fulfill the American-European consensus group criteria
* patients with chronic thromboembolic pulmonary hypertension: Lung scintiscan showing segmental mismatched perfusion defects and confirmation by angiography of the occlusion and the chance of success of endarterectomy according to the location of disease
* Signed written informed consent
* Patients with health insurance

Exclusion Criteria:

* age under 18
* pregnant women
* absence of written informed consent
* associated malignant tumor

Primary outcomes:
measure: Immunological markers of prognosis interest in pulmonary arterial hypertension (PAH)
timeFrame: one year
Secondary outcomes:
measure: Target antigens of autoantibodies
timeFrame: one year
measure: Subpopulations of patients with PAH whose serum is able to induce the production of reactive oxygen species (ROS)
timeFrame: one year
Other outcomes:
Locations:
city: Clamart
country: France
facility: Pneumology Department, Antoine Béclère Hospital
city: Lille
country: France
facility: Internal Medicine Department, Claude Huriez Hospital
city: Paris
country: France
facility: Internal Medicine Department, Cochin Hospital
Study officials:
affiliation: Assistance Publique - Hôpitaux de Paris
name: Luc Mouthon, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: