The Severe Asthma Research Program III-Boston Clinical Site
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Asthma |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 6 - 60 |
| Updated: | 6/30/2016 |
| Start Date: | December 2012 |
| End Date: | June 2017 |
ALXR/FPR Mediated Signaling in Severe Asthma (AMSA)-The Severe Asthma Research Program (SARP) III
Asthma is a disease characterized by inflammation in the airways. The body naturally makes
compounds that reduce inflammation. Unfortunately, for patients with severe asthma, the
pathway these compounds use to reduce inflammation seems to be perturbed. Investigators have
chosen to focus on the anti-inflammatory compounds called lipoxins and how they work through
the "ALX Axis", a name given to the ALX receptor pathway and its ligands. Work from the
Brigham and Women's Hospital has suggested that in patients with severe asthma, the ALX axis
may not work properly and therefore may not shut off inflammation as expected. Also, there
is information to suggest that in some cases, steroids (prednisone and similar drugs), which
are commonly used to treat asthma, may affect the ALX axis in a negative way, paradoxically
making the inflammation worse instead of better.
As part of the NIH Severe Asthma Research Program the Asthma Research Center's goal is to
identify what causes the problems in the ALX axis in severe asthma. To do so, participants
with severe asthma will be compared to participants with milder forms of asthma.
Investigators will use samples taken directly from the lungs of people with asthma, as well
as blood, urine and CT scans of the lungs to better understand how the ALX axis changes both
before and after corticosteroid treatment and throughout a three year span. Participants
will come into the Asthma Research Center to have the procedures done.
Investigators expect participants will perform breathing tests and complete questionnaires
and diaries. To better understand if corticosteroids negatively affect the ALX axis in
severe asthma, researchers will take samples before and after a one time steroid injection
equivalent to a prednisone treatment for asthma. Participants will perform two bronchoscopy
procedures, before and after corticosteroid treatment, where biopsies and cells will be
obtained from the participant's lungs. Investigators will use these samples to observe any
changes that the corticosteroid may have on the ALX axis. At the end of the study,
researchers at the Brigham and Women's Hospital expect to understand the ALX axis in such a
way that will allow them to formulate new therapies and drug targets to treat people with
asthma, especially severe asthma, more effectively.
In Boston, this study will be run together by the Asthma Research Center at the Brigham and
Women's Hospital (adults) and Boston Children's Hospital (children).
compounds that reduce inflammation. Unfortunately, for patients with severe asthma, the
pathway these compounds use to reduce inflammation seems to be perturbed. Investigators have
chosen to focus on the anti-inflammatory compounds called lipoxins and how they work through
the "ALX Axis", a name given to the ALX receptor pathway and its ligands. Work from the
Brigham and Women's Hospital has suggested that in patients with severe asthma, the ALX axis
may not work properly and therefore may not shut off inflammation as expected. Also, there
is information to suggest that in some cases, steroids (prednisone and similar drugs), which
are commonly used to treat asthma, may affect the ALX axis in a negative way, paradoxically
making the inflammation worse instead of better.
As part of the NIH Severe Asthma Research Program the Asthma Research Center's goal is to
identify what causes the problems in the ALX axis in severe asthma. To do so, participants
with severe asthma will be compared to participants with milder forms of asthma.
Investigators will use samples taken directly from the lungs of people with asthma, as well
as blood, urine and CT scans of the lungs to better understand how the ALX axis changes both
before and after corticosteroid treatment and throughout a three year span. Participants
will come into the Asthma Research Center to have the procedures done.
Investigators expect participants will perform breathing tests and complete questionnaires
and diaries. To better understand if corticosteroids negatively affect the ALX axis in
severe asthma, researchers will take samples before and after a one time steroid injection
equivalent to a prednisone treatment for asthma. Participants will perform two bronchoscopy
procedures, before and after corticosteroid treatment, where biopsies and cells will be
obtained from the participant's lungs. Investigators will use these samples to observe any
changes that the corticosteroid may have on the ALX axis. At the end of the study,
researchers at the Brigham and Women's Hospital expect to understand the ALX axis in such a
way that will allow them to formulate new therapies and drug targets to treat people with
asthma, especially severe asthma, more effectively.
In Boston, this study will be run together by the Asthma Research Center at the Brigham and
Women's Hospital (adults) and Boston Children's Hospital (children).
Severe asthma accounts for the majority of the morbidity and mortality related to asthma. It
is characterized by persistent airway inflammation despite anti-inflammatory therapy,
persistent airway hyperresponsiveness, and "remodeling" of the airways that includes
fibrosis. Lipoxin A4 (LXA4) and 15-epimer-LXA4 are lipid-derived mediators that have been
shown to promote anti-inflammatory and pro-resolving cellular responses through their
effects at ALX/FPR2 receptors. They promote resolution of inflammation, inhibit airway
hyperresponsiveness, and counteract pro-fibrotic processes. Investigators at the Brigham and
Women's Hospital and others have shown that the ALX effector pathway and its constituent
ligands (ALX axis) is perturbed in severe asthma (SA) compared with non-severe asthma (NSA).
Specifically, in SA LXA4 production is decreased and ALX/FPR2 receptor expression is
reduced. Further, investigators at the Brigham and Women's Hospital have shown that low
levels of lipoxins, relative to pro phlogistic leukotrienes, are associated with reduced
airway function (FEV1). Considering these data and the function of the ALX axis, it appears
that perturbations of constituents of this axis could identify, and perhaps underlie,
several of the processes that characterize severe, progressive asthma. Further to this
point, work in progress being done at the Brigham and Women's Hospital indicates that
corticosteroids (CS) interactions with the ALX axis may underlie some of these
perturbations. CS can decrease the production of LXA4. More importantly, while CS increase
production of pro-resolving annexin A1, they also appear to promote pro-inflammatory
signaling through ALX/FPR2 via upregulation of serum amyloid A (SAA). SAA is expressed in
the lung and is associated with exacerbations of COPD.
Hypotheses:
Peripheral blood leukocytes and bronchoalveolar lavage fluids will be obtained from SA and
NSA subjects before and after intramuscular triamcinolone at baseline to test the hypothesis
that in vivo corticosteroids will reduce pro-inflammatory cellular responses and enhance
LXA4-mediated anti-inflammatory responses in the majority of asthmatic subjects. There is a
sub-group of individuals with severe asthma in which in vivo corticosteroids will
paradoxically increase pro-inflammatory responses. Investigators will also test the
hypothesis that such paradoxical signaling can be overcome by lipoxins. In addition,
investigators will test the hypothesis that basal p anti-inflammatory responses are dampened
in severe asthma.
Investigators at the Brigham and Women's Hospital hypothesize that a cohort of severe
asthmatic subjects with impaired counter-regulatory signaling will have a specific ALX axis
phenotype that will predispose them to increased inflammation, asthma exacerbations and
disease progression.
Investigators will test the hypothesis that in vivo corticosteroids will not increase (and
may decrease) LXA4 or 15-epi-LXA4 but will increase annexin A1 and serum amyloid A and that
the levels of these compounds post-CS will differ by disease severity, remaining stable over
a 3 year interval.
Samples will be obtained at study entry before and after intramuscular triamcinolone to test
the hypothesis that in vivo corticosteroids increase ALX/FPR2 expression in leukocytes and
airway cells.
is characterized by persistent airway inflammation despite anti-inflammatory therapy,
persistent airway hyperresponsiveness, and "remodeling" of the airways that includes
fibrosis. Lipoxin A4 (LXA4) and 15-epimer-LXA4 are lipid-derived mediators that have been
shown to promote anti-inflammatory and pro-resolving cellular responses through their
effects at ALX/FPR2 receptors. They promote resolution of inflammation, inhibit airway
hyperresponsiveness, and counteract pro-fibrotic processes. Investigators at the Brigham and
Women's Hospital and others have shown that the ALX effector pathway and its constituent
ligands (ALX axis) is perturbed in severe asthma (SA) compared with non-severe asthma (NSA).
Specifically, in SA LXA4 production is decreased and ALX/FPR2 receptor expression is
reduced. Further, investigators at the Brigham and Women's Hospital have shown that low
levels of lipoxins, relative to pro phlogistic leukotrienes, are associated with reduced
airway function (FEV1). Considering these data and the function of the ALX axis, it appears
that perturbations of constituents of this axis could identify, and perhaps underlie,
several of the processes that characterize severe, progressive asthma. Further to this
point, work in progress being done at the Brigham and Women's Hospital indicates that
corticosteroids (CS) interactions with the ALX axis may underlie some of these
perturbations. CS can decrease the production of LXA4. More importantly, while CS increase
production of pro-resolving annexin A1, they also appear to promote pro-inflammatory
signaling through ALX/FPR2 via upregulation of serum amyloid A (SAA). SAA is expressed in
the lung and is associated with exacerbations of COPD.
Hypotheses:
Peripheral blood leukocytes and bronchoalveolar lavage fluids will be obtained from SA and
NSA subjects before and after intramuscular triamcinolone at baseline to test the hypothesis
that in vivo corticosteroids will reduce pro-inflammatory cellular responses and enhance
LXA4-mediated anti-inflammatory responses in the majority of asthmatic subjects. There is a
sub-group of individuals with severe asthma in which in vivo corticosteroids will
paradoxically increase pro-inflammatory responses. Investigators will also test the
hypothesis that such paradoxical signaling can be overcome by lipoxins. In addition,
investigators will test the hypothesis that basal p anti-inflammatory responses are dampened
in severe asthma.
Investigators at the Brigham and Women's Hospital hypothesize that a cohort of severe
asthmatic subjects with impaired counter-regulatory signaling will have a specific ALX axis
phenotype that will predispose them to increased inflammation, asthma exacerbations and
disease progression.
Investigators will test the hypothesis that in vivo corticosteroids will not increase (and
may decrease) LXA4 or 15-epi-LXA4 but will increase annexin A1 and serum amyloid A and that
the levels of these compounds post-CS will differ by disease severity, remaining stable over
a 3 year interval.
Samples will be obtained at study entry before and after intramuscular triamcinolone to test
the hypothesis that in vivo corticosteroids increase ALX/FPR2 expression in leukocytes and
airway cells.
Inclusion Criteria:
- Ages 6-60
- FEV1 bronchodilator reversibility ≥12% or methacholine PC20 ≤16 mg/mL
- Ability to provide informed consent
- Ability to perform pulmonary function tests
Exclusion Criteria:
- Pregnancy (if undergoing methacholine challenge or bronchoscopy)
- Current smoking
- Smoking history > 10 pack years if ≥ 30 years of age or smoking history > 5 pack
years if < 30 years of age (Note: If a subject has a smoking history, no smoking
within the past year)
- Other chronic pulmonary disorders associated with asthma-like symptoms, including
(but not limited to) cystic fibrosis, chronic obstructive pulmonary disease, chronic
bronchitis, vocal cord dysfunction that is the sole cause of asthma symptoms, severe
scoliosis or chest wall deformities that affect lung function, or congenital
disorders of the lungs or airways
- Participants who cannot undergo bronchoscopy due to: 1) hospitalization for asthma
within the 6 weeks prior to bronchoscopy, 2) > 12 asthma exacerbations within the 6
months prior to bronchoscopy, 3) intubation for asthma within the 6 months prior to
bronchoscopy, 4) older than 60 years of age, 5) increased corticosteroid use in the
14 days prior to bronchoscopy. (Increased corticosteroid use recognized as a dose
which is both numerically at least twice that of baseline, and which is at least 20
mg/day greater than the baseline dose.)
- History of premature birth before 35 weeks gestation
- Planning to relocate from the clinical center area before study completion
- Currently participating in an investigational drug trial
- Unwillingness to receive an intramuscular triamcinolone acetonide injection.
We found this trial at
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Boston Children's Hospital Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care....
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