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Bovine Intestinal Alkaline Phosphatase for the Treatment of Patients With Sepsis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00430859
Recruitment Status : Completed
First Posted : February 2, 2007
Last Update Posted : April 2, 2012
Information provided by (Responsible Party):

Brief Summary:
Eligible patients will receive either AP or matching placebo in a double blind, randomized design and following a 2:1 ratio. All medication will be given in addition to standard care for sepsis patients. Patients will be followed for 28 days after the start of study medication administration. A blinded safety review of the study results will take place after the inclusion of 12 patients in the study.

Condition or disease Intervention/treatment Phase
Sepsis Multiple Organ Dysfunction Syndrome Drug: Alkaline Phosphatase Drug: Placebo Phase 2

Detailed Description:

Both bolus and continuous infusions were found to effectively reduce the LPS-induced pro-inflammatory cytokine TNFα in piglets. When AP was administered as a bolus (160 U/kg), the reduction of TNFα after administration of 10 μg/kg LPS in piglets was found to be in the order of 32%. When 100 U/kg of CIAP was administered as an infusion over 50 minutes, reaching steady state levels of 400 U/L, the reduction in TNFα after LPS challenge was substantially (70%), as compared to TNFα levels after LPS only. A series of these studies demonstrated that dosages of 100-120 U/kg administered over 50 minutes could effectively reduce LPS toxicity at steady state levels around 400 U/L, about a 10 fold of the normal alkaline phosphatase plasma levels (40 U/L in piglets). Furthermore, it is estimated that the above-mentioned dosages can effectively detoxify 10 μg LPS/kg in piglets, which represents an LPS-equivalent derived from about 1010 colony forming units (cfu) of E.coli. These amounts of circulating bacteria are not easily established in a sepsis patient. It is estimated (personal communication, Prof. S. van Deventer, Academic Medical Centre, Amsterdam) that the bacterial load in these patients is less than 107 bacteria total, which is equivalent to approx. 2x105 cfu/kg.

In summary, in piglets 160 U/kg AP was able to detoxify an amount of LPS equivalent to 1010 cfu E. Coli/kg, which is approximately 50,000 times the expected amount of bacteria in sepsis patients. We therefore expect that the dosage used in human (200 U/kg) administered over 24 hours is able to detoxify the amount of LPS present in sepsis patients. This dosage will result in 5-times normal plasma level of alkaline phosphatase which was well tolerated during the previous clinical trials. Since the effect of antibiotic treatment is expected to occur within hours of administration we decided to establish this steady state level of AP as fast as possible, which explains the initial bolus-like administration by short infusion, followed by a prolonged steady state infusion.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 37 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Double (Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: A Pilot, Double-blind, Randomised, Placebo-controlled, Exploratory Study to Investigate the Safety and Effect of Bovine Intestinal Alkaline Phosphatase in Patients With Sepsis
Study Start Date : September 2004
Actual Primary Completion Date : March 2006
Actual Study Completion Date : March 2006

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Sepsis

Arm Intervention/treatment
Experimental: 1
Drug: Alkaline Phosphatase
Intravenous over a period of 24 hours
Other Name: AP, BIAP, CIAP

Placebo Comparator: Placebo
Placebo, saline
Drug: Placebo
Saline over a period of 24h
Other Name: saline

Primary Outcome Measures :
  1. Presence of (Serious) Adverse Events ((S)AEs), vital signs (body temperature, heart rate), systolic and diastolic blood pressure, electrocardiogram variables, biochemical, haematological, and coagulation variables, and frequency and type of anti-AP. [ Time Frame: 28 days ]

Secondary Outcome Measures :
  1. Variables for evaluation of the effect on inflammation: C-reactive protein (CRP), plasma lactate, cytokines (TNFalfa, IL-6, IL-8, IL-10), white cell count, and procalcitonin (PCT) were assessed.differential [ Time Frame: 28 ]
  2. Evaluation effect: APACHE-II score, overall mortality at 28 days, length of stay at ICU, number of days requiring mechanical ventilation, length of stay in hospital, SOFA score, and number of dysfunctional organs were assessed. [ Time Frame: 28 ]
  3. Clinical assessment after 90 days [ Time Frame: 90 days ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients between 18 and 80 years (inclusive);
  • proven or suspected infection;
  • meeting 2 of 4 of the systemic inflammatory response syndrome (SIRS) criteria;
  • septic shock or one or more acute organ failures in the preceding 12 hours;
  • written informed consent obtained.

Exclusion Criteria:

  • Pregnant or lactating women;
  • known HIV seropositive patients;
  • patients receiving immunosuppressive therapy or chronically using high doses of glucocorticosteroids (defined as > 1 mg/kg/day) equivalent to prednisone 1 mg/kg/day;
  • patients expected to have rapidly fatal disease within 24 h;
  • known confirmed gram-positive sepsis;
  • known confirmed fungal sepsis;
  • chronic renal failure requiring haemodialysis or peritoneal dialysis;
  • acute pancreatitis with no established source of infection;
  • patients not expected to survive for 28 days due to other medical conditions such as end-stage neoplasm or other diseases;
  • participation in another investigational study within 90 days prior to start of the study which might interfere with this study;
  • previous administration of AP;
  • known allergy for cow milk.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00430859

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University Hospital Vrije Universiteit Brussel
Brussel, Brussels Hoofdstedelijk Gewest, Belgium, B-1090
Hospital Network Antwerpen - Middelheim
Antwerpen, Belgium, B-2020
University Hospital Antwerpen
Antwerpen, Belgium, B-2650
Medical Centre Leeuwarden
Leeuwarden, Friesland, Netherlands, 8934 AD
University Medical Centre St. Radboud
Nijmegen, Gelderland, Netherlands, 6500 HB
St. Elisabeth Hospital
Tilburg, N-Brabant, Netherlands, 5022 GC
Isala Clinics
Zwolle, Overijssel, Netherlands, 8011 JW
Erasmus Medical Centre
Rotterdam, Z-Holland, Netherlands, 3015 GD
University Medical Centre Groningen
Groningen, Netherlands, 9700 RB
University Medical Centre Utrecht
Utrecht, Netherlands, 3508 GA
Sponsors and Collaborators
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Study Chair: Bart Wuurman, M.Sc.
Principal Investigator: Hans JG van der Hoeven, MD, PhD Radboud University Medical Center
Publications of Results:
Other Publications:

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Responsible Party: AM-Pharma Identifier: NCT00430859    
Other Study ID Numbers: AP SEP 02-01
EudraCT No. 2005-005257-21
First Posted: February 2, 2007    Key Record Dates
Last Update Posted: April 2, 2012
Last Verified: March 2012
Keywords provided by AM-Pharma:
Additional relevant MeSH terms:
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Multiple Organ Failure
Systemic Inflammatory Response Syndrome
Pathologic Processes