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Anti-Inflammatory Pulmonal Therapy of CF-Patients With Amitriptyline and Placebo

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ClinicalTrials.gov Identifier: NCT00515229
Recruitment Status : Completed
First Posted : August 13, 2007
Last Update Posted : August 13, 2007
Sponsor:
Information provided by:
University Hospital Tuebingen

Brief Summary:
Our data indicate that the CFTR-molecule functions as a transporter for sphingosine-1-phosphate and sphingosine or regulates the uptake of these sphingolipids by epithelial cells. The disturbed uptake of sphingosine and sphingosine-1-phosphate over the cell membrane results in an accumulation of ceramide in the cell membrane, which finally triggers a pro-inflammatory and pro-apoptotic status in the respiratory tract of cystic fibrosis patients. Amitriptyline reduces the cera-mide levels in the lung tissue, normalises the activity of cytokines and prevents constitutive cell death of epithelial cells observed in CFTR-deficient mice. Most important, amitriptyline prevents pulmonary infections of CFTR-deficient mice with P. aeruginosa. These effects of amitriptyline may result in an improved lung function of cystic fibrosis patients.

Condition or disease Intervention/treatment Phase
Cystic Fibrosis Infection Pseudomonas Aeruginosa Drug: amitriptyline Phase 2

Detailed Description:

Cystic fibrosis (CF), the most common autosomal recessive disorder at least in western countries, is caused by mutations of the cystic fibrosis transmembrane conductance regulator molecule (CFTR) and affects approximately 40 000 patients in Europe. Most, if not all, CF-patients develop a chronic pulmonary infection with Pseudomonas aeruginosa (P. aeruginosa). At present it is un-known why CF-patients are highly sensitive to P. aeruginosa infections and, most important, no curative treatment for cystic fibrosis is available.

Our data on CFTR-deficient mice demonstrate that the CFTR-molecule does not only function as a chloride-channel, but also as a transporter for sphingolipids, in particular sphingosine and sphingosine-1-phosphate. Deficiency of functional CFTR in CFTR-knock-out mice results in an alteration of the sphingolipid metabolism in pulmonary epithelial cells and an accumulation of cellular ceramide in these cells.

Inhibition of ceramide release in the lung was achieved by pharmacological and genetic inhibition of the acid sphingomyelinase (ASM) that generates ceramide from sphingomyelin. Amitriptyline was employed to pharmacologically block the ASM genetic inhibition of the ASM was achieved by crossing CFTR- and ASM-deficient mice. Although the ASM is not affected in cystic fibrosis, an inhibition of the enzyme should block the formation of ceramide and, thus, normalize the increase of pulmonary ceramide caused by CFTR-deficiency.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 18 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Protocol for a Phase II-Study Anti-Inflammatory Pulmonal Therapy of CF-Patients With Amitriptyline and Placebo - Randomised, Double-Blinded, Placebo-Controlled, Cross Over - Study -
Study Start Date : October 2006
Actual Study Completion Date : July 2007


Arm Intervention/treatment
Active Comparator: 1
Verum 1: Each individual capsule has a filling volume of 25 mg amitriptyline, given once an day in the evening over 28 days
Drug: amitriptyline

Each individual capsule has a filling volume of 25 mg, 50 mg und 75 mg Amitriptyline.

Placebo: 25 mg corn starch


Active Comparator: 2
Verum 1: Each individual capsule has a filling volume of 50 mg amitriptyline, given once an day in the evening over 28 days
Drug: amitriptyline

Each individual capsule has a filling volume of 25 mg, 50 mg und 75 mg Amitriptyline.

Placebo: 25 mg corn starch


Active Comparator: 3
Verum 3: Each individual capsule has a filling volume of 75 mg amitriptyline, given once an day in the evening over 28 days
Drug: amitriptyline

Each individual capsule has a filling volume of 25 mg, 50 mg und 75 mg Amitriptyline.

Placebo: 25 mg corn starch


Placebo Comparator: 0
Placebo: Each individual capsule has a filling volume of 25 mg placebo (corn starch), given once an day in the evening over 28 days
Drug: amitriptyline

Each individual capsule has a filling volume of 25 mg, 50 mg und 75 mg Amitriptyline.

Placebo: 25 mg corn starch





Primary Outcome Measures :
  1. Increase in lung function, especially the FEV1 increase [ Time Frame: 5 months ]

Secondary Outcome Measures :
  1. Increase of CO-Diffusion [ Time Frame: 5 months ]
  2. Pulmonary Ceramide expression [ Time Frame: 5 months ]
  3. Decrease of cytokine-concentrations [ Time Frame: 5 months ]
  4. Decrease of leukocytes (sputum) [ Time Frame: 5 months ]
  5. Decrease of Pseudomonas [ Time Frame: 5 months ]
  6. Infection parameters in serum [ Time Frame: 5 months ]
  7. Exacerbations [ Time Frame: 5 months ]


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Ages Eligible for Study:   18 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Cystic Fibrosis is proved
  2. The patient are older than 18 years (<50 years)
  3. No sec discrimination
  4. The patient is pulmonal colonized with bacteria
  5. Signs of pulmonary exacerbation are not present
  6. A full course of therapy is possible without any restrictions
  7. Lung function measurement is possible

Exclusion Criteria:

  1. Poor metabolizer for amitriptyline (CYP2D6 genotyping)
  2. Glaucoma, seizures, heart insufficiency or depression is present
  3. Signs of acute pulmonary illness (bronchial or tracheal stenosis, tuberculosis, thorax trauma, acute pneumonia, pneumothorax, bronchial haemorrhage, ARDS) are present
  4. intravenous antibiotic treatment was necessary in the last 4 weeks
  5. Involvement of the patient in another study
  6. Pregnancy

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 ClinicalTrials.gov identifier (NCT number): NCT00515229


Locations
Germany
University of Tuebingen
Tuebingen, Baden-Wuerttemberg, Germany, 72076
Sponsors and Collaborators
University Hospital Tuebingen
Investigators
Principal Investigator: Joachim Reithmueller, Dr. University of Tuebingen, Paediatric Department

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
ClinicalTrials.gov Identifier: NCT00515229     History of Changes
Other Study ID Numbers: APA-II
First Posted: August 13, 2007    Key Record Dates
Last Update Posted: August 13, 2007
Last Verified: August 2007

Keywords provided by University Hospital Tuebingen:
cystic fibrosis
ceramide
amitriptyline
Pseudomonas aeruginosa
lung function

Additional relevant MeSH terms:
Fibrosis
Cystic Fibrosis
Pseudomonas Infections
Pathologic Processes
Pancreatic Diseases
Digestive System Diseases
Lung Diseases
Respiratory Tract Diseases
Genetic Diseases, Inborn
Infant, Newborn, Diseases
Gram-Negative Bacterial Infections
Bacterial Infections
Anti-Inflammatory Agents
Amitriptyline
Amitriptyline, perphenazine drug combination
Antidepressive Agents, Tricyclic
Antidepressive Agents
Psychotropic Drugs
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Adrenergic Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Neurotransmitter Agents
Antipsychotic Agents