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Trial record 6 of 80 for:    ALPHA-1-ANTITRYPSIN DEFICIENCY

Epigenetic Regulation of Immunity in Alpha-1 Anti-trypsin Deficiency (AATD_Epi)

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ClinicalTrials.gov Identifier: NCT02691611
Recruitment Status : Recruiting
First Posted : February 25, 2016
Last Update Posted : April 5, 2018
Sponsor:
Collaborator:
Medical University of South Carolina
Information provided by (Responsible Party):
National Jewish Health

Brief Summary:
The investigators hypothesize that environmentally influenced histone modifications regulate AM mediated inflammation, contributing to a variable clinical course of AATD, and may also influence or be influenced by the activity of AAT augmentation therapy.

Condition or disease
Alpha 1-Antitrypsin Deficiency

Detailed Description:

The variable natural clinical course of alpha-1 anti-trypsin deficiency (AATD) disease and strong influence of environmental exposures such as smoking, implicate a major role for epigenetic mechanisms in modifying AATD disease penetrance. The goal of this study proposal is to investigate epigenetic regulation of alveolar macrophage (AM) inflammation and function in AATD PiZZ and PiMZ patients. The investigators proposal focuses on epigenetic histone modifications and gene expression specifically in AM.

AAT augmentation therapy, which alters disease symptoms, may also modulate AM epigenetics. To identify epigenetic regulation of AM inflammation in AATD in the context of AAT therapy, the investigators will perform and computationally integrate ChIP-seq and RNA-seq data. This will help elucidate the immunomodulatory mechanisms regulating AATD and provide an epigenetic map for diagnosis and targeted treatment. The investigators will test the efficacy of FDA-approved histone modifying drugs, such as SAHA and more specific next-generation histone modifiers, such as GSK-J4, to modulate AM AATD-associated activity ex vivo.

The goal of this study is to enroll up to a total of 13 AATD cases and 6 healthy controls. All AATD patients will be asked to give a blood sample and/or undergo a bronchoscopy. AATD patients will also be asked to undergo a follow up bronchoscopy and/or blood draw after 6 months if treatment with alpha-1 antitrypsin augmentation therapy is initiated to study the changes in these markers after augmentation therapy.


Study Type : Observational
Estimated Enrollment : 19 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Defining Epigenetic Regulation of Immunity in Alpha-1 Anti-trypsin Deficiency
Study Start Date : December 2015
Estimated Primary Completion Date : November 2018
Estimated Study Completion Date : November 2020


Group/Cohort
Alpha-1 Antitrypsin
All AATD patients who will start treatment with alpha-1 antitrypsin augmentation therapy
Healthy Control
Healthy controls with no lung diseases



Primary Outcome Measures :
  1. Epigenetic signature of specific inflammation-associated histone modifications from CD14+ macrophages [ Time Frame: Change from Baseline histones at 6 months ]

Secondary Outcome Measures :
  1. Epigenetically regulated genomic profile of AATD in AM [ Time Frame: Change from Baseline polyA RNA at 6 months ]
  2. Epigenetic mechanisms to regulate gene expression and cell function [ Time Frame: Change from Baseline epigenetic modified cells at 6 months ]


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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
  • AATD from clinic
  • Healthy controls from community
Criteria

Inclusion Criteria:

AATD

  • Age between the ages of 18 and 85
  • Have a diagnosis of AATD PiZZ or PiMZ established by AAT blood levels and Pi genotyping
  • Are not and have not been on AAT augmentation therapy for the past 6 months
  • Able to tolerate and willing to undergo study procedures
  • Provide signed informed consent.

Exclusion Criteria:

AATD

  1. History of comorbid condition severe enough to significantly increase risks based on investigator discretion
  2. Diagnosis of unstable cardiovascular disease including myocardial infarction in the past 6 weeks, uncontrolled congestive heart failure, or uncontrolled arrhythmia
  3. PaO2 on room air at rest <50 mmHg or SaO2 on room air at rest <85%
  4. Post bronchodilator FEV1<30% predicted
  5. Use of anticoagulation (patients on warfarin or clopidogrel will be excluded; patients on aspirin alone can be studied even with concurrent use)
  6. Dementia or other cognitive dysfunction which in the opinion of the investigator would prevent the participant from consenting to the study or completing study procedures
  7. Active pulmonary infection with tuberculosis
  8. History of pulmonary embolism in the past 2 years
  9. Non-COPD obstructive disease (various bronchiolitides, sarcoid, LAM, histiocytosis X) or parenchymal lung disease, pulmonary vascular disease, pleural disease, severe kyphoscoliosis, neuromuscular weakness, or other cardiovascular and pulmonary disease, that, in the opinion of the investigator, limit the interpretability of the pulmonary function measures
  10. Prior significant difficulties with pulmonary function testing
  11. Hypersensitivity to or intolerance of albuterol sulfate or ipratropium bromide or propellants or excipients of the inhalers
  12. Hypersensitivity to or intolerance of all drugs required for sedation during conscious sedation bronchoscopy.
  13. History of Lung volume reduction surgery, lung resection or bronchoscopic lung volume reduction in any form
  14. History of lung or other organ transplant
  15. History of large thoracic metal implants (e.g., AICD and/or pacemaker) that in the opinion of the investigator limit the interpretability of CT scans
  16. Currently taking >=10mg a day/20mg every other day of prednisone or equivalent systemic corticosteroid
  17. Currently taking any immunosuppressive agent excepting systemic corticosteroids
  18. History of lung cancer or any cancer that spread to multiple locations in the body
  19. Current illicit substance abuse, excluding marijuana
  20. Known HIV/AIDS infection
  21. History of or current exposure to chemotherapy or radiation treatments that, in the opinion of the investigator, limits the interpretability of the pulmonary function measures.
  22. Has a BMI > 40 kg/m2 at baseline exam
  23. Current or planned pregnancy within the study course.
  24. Currently institutionalized (e.g., prisons, long-term care facilities)
  25. Have a genotype of PiMZ and ever received intravenous or inhaled alpha-1 augmentation therapy (Alpha-1 Proteinase Inhibitor, A1PI)

Conditional Exclusions

  1. Participants who present with an upper respiratory infection or pulmonary exacerbation, either solely participant-identified or that has been clinically treated, in the last six weeks can be rescreened for the study once the six-week window has passed.
  2. Participants who present with current use of acute antibiotics or steroids can be rescreened for the study ≥30 days after discontinuing acute antibiotics/steroids.

    This does not apply to participants who are on chronic prednisone therapy of <10 mg per day or <20 mg every other day.

  3. Participants who present with a myocardial infarction or eye, chest, or abdominal surgery within six weeks can be rescreened after the six week window has passed.

    Study coordinators should consult with the site principal investigator prior to rescreening these participants.

  4. Female participants who present <3 months after giving birth will be asked to reschedule their visit until three months have passed since the birth.
  5. Individuals who are PiZZ receiving alpha-1 augmentation therapy (Alpha-1 Proteinase Inhibitor, A1PI) must be off augmentation therapy for >6 months to qualify for stratified enrollment in the PiZZ group not receiving augmentation therapy.

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): NCT02691611


Contacts
Contact: Briana Barkes, MPH 303-398-1699 barkesb@njhealth.org

Locations
United States, Colorado
National Jewish Health Recruiting
Denver, Colorado, United States, 80206
Contact: Briana Barkes, MPH    303-398-1699    barkesb@njhealth.org   
United States, South Carolina
Medical University of South Carolina Not yet recruiting
Charleston, South Carolina, United States, 29425
Contact: Charlton Strange, MD       strangec@musc.edu   
Sponsors and Collaborators
National Jewish Health
Medical University of South Carolina
Investigators
Principal Investigator: Brian P O'Connor, PhD National Jewish Health
Principal Investigator: Nabeel Y Hamzeh, MD National Jewish Health
Principal Investigator: Robert Sandhaus, MD, PhD National Jewish Health
Principal Investigator: Charlton B Strange, MD Medical University of South Carolina

Publications:

Responsible Party: National Jewish Health
ClinicalTrials.gov Identifier: NCT02691611     History of Changes
Other Study ID Numbers: HS-2939
First Posted: February 25, 2016    Key Record Dates
Last Update Posted: April 5, 2018
Last Verified: April 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Additional relevant MeSH terms:
Alpha 1-Antitrypsin Deficiency
Liver Diseases
Digestive System Diseases
Lung Diseases
Respiratory Tract Diseases
Genetic Diseases, Inborn
Subcutaneous Emphysema
Emphysema
Pathologic Processes
Alpha 1-Antitrypsin
Protein C Inhibitor
Trypsin Inhibitors
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action