Nasal Epithelial Cells/Blood Lymphocyte Markers for Cystic Fibrosis (CF)/CF Pulmonary Exacerbations

This study has been completed.
Sponsor:
Collaborator:
Cystic Fibrosis Foundation Therapeutics
Information provided by (Responsible Party):
James F. Chmiel, University Hospital Case Medical Center
ClinicalTrials.gov Identifier:
NCT00381628
First received: September 27, 2006
Last updated: May 28, 2015
Last verified: May 2015
  Purpose

Study Hypothesis: We hypothesize that cellular markers from nasal epithelial cells and blood lymphocytes can serve as potential biomarkers reflect the underlying inflammatory state of the lung and will be helpful in determining the presence of a CF pulmonary exacerbation and its overall severity.


Condition Intervention
Cystic Fibrosis
Procedure: epithelial cells and blood lymphocyte extraction

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Use of Nasal Epithelial Cells and Blood Lymphocytes to Identify Markers for Cystic Fibrosis and Cystic Fibrosis Pulmonary Exacerbations

Resource links provided by NLM:


Further study details as provided by University Hospital Case Medical Center:

Enrollment: 59
Study Start Date: September 2006
Study Completion Date: September 2011
Primary Completion Date: September 2011 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Stable subjects with CF
These subjects will undergo epithelial cells and blood lymphocyte extraction. Nasal curettage will be performed to obtain nasal epithelial cells and blood will be obtained to isolate circulating lymphocytes one time from these subjects (age 15 years and above) when they are in their usual state of well-health. These cells will be studied in vitro.
Procedure: epithelial cells and blood lymphocyte extraction
Nasal curettage will be performed from each nostril to obtain nasal epithelial cells. Venipuncture will be performed and up to 60-ml of blood will be obtained from which neutrophils will be isolated.
Exacerbating subjects with CF
These subjects will undergo epithelial cells and blood lymphocyte extraction. Nasal curettage will be performed to obtain nasal epithelial cells and blood will be obtained to isolate circulating lymphocytes one time from these subjects (age 15 years and above) at the beginning and end of treatment for a pulmonary exacerbation. These cells will be studied in vitro.
Procedure: epithelial cells and blood lymphocyte extraction
Nasal curettage will be performed from each nostril to obtain nasal epithelial cells. Venipuncture will be performed and up to 60-ml of blood will be obtained from which neutrophils will be isolated.
Stable subjects with asthma
These subjects will undergo epithelial cells and blood lymphocyte extraction. Nasal curettage will be performed to obtain nasal epithelial cells and blood will be obtained to isolate circulating lymphocytes one time from these subjects (age 15 years and above) when they are in their usual state of well-health. These cells will be studied in vitro. This is the disease control group.
Procedure: epithelial cells and blood lymphocyte extraction
Nasal curettage will be performed from each nostril to obtain nasal epithelial cells. Venipuncture will be performed and up to 60-ml of blood will be obtained from which neutrophils will be isolated.
Healthy volunteers
These subjects will undergo epithelial cells and blood lymphocyte extraction. Nasal curettage will be performed to obtain nasal epithelial cells and blood will be obtained to isolate circulating lymphocytes one time from these subjects (age 15 years and above) when they are in their usual state of well-health. These cells will be studied in vitro. This is the control group
Procedure: epithelial cells and blood lymphocyte extraction
Nasal curettage will be performed from each nostril to obtain nasal epithelial cells. Venipuncture will be performed and up to 60-ml of blood will be obtained from which neutrophils will be isolated.

Detailed Description:

Cystic fibrosis (CF) is the most common lethal genetic disease in the US afflicting approximately 30,000 people. Chronic disease of the respiratory tract, which is responsible for early death, affects both the upper and lower airways.

We propose to utilize cells (blood lymphocytes and nasal epithelial cells) that are readily accessible and are known to express the cystic fibrosis transmembrane conductance regulator (CFTR) and therefore candidates to express markers of the downstream consequences of CFTR deficiency.

A marker that indicates the inflammatory state of the lung would be useful to identify infective/inflammatory exacerbations as opposed to worsening due to pulmonary vascular disease or simply upper airway infection. This marker might help to guide therapy for intensity and duration. Evidence in mice suggest that lymphocytes may be a driving force for inflammation in the CF lung, particularly during exacerbations, and also that human CF lymphocytes have dysfunctional production of cytokines.

Specific Aims:

To identify markers in nasal epithelial cells or blood lymphocytes that distinguish CF patients from those with functional CFTR (healthy volunteers and patients with asthma). If successful this could become a marker for CFTR correction by drugs or other systemic therapies.

To identify markers in blood lymphocytes that will identify inflammatory status (ie, distinguish an active exacerbation from return to clinical stability) in CF patients. This could become a marker for infectious exacerbations of CF airway disease.

  Eligibility

Ages Eligible for Study:   15 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population

Nasal epithelial cells and blood will be obtained from four groups of subjects age 15 years and older: Stable subjects with CF at baseline, Subjects with CF at the beginning and end of treatment for a pulmonary exacerbation, stable subjects with asthma, and healthy voulnteers

Criteria

Stable CF Patients:

Inclusion Criteria:

  • Male or female >= 15 years of age
  • Confirmed diagnosis of CF
  • Clinically stable with no evidence of acute upper respiratory tract infection or current pulmonary exacerbation within the previous month
  • Ability to understand and sign a written informed consent and comply with the requirements of the study

Exclusion Criteria:

  • Chronic use of a medication with anti-neutrophil or anti-inflammatory effect (ibuprofen, systemic or inhaled corticosteroids, or other immunosuppressive agents, etc
  • Oxygen saturation <92% on room air
  • Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the subject or the quality of the data

CF patients with pulmonary exacerbations:

Male of female >= 15 years of age Confirmed diagnosis of CF

Patient meets a modified definition for a pulmonary exacerbation based upon Fuchs criteria which is treated with intravenous antibiotics for any 4 of the following 12 signs or symptoms:

  • Increased sputum production
  • New or increased coughing up of blood
  • Increased cough
  • Increased dyspnea with exertion
  • Malaise, fatigue or lethargy
  • Anorexia or weight loss
  • Fever
  • Sinus pain or tenderness
  • Changes in sinus discharge
  • New findings on chest examination
  • Decline in forced expiratory volume in 1 second (FEV1) > 10% since previous visit
  • Radiographic changes indicative of pulmonary infection
  • Ability to understand and sign a written informed consent and comply with the requirements of the study

Exclusion criteria for CF patients with pulmonary exacerbation:

  • Concurrent use a medication with anti-neutrophil or anti-inflammatory effect within the previous 4 weeks
  • Presence of a condition or abnormality that in the opinion of the investigator would compromise the safety of the subject or the quality of the data.

Inclusion Criteria - Asthma patients

  • Male or female >= 15 years of age
  • Physician diagnosed asthma
  • Clinically stable with no evidence of acute upper or lower respiratory tract infection or current pulmonary exacerbation within the previous month

Exclusion Criteria - Asthma patients

  • Chronic use of a medication with anti-neutrophil or anti-inflammatory effect within the previous 4 weeks
  • Treated for an asthma exacerbation with the previous 4 weeks
  • Treated with oral corticosteroids within the previous 4 weeks
  • Oxygen saturation <92% on room air
  • Presence of a condition or abnormality that in the opinion of the investigator would compromise the safety of the subject or the quality of the data.

Inclusion Criteria for Healthy Volunteers

  • Male or female >= 18 years of age
  • Free of any chronic medical condition
  • Clinically stable with no evidence of acute upper or lower respiratory tract infection within the previous month
  • Ability to understand and sign a written informed consent and comply with the requirements of the study

Exclusion Criteria for Healthy Volunteers

  • Use of a medication with anti-neutrophil or anti-inflammatory effect within the previous 4 months
  • Presence of any chronic medical condition
  • Oxygen saturation <92% on room air
  • Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the subject or the quality of the data
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00381628

Locations
United States, Ohio
Rainbow Babies and Children's Hospital
Cleveland, Ohio, United States, 44106
Sponsors and Collaborators
University Hospital Case Medical Center
Cystic Fibrosis Foundation Therapeutics
Investigators
Principal Investigator: James F Chmiel, MD, MPH University Hospital Case Medical Center
  More Information

No publications provided

Responsible Party: James F. Chmiel, Associate Professor of Pediatrics, University Hospital Case Medical Center
ClinicalTrials.gov Identifier: NCT00381628     History of Changes
Other Study ID Numbers: Protocol 08-06-23
Study First Received: September 27, 2006
Last Updated: May 28, 2015
Health Authority: United States: Institutional Review Board

Keywords provided by University Hospital Case Medical Center:
Anatomy
cells
epithelial cells
blood cells
cystic fibrosis
equipment and supplies
disposable equipment
reagent kits

Additional relevant MeSH terms:
Cystic Fibrosis
Fibrosis
Digestive System Diseases
Genetic Diseases, Inborn
Infant, Newborn, Diseases
Lung Diseases
Pancreatic Diseases
Pathologic Processes
Respiratory Tract Diseases

ClinicalTrials.gov processed this record on May 28, 2015