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Effect of C1-esterase Inhibitor on Systemic Inflammation in Trauma Patients With a Femur or Pelvic Fracture (CAESAR)

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: NCT01275976
Recruitment Status : Terminated (Futility and limited feasibility)
First Posted : January 13, 2011
Last Update Posted : February 4, 2015
Sanquin Plasma Products BV
Information provided by (Responsible Party):
Prof. dr Leenen, UMC Utrecht

Brief Summary:

Trauma and major operation are associated with an excessive inflammation reaction due to tissue injury. This overwhelming immune response is considered to be a major risk factor in the pathogenesis of late inflammatory complications such as acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS) and sepsis.

The investigators hypothesize that administration of C1-esterase inhibitor (C1-INH) will attenuate the humane inflammatory response and, thereby, reduce the risk of inflammatory complications due to surgical interventions in trauma patients with a femur or pelvic fracture

Condition or disease Intervention/treatment Phase
Trauma Inflammation Sepsis Multiple Organ Dysfunction Syndrome Drug: C1-esterase inhibitor Other: Saline 0.9% Phase 3

Detailed Description:

Systemic inflammation in response to a femur or pelvic fracture and fixation is associated with complications, such as acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS). The injury itself, but also the additional fixation procedure give a release of pro-inflammatory cytokines, in particular interleukin (IL)-6. This results in an aggravation of the initial systemic inflammatory response, and will cause in some patients an increased risk on the development of inflammatory complications, like ARDS and MODS. Which can lead to higher morbidity, mortality and prolonged hospital stay.

Various strategies, such as damage control orthopedics, have been proposed to prevent these complications. Another strategy is to decrease the inflammatory reaction caused by the surgical procedure, and by interventions focused on inhibition of the innate inflammatory response. This will lower the risk of complications.

A promising candidate is the endogenously produced serum protein C1-esterase inhibitor (C1-INH). This protein is an acute phase protein, produced by the liver in response to inflammatory conditions. C1-INH is a major inactivator of the complement system, but important additional anti-inflammatory properties have been demonstrated. A previous study of from our laboratory showed that administration of the drug C1-INH significantly reduced the concentration of circulating pro-inflammatory cytokines such as IL-6, during human experimental endotoxemia. Treatment with C1-INH has been proven to be safe in treatment with humans, even in high dosages and in pregnant patients with C1-INH deficiency.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 11 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Effect of C1-esterase Inhibitor on Systemic Inflammation in Trauma Patients With a Femur or Pelvic Fracture
Study Start Date : April 2012
Actual Primary Completion Date : February 2015
Actual Study Completion Date : February 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: C1-esterase inhibitor
C1-esterase inhibitor, 100 U/kg bodyweight
Drug: C1-esterase inhibitor
C1-esterase inhibitor 200 U/kg infusion over 30 minutes, just before the start of the femur or pelvic fixation operation.
Other Name: Cetor® (RVG 19303)

Placebo Comparator: Saline 0.9%
Saline 0.9%
Other: Saline 0.9%
Infusion, just before the start of the femur or pelvic fixation operation

Primary Outcome Measures :
  1. Delta Interleukine-6 [ Time Frame: 6 hours after C1-INH administration ]

Secondary Outcome Measures :
  1. Cytokines and other markers of inflammation [ Time Frame: up to 12 days after C1-INH administration ]
  2. Neutrophil redistribution and phenotype [ Time Frame: Up to 12 days after C1-INH administration ]
  3. C1-inhibitor and complement concentration and activity [ Time Frame: Up to 12 days after C1-INH administration ]
  4. Hemodynamic response [ Time Frame: Up to 12 days after C1-INH administration ]

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:

  • Multi trauma patients
  • Femur or pelvic fracture
  • Injury Severity Score (ISS) ≥ 18
  • Age 18-80 yrs

Exclusion Criteria:

  • Congenital C1-inhibitor deficiency
  • Use of immune suppressants
  • Pregnancy
  • Known hypersensitivity for blood products
  • Fixation of femur fracture with external fixation or osteosynthesis

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): NCT01275976

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University Medical Centre Utrecht
Utrecht, Netherlands, 3508 GA
Sponsors and Collaborators
UMC Utrecht
Sanquin Plasma Products BV
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Principal Investigator: Luke P Leenen, MD, PhD UMC Utrecht

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Prof. dr Leenen, L.P.H. Leenen, MD, PhD, UMC Utrecht., UMC Utrecht Identifier: NCT01275976     History of Changes
Other Study ID Numbers: 34932
First Posted: January 13, 2011    Key Record Dates
Last Update Posted: February 4, 2015
Last Verified: February 2015

Keywords provided by Prof. dr Leenen, UMC Utrecht:
C1-esterase inhibitor
Systemic inflammation
Multiple Organ Dysfunction Syndrome

Additional relevant MeSH terms:
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Multiple Organ Failure
Hip Fractures
Wounds and Injuries
Pathologic Processes
Systemic Inflammatory Response Syndrome
Femoral Fractures
Fractures, Bone
Hip Injuries
Leg Injuries
Complement C1s
Complement C1 Inhibitor Protein
Complement C1 Inactivator Proteins
Immunologic Factors
Physiological Effects of Drugs
Complement Inactivating Agents
Immunosuppressive Agents