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Impact of Smoking and Its Cessation on Systemic and Airway Immune Activation

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ClinicalTrials.gov Identifier: NCT02836067
Recruitment Status : Recruiting
First Posted : July 18, 2016
Last Update Posted : August 14, 2019
Sponsor:
Collaborator:
National Institute on Drug Abuse (NIDA)
Information provided by (Responsible Party):
Boston Medical Center

Brief Summary:
The purpose of this study is to learn how smoking affects the immune systems in people with HIV infection. The investigators would like to know if HIV infected smokers who quit smoking have different responses in their tissues from people who keep smoking.

Condition or disease Intervention/treatment Phase
HIV Smoking Behavioral: Counseling Drug: Smoking Cessation drugs Procedure: Bronchoscopy Procedure: Blood Draw Behavioral: Questionnaires Not Applicable

Detailed Description:

For Aim 1, 20 patients with HIV disease who have never smoked will be recruited with comparison to 20 active smokers with HIV disease, without evidence of COPD from spirometry, who are matched in demographics. Smokers who are interested in participating in a smoking cessation program will be referred to our Clinical Trials Unit (CTU) for all subsequent study visits.

Additionally, a comparison group of 20 uninfected smokers who have already been enrolled in the co-investigator's (Dr. Kwon) study will be used as comparison group. These patients have similar inclusion/exclusion criteria as this study and have been verified to be HIV-antibody negative. We will obtain de-identified samples and immunological and virological data already collected by Dr. Kwon. De-identified banked PBMC, plasma and BAL samples will also be accessible to us using a material transfer agreement to perform epithelial transcriptional gene expression profiling.

For Aim 2, a total of 100 HIV-infected individuals on effective ART who are active smokers and interested in participating in a smoking cessation program will be recruited. If 20 individuals who achieve 10-week of cessation are enrolled before 100 HIV smokers are fully enrolled, enrollment will cease, as 100 participants is an overestimate of the number of patients needed need to enroll to have 20 subjects achieve successful smoking cessation. The maximum total number of patients needed for the grant is 120 (100 HIV smokers, 20 HIV non-smokers).

We will recruit up to 120 patients from the BMC Center for Infectious Diseases (CID) outpatient clinic. The clinic serves the largest HIV-infected population in Boston, approximately 1,700 persons, and is composed largely of an urban socioeconomically disadvantaged population. Over 50% of HIV-infected patients in the CID are smokers, and >60% (based on prescription history of NRT, bupropion, varenicline) have attempted smoking cessation. We will recruit from flyers, the BMC ReSPECT registry, medical record screening, and physician referrals. A listing of the trial will also be posted on clinicaltrials.gov.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Impact of Smoking and Its Cessation on Systemic and Airway Immune Activation
Actual Study Start Date : June 15, 2017
Estimated Primary Completion Date : September 2021
Estimated Study Completion Date : September 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS Smoking

Arm Intervention/treatment
Smokers

HIV-positive smokers will be enrolled in a smoking cessation program including the following procedures:

Counseling Smoking cessation drugs Questionnaires Blood Draw Bronchoscopy

Behavioral: Counseling
Smoking cessation counseling

Drug: Smoking Cessation drugs
Medication to aid smoking cessation

Procedure: Bronchoscopy
Bronchoscopy

Procedure: Blood Draw
Screening and research blood draws

Behavioral: Questionnaires
Behavioral questionnaires

Non-Smokers

HIV-positive non-smokers will be enrolled as a comparison group to HIV-positive smokers and will have the following procedures:

Questionnaires Blood Draw Bronchoscopy

Procedure: Bronchoscopy
Bronchoscopy

Procedure: Blood Draw
Screening and research blood draws

Behavioral: Questionnaires
Behavioral questionnaires




Primary Outcome Measures :
  1. .Difference in T cell and monocyte immune subsets, level of activation [ Time Frame: Week 12 ]
    Aliquots of BAL and PBMC will be stained for surface antibodies to distinguish differentiation and activation markers. Monocyte cells will be phenotyped by CD3, CD19 and CD56 all on FITC, CD14 BUV 395, CD16 BV510, CCR2 PE, CX3CR1 APC, CD11c PEcf594, CD80 BV 421, CD86 BV 605, HLA-DR BV785, CD123 PE Cy7 and eFluor780 fixable viability dye. T cell populations will be stained for CD3, CD4, CD8, CD45RA, CCR7, CD27 and CD28; activation status by expression of CD25, CD38, CD69, HLA-DR, OX40. We will determine if they are Th2/Tc2-type cells by expression of CCR4, CCR8, T1/ST2, CRTH2. Flow will be performed on a LSRII (BD) and analyzed with FlowJo (Tree Star).


Secondary Outcome Measures :
  1. Difference in levels of plasma inflammatory markers [ Time Frame: Week 12 ]
    For analysis of inflammatory protein levels, BAL fluid will be concentrated 10-fold using a Centricon filter (Millipore) with a 3,000 MW cutoff. We have found that assaying for cytokines is more reliable when the BAL is concentrated 10-fold since BAL is diluted ~100-fold by the procedure. sCD14 (R&D) and iFABP (Hycult) will be measured by ELISA. LPS will be measured with the LAL assay (Pierce) and sCD163 (Trillium Diag). Additional human cytokines associated with inflammatory processes, including TNF-α, IFN-α/g, IL-6/7/10, IP-10 and MCP-1, will be measured using the Milliplex cytokine- kit (Millipore), read on a Luminex 100 and analyzed with Beadview software (Upstate Cell).

  2. Differences in level of oxidative stress [ Time Frame: Week 12 ]
    Cells from blood and BAL will be stimulated with and without PMA for 30 min. and incubated with DHR123 to directly detect intracellular ROS production. Cells will be stained with fluorescent antibodies recognizing lineage markers for T cells (CD3, CD4, CD8), macrophages (CD14), B cells (CD19, CD20), and granulocytes (CD66b).

  3. Differences in the level of measure of HIV residual viremia [ Time Frame: Week 12 ]
    Measure levels of HIV-1 ca-DNA, ca-RNA and 2-LTR circles in BAL and PBMC samples collected from HIV-infected smokers versus non-smokers. Cellular DNA and RNA from PBMCs and BAL cells will be extracted with AllPrep DNA/RNA mini kit (Qiagen). HIV-1 ca-DNA will be quantified using a sensitive quantitative PCR (qPCR) assay to measure a conserved LTR/gag region96, and modified in our lab118. Measurements of ca-DNA will be reported as copies of HIV DNA/106 cells. Quantification of a conserved region of the human CCR5 will be used to determine the number of cells in each sample well.

  4. Differences airway transcriptional profile [ Time Frame: Week 12 ]
    Compare gene expression profiles between HIV smokers and non-smokers. Library preparation for RNA sequencing will be accomplished using Illumina's TruSeq RNA Sample Prep Kit v2, using 200-500ng of total RNA from each bronchial epithelial brushing. Briefly, RNA will be isolated using poly(A) selection, fragmented into a range of lengths centered around 200 base pairs, and randomly primed for reverse transcription followed by first and second-strand synthesis to create double-stranded cDNA fragments. Subsequently, these fragments will undergo PCR amplification, purification, and be used for cluster generation on a cBot machine using Illumina TruSeq Paired-End Cluster Generation Kits.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

To be eligible for this study, participants must be a patient at BMC and meet all of the following inclusion criteria.

  1. Ages 18-75
  2. HIV infected on ART ≥ 6 months and virologically suppressed (<50 cop/ml) at the time of enrollment (lab test within 3 months )
  3. Currently active smoker with self-reported ≥5 cigarettes per day most days of the week and confirmed by positive salivary cotinine verification at screening.
  4. Aim 1 self-reported non-smokers will be confirmed by salivary cotinine verification at screening.
  5. Laboratory values within 60 days prior to enrollment that meet the following criteria:

    1. Hemoglobin ≥ 10.0 g/dL
    2. Absolute neutrophil count ≥ 1000/mm3
    3. Platelet count ≥ 80,000/mm3
  6. Negative urine pregnancy test (sensitive to 25 IU HCG) at screening and within 24 hours of the study procedure for female participants
  7. Ability and willingness to give written informed consent and to comply with study requirements.

Participants will be excluded from this study if:

  1. Pregnant or breast-feeding or less than 8 weeks post-partum.
  2. Active malignancy
  3. Significant immunological illnesses/deficiencies
  4. Use of any immunomodulatory agents within 30 days prior to study enrollment.
  5. Recent active illness (2 months)
  6. History of tuberculosis, lung cancer, bronchiectasis, pulmonary fibrosis, and pulmonary hypertension
  7. Self-reported regular or recreational use of inhaled substances (such as marijuana, crack, fentanyl, heroin, hookah, e-cigarettes) as well as chewing tobacco within past month
  8. COPD GOLD Stage 3-4 based on screening spirometry. Subjects who meet all the inclusion and exclusion criteria will undergo spirometry.

    1. Aim 1: Only HIV smokers with no diagnosis of COPD; normal spirometry and FEV1/FVC >0.7.
    2. Aim 2: HIV smokers with evidence of COPD GOLD Stage 1-2 (mild-moderate) can be enrolled.
    3. All screened participants with known COPD or spirometry diagnosis of GOLD Stage 3-4 will be excluded due to safety of bronchoscopy.
  9. A history of alcohol dependence within the 6 months prior to the screening visit.
  10. History of intolerance, sensitivity, allergy or anaphylaxis to lidocaine or other amide anesthetics, as well as benzocaine or other ester type anesthetics.
  11. History of recent myocardial infarction, chronic renal failure requiring dialysis, decompensated cirrhosis, or any other condition that in the opinion of the investigator will compromise ability to participate in the study.
  12. Currently taking anticoagulants including but not limited to: heparin (Hep-Lock, Hep-Pak), Hep-Pak CVC, Heparin Lock Flush), warfarin (Coumadin), tinzaparin (Innohep), enoxaparin (Lovenox), danaparoid (Orgaran), dalteparin (Fragmin), clopidogrel (Plavix), prophylactic aspirin, and NSAID use 48 hours prior to bronchoscopy.
  13. Subject taking any of the following medications: systemic steroids (inhaled or nasal steroid therapy is permitted), interleukins, systemic interferons (e.g., local injection of interferon alpha for treatment of HPV is permitted) or systemic chemotherapy.
  14. Prior recipient of HIV vaccine.
  15. Recent abdominal or cataract surgery
  16. Investigator discretion Note: If subject reports current symptoms of upper respiratory infection, study start will be delayed 1 week or until symptoms are resolved.

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): NCT02836067


Contacts
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Contact: Nina Lin, M.D. 617-414-5242 nina.lin@bmc.org
Contact: Jennifer Bombard 617-414-7719 jennifer.bombard@bmc.org

Locations
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United States, Massachusetts
Boston Medical Center Recruiting
Boston, Massachusetts, United States, 02118
Contact: Nina Lin, MD    617-414-5242    nina.lin@bmc.org   
Sponsors and Collaborators
Boston Medical Center
National Institute on Drug Abuse (NIDA)
Investigators
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Principal Investigator: Nina Lin, M.D. Boston Medical Center

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Responsible Party: Boston Medical Center
ClinicalTrials.gov Identifier: NCT02836067     History of Changes
Other Study ID Numbers: H-35295
R01DA042685-02 ( U.S. NIH Grant/Contract )
First Posted: July 18, 2016    Key Record Dates
Last Update Posted: August 14, 2019
Last Verified: August 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes