TY - JOUR
T1 - A pilot clinical trial of recombinant human angiotensin-converting enzyme 2 in acute respiratory distress syndrome
AU - Khan, Akram
AU - Benthin, Cody
AU - Zeno, Brian
AU - Albertson, Timothy E.
AU - Boyd, John
AU - Christie, Jason D.
AU - Hall, Richard
AU - Poirier, Germain
AU - Ronco, Juan J.
AU - Tidswell, Mark
AU - Hardes, Kelly
AU - Powley, William M.
AU - Wright, Tracey J.
AU - Siederer, Sarah K.
AU - Fairman, David A.
AU - Lipson, David A.
AU - Bayliffe, Andrew I.
AU - Lazaar, Aili L.
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/9/7
Y1 - 2017/9/7
N2 - Background: Renin-angiotensin system (RAS) signaling and angiotensin-converting enzyme 2 (ACE2) have been implicated in the pathogenesis of acute respiratory distress syndrome (ARDS). We postulated that repleting ACE2 using GSK2586881, a recombinant form of human angiotensin-converting enzyme 2 (rhACE2), could attenuate acute lung injury. Methods: We conducted a two-part phase II trial comprising an open-label intrapatient dose escalation and a randomized, double-blind, placebo-controlled phase in ten intensive care units in North America. Patients were between the ages of 18 and 80years, had an American-European Consensus Criteria consensus diagnosis of ARDS, and had been mechanically ventilated for less than 72h. In part A, open-label GSK2586881 was administered at doses from 0.1mg/kg to 0.8mg/kg to assess safety, pharmacokinetics, and pharmacodynamics. Following review of data from part A, a randomized, double-blind, placebo-controlled investigation of twice-daily doses of GSK2586881 (0.4mg/kg) for 3days was conducted (part B). Biomarkers, physiological assessments, and clinical endpoints were collected over the dosing period and during follow-up. Results: Dose escalation in part A was well-tolerated without clinically significant hemodynamic changes. Part B was terminated after 39 of the planned 60 patients following a planned futility analysis. Angiotensin II levels decreased rapidly following infusion of GSK2586881, whereas angiotensin-(1-7) and angiotensin-(1-5) levels increased and remained elevated for 48h. Surfactant protein D concentrations were increased, whereas there was a trend for a decrease in interleukin-6 concentrations in rhACE2-treated subjects compared with placebo. No significant differences were noted in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, oxygenation index, or Sequential Organ Failure Assessment score. Conclusions: GSK2586881 was well-tolerated in patients with ARDS, and the rapid modulation of RAS peptides suggests target engagement, although the study was not powered to detect changes in acute physiology or clinical outcomes. Trial registration: ClinicalTrials.gov, NCT01597635. Registered on 26 January 2012.
AB - Background: Renin-angiotensin system (RAS) signaling and angiotensin-converting enzyme 2 (ACE2) have been implicated in the pathogenesis of acute respiratory distress syndrome (ARDS). We postulated that repleting ACE2 using GSK2586881, a recombinant form of human angiotensin-converting enzyme 2 (rhACE2), could attenuate acute lung injury. Methods: We conducted a two-part phase II trial comprising an open-label intrapatient dose escalation and a randomized, double-blind, placebo-controlled phase in ten intensive care units in North America. Patients were between the ages of 18 and 80years, had an American-European Consensus Criteria consensus diagnosis of ARDS, and had been mechanically ventilated for less than 72h. In part A, open-label GSK2586881 was administered at doses from 0.1mg/kg to 0.8mg/kg to assess safety, pharmacokinetics, and pharmacodynamics. Following review of data from part A, a randomized, double-blind, placebo-controlled investigation of twice-daily doses of GSK2586881 (0.4mg/kg) for 3days was conducted (part B). Biomarkers, physiological assessments, and clinical endpoints were collected over the dosing period and during follow-up. Results: Dose escalation in part A was well-tolerated without clinically significant hemodynamic changes. Part B was terminated after 39 of the planned 60 patients following a planned futility analysis. Angiotensin II levels decreased rapidly following infusion of GSK2586881, whereas angiotensin-(1-7) and angiotensin-(1-5) levels increased and remained elevated for 48h. Surfactant protein D concentrations were increased, whereas there was a trend for a decrease in interleukin-6 concentrations in rhACE2-treated subjects compared with placebo. No significant differences were noted in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen, oxygenation index, or Sequential Organ Failure Assessment score. Conclusions: GSK2586881 was well-tolerated in patients with ARDS, and the rapid modulation of RAS peptides suggests target engagement, although the study was not powered to detect changes in acute physiology or clinical outcomes. Trial registration: ClinicalTrials.gov, NCT01597635. Registered on 26 January 2012.
KW - Acute lung injury
KW - Acute respiratory failure
KW - Adult
KW - Angiotensin-converting enzyme 2
KW - Humans
KW - Interleukin-6
KW - Renin-angiotensin system
KW - Respiratory distress syndrome
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U2 - 10.1186/s13054-017-1823-x
DO - 10.1186/s13054-017-1823-x
M3 - Article
C2 - 28877748
AN - SCOPUS:85028931663
SN - 1364-8535
VL - 21
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 234
ER -