Projects & Collaborations 2 foundShow per page10 10 20 50 Recombinant human C1 esterase inhibitor (conestat alfa) in the prevention of critical SARS-CoV-2 infection in hospitalized patients with COVID-19: a randomized, parallel-group, openlabel, multi-center exploratory trial. NFP 78 Research Project | 4 Project MembersSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally since December 2019 causing a worldwide pandemic of coronavirus disease 2019 (COVID-19). Systemic hyper-inflammation is a hallmark of severe stages of COVID-19 leading to acute lung injury (ALI), need for mechanical ventilation and ultimately death. The mechanism responsible for virus-induced hyper-activation of the host immune system remains to be fully elucidated. Unregulated complement system activation induced by CoVs plays a crucial role in the pathogenesis of acute lung injury in COVID-19. Similarly, involvement of the kinin-kallikrein system in capillary leakage and subsequent pulmonary angioedema has been suspected. In particular, a reduced activity of angiotensin converting enzyme 2 (ACE2) caused by SARS-CoV-2 leads to a relative abundance of bradykinin degradation products and local pulmonary edema. Lastly, over-activation of the contact activation system may be involved in the observed thromboinflammation. C1 esterase inhibitor (C1INH) is a potent inhibitor of these three plasmatic cascades and has been shown to reduce pulmonary inflammation and death in a CoV mouse model and in human studies of severe sepsis. Aims: To assess the safety and efficacy of recombinant C1INH (conestat alfa, Ruconest®) in addition to standard of care (SOC) in patients hospitalized with severe SARS-CoV-2 compared to SOC only.Hypothesis: Administration of conestat alfa for 72 hours in addition to SOC in patients with severe SARS-CoV-2 pneumonia is safe and associated with a reduced clinical severity on day 7 and a lower risk of disease progression to mechanical ventilation compared to SOC.Methodology: The PROTECT-COVID-19 trial is a randomized, open-label, parallel-group, controlled, multi-center clinical trial. Consecutive patients admitted with COVID-19 not requiring intensive care support will be randomized in a 2:1 ratio to treatment with conestat alfa for 72 hours in addition to SOC or SOC only. The primary endpoint will be the disease severity on the 7-point Ordinal WHO scale on day 7. Secondary endpoints include time to clinical improvement, the proportion of participants alive and not having required invasive or non-invasive ventilation and the incidence of ALI within 14 days after enrolment. Treatment safety and the activity of the above mentioned plasmatic cascades will be assessed. For a 2:1-randomization, a nonparametric analysis by the stratified logrank-test, and an adaptive group sequential analysis, the overall sample size is estimated as 120 = 80 + 40. Two interim analyses after 40 and 80 patients are planned according to the Pocock adjusted levels ap = 0.0221.Potential significance: Targeting multiple inflammatory cascades with conestat alfa early during COVID-19 is an innovative approach to prevent disease progression by ameliorating excessive (thrombo-) inflammation. Interventions that prevent deterioration and mechanical ventilation in COVID-19 are highly desired in a pandemic situation with limited ICU and ventilation support capacity. If treatment with conesta alfa proves to ameliorate pulmonary inflammation and injury, this may be relevant not only on an individual but also on a population level. Significance of mannose-binding lectin and the lectin pathway in acute and recurrent ischemia/repefusion injury Research Project | 4 Project MembersMannose-binding lectin (MBL), a circulating pattern-recognition protein of the lectin pathway of complement is involved in the clearance of microorganisms and apoptotic cells. The concentration of functional MBL multimers is profoundly influenced by several polymorphisms in the MBL2 gene on chromosome 10, resulting in remarkable variations in serum MBL concentrations in apparently healthy individuals. Beyond infections, recent experimental studies have acknowledged additional important roles of MBL in atherosclerosis and ischemia/reperfusion (IR) injury. However, human data are scarce. This proposal aims to characterise in more depth the role of MBL and the lectin pathway in three human diseases, in which acute or repetitive I/R injury and/or atherosclerosis contribute to pathophysiology and outcome: systemic lupus erythematosus.primary (SLE), systemic sclerosis (SSc), and primary open angle glaucoma (POAG). In the SLE cohort sub-study, association of MBL deficiency with vascular events will be investigated in subjects from the well characterized Swiss SLE cohort. This is of importance, as SLE patients have an increased cardiovascular mortality and morbidity compared to the average individual. In the SSc cohort sub-study, activity of the lectin pathway including levels of MBL and the ficolins will be correlated with disease activity and organ involvement in individuals from a large European SSc cohort. Our preliminary data from a previous small Australian SSc cohort indicates that MBL deficiency might be associated with less organ damage. Hence, it might be worth to explore inhibition of the MBL or the lectin pathway in the future. In the POAG case-control sub-study, activity of the complement system in general and the lectin pathway in particular will be examined in POAG cases compared to healthy controls. This is of interest, as vascular dysfunction and repetitive I/R injury seem to be a hallmark in the pathogenesis of POAG, and current treatment options are limited. This project will lead to a more comprehensive understanding of the pathogenesis and the importance of MBL and the lectin pathway in I/R injury in SLE, SSc and POAG. Furthermore, it might facilitate future therapeutic interventions like inhibition of MBL or the lectin pathway to ameliorate I/R injury in these settings. 1 1
Recombinant human C1 esterase inhibitor (conestat alfa) in the prevention of critical SARS-CoV-2 infection in hospitalized patients with COVID-19: a randomized, parallel-group, openlabel, multi-center exploratory trial. NFP 78 Research Project | 4 Project MembersSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally since December 2019 causing a worldwide pandemic of coronavirus disease 2019 (COVID-19). Systemic hyper-inflammation is a hallmark of severe stages of COVID-19 leading to acute lung injury (ALI), need for mechanical ventilation and ultimately death. The mechanism responsible for virus-induced hyper-activation of the host immune system remains to be fully elucidated. Unregulated complement system activation induced by CoVs plays a crucial role in the pathogenesis of acute lung injury in COVID-19. Similarly, involvement of the kinin-kallikrein system in capillary leakage and subsequent pulmonary angioedema has been suspected. In particular, a reduced activity of angiotensin converting enzyme 2 (ACE2) caused by SARS-CoV-2 leads to a relative abundance of bradykinin degradation products and local pulmonary edema. Lastly, over-activation of the contact activation system may be involved in the observed thromboinflammation. C1 esterase inhibitor (C1INH) is a potent inhibitor of these three plasmatic cascades and has been shown to reduce pulmonary inflammation and death in a CoV mouse model and in human studies of severe sepsis. Aims: To assess the safety and efficacy of recombinant C1INH (conestat alfa, Ruconest®) in addition to standard of care (SOC) in patients hospitalized with severe SARS-CoV-2 compared to SOC only.Hypothesis: Administration of conestat alfa for 72 hours in addition to SOC in patients with severe SARS-CoV-2 pneumonia is safe and associated with a reduced clinical severity on day 7 and a lower risk of disease progression to mechanical ventilation compared to SOC.Methodology: The PROTECT-COVID-19 trial is a randomized, open-label, parallel-group, controlled, multi-center clinical trial. Consecutive patients admitted with COVID-19 not requiring intensive care support will be randomized in a 2:1 ratio to treatment with conestat alfa for 72 hours in addition to SOC or SOC only. The primary endpoint will be the disease severity on the 7-point Ordinal WHO scale on day 7. Secondary endpoints include time to clinical improvement, the proportion of participants alive and not having required invasive or non-invasive ventilation and the incidence of ALI within 14 days after enrolment. Treatment safety and the activity of the above mentioned plasmatic cascades will be assessed. For a 2:1-randomization, a nonparametric analysis by the stratified logrank-test, and an adaptive group sequential analysis, the overall sample size is estimated as 120 = 80 + 40. Two interim analyses after 40 and 80 patients are planned according to the Pocock adjusted levels ap = 0.0221.Potential significance: Targeting multiple inflammatory cascades with conestat alfa early during COVID-19 is an innovative approach to prevent disease progression by ameliorating excessive (thrombo-) inflammation. Interventions that prevent deterioration and mechanical ventilation in COVID-19 are highly desired in a pandemic situation with limited ICU and ventilation support capacity. If treatment with conesta alfa proves to ameliorate pulmonary inflammation and injury, this may be relevant not only on an individual but also on a population level.
Significance of mannose-binding lectin and the lectin pathway in acute and recurrent ischemia/repefusion injury Research Project | 4 Project MembersMannose-binding lectin (MBL), a circulating pattern-recognition protein of the lectin pathway of complement is involved in the clearance of microorganisms and apoptotic cells. The concentration of functional MBL multimers is profoundly influenced by several polymorphisms in the MBL2 gene on chromosome 10, resulting in remarkable variations in serum MBL concentrations in apparently healthy individuals. Beyond infections, recent experimental studies have acknowledged additional important roles of MBL in atherosclerosis and ischemia/reperfusion (IR) injury. However, human data are scarce. This proposal aims to characterise in more depth the role of MBL and the lectin pathway in three human diseases, in which acute or repetitive I/R injury and/or atherosclerosis contribute to pathophysiology and outcome: systemic lupus erythematosus.primary (SLE), systemic sclerosis (SSc), and primary open angle glaucoma (POAG). In the SLE cohort sub-study, association of MBL deficiency with vascular events will be investigated in subjects from the well characterized Swiss SLE cohort. This is of importance, as SLE patients have an increased cardiovascular mortality and morbidity compared to the average individual. In the SSc cohort sub-study, activity of the lectin pathway including levels of MBL and the ficolins will be correlated with disease activity and organ involvement in individuals from a large European SSc cohort. Our preliminary data from a previous small Australian SSc cohort indicates that MBL deficiency might be associated with less organ damage. Hence, it might be worth to explore inhibition of the MBL or the lectin pathway in the future. In the POAG case-control sub-study, activity of the complement system in general and the lectin pathway in particular will be examined in POAG cases compared to healthy controls. This is of interest, as vascular dysfunction and repetitive I/R injury seem to be a hallmark in the pathogenesis of POAG, and current treatment options are limited. This project will lead to a more comprehensive understanding of the pathogenesis and the importance of MBL and the lectin pathway in I/R injury in SLE, SSc and POAG. Furthermore, it might facilitate future therapeutic interventions like inhibition of MBL or the lectin pathway to ameliorate I/R injury in these settings.
