A Randomized-Controlled Trial of Inhaled Hypertonic Saline (7%) to Evaluate the Lung Clearance Index

The Hospital for Sick Children24 enrolled

Overview

The Lung Clearance Index (LCI) is a non invasive measure of lung function that is more sensitive than FEV1. It can be used to measure lung function in children younger than 6 years of age. Therefore, it has a future role in assessing novel therapeutics in the Cystic Fibrosis (CF) population. As such, determining if it can be used as a short term pharmacodynamic biomarker is paramount.

Inhaled Hypertonic saline (7%) is a treatment intervention for Cystic Fibrosis patients and has previously been shown to improve lung function and decrease the number of pulmonary exacerbations. The Cystic Fibrosis Transmembrane Regulator Gene (CFTR) protein is essential for maintaining fluid and electrolyte homeostasis in the lung and CFTR defects cause depletion of the periciliary liquid layer which results in impaired mucociliary clearance. Inhaled hypertonic saline (7%) acts as an osmotic agent in the lungs; it repletes the airway surface liquid (ASL) and improves mucociliary clearance. In addition, we have recently demonstrated that the Lung Clearance Index (LCI) is also a responsive outcome measure. In an intervention study in which patients were treated with hypertonic saline inhalation twice daily for 28 days, LCI but not FEV1 significantly improved in 17 pediatric Cystic Fibrosis (CF) patients with mild lung disease. In this study, LCI was more sensitive to a change in response to treatment than spirometry in a small number of patients. However, it still remains unknown if the LCI will be able to detect a treatment effect on a shorter time scale after an intervention. Its use as a short-term pharmacodynamic biomarker in CF patients remains unknown. The ability of the LCI to detect treatment effects within hours after an intervention would be invaluable to the development of new therapeutic interventions for CF patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Cystic Fibrosis

Interventions

Hypertonic Saline 7%DRUG

PARI Hyper-Sal™ Sodium Chloride Solution - 7%

Isotonic Saline 0.9% (Placebo)DRUG

Eligibility

Sex: ALLMin age: 6 YearsMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of CF as defined by two or more clinical features of CF and a documented sweat chloride \> 60 mEq/L by quantitative pilocarpine iontophoresis test or a genotype showing two well characterized disease causing mutations * Informed consent and verbal assent (as appropriate) provided by the subject's parent or legal guardian and the subject * At least six years of age at enrolment * Able to perform reproducible spirometry meeting American Thoracic Society standards * Pre-bronchodilator FEV1 % predicted \> or equal to 40 % predicted * Ability to perform a reproducible LCI maneuver at screening Exclusion Criteria: * Known respiratory culture positive for Burkholderia cepacia * Previous lung transplantation * Use of intravenous antibiotics within 14 days of screening * Use of oral antibiotics including prophylactic antibiotics (e.g., augmentin, tetracycline, cloxacillin, cephalosporins, septra, bactrim) within 14 days of screening * Initiation of a new maintenance (e.g high dose ibuprofen, Pulmozyme®, aerosolized antibiotics) within 14 days of screening * Use of systemic corticosteroids within 14 days of screening * Investigational drug use within 30 days of screening * Use of hypertonic saline (7%) \< 4 weeks before screening or outside of the study protocol * Participation in any therapeutic clinical study \<4 weeks or, 5 half-lives, whichever is longer, before screening * Smoking \< 3 months before screening * Presence of a condition or abnormality that in the opinion of the site investigator would compromise the safety of the subject or the quality of the data

Locations (2)

The Hospital for Sick Children

Toronto, Ontario, Canada

St. Michaels Hospital

Toronto, Ontario, Canada

Outcomes

Primary Outcomes

Lung Clearance Index

The change in the Lung Clearance Index as measured by nitrogen washout between baseline and 24 hours after each inhalation of Hypertonic Saline (7%) and Isotonic Saline (0.9%)

Time frame: Baseline to 24 hrs post dose

Secondary Outcomes

Pulmonary Function Testing

Forced Expiratory Volume in one second (FEV1) % predicted, Forced Expiratory Vital Capacity (FVC) % predicted and Forced Expiratory Flow rate (FEF) 25-75 % predicted will be measured using spirometry.

Time frame: Baseline, 1,2,4 and 24hrs post-dose

Lung Clearance Index measured using Mass Spectroscopy

The multiple breath washout will be performed in the classical method using a mass spectroscopy (MS): each test consists of two phases: a wash-in phase and washout phase using an inert dry gas mixture containing 4% Sulfur hexafluoride (SF6), 4% He, 21% oxygen and balance nitrogen.

Time frame: Baseline, 1,2,4 and 24 hrs post dose

Lung Clearance Index measured using Nitrogen Washout

The change in the Lung Clearance Index as measured by nitrogen washout between baseline and 1,2 and 4 hours after each inhalation of Hypertonic Saline (7%) and Isotonic Saline (0.9%)

Time frame: Baseline, 1,2, 4hrs post dose

Data from ClinicalTrials.gov

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