Recombinant Surfactant Protein D (rfhSP-D) to Prevent Neonatal Chronic Lung Disease

University College, London18 enrolled

Overview

The purpose of this study is to identify the safest dose of recombinant surfactant protein D (drug name: rfhSP-D) that can be administered to preterm infants born at less than 30 weeks gestation, and to help identify whether this can prevent the development of neonatal chronic lung disease.

This is a Phase I, dose escalation safety study that aims to identify the recommended phase 2 dose of recombinant fragment of human surfactant protein D (rfhSP-D) (drug name: rfhSP-D) for infants at risk of neonatal chronic lung disease. This study will aim to establish if the administration of rfhSP-D to the lungs of preterm babies, via an endotracheal tube, is safe at the proposed dosage range (1mg/kg - 4mg/kg) and whether this dose results in detectable concentrations in lung secretions or serum. Surfactant protein D (SP-D) is a naturally occurring component of the surfactant system with anti-inflammatory properties. Current surfactant replacement therapy contains phospholipids and surfactant proteins B and C (SP-B and SP-C) but no surfactant protein A (SP-A) or surfactant protein D (SP-D). Proof of concept regarding the anti-infective and anti-inflammatory activity of SP-D has been achieved in mouse and a preterm lamb models of lung disease and supports increasing evidence of the role played by deficiency of SP-D in human respiratory diseases. Subjects will be enrolled in cohorts with increasing dose. Whether or not the dose is escalated will depend on the occurrence of dose limiting events (DLE) in all current patients and the doses that they have received. A model will be used to estimate the risk of DLE per dose level. Initial estimates of these risks will be updated using data collected throughout the trial. Up to 24 infants of less than 30 weeks gestation will be recruited in the study and receive intra-tracheal administration of SP-D59, in the dose range 1mg/kg, 2mg/kg or 4mg/kg per dose for up to 3 doses. The first dose of SP-D59 will be given as soon as possible after the first dose of standard surfactant therapy (e.g., Curosurf). Subsequent doses of the IMP will be given at 12 hours and 24 hours after the first dose was administered.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Chronic Lung Disease of Prematurity Respiratory Distress Syndrome in Premature Infant Bronchopulmonary Dysplasia

Interventions

Recombinant fragment of human surfactant protein D (rfhSP-D)DRUG

Administration of rfhSP-D

Eligibility

Sex: ALLMin age: 23 WeeksMax age: 30 Weeks

Medical Language ↔ Plain English

Participant Inclusion Criteria: 1. Inborn infants born at between 23 weeks and 0 days and 29 weeks and 6 days gestation. 2. Infant must be intubated or planned to be intubated for respiratory distress at time of eligibility check, and this should be done within 12 hours from time of birth. 3. Receiving standard surfactant therapy 4. Clinically stable on mechanical ventilation. Stability is defined at the time of IMP instillation and is defined below. 5. Written informed consent from parents/guardians/person with legal responsibility Definition of stability: 1. Blood gases within the normal range for preterm infants (pH\>7.20; paCO2 \<60mmHg) 2. Mean blood pressure with or without inotropic support at at least gestational age or above (mmHg) 3. No evidence of a pneumothorax 4. Clinical observations within acceptable range for an infant of that gestational age 5. No stability concerns from the attending neonatologist Participant Exclusion Criteria: 1. Congenital anomalies i.e any major antenatal diagnosed congenital abnormalities such as congenital heart disease, suspected or known chromosomal abnormalities 2. Parents/legal guardians unable to give consent due to learning or other difficulties 3. Infants requiring only CPAP support without the need for surfactant replacement therapy, i.e. without endotracheal intubation 4. Infants born in very poor condition and judged too sick or unstable to be included (high risk of mortality) in an experimental first in human study, for example infants that are requiring maximal intensive care therapy and have findings such as a grade IV intraventricular haemorrhage that is likely to be life limiting. 5. Infants that are born out of the participating site. 6. Participation in any other interventional study (participation in an observational study is permissible).

Locations (1)

University College London Hospitals

London, United Kingdom

Outcomes

Primary Outcomes

Occurence of Dose Limiting Events to assess the safety profile of the IMP (rfhSP-D)

To assess the safety profile of rfhSP-D across dose levels based on the occurrence of Dose Limiting Events (DLEs) which are events Garde 3 or above on the NAESS scale related to the IMP

Time frame: Day 0 to 96 hours

To find recommended Phase 2 Dose of rfhSP-D

To establish the Recommended Phase 2 Dose (RP2D) of rfhSP-D for preterm infants born at gestational age of 23 weeks to 29 weeks + 6 days.

Time frame: Day 0 to the point of hospital discharge (40 weeks post-menstrual age)

Secondary Outcomes

Occurrence of non-dose limiting events, including SAE/AEs

To establish the safety profile of rfhSP-D across dose levels based on the occurrence of non-DLEs, including SAE/AEs.

Time frame: Day 0 to the point of hospital discharge (40 weeks post-menstrual age)

Systemic absorption of rfhSP-D

To evaluate systemic absorption of rfhSP-D using serial measurements of rfhSP-D in serum and its continued presence in tracheal fluid.

Time frame: Day 0 to 36 weeks post menstrual age

Effects of rfhSP-D on the cell counts of inflammatory markers

To determine the effect of rfhSP-D on Inflammatory markers in the lung secretions (eg.cell counts of the following markers: neutrophils, macrophages, MMPs, neutrophil elastase, IL-8,IL-6, IL-1).

Time frame: Day 0 to 36 weeks post menstrual age

Data from ClinicalTrials.gov

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