This is a multicentre, double-blind, placebo-controlled Phase III randomized clinical trial designed to evaluate the efficacy and safety of inhaled aprotinin in adult patients with moderate or severe acute respiratory distress syndrome (ARDS). A total of 156 critically ill patients admitted to intensive care units will be randomized to receive either inhaled aprotinin or placebo in addition to standard supportive care. The primary objective is to determine whether aprotinin improves clinical outcomes based on a composite endpoint of mortality and ventilator-free days at 28 days.
This study is a nation-wide, multicentre, double-blind, placebo-controlled, Phase III randomized clinical trial designed to investigate the efficacy and safety of inhaled aprotinin in adult patients diagnosed with moderate or severe acute respiratory distress syndrome (ARDS). ARDS is a heterogeneous acute inflammatory lung syndrome characterized by diffuse alveolar damage, increased vascular permeability, alveolar and interstitial edema, and severe hypoxemic respiratory failure. Despite advances in supportive care, no specific pharmacological therapy has demonstrated proven benefit. Aprotinin is a broad-spectrum serine protease inhibitor that targets the kallikrein-kinin system and attenuates systemic inflammatory responses, including reductions in pro-inflammatory cytokines and matrix metalloproteinases (MMPs). Experimental and clinical data suggest that MMP overexpression contributes to tissue damage, coagulation abnormalities, and impaired lung repair, representing a potential therapeutic target in ARDS. Inhaled aprotinin has been used clinically in patients with respiratory conditions, including COVID-19 and chronic pulmonary disease, with no reported adverse events via this route of administration. In this trial, 156 ICU patients with moderate or severe ARDS will be enrolled and randomized in a 1:1 ratio to receive either inhaled aprotinin or placebo, both administered alongside standard supportive care. The aprotinina dosing regimen will be four inhaled doses of 500 KIU every six hours (total 2,000 KIU/day), selected to achieve effective local pulmonary concentrations while minimizing systemic exposure. The primary endpoint is a composite of mortality and ventilator-free days at 28 days among survivors. Secondary outcomes include ICU and hospital mortality, duration of mechanical ventilation, and other clinically relevant respiratory and functional endpoints. Detailed study procedures, dosing, and administration are described in the study protocol. All study procedures will be conducted under a double-blind design. Patients will be prospectively followed for clinical outcomes during their ICU and hospital stay according to prespecified assessment timepoints. A Data Monitoring Committee (DMC) composed of independent clinical experts will periodically review safety and efficacy data, ensuring the protection of participants and the scientific validity of the study. The estimated study duration is four years, from September 2025 to September 2029.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
156
Inhaled aprotinin, diluted in 0.9% sodium chloride, is administrated via nebulization through an endotracheal or tracheostomy tube. The dose is 500 UI every 6 hours (totaling 2,000 UI/day) for six consecutive days. Each administration consists of a nebulized inhalation lasting no less than six minutes, with four inhalations delivered per day. Nebulization is performed using Aerogen® Solo vibrating mesh nebulizers to maintain a closed ventilatory circuit. The device produces aerosol particles with a median diameter of 2-10 µm; 30-50% of these aggregates reach diameters of 50-100 µm. Administration follows pharmacy blinding procedures. All patients receive standard supportive care according to local practice.
Placebo (sodium chloride) is administered by inhalation via endotracheal or tracheostomy tube using the Aerogen® Solo vibrating mesh nebulizer, four times daily for six consecutive days. It is delivered following the same dosing schedule, device specifications, and administration procedures as the active treatment. Administration follows pharmacy blinding procedures to maintain double-blind conditions. All patients receive standard supportive care according to local practice.
Hospital General Universitario de Ciudad Real
Ciudad Real, Ciudad Real, Spain
Ventilator-Free Days (VFD) in patients with moderate or severe ARDS
Number of days a patient is free from invasive mechanical ventilation (DLVI) within 28 days after first dose. A patient is considered ventilator-free after two consecutive calendar days of unassisted breathing. This outcome will be used to assess the efficacy of inhaled aprotinin compared with placebo.
Time frame: From first dose up to Day 28
Number of participants with at least one treatment-emergent adverse event
Incidence, severity, and relationship to treatment of adverse events (AEs), coded according to MedDRA (Medical Dictionary for Regulatory Activities), in treated participants. This outcome evaluates the safety profile of aprotinin compared with placebo.
Time frame: From first dose up to Day 180
Proportion of patients who die from any cause within 28, 90, or 180 days after receiving first dose of study treatment.
All-Cause Mortality.
Time frame: At Day 28, Day 90, and Day 180
Number of days free from ICU or hospital
Total number of days a patient remains outside the intensive care unit (ICU) and outside the hospital within 28 days after receiving first dose of study treatment.
Time frame: From first dose up to Day 28
Number of days on renal or vasoactive support within 28 days after first dose
Total number of days a patient requires renal replacement therapy or vasoactive support within 28 days after receiving first dose of study treatment.
Time frame: From first dose up to Day 28
Sequential Organ Failure Assessment (SOFA) score
Sequential Organ Failure Assessment (SOFA) score evaluated daily from Day 1 to Day 14, and on Days 21 and 28.
Time frame: From Day 1 up to Day 28
PaO₂/FiO₂ ratio during mechanical ventilation
Daily evaluation of the arterial oxygen partial pressure to inspired oxygen fraction (PaO₂/FiO₂) ratio during mechanical ventilation as an indicator of pulmonary function improvement in patients receiving study treatment.
Time frame: From Day 1 up to Day 28
Plasma inflammatory biomarkers
Measurement of plasma levels of selected pro- and anti-inflammatory cytokines (GM-CSF, IFN-α, IFN-γ, IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, TNF-α), chemokines (IP-10/CXCL10, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4), and cell adhesion/response markers (ICAM-1, CD62E/E-selectin, CD62P/P-selectin) in plasma on Day 1 and Day 5 in all participants receiving study treatment. Evaluates the effect of aprotinina on systemic inflammation.
Time frame: Day 1 and Day 5
Pulmonary biomarkers in bronchial and plasma samples
Determination of granular proteins, bradykinin, and kallikreins in bronchial brush and plasma samples on Day 1 and Day 5 as exploratory markers of pulmonary response and treatment effect of aprotinin.
Time frame: Day 1 and Day 5
Plasma aprotinin levels
Measurement of plasma aprotinin concentrations on Day 1 and Day 5 in all participants receiving study treatment.
Time frame: Day 1 and Day 5
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.