Covid19APEL-COVIDNCT04632732
Apelin; ACE2 and Biomarkers of Alveolar-capillary Permeability in SARS-cov-2 (COVID-19).
An observational study of Covid19, run by Centre de recherche du Centre hospitalier universitaire de Sherbrooke at 1 site in Canada.
Trial summary
Hypothesis: The apelin/APJ system is involved in the protection of the lung affected by the COVID-19 by interacting with the SARS-coV-2 entry door: the Angiotensin I Converting Enzyme 2 (ACE2) and the renin-angiotensin system (ras). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Covid19
- What is being tested?
- COVID-19 test and Blood sampling
- How many people
- 140 participants
- Where
- 1 siteCanada
- Study dates
- 26 Oct 2020to 1 Oct 2021
- How long will I take part?
- 28 Days
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients hospitalized on floors (pulmonology or in internal medecine) or in intensive care units of the Sherbrooke hospital/CHUS and patients hospitalized in intensive care units of the Angers hospital/CHUA.
Who may be able to join
- For the 4 -non-control- major groups:
- Adults patients hospitalized for symptomatic acute (presumably infectious) respiratory illness
- In the 36 hours after admission.
Who cannot join
- Patients already hospitalized for more than 36 hours.
- Pediatric patients.
- Asymptomatic patients.
- Non acute respiratory illness patients.
- Primary pulmonary embolism as causative (i.e pulmonary embolism can be concomitant to respiratory symptoms related to SRAS COVID but not without).
- Exacerbated terminal/severe COPD of Pulmonary fibrosis with or without home oxygen.
- Patients with indirect form of ARDS.
- Cystic fibrosis.
Trial locations and contacts
1 site in 1 country.
About this study
Hypothesis: The apelin/APJ system is involved in the protection of the lung affected by the COVID-19 by interacting with the SARS-coV-2 entry door: the Angiotensin I Converting Enzyme 2 (ACE2) and the renin-angiotensin system (ras). Elevated systemic levels of apelins and ACE2 activity are associated to less critical forms of COVID-19 and characterized by less pulmonary hyperpermeability and inflammation.
Goals: Main: In COVID-19+ patients, to establish the basic knowledge of 1) apelins and related systems (ras and degradation enzymes, of which ACE2) pheno-dynamic profile in bloodstream, 2) pulmonary hyperpermeability profile by biomarker's assessment i) comparison of SARS vs. lesser COVID-19 respiratory injury, and with non COVID-19 ARDS and non ARDS acute respiratory condition. Secondary: To set up links between basic and progressive clinical data (data collection system APEL-COVID).
Read the detailed description
COVID-19 affects patients by it's entry way: the airways and the deep lung. 20 to 30% of symptomatic adult patients which are hospitalised in or out of the intensive care unit exhibit respiratory distress with major oxygenation index alterations. That syndrome is specifically designated severe acute respiratory syndrome coronavirus 2 (SARS-coV-2). SARS-coV-2 develops 2 weeks after the symptoms start, with a recurring fever, progressing dyspnea and a mortality rate of 10 to 50%. In SARS-coV-2: 1) radiological pulmonary infiltrates are more peripheral and 2) dominancy of hyperinflammation (cytokine storm, of which the interleukine-6 IL-6) and hyperpermeability of the alveolar-capillary barrier is observed, 3) in comparison to a traditional (non COVID) ARDS, the hypoxia generated is exceptionally severe and associated to a pulmonary compliance sparsely reduce in more than 70% of cases.
The Angiotensin I Converting Enzyme 2 (ACE2) is a transmembrane carboxypeptidase of the renin-angiotensin system (ras) implicated in cardiovascular homeostasis. ACE2 counter-regulates the proinflammatory hypertensive ACE1/Angiotensin II (Ang II). ACE2 converts Ang II in Ang1-7 to promote vasodilation, anti-inflammation and tissular protection. ACE2 is expressed abundantly in the lung and is the entry door for many virus like the influenza A, coV-1 and -2. A downregulation of ACE2 activity leads to Ang II excess, with a stimulation of the AngI receptor (AT1R) and an increase of pulmonary vascular permeability, negatively impacting the prognosis of the influenza virus H7N9. More than 85% of pulmonary ACE2 is expressed in apical membrane of alveolar epithelial cell type II (AECII) which are located in the lung distal air spaces at the alveolar-capillary barrier interface. This is where the coV-2 set up and induces the SARS (COVID-19+). AECII regulate the alveolar-capillary barrier permeability. Those produce specific proteins (SP-D or surfactant protein D, and CC-16 or Clara Cell protein) which are released in bloodstream when the alveolar-capillary barrier becomes hyperpermeable and are diagnostic and prognostic biological markers.
The apelin/APJ system could be a protective way by interacting with the renin-angiotensin system (ras) and Angiotensin I Converting Enzyme 2 (ACE2). The apelin/APJ system is recognized to protect and optimize cardiovascular functions. The apelins and receptor APJ operate independently of the catecholaminergic system and constitute a counter regulatory response to the vasopressinergic way with an inodilator activity. The apelin/APJ is largely expressed in the lung and is involved in the reduction of pulmonary inflammation. Apelin-13 stabilizes the mitochondrial function, reduces membrane permeability, prevents apoptosis and stimulates AECII proliferation. The apelin/APJ is reactive to hypoxia like in SARS or ARDS with an increase of blood apelins levels. Apelins are substrates for the ras system and kallikrein/kinin which are producing degradation enzymes like ACE2. Despite this, apelins can reverse a decreased activity of ACE2, and regulate the overproduction of Ang II and the AT1R stimulation which lead to an increase pulmonary vascular permeability and lung edema. APJ is also able to inhibit AT1R by trans-allosteric combination. APJ is a co-receptor for the human and simian immunodeficiency virus, and the apelins block their entry. The proximity between ACE2 and APJ on AECII membranes and their internalization/degradation management in term of the apelins isoform lead to the query of their interaction and the link with their pulmonary protective activity.
Hypothesis: The apelin/APJ system is involved in the protection of the lung affected by the COVID-19 by interacting with the SARS-coV-2 entry door: the Angiotensin I Converting Enzyme 2 (ACE2) and the renin-angiotensin system (ras). Elevated systemic levels of apelins and ACE2 activity are associated to less critical forms of COVID-19 and characterized by less pulmonary hyperpermeability and inflammation.
Goals: Main: In COVID-19+ patients, to establish the basic knowledge of 1) apelins and related systems (ras and degradation enzymes, of which ACE2) pheno-dynamic profile in bloodstream, 2) pulmonary hyperpermeability profile by biomarker's assessment i) comparison of SARS vs. lesser COVID-19 respiratory injury, and with non COVID-19 ARDS and non ARDS acute respiratory condition. Secondary: To set up links between basic and progressive clinical data (data collection system APEL-COVID).
Methods: Observational pilot study of a prospective cohort recruiting in the 36 hours after admission adult patients hospitalized for a symptomatic acute respiratory illness. Groups: 1) COVID+, SARS, MV+ (mechanical ventilation) or not, with more than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30); 2) COVID+, non SARS, MV-, with less than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30); 3) COVID-, ARDS, MV+, with more than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30); 4) COVID-, non ARDS, MV-, with less than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30). Given the effects of the pressure generated by mechanical ventilation on epithelial biological markers, 2 sub-groups of 10 controls patients hospitalized for non-respiratory reasons will be constituted post hoc with sex-age matching to the above groups. The patients COVID+ non SARS will be respiratory symptomatic, with or without lung infiltrates and needs in O2 less than 6L/min-40% FiO2 for a SpO2 more than 90% and hospitalized on floors of the pulmonology or internal medicine or in the intensives cares units. The ARDS patients will be selected in the direct form (e.g. pneumonia, aspiration) and the oxygenation index parameters established by Berlin definition.
- Conditions
- Covid19
- Being tested
- COVID-19 test, Blood sampling
- Keywords
- Covid19, Apelins, ACE2, ras, ARDS, SARS, lung permeability biomarkers, ELABELA, inflammation, kallikrein-kinin
- Medical subject headings
- COVID-19, Inflammation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
COVID-19 testDiagnostic test
Nasal pharyngeal swab
Blood samplingDiagnostic test
20cc of blood will be collected each 7 days during 28 days.
| Study group | Role | What they receive |
|---|---|---|
| COVID+, SARS | patients COVID+ SARS mechanically ventilated and/or needing more than 6L/min of O2-40% FiO2 for a SpO2 equal or above 90% for more than 24hours. Receives: Diagnostic Test: COVID-19 test; Diagnostic Test: Blood sampling | |
| COVID+, nonSARS | patients COVID+ nonSARS respiratory symptomatic, with or without lung infiltrates, non mechanically ventilated, and needing less than 6L/min O2-40% FiO2 for a SpO2 equal or above 90%. They are hospitalized on floors (pulmonolgy, internal medecine or in intensives cares units). Receives: Diagnostic Test: COVID-19 test; Diagnostic Test: Blood sampling | |
| COVID-, ARDS | patients are in ARDS according to the Berlin definition and the lung injury is categorized in the direct form (e.g. pneumonia, aspiration). Receives: Diagnostic Test: COVID-19 test; Diagnostic Test: Blood sampling | |
| COVID-, nonARDS | patients are not in ARDS according to the Berlin definition but are respiratory symptomatic, with or without lung infiltrates and needing less than 6L O2/min-40% FiO2 for a SpO2 equal or above 90%. Receives: Diagnostic Test: COVID-19 test; Diagnostic Test: Blood sampling | |
| COVID-, control, MV+ | patients hospitalized and mechanically ventilated for non-respiratory reasons (post hoc with sex-age matching). Receives: Diagnostic Test: COVID-19 test; Diagnostic Test: Blood sampling | |
| COVID-, control, MV- | non mechanically ventilated patients hospitalized for non-respiratory reasons (post hoc with sex-age matching). Receives: Diagnostic Test: COVID-19 test; Diagnostic Test: Blood sampling |
What is being measured
The primary outcome is the main question the study is designed to answer.
Blood apelins-13/12, -17/16, -36
Measurement by MS/MS of the blood apelins-13/12, -17/16, -36 each 7 days during 28 days.
Measured: 28 days
Blood angiotensin II
Measurement by ELISA of the blood angiotensin II each 7 days during 28 days.
Measured: 28 days
Blood Clara cell protein (CC16)
Measurement by ELISA of the blood CC16 each 7 days during 28 days.
Measured: 28 days
Blood interleukine-6 (IL-6)
Measurement by ELISA of the blood IL-6 each 7 days during 28 days.
Measured: 28 days
Blood surfactant protein D (SP-D)
Measurement by ELISA of the blood SP-D each 7 days during 28 days.
Measured: 28 days
Plasma ACE2 activity measurement by fluorometry
Measurement of the plasma ACE2 activity each 7 days during 28 days.
Measured: 28 days
Plasma lysyl oxidase activity measurement by fluorometry
Measurement of the plasma lysyl oxidase activity each 7 days during 28 days.
Measured: 28 days
Plasma neprilysin activity measurement by fluorometry
Measurement of the plasma neprilysin activity each 7 days during 28 days.
Measured: 28 days
Secondary outcomes (6)
APACHEII
Prognostic score (APACHEII) each day during 28 days.
Measured: 28 days
Oxygenation index
Oxygenation index each day during 28 days.
Measured: 28 days
Mechanical ventilation
Duration of the mechanical ventilation.
Measured: 28 days
Pulmonary compliance (Dynamic, real-time, on ventilator device: Tidal volume / Plateau pressure - PEEP
Measurement of the pulmonary compliance each day during 28 days.
Measured: 28 days
Length of hospital stay
Measurement of the length of hospital stay and/or mortality in-hospital.
Measured: 28 days
SOFA
Prognostic score (SOFA) each day during 28 days.
Measured: 28 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Nov 2020
- Study start26 Oct 2020
- Primary completion1 Oct 2021
- Study completion1 Oct 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (49)Papers the sponsor has linked to this study.
- Other trials for Covid19Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 140 participants (actual)
- Target duration
- 28 Days
Sponsor and investigators
- Lead sponsor
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke
- Sponsor type
- University, hospital or other
- Collaborators
- University Hospital, Angers
- Responsible party
- Principal investigator, Olivier Lesur, Centre de recherche du Centre hospitalier universitaire de Sherbrooke
- Investigators
- Olivier Lesur, MD PhD, Principal investigator, Sherbrooke University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04632732
- Sponsor's protocol ID
- 2021-3862-APEL-COVID
- Acronym
- APEL-COVID
- Status last verified
- Dec 2022
- First submitted
- 3 Nov 2020
- Last updated
- 23 Dec 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.
PubMed 32171076Sun H, Ning R, Tao Y, Yu C, Deng X, Zhao C, Meng S, Tang F, Xu D. Risk Factors for Mortality in 244 Older Adults With COVID-19 in Wuhan, China: A Retrospective Study. J Am Geriatr Soc. 2020 Jun;68(6):E19-E23. doi: 10.1111/jgs.16533. Epub 2020 May 12.
PubMed 32383809Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, Sepandi M, Jafari NJ, Izadi M, Qazvini A, Dorostkar R, Tat M, Shahriary A, Farnoosh G, Hosseini Zijoud SR, Taghdir M, Alimohamadi Y, Abbaszadeh S, Gouvarchin Ghaleh HE, Bagheri M. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020 Jun;127:104378. doi: 10.1016/j.jcv.2020.104378. Epub 2020 Apr 21.
PubMed 32353762Zangrillo A, Beretta L, Scandroglio AM, Monti G, Fominskiy E, Colombo S, Morselli F, Belletti A, Silvani P, Crivellari M, Monaco F, Azzolini ML, Reineke R, Nardelli P, Sartorelli M, Votta CD, Ruggeri A, Ciceri F, De Cobelli F, Tresoldi M, Dagna L, Rovere-Querini P, Serpa Neto A, Bellomo R, Landoni G; COVID-BioB Study Group. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc. 2020 Apr 23. Online ahead of print.
PubMed 32353223Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. COVID-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020 May 15;201(10):1299-1300. doi: 10.1164/rccm.202003-0817LE. No abstract available.
PubMed 32228035Lu W, Zhang S, Chen B, Chen J, Xian J, Lin Y, Shan H, Su ZZ. A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound. Ultraschall Med. 2020 Jun;41(3):300-307. doi: 10.1055/a-1154-8795. Epub 2020 Apr 15.
PubMed 32294796Sayiner A, Cinkooglu A, Tasbakan MS, Basoglu OK, Ceylan N, Savas R, Bayraktaroglu S, Ozhan MH. Radiographic examination of the chest and COVID-19. Ann R Coll Surg Engl. 2020 May;102(5):334. doi: 10.1308/rcsann.2020.0099. No abstract available.
PubMed 32357307Wu J, Pan J, Teng D, Xu X, Feng J, Chen YC. Interpretation of CT signs of 2019 novel coronavirus (COVID-19) pneumonia. Eur Radiol. 2020 Oct;30(10):5455-5462. doi: 10.1007/s00330-020-06915-5. Epub 2020 May 4.
PubMed 32367422Toniati P, Piva S, Cattalini M, Garrafa E, Regola F, Castelli F, Franceschini F, Airo P, Bazzani C, Beindorf EA, Berlendis M, Bezzi M, Bossini N, Castellano M, Cattaneo S, Cavazzana I, Contessi GB, Crippa M, Delbarba A, De Peri E, Faletti A, Filippini M, Filippini M, Frassi M, Gaggiotti M, Gorla R, Lanspa M, Lorenzotti S, Marino R, Maroldi R, Metra M, Matteelli A, Modina D, Moioli G, Montani G, Muiesan ML, Odolini S, Peli E, Pesenti S, Pezzoli MC, Pirola I, Pozzi A, Proto A, Rasulo FA, Renisi G, Ricci C, Rizzoni D, Romanelli G, Rossi M, Salvetti M, Scolari F, Signorini L, Taglietti M, Tomasoni G, Tomasoni LR, Turla F, Valsecchi A, Zani D, Zuccala F, Zunica F, Foca E, Andreoli L, Latronico N. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020 Jul;19(7):102568. doi: 10.1016/j.autrev.2020.102568. Epub 2020 May 3.
PubMed 32376398van de Veerdonk FL, Netea MG, van Deuren M, van der Meer JW, de Mast Q, Bruggemann RJ, van der Hoeven H. Kallikrein-kinin blockade in patients with COVID-19 to prevent acute respiratory distress syndrome. Elife. 2020 Apr 27;9:e57555. doi: 10.7554/eLife.57555.
PubMed 32338605Gralinski LE, Bankhead A 3rd, Jeng S, Menachery VD, Proll S, Belisle SE, Matzke M, Webb-Robertson BJ, Luna ML, Shukla AK, Ferris MT, Bolles M, Chang J, Aicher L, Waters KM, Smith RD, Metz TO, Law GL, Katze MG, McWeeney S, Baric RS. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury. mBio. 2013 Aug 6;4(4):e00271-13. doi: 10.1128/mBio.00271-13.
PubMed 23919993Herold S, Gabrielli NM, Vadasz I. Novel concepts of acute lung injury and alveolar-capillary barrier dysfunction. Am J Physiol Lung Cell Mol Physiol. 2013 Nov 15;305(10):L665-81. doi: 10.1152/ajplung.00232.2013. Epub 2013 Sep 13.
PubMed 24039257Keidar S, Kaplan M, Gamliel-Lazarovich A. ACE2 of the heart: From angiotensin I to angiotensin (1-7). Cardiovasc Res. 2007 Feb 1;73(3):463-9. doi: 10.1016/j.cardiores.2006.09.006. Epub 2006 Sep 19.
PubMed 17049503Gichuhi PM, Isahakia MA. Electron-microscopic localization of baboon acrosomal antigens using antisperm monoclonal antibody. Acta Anat (Basel). 1992;144(2):178-83. doi: 10.1159/000147304.
PubMed 1514377Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Muller MA, Drosten C, Pohlmann S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Apr 16;181(2):271-280.e8. doi: 10.1016/j.cell.2020.02.052. Epub 2020 Mar 5.
PubMed 32142651
Study at a glance
From the registry record, last updated by the sponsor on 23 Dec 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Apelin; ACE2 and Biomarkers of Alveolar-capillary Permeability in SARS-cov-2 (COVID-19).
- ClinicalTrials.gov ID
- NCT04632732
- Acronym / sponsor ID
- APEL-COVID / 2021-3862-APEL-COVID
- Conditions
- Covid19
- Keywords
- Covid19, Apelins, ACE2, ras, ARDS, SARS, lung permeability biomarkers, ELABELA
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 140 participants (actual)
- Lead sponsor
- Centre de recherche du Centre hospitalier universitaire de SherbrookeUniversity, hospital or other
- Collaborators
- University Hospital, Angers
- Study start
- 26 Oct 2020 (actual)
- Primary completion
- 1 Oct 2021 (actual)
- Study completion
- 1 Oct 2021 (actual)
- First posted
- 17 Nov 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Hypothesis: The apelin/APJ system is involved in the protection of the lung affected by the COVID-19 by interacting with the SARS-coV-2 entry door: the Angiotensin I Converting Enzyme 2 (ACE2) and the renin-angiotensin system (ras). Elevated systemic levels of apelins and ACE2 activity are associated to less critical forms of COVID-19 and characterized by less pulmonary hyperpermeability and inflammation.
Goals: Main: In COVID-19+ patients, to establish the basic knowledge of 1) apelins and related systems (ras and degradation enzymes, of which ACE2) pheno-dynamic profile in bloodstream, 2) pulmonary hyperpermeability profile by biomarker's assessment i) comparison of SARS vs. lesser COVID-19 respiratory injury, and with non COVID-19 ARDS and non ARDS acute respiratory condition. Secondary: To set up links between basic and progressive clinical data (data collection system APEL-COVID).
Detailed description
COVID-19 affects patients by it's entry way: the airways and the deep lung. 20 to 30% of symptomatic adult patients which are hospitalised in or out of the intensive care unit exhibit respiratory distress with major oxygenation index alterations. That syndrome is specifically designated severe acute respiratory syndrome coronavirus 2 (SARS-coV-2). SARS-coV-2 develops 2 weeks after the symptoms start, with a recurring fever, progressing dyspnea and a mortality rate of 10 to 50%. In SARS-coV-2: 1) radiological pulmonary infiltrates are more peripheral and 2) dominancy of hyperinflammation (cytokine storm, of which the interleukine-6 IL-6) and hyperpermeability of the alveolar-capillary barrier is observed, 3) in comparison to a traditional (non COVID) ARDS, the hypoxia generated is exceptionally severe and associated to a pulmonary compliance sparsely reduce in more than 70% of cases.
The Angiotensin I Converting Enzyme 2 (ACE2) is a transmembrane carboxypeptidase of the renin-angiotensin system (ras) implicated in cardiovascular homeostasis. ACE2 counter-regulates the proinflammatory hypertensive ACE1/Angiotensin II (Ang II). ACE2 converts Ang II in Ang1-7 to promote vasodilation, anti-inflammation and tissular protection. ACE2 is expressed abundantly in the lung and is the entry door for many virus like the influenza A, coV-1 and -2. A downregulation of ACE2 activity leads to Ang II excess, with a stimulation of the AngI receptor (AT1R) and an increase of pulmonary vascular permeability, negatively impacting the prognosis of the influenza virus H7N9. More than 85% of pulmonary ACE2 is expressed in apical membrane of alveolar epithelial cell type II (AECII) which are located in the lung distal air spaces at the alveolar-capillary barrier interface. This is where the coV-2 set up and induces the SARS (COVID-19+). AECII regulate the alveolar-capillary barrier permeability. Those produce specific proteins (SP-D or surfactant protein D, and CC-16 or Clara Cell protein) which are released in bloodstream when the alveolar-capillary barrier becomes hyperpermeable and are diagnostic and prognostic biological markers.
The apelin/APJ system could be a protective way by interacting with the renin-angiotensin system (ras) and Angiotensin I Converting Enzyme 2 (ACE2). The apelin/APJ system is recognized to protect and optimize cardiovascular functions. The apelins and receptor APJ operate independently of the catecholaminergic system and constitute a counter regulatory response to the vasopressinergic way with an inodilator activity. The apelin/APJ is largely expressed in the lung and is involved in the reduction of pulmonary inflammation. Apelin-13 stabilizes the mitochondrial function, reduces membrane permeability, prevents apoptosis and stimulates AECII proliferation. The apelin/APJ is reactive to hypoxia like in SARS or ARDS with an increase of blood apelins levels. Apelins are substrates for the ras system and kallikrein/kinin which are producing degradation enzymes like ACE2. Despite this, apelins can reverse a decreased activity of ACE2, and regulate the overproduction of Ang II and the AT1R stimulation which lead to an increase pulmonary vascular permeability and lung edema. APJ is also able to inhibit AT1R by trans-allosteric combination. APJ is a co-receptor for the human and simian immunodeficiency virus, and the apelins block their entry. The proximity between ACE2 and APJ on AECII membranes and their internalization/degradation management in term of the apelins isoform lead to the query of their interaction and the link with their pulmonary protective activity.
Hypothesis: The apelin/APJ system is involved in the protection of the lung affected by the COVID-19 by interacting with the SARS-coV-2 entry door: the Angiotensin I Converting Enzyme 2 (ACE2) and the renin-angiotensin system (ras). Elevated systemic levels of apelins and ACE2 activity are associated to less critical forms of COVID-19 and characterized by less pulmonary hyperpermeability and inflammation.
Goals: Main: In COVID-19+ patients, to establish the basic knowledge of 1) apelins and related systems (ras and degradation enzymes, of which ACE2) pheno-dynamic profile in bloodstream, 2) pulmonary hyperpermeability profile by biomarker's assessment i) comparison of SARS vs. lesser COVID-19 respiratory injury, and with non COVID-19 ARDS and non ARDS acute respiratory condition. Secondary: To set up links between basic and progressive clinical data (data collection system APEL-COVID).
Methods: Observational pilot study of a prospective cohort recruiting in the 36 hours after admission adult patients hospitalized for a symptomatic acute respiratory illness. Groups: 1) COVID+, SARS, MV+ (mechanical ventilation) or not, with more than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30); 2) COVID+, non SARS, MV-, with less than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30); 3) COVID-, ARDS, MV+, with more than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30); 4) COVID-, non ARDS, MV-, with less than 6L/min-40% FiO2 for a SpO2 more than 90% for more than 24hrs (n=30). Given the effects of the pressure generated by mechanical ventilation on epithelial biological markers, 2 sub-groups of 10 controls patients hospitalized for non-respiratory reasons will be constituted post hoc with sex-age matching to the above groups. The patients COVID+ non SARS will be respiratory symptomatic, with or without lung infiltrates and needs in O2 less than 6L/min-40% FiO2 for a SpO2 more than 90% and hospitalized on floors of the pulmonology or internal medicine or in the intensives cares units. The ARDS patients will be selected in the direct form (e.g. pneumonia, aspiration) and the oxygenation index parameters established by Berlin definition.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Target follow-up
- 28 Days
- Number of arms
- 6
| Arm | Type | Receives |
|---|---|---|
| COVID+, SARS | – | Diagnostic Test: COVID-19 test, Diagnostic Test: Blood samplingpatients COVID+ SARS mechanically ventilated and/or needing more than 6L/min of O2-40% FiO2 for a SpO2 equal or above 90% for more than 24hours. |
| COVID+, nonSARS | – | Diagnostic Test: COVID-19 test, Diagnostic Test: Blood samplingpatients COVID+ nonSARS respiratory symptomatic, with or without lung infiltrates, non mechanically ventilated, and needing less than 6L/min O2-40% FiO2 for a SpO2 equal or above 90%. They are hospitalized on floors (pulmonolgy, internal medecine or in intensives cares units). |
| COVID-, ARDS | – | Diagnostic Test: COVID-19 test, Diagnostic Test: Blood samplingpatients are in ARDS according to the Berlin definition and the lung injury is categorized in the direct form (e.g. pneumonia, aspiration). |
| COVID-, nonARDS | – | Diagnostic Test: COVID-19 test, Diagnostic Test: Blood samplingpatients are not in ARDS according to the Berlin definition but are respiratory symptomatic, with or without lung infiltrates and needing less than 6L O2/min-40% FiO2 for a SpO2 equal or above 90%. |
| COVID-, control, MV+ | – | Diagnostic Test: COVID-19 test, Diagnostic Test: Blood samplingpatients hospitalized and mechanically ventilated for non-respiratory reasons (post hoc with sex-age matching). |
| COVID-, control, MV- | – | Diagnostic Test: COVID-19 test, Diagnostic Test: Blood samplingnon mechanically ventilated patients hospitalized for non-respiratory reasons (post hoc with sex-age matching). |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients hospitalized on floors (pulmonology or in internal medecine) or in intensive care units of the Sherbrooke hospital/CHUS and patients hospitalized in intensive care units of the Angers hospital/CHUA.
Key inclusion criteria (3 listed)
- For the 4 -non-control- major groups:
- Adults patients hospitalized for symptomatic acute (presumably infectious) respiratory illness
- In the 36 hours after admission.
Key exclusion criteria (8 listed)
- Patients already hospitalized for more than 36 hours.
- Pediatric patients.
- Asymptomatic patients.
- Non acute respiratory illness patients.
- Primary pulmonary embolism as causative (i.e pulmonary embolism can be concomitant to respiratory symptoms related to SRAS COVID but not without).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| COVID-19 testNasal pharyngeal swab | Diagnostic test | COVID+, SARS, COVID+, nonSARS, COVID-, ARDS, COVID-, control, MV+, COVID-, control, MV-, COVID-, nonARDS |
| Blood sampling20cc of blood will be collected each 7 days during 28 days. | Diagnostic test | COVID+, SARS, COVID+, nonSARS, COVID-, ARDS, COVID-, control, MV+, COVID-, control, MV-, COVID-, nonARDS |
Primary outcome
Blood apelins-13/12, -17/16, -36
Time frame: 28 days
Measurement by MS/MS of the blood apelins-13/12, -17/16, -36 each 7 days during 28 days.
Blood angiotensin II
Time frame: 28 days
Measurement by ELISA of the blood angiotensin II each 7 days during 28 days.
Blood Clara cell protein (CC16)
Time frame: 28 days
Measurement by ELISA of the blood CC16 each 7 days during 28 days.
Blood interleukine-6 (IL-6)
Time frame: 28 days
Measurement by ELISA of the blood IL-6 each 7 days during 28 days.
Blood surfactant protein D (SP-D)
Time frame: 28 days
Measurement by ELISA of the blood SP-D each 7 days during 28 days.
Plasma ACE2 activity measurement by fluorometry
Time frame: 28 days
Measurement of the plasma ACE2 activity each 7 days during 28 days.
Plasma lysyl oxidase activity measurement by fluorometry
Time frame: 28 days
Measurement of the plasma lysyl oxidase activity each 7 days during 28 days.
Plasma neprilysin activity measurement by fluorometry
Time frame: 28 days
Measurement of the plasma neprilysin activity each 7 days during 28 days.
6 secondary outcomes
APACHEII
Time frame: 28 days
Oxygenation index
Time frame: 28 days
Mechanical ventilation
Time frame: 28 days
Pulmonary compliance (Dynamic, real-time, on ventilator device: Tidal volume / Plateau pressure - PEEP
Time frame: 28 days
Length of hospital stay
Time frame: 28 days
SOFA
Time frame: 28 days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 23 Dec 2022.
- Background: PubMed 32171076Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.
- Background: PubMed 32383809Sun H, Ning R, Tao Y, Yu C, Deng X, Zhao C, Meng S, Tang F, Xu D. Risk Factors for Mortality in 244 Older Adults With COVID-19 in Wuhan, China: A Retrospective Study. J Am Geriatr Soc. 2020 Jun;68(6):E19-E23. doi: 10.1111/jgs.16533. Epub 2020 May 12.
- Background: PubMed 32353762Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, Sepandi M, Jafari NJ, Izadi M, Qazvini A, Dorostkar R, Tat M, Shahriary A, Farnoosh G, Hosseini Zijoud SR, Taghdir M, Alimohamadi Y, Abbaszadeh S, Gouvarchin Ghaleh HE, Bagheri M. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020 Jun;127:104378. doi: 10.1016/j.jcv.2020.104378. Epub 2020 Apr 21.
- Background: PubMed 32353223Zangrillo A, Beretta L, Scandroglio AM, Monti G, Fominskiy E, Colombo S, Morselli F, Belletti A, Silvani P, Crivellari M, Monaco F, Azzolini ML, Reineke R, Nardelli P, Sartorelli M, Votta CD, Ruggeri A, Ciceri F, De Cobelli F, Tresoldi M, Dagna L, Rovere-Querini P, Serpa Neto A, Bellomo R, Landoni G; COVID-BioB Study Group. Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy. Crit Care Resusc. 2020 Apr 23. Online ahead of print.
- Background: PubMed 32228035Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. COVID-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020 May 15;201(10):1299-1300. doi: 10.1164/rccm.202003-0817LE. No abstract available.
- Background: PubMed 32294796Lu W, Zhang S, Chen B, Chen J, Xian J, Lin Y, Shan H, Su ZZ. A Clinical Study of Noninvasive Assessment of Lung Lesions in Patients with Coronavirus Disease-19 (COVID-19) by Bedside Ultrasound. Ultraschall Med. 2020 Jun;41(3):300-307. doi: 10.1055/a-1154-8795. Epub 2020 Apr 15.
- Background: PubMed 32357307Sayiner A, Cinkooglu A, Tasbakan MS, Basoglu OK, Ceylan N, Savas R, Bayraktaroglu S, Ozhan MH. Radiographic examination of the chest and COVID-19. Ann R Coll Surg Engl. 2020 May;102(5):334. doi: 10.1308/rcsann.2020.0099. No abstract available.
- Background: PubMed 32367422Wu J, Pan J, Teng D, Xu X, Feng J, Chen YC. Interpretation of CT signs of 2019 novel coronavirus (COVID-19) pneumonia. Eur Radiol. 2020 Oct;30(10):5455-5462. doi: 10.1007/s00330-020-06915-5. Epub 2020 May 4.
- Background: PubMed 32376398Toniati P, Piva S, Cattalini M, Garrafa E, Regola F, Castelli F, Franceschini F, Airo P, Bazzani C, Beindorf EA, Berlendis M, Bezzi M, Bossini N, Castellano M, Cattaneo S, Cavazzana I, Contessi GB, Crippa M, Delbarba A, De Peri E, Faletti A, Filippini M, Filippini M, Frassi M, Gaggiotti M, Gorla R, Lanspa M, Lorenzotti S, Marino R, Maroldi R, Metra M, Matteelli A, Modina D, Moioli G, Montani G, Muiesan ML, Odolini S, Peli E, Pesenti S, Pezzoli MC, Pirola I, Pozzi A, Proto A, Rasulo FA, Renisi G, Ricci C, Rizzoni D, Romanelli G, Rossi M, Salvetti M, Scolari F, Signorini L, Taglietti M, Tomasoni G, Tomasoni LR, Turla F, Valsecchi A, Zani D, Zuccala F, Zunica F, Foca E, Andreoli L, Latronico N. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020 Jul;19(7):102568. doi: 10.1016/j.autrev.2020.102568. Epub 2020 May 3.
- Background: PubMed 32338605van de Veerdonk FL, Netea MG, van Deuren M, van der Meer JW, de Mast Q, Bruggemann RJ, van der Hoeven H. Kallikrein-kinin blockade in patients with COVID-19 to prevent acute respiratory distress syndrome. Elife. 2020 Apr 27;9:e57555. doi: 10.7554/eLife.57555.
- Background: PubMed 23919993Gralinski LE, Bankhead A 3rd, Jeng S, Menachery VD, Proll S, Belisle SE, Matzke M, Webb-Robertson BJ, Luna ML, Shukla AK, Ferris MT, Bolles M, Chang J, Aicher L, Waters KM, Smith RD, Metz TO, Law GL, Katze MG, McWeeney S, Baric RS. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury. mBio. 2013 Aug 6;4(4):e00271-13. doi: 10.1128/mBio.00271-13.
- Background: PubMed 24039257Herold S, Gabrielli NM, Vadasz I. Novel concepts of acute lung injury and alveolar-capillary barrier dysfunction. Am J Physiol Lung Cell Mol Physiol. 2013 Nov 15;305(10):L665-81. doi: 10.1152/ajplung.00232.2013. Epub 2013 Sep 13.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Olivier Lesur, MD PhD principal investigator
Sherbrooke University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Covid19, run by Centre de recherche du Centre hospitalier universitaire de Sherbrooke at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 23 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Blood apelins-13/12, -17/16, -36 (time frame: 28 days). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04632732, which also lists 49 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Dec 2022.