COVID-19CROSS-CO19NCT05736900
Counter-Regulatory Hormonal and Stress Systems in Patients With COVID-19
A study testing Blood sampling in people with COVID-19, run by Fondazione Policlinico Universitario Agostino Gemelli IRCCS at 1 site in Italy.
Trial summary
The COVID-19 pandemic is associated with a highly variable presentation, ranging from patients who are asymptomatic or experience only mild symptoms to others with acute respiratory syndrome (ARDS) who require ventilatory support and carry a high risk of severe adverse outcomes and mortality. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- COVID-19
- What is being tested?
- Blood sampling
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 200 participants
- Where
- 1 siteItaly
- Study dates
- 10 Sep 2020to 12 Jun 2021
- Phase
- Interventional
- 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
Who may be able to join
- Adult (age > 18 years)
- Patients who meet on one or more of the following criteria for the screening test according to the CDC guidelines:
- Have fever or lower respiratory symptoms (cough, shortness of breath) and close contact with a confirmed COVID-19 case within the past 14 days; OR Have fever and lower respiratory symptoms (cough, shortness of breath) and a negative rapid flu test
- Patients with previous documented history of SARS-CoV-2 infection withn appropriate retrospectively collected andv available data.
Who cannot join
- Patients with impaired mental capacity that precludes informed consent
- Subjects who need medications that may interfere with or invalidate outcome parameters and that can not be stopped without significant risk (e.g., steroids, oral contraceptives)
- Severe or terminal co-morbidity which seriously interferes with possible treatment or health related quality of life
- Pregnancy
Trial locations and contacts
1 site in 1 country.
About this study
The COVID-19 pandemic is associated with a highly variable presentation, ranging from patients who are asymptomatic or experience only mild symptoms to others with acute respiratory syndrome (ARDS) who require ventilatory support and carry a high risk of severe adverse outcomes and mortality. The most vulnerable population are older adults, usually people with chronic medical conditions and more often men than women.. Nevertheless, infection with SARS-CoV-2 can have deadly consequences even among those without any clear pre-existing medical conditions. Differences in adaptive immune responses and ensuing inflammatory reactions are proposed to contribute to the variable vulnerability to severe disease among patients infected with SARS-CoV-19. It is also possible that inter-individual differences in responsiveness of counter-regulatory hormonal and stress systems may further contribute to variable outcomes in infected patients, and that this may involve modulation of inflammatory responses. The hypothalamo-pituitary adrenal (HPA) axis in particular is a critical regulator of adaptive responses of metabolic and immune systems to various stressors, including. Sex-differences and age-related declines in adrenal cortical production of glucocorticoids and androgens as well as responsiveness of the HPA axis and immune function to stressors are particularly in older men. Such factors may contribute to the high morbidity associated with SARS-CoV-2 infection in elderly males.Among other important hormonal counter-regulatory systems, the renin angiotensin aldosterone system (RAAS) is prominently and directly impacted by SARS-CoV-2. Specifically both SARS-CoV-2 and SARS-CoV angiotensin-converting enzyme 2 (ACE2) to gain entry into cells. Tissue distrubtions of ACE2 match to viral distributions and systemic-wide impacts of SARS-CoV-2 or SARS-CoV beyond the lungs to kidneys, pancreas heart and other tissues. Studies in rats have shown that ACE2 is expressed in substantially higher amounts in alveolar epithelium, bronchiolar epithelium, endothelium and smooth muscle cells of pulmonary vessels of younger than older animals and among the latter group in higher amounts in females than males. Should the same apply to humans such differences may underly the predominance of symptomatic and more severe infections with both SARS-CoV-2 and SARS-CoV in older than younger patients, particularly male
Read the detailed description
The evidence outlined above altogether favors the possibility that inbalance of the RAAS involving upregulated ACE and and angiotensin II and downregulated ACE2 and angiotensin 1-7 might be involved in the susceptibility of SARS-CoV-2 infected patients to more severe outcomes. Given links between the RAAS and the HPA axis with inflammatory processes [38-40], it is also possible that alterations in adrenal steroidal systems might further contribute to the highly variable responses to SARS-CoV-2 infection. This clinical protocol will therefore examine RAAS and the HPA stress system in SARS-CoV-2 infected patients with the objective of identifying differences in these counter-regulatory hormonal and stress systems that might explain progression to more severe disease in infected patients. With this and associated patient data (e.g., age, sex, comorbidities, medications) the plan is to also include application of artificial intelligence-based machine learning approaches to develop algorithms for prognostic prediction of disease outcomes. Given the forecasted numbers of deaths and secondary impacts on health even amongst those not infected, as well as the estimated more than one trillion dollar hit to the world economy, it is clearly important to identify effective treatments that may also be relevant to possible future outbreaks resistant to vacines developed based on the current pandemic. With this in mind the associated data should better facilitate identification of disease mechanisms that underly the more severe clinical phenotypes, thereby enabling educated identification of most appropriate therapeutic approaches for successful management of infected patients. Finally there is some evidence from the earlier SARS-CoV epidemic that infection with these coronaviruses may have health consequences well beyond the acute infection stage. By long-term follow-up, that also allows for inclusion of additional patients at follow-up, this protocol will further address concerns about chronic impacts on health among patients infected with the virus.
- Conditions
- COVID-19
- Being tested
- Blood sampling
- Medical subject headings
- COVID-19
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Blood samplingDiagnostic test
One samples of 5 mL blood is taken into a Serum tube for measurement of the RAAS-Biomarkers. After allowing to coagulate between 30 min and 60 min at room temperature, samples are centrifuged at 3000g for 10 min at room temperature.
| Study group | Role | What they receive |
|---|---|---|
| Patients with COVID-19 | Other | Patients admitted as in-patients with SARS-CoV-2 Infection Receives: Diagnostic Test: Blood sampling |
What is being measured
The primary outcome is the main question the study is designed to answer.
measure of the clinical status of patients at long-term follow up
This will be based on a composite cardiovascular and metabolic score that takes into account multiple clinical conditions known to be associated with SARS-CoV2 and SARS-CoV infections and hypothesized to be further worsened be infections. We will evaluate these scores using an established and widely implemented metabolic syndrome (MetS) severity Z-score (http://mets.health-outcomes-policy.ufl.edu). Clinical conditions will include diabetes mellitus, hypertension, ischemic heart disease, pulmonary disorders and any associated clinical complications that develop after infection (e.g., stroke, cardiac failure, death).
Measured: 1 year
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Feb 2023
- Study start10 Sep 2020
- Primary completion9 Feb 2021
- Study completion12 Jun 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for COVID-19Studies of the same condition, open and under way.
- More trials run by Fondazione Policlinico Universitario Agostino Gemelli IRCCSThe sponsor's other registered studies.
- 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
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 200 participants (actual)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mingrone Geltrude, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Investigators
- geltrude mingrone, Principal investigator, Policlinico A. Gemelli IRCCS
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05736900
- Sponsor's protocol ID
- 3223
- Acronym
- CROSS-CO19
- Status last verified
- Mar 2023
- First submitted
- 20 Feb 2023
- Last updated
- 14 Mar 2023
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- 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 32171076Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, Pan P, Wang W, Hu D, Liu X, Zhang Q, Wu J. Coronavirus infections and immune responses. J Med Virol. 2020 Apr;92(4):424-432. doi: 10.1002/jmv.25685. Epub 2020 Feb 7.
PubMed 31981224Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020 Jun;16(6):297-298. doi: 10.1038/s41574-020-0353-9.
PubMed 32242089Sternberg EM, Chrousos GP, Wilder RL, Gold PW. The stress response and the regulation of inflammatory disease. Ann Intern Med. 1992 Nov 15;117(10):854-66. doi: 10.7326/0003-4819-117-10-854.
PubMed 1416562
Study at a glance
From the registry record, last updated by the sponsor on 14 Mar 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Counter-Regulatory Hormonal and Stress Systems in Patients With COVID-19
- ClinicalTrials.gov ID
- NCT05736900
- Acronym / sponsor ID
- CROSS-CO19 / 3223
- Conditions
- COVID-19
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 200 participants (actual)
- Lead sponsor
- Fondazione Policlinico Universitario Agostino Gemelli IRCCSUniversity, hospital or other
- Study start
- 10 Sep 2020 (actual)
- Primary completion
- 9 Feb 2021 (actual)
- Study completion
- 12 Jun 2021 (actual)
- First posted
- 21 Feb 2023 (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.
The COVID-19 pandemic is associated with a highly variable presentation, ranging from patients who are asymptomatic or experience only mild symptoms to others with acute respiratory syndrome (ARDS) who require ventilatory support and carry a high risk of severe adverse outcomes and mortality. The most vulnerable population are older adults, usually people with chronic medical conditions and more often men than women.. Nevertheless, infection with SARS-CoV-2 can have deadly consequences even among those without any clear pre-existing medical conditions. Differences in adaptive immune responses and ensuing inflammatory reactions are proposed to contribute to the variable vulnerability to severe disease among patients infected with SARS-CoV-19. It is also possible that inter-individual differences in responsiveness of counter-regulatory hormonal and stress systems may further contribute to variable outcomes in infected patients, and that this may involve modulation of inflammatory responses. The hypothalamo-pituitary adrenal (HPA) axis in particular is a critical regulator of adaptive responses of metabolic and immune systems to various stressors, including. Sex-differences and age-related declines in adrenal cortical production of glucocorticoids and androgens as well as responsiveness of the HPA axis and immune function to stressors are particularly in older men. Such factors may contribute to the high morbidity associated with SARS-CoV-2 infection in elderly males.Among other important hormonal counter-regulatory systems, the renin angiotensin aldosterone system (RAAS) is prominently and directly impacted by SARS-CoV-2. Specifically both SARS-CoV-2 and SARS-CoV angiotensin-converting enzyme 2 (ACE2) to gain entry into cells. Tissue distrubtions of ACE2 match to viral distributions and systemic-wide impacts of SARS-CoV-2 or SARS-CoV beyond the lungs to kidneys, pancreas heart and other tissues. Studies in rats have shown that ACE2 is expressed in substantially higher amounts in alveolar epithelium, bronchiolar epithelium, endothelium and smooth muscle cells of pulmonary vessels of younger than older animals and among the latter group in higher amounts in females than males. Should the same apply to humans such differences may underly the predominance of symptomatic and more severe infections with both SARS-CoV-2 and SARS-CoV in older than younger patients, particularly male
Detailed description
The evidence outlined above altogether favors the possibility that inbalance of the RAAS involving upregulated ACE and and angiotensin II and downregulated ACE2 and angiotensin 1-7 might be involved in the susceptibility of SARS-CoV-2 infected patients to more severe outcomes. Given links between the RAAS and the HPA axis with inflammatory processes [38-40], it is also possible that alterations in adrenal steroidal systems might further contribute to the highly variable responses to SARS-CoV-2 infection. This clinical protocol will therefore examine RAAS and the HPA stress system in SARS-CoV-2 infected patients with the objective of identifying differences in these counter-regulatory hormonal and stress systems that might explain progression to more severe disease in infected patients. With this and associated patient data (e.g., age, sex, comorbidities, medications) the plan is to also include application of artificial intelligence-based machine learning approaches to develop algorithms for prognostic prediction of disease outcomes. Given the forecasted numbers of deaths and secondary impacts on health even amongst those not infected, as well as the estimated more than one trillion dollar hit to the world economy, it is clearly important to identify effective treatments that may also be relevant to possible future outbreaks resistant to vacines developed based on the current pandemic. With this in mind the associated data should better facilitate identification of disease mechanisms that underly the more severe clinical phenotypes, thereby enabling educated identification of most appropriate therapeutic approaches for successful management of infected patients. Finally there is some evidence from the earlier SARS-CoV epidemic that infection with these coronaviruses may have health consequences well beyond the acute infection stage. By long-term follow-up, that also allows for inclusion of additional patients at follow-up, this protocol will further address concerns about chronic impacts on health among patients infected with the virus.
Study design
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients with COVID-19 | Other | Diagnostic Test: Blood samplingPatients admitted as in-patients with SARS-CoV-2 Infection |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Adult (age > 18 years)
- Patients who meet on one or more of the following criteria for the screening test according to the CDC guidelines:
- Have fever or lower respiratory symptoms (cough, shortness of breath) and close contact with a confirmed COVID-19 case within the past 14 days; OR Have fever and lower respiratory symptoms (cough, shortness of breath) and a negative rapid flu test
- Patients with previous documented history of SARS-CoV-2 infection withn appropriate retrospectively collected andv available data.
Key exclusion criteria (4 listed)
- Patients with impaired mental capacity that precludes informed consent
- Subjects who need medications that may interfere with or invalidate outcome parameters and that can not be stopped without significant risk (e.g., steroids, oral contraceptives)
- Severe or terminal co-morbidity which seriously interferes with possible treatment or health related quality of life
- Pregnancy
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 |
|---|---|---|
| Blood samplingOne samples of 5 mL blood is taken into a Serum tube for measurement of the RAAS-Biomarkers. After allowing to coagulate between 30 min and 60 min at room temperature, samples are centrifuged at 3000g for 10 min at room temperature. | Diagnostic test | Patients with COVID-19 |
Primary outcome
measure of the clinical status of patients at long-term follow up
Time frame: 1 year
This will be based on a composite cardiovascular and metabolic score that takes into account multiple clinical conditions known to be associated with SARS-CoV2 and SARS-CoV infections and hypothesized to be further worsened be infections. We will evaluate these scores using an established and widely implemented metabolic syndrome (MetS) severity Z-score (http://mets.health-outcomes-policy.ufl.edu). Clinical conditions will include diabetes mellitus, hypertension, ischemic heart disease, pulmonary disorders and any associated clinical complications that develop after infection (e.g., stroke, cardiac failure, death).
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 14 Mar 2023.
- 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 31981224Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, Pan P, Wang W, Hu D, Liu X, Zhang Q, Wu J. Coronavirus infections and immune responses. J Med Virol. 2020 Apr;92(4):424-432. doi: 10.1002/jmv.25685. Epub 2020 Feb 7.
- Background: PubMed 32242089Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020 Jun;16(6):297-298. doi: 10.1038/s41574-020-0353-9.
- Background: PubMed 1416562Sternberg EM, Chrousos GP, Wilder RL, Gold PW. The stress response and the regulation of inflammatory disease. Ann Intern Med. 1992 Nov 15;117(10):854-66. doi: 10.7326/0003-4819-117-10-854.
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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.
geltrude mingrone principal investigator
Policlinico A. Gemelli IRCCS
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Blood sampling in people with COVID-19, run by Fondazione Policlinico Universitario Agostino Gemelli IRCCS at 1 site in Italy.
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 4 inclusion and 4 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 14 Mar 2023. 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 Italy. 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?
measure of the clinical status of patients at long-term follow up (time frame: 1 year). 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 NCT05736900, which also lists 4 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 14 Mar 2023.