AzTrials
AzTrials

COVID-19SAMONCT06968442

The Role of Obesity in Severe COVID-19 Pathophysiology

A study testing Venipuncture in people with COVID-19 and Antibody COVID-19, run by Franciscus Gasthuis at 1 site in Netherlands.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in millions of deaths worldwide. As of 2024, the SARS-CoV-2 Omicron variant is the predominant strain circulating within the population, generally causing mild upper respiratory… Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
COVID-19, Antibody COVID-19
What is being tested?
Venipuncture
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteNetherlands
Study dates
22 Apr 2025to 22 Apr 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

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 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Cohort 1 (obesity cohort)
  • ≥18 and ≤65 years of age
  • BMI ≥30 kg/m²
  • Patient of Franciscus Hospital
  • Cohort 2 (control cohort)
  • ≥18 and ≤65 years of age
  • BMI <25 kg/m²
  • Healthcare workers of Franciscus Hospital

Who cannot join

  • Acute infection or current systemic immunological disorders
  • Use of immune-modulatory medication (i.e., corticosteroids and biologicals)
  • Hormonal therapy

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Willem A Mak, M.Sc. contact

+316 40897778

ashwinmak98@gmail.com

Netherlands1 site, 1 recruiting
  • Franciscus

    Rotterdam, South Holland, 3045PM

    David S.Y. Ong, M.D., Ph.D., Pharm.D., M.Sc.

    Recruiting

Other trials in Netherlands

About this study

Official title: SARS-CoV-2 Antibody-mediated Inflammatory Responses by Macrophages in Individuals With and Without Obesity

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in millions of deaths worldwide. As of 2024, the SARS-CoV-2 Omicron variant is the predominant strain circulating within the population, generally causing mild upper respiratory tract infections. However, hospitalizations and case fatalities due to COVID-19 continue, and there is a high probability that a new human coronavirus will emerge in the future. Understanding the pathophysiology of severe COVID-19 remains highly relevant, as its mechanisms may be comparable to those of other respiratory viral infections.

SARS-CoV-2 infects human cells primarily by binding to angiotensin-converting enzyme 2 (ACE2) and type 2 transmembrane serine protease (TMPRSS2) receptors, which are both expressed in alveolar epithelial type II cells, through the virus' spike protein. In a later stage, the replication of SARS-CoV-2 and activation of resident immune cells lead to the infiltration and activation of large numbers of innate immune cells. Consequently, this results in an excessive pro-inflammatory immune response, including increased production of IL-6, a hallmark cytokine of severe COVID-19. Eventually, the excessive inflammation results in microthrombus formation and pulmonary edema.

Read more

Further studies have indicated that SARS-CoV-2 spike-specific antibodies, along with alveolar macrophages, play a pivotal role in the pathophysiology of severe COVID-19. Alveolar macrophages, which reside in the lung alveoli, are typically the first immune cells to sense pulmonary pathogens. However, these cells can also bind IgG antibodies through their Fc-receptor, leading to cellular activation. When stimulated with both a viral stimulus and anti-SARS-CoV-2 IgG antibodies from severe COVID-19 patients (a situation similar to that in the lungs of these patients) alveolar macrophages elicit a significant proinflammatory response. This response aligns with the observed post-seral conversion deterioration in COVID-19 patients.

Obesity is a significant risk factor for developing severe COVID-19, but the underlying mechanism is not well understood. Previous studies report that macrophages in obese patients are skewed towards a pro-inflammatory phenotype due to altered fatty acid contents, particularly increased saturated fatty acids. Using our in vitro obesity model, which incorporates higher saturated fatty acid contents, the investigators already demonstrated that SARS-CoV-2 antibody-mediated inflammation of alveolar macrophages is increased (unpublished data). Thus, this may explain why obese patients are more likely to develop severe COVID-19.

To validate these in vitro findings, the investigators aim to confirm these results in monocyte-derived macrophages isolated from individuals with and without obesity. Additionally, the investigators will investigate the underlying mechanisms involved in detail. This study will provide valuable insights into the role of obesity in severe COVID-19 and potentially inform therapeutic strategies for at-risk populations.

Read the detailed description

This is a mono-center, prospective cohort study involving both a test group and a control group. The test group comprises patients with obesity eligible for bariatric surgery at Franciscus Hospital, while the control group consists of age- (maximum 5-year difference) and sex-matched non-obese healthcare workers at Franciscus Hospital. Blood samples will be collected from all participants at a single time point.

Obese patients will be approached for informed consent during their intake appointments, typically weeks to months before their bariatric surgery. Blood samples will be collected before surgery or during surgery to minimize any potential adverse effects. Collaborating researchers from the surgery department will manage the inclusion of obese patients and coordinate their blood collection.

For the non-obese control group, investigators from MMI will manage participant inclusion and blood sample collection.

Participants from Franciscus Hospital with obesity (Cohort 1) and healthcare workers without obesity (Cohort 2) will undergo a single venipuncture after an 8-hour fasting period. A total of 40 mL of blood will be collected in four 10 mL EDTA tubes.

At the Medical Microbiology and Infection Control (MMI) laboratory of Franciscus, blood samples will be collected after which these are sent to the Center for Infection and Molecular Medicine (CIMM) laboratory in Amsterdam UMC. Here, blood will be processed (i.e., isolation of plasma, monocytes, and remaining peripheral blood mononuclear cells (PBMCs)), where after monocytes will be put into culture to become monocyte-derived macrophages. Macrophage stimulations and additional macrophage analyses will be performed at Amsterdam UMC. Data obtained from analyses in Amsterdam UMC will be further analyzed in Amsterdam UMC by coordinating investigator Ashwin Mak (who is also affiliated at CIMM in Amsterdam UMC) and co-investigator Dr. Jeroen den Dunnen. Monocytes and plasma will be stored in Amsterdam UMC until the end of this study, where after the remaining materials will be transported to Franciscus.

Isolated PBMCs and plasma will be transported in the following days after isolation to Franciscus MMI for T cell stimulations and antibody analyses. In the analyses overview below, the location where each analysis will be performed is noted (i.e., MMI and CIMM). Coded samples and data will be stored at Amsterdam UMC until the end of this study, where after these samples are destroyed and data are deleted. MTA and DTA documents will be prepared for the transfer of blood and data to Amsterdam UMC.

Being tested
Venipuncture
Keywords
COVID-19, Obesity, Antibodies, Macrophages, Immunity, Fc receptors
Medical subject headings
COVID-19, Obesity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • VenipunctureProcedure or surgery

    Also called Venapuncture, Blood collection

    Simple blood collection

Study groups in NCT06968442
Study groupRoleWhat they receive
GeneralOtherThe intervention is a blood collection, whereafter blood will be analyzed for immunological parameters.
Receives: Procedure: Venipuncture

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The concentration of pro-inflammatory cytokines (IL-6, IL-1β, and TNF) produced by macrophages upon both SARS-CoV-2 viral and antibody costimulation.

    Monocytes will be isolated from blood of participants of both groups, whereafter these are differentiated into macrophages. These macrophages will be stimulated with a virus and SARS-CoV-2 IgG combined stimulation. After the stimulation, the concentration of pro-inflammatory cytokines is measured in the supernatant of the macrophages.

    Measured: Baseline

Secondary outcomes (10)
  1. The concentration of pro-inflammatory cytokines (IL-6, IL-1β, and TNF) produced by macrophages upon separate viral stimulation or SARS-CoV-2 antibody stimulation

    Monocytes will be isolated from blood of participants of both groups, whereafter these are differentiated into macrophages. These macrophages will be stimulated separately with a virus and SARS-CoV-2 IgG stimulation. After the stimulation, the concentration of pro-inflammatory cytokines is measured in the supernatant of the macrophages.

    Measured: Baseline

  2. The plasma concentration of pro-inflammatory cytokines

    Pro-inflammatory cytokines will be directly measured in plasma.

    Measured: Baseline

  3. Measurement of other cytokines that are produced by macrophages upon viral stimulation, antibody stimulation, or both

    Monocytes will be isolated from blood of participants of both groups, whereafter these are differentiated into macrophages. These macrophages will be stimulated with a viral stimulation, SARS-CoV-2 IgG stimulation or both combined. After the stimulations, the concentration of additional cytokines (IL-10, IFNg, IFNa, IFNb) will be measured in the supernatant of the macrophages.

    Measured: Baseline

  4. Expression levels of Fc receptors on the surface of macrophages

    Macrophages will be analyzed by flow cytometry to determine the expression levels of Fc receptors (including CD16, CD32a, CD32b, CD64).

    Measured: Baseline

  5. The level of intracellular lipids in monocytes

    Monocytes isolated from blood will be analyzed by flow cytometry to assess the intracellular lipid content

    Measured: Baseline

  6. Gene expression levels of proteins related to immune signalling or metabolic pathways

    Molecular techniques will be applied to assess the gene expression levels of interesting proteins involved in immune signalling or metabolic pathways.

    Measured: Baseline

  7. Chromatin accessibility, measured as the number of 'reads per genomic region' of genes related to Fc-receptor activation in macrophages

    ATAC-seq will be applied to determine the chromatine accessibility of genes related to Fc-receptor (i.e., receptors binding the Fc-part of antibodies) activation in macrophages. These include genes encoding for the receptors itself, as well as genes encoding for proteins related with the related intracellular signalling pathways upon Fc-receptor activation. The measured unit will be the number of reads per genomc region.

    Measured: Baseline

  8. The level of lactate production by macrophages upon stimulation with anti-SARS-CoV-2 IgG.

    Lactate is the final product of the glycolysis metabolic pathway. The level of lactate produced by macrophages, thus resembling glycolysis activity, will be assessed after stimulaten with anti-SARS-CoV-2 IgG. The concentration will be measured in mM.

    Measured: Baseline

  9. The concentration of proteins in plasma

    Using a proteomics approach, the concentration of over 1000 proteins will be assessed in plasma.

    Measured: Baseline

  10. The level of SARS-CoV-2 specific T cell responses and plasma antibodies

    To determine the adaptive immunity against SARS-CoV-2, T cell responses and antibodies specific to SARS-CoV-2 proteins Spike, Spike S2, Spike S2, and Nucleocapsid will be assessed

    Measured: Baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 May 2025
  2. Study start22 Apr 2025
  3. Primary completion31 Dec 2025 (estimated)
  4. Study completion22 Apr 2026 (estimated)

Resources

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
Basic science
Allocation
Not applicable
Intervention model
Single group
Model description
The investigators include a cohort of obesity patients (all BMI \>35) who are eligible for bariatric surgery and a control cohort of age and sex matched lean (all BMI \<25) healthcare workers. From all individuals, blood is collected and immunological analyses are performed.
Masking
None (open label)
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06968442
Sponsor's protocol ID
NL88800.100.25
Acronym
SAMO
Status last verified
Apr 2025
First submitted
28 Apr 2025
Last updated
16 May 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: If requested we will make the IPD available

Publications

  • Hoepel W, Chen HJ, Geyer CE, Allahverdiyeva S, Manz XD, de Taeye SW, Aman J, Mes L, Steenhuis M, Griffith GR, Bonta PI, Brouwer PJM, Caniels TG, van der Straten K, Golebski K, Jonkers RE, Larsen MD, Linty F, Nouta J, van Roomen CPAA, van Baarle FEHP, van Drunen CM, Wolbink G, Vlaar APJ, de Bree GJ, Sanders RW, Willemsen L, Neele AE, van de Beek D, Rispens T, Wuhrer M, Bogaard HJ, van Gils MJ, Vidarsson G, de Winther M, den Dunnen J. High titers and low fucosylation of early human anti-SARS-CoV-2 IgG promote inflammation by alveolar macrophages. Sci Transl Med. 2021 Jun 2;13(596):eabf8654. doi: 10.1126/scitranslmed.abf8654. Epub 2021 May 11.

    PubMed 33979301

Questions about this trial

What is this clinical trial studying?

A study testing Venipuncture in people with COVID-19 and Antibody COVID-19, run by Franciscus Gasthuis at 1 site in Netherlands.

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 8 inclusion and 3 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: looking for participants now, as of the sponsor's last update on 16 May 2025. 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 Netherlands. 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?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Willem A Mak, M.Sc. (+316 40897778, ashwinmak98@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The concentration of pro-inflammatory cytokines (IL-6, IL-1β, and TNF) produced by macrophages upon both SARS-CoV-2 viral and antibody costimulation. (time frame: Baseline). 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 NCT06968442, which also lists 1 linked publication.

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 16 May 2025.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in