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During sepsis and septic shock the immune response can be overwhelming leading to excessive tissue damage, organ failure and death. Ideally, the inflammatory response is modulated leading to both adequate protection to invading pathogens as well as limitation of an exuberant immune response. In the last few years adenosine is proposed to have a central role in the modulation of inflammation. In unfavorable conditions such as hypoxia, ischemia or inflammation adenosine is quickly up-regulated; with concentrations up to tenfold in septic patients. Many animal studies have shown that adenosine is able to attenuate the inflammatory response and decrease mortality rates. Therefore, pharmacological elevation of the adenosine concentration is an potential target to attenuate inflammation and limit organ injury. Dipyridamole, an adenosine re-uptake inhibitor is able to increase the adenosine concentration and limit ischemia-reperfusion injury. In order to study the effects of dipyridamole on the inflammatory response we aim to use the so called human endotoxemia model. This model permits elucidation of key players in the immune response to a gram negative stimulus in vivo, therefore serving as a useful tool to investigate potential novel therapeutic strategies in a standardized setting.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Endotoxemia placebo | Placebo Comparator | Endotoxin combined with placebo |
|
| Endotoxemia Dipyridamole | Experimental | Endotoxin combined with Dipyridamol treatment |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dipyridamole | Drug | Oral treatment with dipyridamole 200 mg twice daily during seven consecutive days |
|
| Measure | Description | Time Frame |
|---|---|---|
| Circulating cytokines | TNFx, IL6, IL10, IL1RA | 24 hours after LPS administration |
| Measure | Description | Time Frame |
|---|---|---|
| Hemodynamics | Continious heart rate and blood pressure measurement | 24 hours after LPS administration |
| Sensitivity to norepinephrine | Venous occlusion plethysmography |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Bart P Ramakers, MD | Radboud University Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Radboud University Nijmegen Medical Centre | Nijmegen | 6500 HB | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22129171 | Derived | Ramakers BP, Riksen NP, Stal TH, Heemskerk S, van den Broek P, Peters WH, van der Hoeven JG, Smits P, Pickkers P. Dipyridamole augments the antiinflammatory response during human endotoxemia. Crit Care. 2011;15(6):R289. doi: 10.1186/cc10576. Epub 2011 Nov 30. |
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| ID | Term |
|---|---|
| D019446 | Endotoxemia |
| ID | Term |
|---|---|
| D016470 | Bacteremia |
| D018805 | Sepsis |
| D007239 | Infections |
| D014115 | Toxemia |
| D018746 |
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| ID | Term |
|---|---|
| D004176 | Dipyridamole |
| ID | Term |
|---|---|
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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| Placebo | Drug | Placebo twice daily during seven consecutive days |
|
| LPS | Other | The LPS derived from E. coli O:113 2ng/kg iv will be injected in 1 minute at a dosage of 2 ng/kg body weight. |
|
|
| 24 hrs after LPS administration |
| Endothelial-dependent and independent vasorelaxation | Venous occlusion plethysmography | 24 hours after LPS administration |
| Markers of endothelial damage and circulating endothelial cells | circulating adhesion molecules (ICAM, VCAM, E-selectin, P-selectin) circulating endothelial cells | 24 hrs after LPS administration |
| Urinary excretion of markers of renal injury | GSTAlpha1-1 and GSTPi1-1 | 24 hrs after LPS administration |
| Adenosine and related nucleotide concentrations | 24 hrs after LPS administration |
| Additional blood samples will be drawn for genetic testing and measurement of: mRNA and proteins part of the adenosine metabolism | 24 hours after LPS administration |
| Oxydative stress | Thiols, neutrophilic burst, calcium release of neuthrophils, TBARS, Carbonyls, FRAP, Myeloperoxidase, catalase, Griess assay | 24 hours after LPS administration |
| Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |