Aerosol Liposomal Cyclosporine for Chronic Rejection in L... | NCT01650545

NCT01650545

Status Module

Description Module

Arms/Interventions Module

Arm Groups

Label	Type	Description	Intervention Names
Liposomal Aerosol Cyclosporine	Experimental	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant )	Drug: Liposomal aerosol cyclosporine Other: standard immune suppression, oral
Conventional oral immune suppression	Active Comparator	Arm 2) Standard immune suppression consisting of typical oral immune suppression for lung transplant recipients typically tacrolimus, mycophenolate mofetil and prednisone. Conventrional oral immune suppression as standard of care thus consists of tacrolimus, mycophenolate mofetil prednisone rapamycin described in the subsequent section as well.	Other: standard immune suppression, oral

Name	Type	Description	Arm Group Labels	Other Names
Liposomal aerosol cyclosporine	Drug	inhaled form of immune suppression	Liposomal Aerosol Cyclosporine

Measure	Description	Time Frame
Number Of Participants With Chronic Rejection Who Met Primary Combined End-point	Treatment failure defined as: BOS progression (> 20% decline lung function), re-transplant, or death	approximately 1 year

Measure	Description	Time Frame
Cytokine Analysis From BAL Fluid in Lung	Multiple cytokines were assessed as markers of lung inflammation that may be used in addition to biopsy data, collected per patient as clinically indicated during the follow-up interval. Values are reported as mean change from baseline in each group, per week	baseline to approximately 1 year

Eligibility Module

Name	Affiliation	Role
Aldo T Iacono, MD	University of Maryland	Principal Investigator

Facility	Status	City	State	ZIP	Country	Contacts
University of Maryland Medical Center		Baltimore	Maryland	21201	United States

PubMed Identifier	Type	Citation	Retractions
16407509	Background	Iacono AT, Johnson BA, Grgurich WF, Youssef JG, Corcoran TE, Seiler DA, Dauber JH, Smaldone GC, Zeevi A, Yousem SA, Fung JJ, Burckart GJ, McCurry KR, Griffith BP. A randomized trial of inhaled cyclosporine in lung-transplant recipients. N Engl J Med. 2006 Jan 12;354(2):141-50. doi: 10.1056/NEJMoa043204.

Results Section

Participant Flow Module

Arm/Group Information

ID	Title	Description
FG000	Liposomal Aerosol Cyclosporine	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant ) Liposomal aerosol cyclosporine: inhaled form of immune suppression standard immune suppression, oral: conventional drug

Baseline Characteristics Module

Outcome Measures Module

Adverse Events Module

More Info Module

Arm/Group Information

ID	Title	Description
BG000	Liposomal Aerosol Cyclosporine	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant ) Liposomal aerosol cyclosporine: inhaled form of immune suppression standard immune suppression, oral: conventional drug
BG001	Conventional Oral Immune Suppression	Arm 2) Standard immune suppression consisting of typical oral immune suppression for lung transplant recipients typically tacrolimus, mycophenolate mofetil and prednisone standard immune suppression, oral: conventional drug
BG002	Total	Total of all reporting groups

Units	Counts
Participants	BG00011 BG00110 BG00221

Type

Title

Description

Population Description

Reporting Status

Anticipated Posting Date

Parameter Type

Dispersion Type

Unit of Measure

Calculate Percentage

Time Frame

Units Analyzed

Denominator Units Selected

Arm/Group Information

Denominators

Classes

Analyses

Primary

Number Of Participants With Chronic Rejection Who Met Primary Combined End-point

Treatment failure defined as: BOS progression (> 20% decline lung function), re-transplant, or death

Posted

Count of Participants

Participants

approximately 1 year

ID	Title	Description
OG000	Liposomal Aerosol Cyclosporine	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant ) Liposomal aerosol cyclosporine: inhaled form of immune suppression standard immune suppression, oral: conventional drug
OG001	Conventional Oral Immune Suppression	Arm 2) Standard immune suppression consisting of typical oral immune suppression for lung transplant recipients typically tacrolimus, mycophenolate mofetil and prednisone standard immune suppression, oral: conventional drug

Units	Counts
Participants	OG00011 OG00110

Title

Denominators

Categories

Title	Measurements
	OG0002 OG0015

Group IDs	Group Description	Statistical Method	Statistical Comment	P-Value	P-Value Comment	Parameter Type	Parameter Value	Dispersion Type	Dispersion Value	Confidence Interval Sides	Confidence Interval %	CI Lower Limit	CI Upper Limit	CI Lower Limit Comment	CI Upper Limit Comment	Estimate Comment	Tested Non-Inferiority	Non-Inferiority Type	Non-Inferiority Comment	Other Analysis Description
OG000 OG001		Log Rank		0.03														Superiority

Secondary

Cytokine Analysis From BAL Fluid in Lung

Multiple cytokines were assessed as markers of lung inflammation that may be used in addition to biopsy data, collected per patient as clinically indicated during the follow-up interval. Values are reported as mean change from baseline in each group, per week

Posted

Mean

95% Confidence Interval

pg/mL

baseline to approximately 1 year

ID	Title	Description
OG000	Liposomal Aerosol Cyclosporine	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant ) Liposomal aerosol cyclosporine: inhaled form of immune suppression standard immune suppression, oral: conventional drug
OG001	Conventional Oral Immune Suppression	Arm 2) Standard immune suppression consisting of typical oral immune suppression for lung transplant recipients typically tacrolimus, mycophenolate mofetil and prednisone standard immune suppression, oral: conventional drug

Units	Counts

Secondary

Overall Survival at 5 Years Follow-up

Number of participants surviving at 5 year follow-up

Posted

Count of Participants

Participants

5 years

ID	Title	Description
OG000	Liposomal Aerosol Cyclosporine	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant ) Liposomal aerosol cyclosporine: inhaled form of immune suppression standard immune suppression, oral: conventional drug Conventrional oral immune suppression as standard of care thus consists of tacrolimus, mycophenolate mofetil prednisone and rapamycin
OG001	Conventional Oral Immune Suppression	Arm 2) Standard immune suppression consisting of typical oral immune suppression for lung transplant recipients typically tacrolimus, mycophenolate mofetil and prednisone. Conventrional oral immune suppression as standard of care thus consists of tacrolimus, mycophenolate mofetil prednisone rapamycin described in the subsequent section as well. standard immune suppression, oral: conventional drug Conventrional oral immune suppression as standard of care thus consists of tacrolimus, mycophenolate mofetil prednisone and rapamycin

Arm/Groups

ID	Title	Description	Deaths (Affected)	Deaths (At Risk)	Serious Events (Affected)	Serious Events (At Risk)	Other Events (Affected)	Other Events (At Risk)
EG000	Liposomal Aerosol Cyclosporine	Arm 1) Aerosol liposomal cyclosporine Open label randomized trial using experimental inhalational therapy with liposomal aerosol cyclosporine in addition to standard immune suppression (tacrolimus , mycophenolate mofetil and prednisone) for 6 month duration at inhalational doses (5mg and 10 mg bid), to be defined by transplant type respectively (single, double lung transplant ) Liposomal aerosol cyclosporine: inhaled form of immune suppression standard immune suppression, oral: conventional drug	6	11	8	11	11	11
EG001	Conventional Oral Immune Suppression	Arm 2) Standard immune suppression consisting of typical oral immune suppression for lung transplant recipients typically tacrolimus, mycophenolate mofetil and prednisone standard immune suppression, oral: conventional drug	10	10	8	10	10	10

Serious Adverse Events

Term	Organ System	Assessment Type	Statistical Information
Atrial flutter	Cardiac disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Congestive heart failure	Cardiac disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Myocardial infarction	Cardiac disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Rapid atrial fibrillation	Cardiac disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Cholelithiasis	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Diarrhea	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Gastroenteritis	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Melena	Gastrointestinal disorders	Systematic Assessment	EG0000 affected11 at risk EG0012 affected10 at risk
Weakness	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Acute graft rejection	Immune system disorders	Systematic Assessment	EG0003 affected11 at risk EG0011 affected10 at risk
Bacteremia	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Bronchitis	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Herpes zoster exacerbation	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Influenza	Infections and infestations	Systematic Assessment	EG0002 affected11 at risk EG0010 affected10 at risk
Pneumonia	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0014 affected10 at risk
Pyrexia	Infections and infestations	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Respiratory syncytial virus	Infections and infestations	Systematic Assessment	EG0000 affected11 at risk EG0013 affected10 at risk
Rhinovirus	Infections and infestations	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Urinary tract infection	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Hypoglycemia	Metabolism and nutrition disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Aspiration	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Dyspnea	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0004 affected11 at risk EG0014 affected10 at risk
Hypoxic respiratory failure	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0012 affected10 at risk
Pneumomediastinum	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Pulmonary embolism	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Squamous cell carcinoma (scalp/left cheek)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Deep vein thrombosis	Vascular disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk

Other Adverse Events

Term	Organ System	Assessment Type	Statistical Information
Atrial flutter	Cardiac disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Carotid atherosclerosis	Cardiac disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Chest pain	Cardiac disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Congestive heart failure	Cardiac disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Myocardial infarction	Cardiac disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Rapid atrial fibrillation	Cardiac disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Ear inflammation	Ear and labyrinth disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Conjunctivitis	Eye disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Anorexia	Gastrointestinal disorders	Systematic Assessment	EG0002 affected11 at risk EG0011 affected10 at risk
Cholelithiasis	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Clostridium difficile	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Constipation	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Diarrhea	Gastrointestinal disorders	Systematic Assessment	EG0002 affected11 at risk EG0011 affected10 at risk
Emesis	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Gastroenteritis	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Gastrointestinal discomfort	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Melena	Gastrointestinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0012 affected10 at risk
Allergic rhinitis	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Ankle edema	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Ankle pain	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Back pain	General disorders	Systematic Assessment	EG0003 affected11 at risk EG0013 affected10 at risk
Bilateral ankle edema	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Bilateral foot edema	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0012 affected10 at risk
Bilateral knee pain	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Bilateral leg edema	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0012 affected10 at risk
Elevated creatinine level	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Elevated tacrolimus level	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Fall	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Fatigue	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Generalized pain (in joints)	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Left knee pain	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Leg edema	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Low back pain	General disorders	Systematic Assessment	EG0003 affected11 at risk EG0010 affected10 at risk
Malaise	General disorders	Systematic Assessment	EG0006 affected11 at risk EG0011 affected10 at risk
Motor vehicle crash	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Muscle spasms	General disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Neck edema	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0012 affected10 at risk
Pain	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Paresthesia (lower legs)	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0012 affected10 at risk
Right leg weakness	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Shoulder and back pain	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Weakness	General disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Bacteremia	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Bronchitis	Infections and infestations	Systematic Assessment	EG0002 affected11 at risk EG0010 affected10 at risk
Cytomegalovirus	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Herpes zoster exacerbation	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Influenza	Infections and infestations	Systematic Assessment	EG0003 affected11 at risk EG0010 affected10 at risk
Lower respiratory infection	Infections and infestations	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Pharyngitis	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Pneumonia	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0015 affected10 at risk
Pyrexia	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Respiratory syncytial virus	Infections and infestations	Systematic Assessment	EG0000 affected11 at risk EG0013 affected10 at risk
Rhinitis	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Rhinovirus	Infections and infestations	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Upper respiratory infection	Infections and infestations	Systematic Assessment	EG0004 affected11 at risk EG0011 affected10 at risk
Urinary tract infection	Infections and infestations	Systematic Assessment	EG0003 affected11 at risk EG0010 affected10 at risk
Viral infection	Infections and infestations	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Hypoglycemia	Metabolism and nutrition disorders	Systematic Assessment	EG0002 affected11 at risk EG0010 affected10 at risk
Confusion	Nervous system disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Hallucinations	Nervous system disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Tremor	Nervous system disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Uterine pain	Reproductive system and breast disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Acute rejection	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0004 affected11 at risk EG0011 affected10 at risk
Aspiration	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Cough	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0002 affected11 at risk EG0010 affected10 at risk
Dyspepsia	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Dyspnea	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0007 affected11 at risk EG0015 affected10 at risk
Hypoxic respiratory failure	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0012 affected10 at risk
Pneumomediastinum	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Productive cough	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0000 affected11 at risk EG0013 affected10 at risk
Pulmonary embolism	Respiratory, thoracic and mediastinal disorders	Systematic Assessment	EG0001 affected11 at risk EG0011 affected10 at risk
Abscess (right axillary)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Anterior tongue lesion	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Foot rash	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Herpes zoster (left scalp, ear, face)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Skin hyperpigmentation	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Skin rash	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Squamous cell carcinoma (chest, temple)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Squamous cell carcinoma (scalp/left cheek)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Squamous cell carcinoma (left ear)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Squamous cell carcinoma (left hand)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Urticarial (left cheek)	Skin and subcutaneous tissue disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Deep vein thrombosis	Vascular disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk
Hypertension	Vascular disorders	Systematic Assessment	EG0003 affected11 at risk EG0012 affected10 at risk
Postural hypotension	Vascular disorders	Systematic Assessment	EG0000 affected11 at risk EG0011 affected10 at risk
Pulmonary hypertension	Vascular disorders	Systematic Assessment	EG0001 affected11 at risk EG0010 affected10 at risk

ID	Term
D001989	Bronchiolitis Obliterans
D000092122	Bronchiolitis Obliterans Syndrome

ID	Term
D001988	Bronchiolitis
D001991	Bronchitis
D001982	Bronchial Diseases
D012140	Respiratory Tract Diseases
D008173	Lung Diseases, Obstructive
D008171	Lung Diseases
D000092124	Organizing Pneumonia
D006086	Graft vs Host Disease
D007154	Immune System Diseases

ID	Term
D016572	Cyclosporine
D016559	Tacrolimus
D020123	Sirolimus

ID	Term
D003524	Cyclosporins
D010456	Peptides, Cyclic
D047028	Macrocyclic Compounds
D011083	Polycyclic Compounds
D010455	Peptides
D000602	Amino Acids, Peptides, and Proteins
D018942	Macrolides
D007783	Lactones
D009930	Organic Chemicals