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| ID | Type | Description | Link |
|---|---|---|---|
| 2013-002390-21 | EudraCT Number | ||
| NL44630.091.13 | Other Identifier | CCMO | |
| 2013/290 | Other Identifier | CMO Arnhem-Nijmegen |
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Oxygen is a widely available gas that is cheap, easy to get and extensively used in medicine. From animal studies it has become apparent that increasing or lowering the degree of oxygen in the blood, the inflammatory response can be altered. We will investigate of this is also true in humans by increasing, lowering or keeping oxygen levels normal while giving healthy subjects a short inflammatory stimulus.
The primary objective of the study is to determine the effects of hyperoxia and hypoxia compared to normoxia in the human endotoxemia model on the innate immune reponse in healthy volunteers.
A parallel, randomized study in healthy male volunteers. The subjects will be randomized to hypoxia, hyperoxia, or normoxia, and will all undergo experimental human endotoxemia (administration of 2 ng/kg LPS iv).
In the hypoxia group: the subjects will breathe an individualized mix of nitrogen and room air for 3.5 hours using an air-tight respiratory helmet. The gas mixture will be adjusted to achieve a saturation of 80-85%. In the hyperoxia group, subjects will breathe 100% oxygen for 3.5 hours using the same respiratory helmet. In the normoxia group, subjects will breathe room air (21% oxygen, 79% nitrogen) also wearing the respiratory helmet. 1 hour after oxygen status adjustment (t=0), all subject will be administered an intravenous bolus (2ng/kg) of LPS derived from E coli O:113. 2.5 hours after LPS administration, the helmets will be removed and all subjects will breathe ambient room air.
The primary study endpoint is the difference in plasma cytokines between the hypoxia and normoxia group, and between the hyperoxia and normoxia group. Secondary objectives include HIF-1α protein and mRNA, aHIF mRNA expression in circulating leukocytes, measures of ROS, leukocyte phagocytosis, and cytokine production by leukocytes stimulated ex vivo with various inflammatory stimuli, and measurement of basic hemodynamic and ventilatory parameters and temperature.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Hypoxia | Experimental | Subjects will be breathing an individualized mix of nitrogen and room air titrated to an oxygen saturation of 80-85%. |
|
| Hyperoxia | Experimental | Subjects will be breathing 100% of oxygen |
|
| Normoxia | Active Comparator | Subjects wil be breathing room air (21%) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lipopolysaccharide | Drug | LPS is used to elicit an inflammatory response in all subjects |
|
| Measure | Description | Time Frame |
|---|---|---|
| Plasma TNF-alpha concentration following LPS administration | Plasma TNF-α concentration after LPS administration (Area Under Curve); comparison of subjects treated with hypoxia compared to normoxia and hyperoxia compared to hypoxia | 1 day |
| Measure | Description | Time Frame |
|---|---|---|
| Hypoxia Inducible Factor 1 alpha in circulating leukocytes | Hypoxia Inducible Factor 1 alpha in circulating neutrophils, lymfocytes and monocytes as measured with flow cytometry | 1 day |
| Hypoxia Inducible Factor mRNA and anti Hypoxia Inducible Factor mRNA in circulating leukocytes |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Peter Pickkers, MD, PhD | Intensive Care Medicine, Radboud University Nijmegen Medical Centre | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Intensive Care Medicine | Nijmegen | Gelderland | 6500HB | Netherlands |
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| ID | Term |
|---|---|
| D000860 | Hypoxia |
| D018496 | Hyperoxia |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010335 | Pathologic Processes |
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| ID | Term |
|---|---|
| D008070 | Lipopolysaccharides |
| ID | Term |
|---|---|
| D006001 | Glycoconjugates |
| D002241 | Carbohydrates |
| D011135 | Polysaccharides, Bacterial |
| D011134 | Polysaccharides |
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| 24 hours |
| Reactive Oxygen Species in circulating leukocytes | 1 day |
| Phagocytic function of circulating leukocytes | 1 day |
| cytokine production after ex vivo stimulation of leukocytes | 1 day |
| circulating cytokines (including but not limited to IL-6, IL-10, IL-1RA) | 1 day |
| Hemodynamic parameters | Blood pressure, heart frequency, cardiac output measurement | 1 day |
| ventilatory response | Measures of ventilation: respiratory rate, blood gas changes | 1 day |
| adenosine metabolism | urine and plasma adenosine,adenosine receptor mRNA, purines | 1 day |
| alkaline phosphatase | 1 day |
| cognitive function | neuropsychologic assessment of cognitive function | 1 day |
| Hepcidin and iron parameters | 1 day |
| catecholamines and cortisol | adrenaline, noradrenaline, dopamine and cortisol | 1 day |
| Neutrophilic function | 1 day |
| body temperature | 1 day |
| oxygen saturation and arterial blood gas | 1 |
| subjective symptom scores | 1 day |
| high sensitive troponine | 1 day |
| iFABP | 1 day |
| brain specific proteins | 1 day |
| endocan | 1 day |
| downstream targets of HIF | adrenomedullin, VEGF, EPO | 1 day |
| heart rate variability | 1 day |
| kidney injury markers in plasma and urine | 2 days |
| microbiome in feces | -1 day untill 1 week |
| markers of immunoparalysis | monocytic histone 3 lysine 4 trimethylation of the promotor region of pro-inflammatory genes, ex viv production of proinflammatory cytokines, HLA-DR expression on moncytes. | 1 day |
| measures of coagulation and plateletfunction | platelet activation and platelet function, thrombin generation and other coagulation parameters, hematolocial infection profile using hematology analyser | 1 day |
| meausures of coagulation and fibrinolysis | thrombin generation, thrombocyte function, ROTEM, plasmatic coagulation, fibrinolysis parameters | 1 day |
| D008055 |
| Lipids |
| D000942 | Antigens, Bacterial |
| D000941 | Antigens |
| D001685 | Biological Factors |
| D004731 | Endotoxins |
| D001427 | Bacterial Toxins |
| D014118 | Toxins, Biological |