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| Name | Class |
|---|---|
| Avisa Pharma Inc. | UNKNOWN |
| Malvern Consulting Group, Inc. | UNKNOWN |
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This is a Phase 1, open label, evaluation of a 13C-urea breath test for the detection of urease-producing bacteria in patient with pneumonia in the emergency department.
This is a Phase 1, open-label evaluation of an inhaled 13C-urea breath test in the identification of urease positive bacteria in patients diagnosed with pneumonia in the emergency department (ED). This study will enroll up to 75 adult male and female subjects in two cohorts. Adult subjects will be screened for participation in two dosing cohorts to be enrolled sequentially. Cohort A will enroll 15 subjects presenting to the ED with clinical concern for pneumonia and plan for outpatient treatment. Following enrollment and review of the safety of dosing in Cohort A, subjects receiving a diagnosis of pneumonia in the ED that are planned for admission will be screened for enrollment in Cohort B. Eligible subjects will provide informed consent, medical history, and samples for laboratory testing (including pregnancy testing for females of childbearing potential) during screening. Subjects will be evaluated for their CURB-65 Pneumonia Severity Score, and Community-Acquired Pneumonia Severity Index (PSI) where required data are available.
Prior to breath test administration, subjects will provide a sputum sample for bacterial culture; sample may be induced, or collected as part of initial ED workup if appropriate culture has been ordered. Subjects will undergo breath test with collection of baseline breath samples (up to 6), followed by complete nebulization of 13C-urea solution. Immediately following the end of nebulization, breath collection bag samples will be collected at up to 6 time points with at least 1 minute intervals within 10 minutes post-nebulization. Exhaled breath bags will be centrally processed to determine the change in exhaled 13CO2 levels. Vital signs, including resting blood pressure, resting pulse, respiratory rate, peripheral oxygen saturation, and temperature will be collected prior to, and following completion of, nebulization treatment. In the event of bronchospasm, during or following nebulization, albuterol rescue will be available for treatment at the discretion of the investigator.
Once required tests are complete, the subject will be treated/followed according to standard institutional protocol/practice. The subjects' clinical course will be followed for at least 24 hours, where possible, to document the final diagnosis and outcome.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study of Outpatient Treatment Cohort | Experimental | Subjects presenting to the emergency department with clinical suspicion for bacterial pneumonia and plan for outpatient treatment will undergo collection of baseline breath samples (up to 6), followed by complete nebulization of 13C-urea solution. Immediately following the end of nebulization, breath collection bag samples will be collected at up to 6 time points with at least 1 minute intervals within 10 minutes post-nebulization. Exhaled breath bags will be centrally processed to determine the change in exhaled 13CO2 levels. |
|
| Study of Inpatient Treatment Cohort | Experimental | Subjects presenting to the emergency department with clinical suspicion for bacterial pneumonia and plan for inpatient treatment will undergo collection of baseline breath samples (up to 6), followed by complete nebulization of 13C-urea solution. Immediately following the end of nebulization, breath collection bag samples will be collected at up to 6 time points with at least 1 minute intervals within 10 minutes post-nebulization. Exhaled breath bags will be centrally processed to determine the change in exhaled 13CO2 levels. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 13C-urea breath test | Device | Subjects will undergo 13C-urea breath test involving collection of baseline breath samples, nebulization of 13C-urea, and collection of post-nebulization breath samples |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse Events | Any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. | Within 24-48 hours of breath test |
| Serious Adverse Events | Death, disability, incapacitation, escalation of level of care, prolongation of hospitalization, birth defect, or intervention to prevent the above. | Within 24-48 hours of breath test |
| Suspected Adverse Reaction | Any adverse event for which there is a reasonable possibility that the adverse event was caused by the study drug. | Within 24-48 hours of breath test |
| Serious Suspected Adverse Reaction | Any Suspected Adverse Reaction that is determined to be serious, based on the outcomes of a Serious Adverse Event; i.e. death, life-threatening, causes or prolongs inpatient hospitalization, causes a persistent of significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital abnormality/birth defect. | Within 24-48 hours of breath test |
| Measure | Description | Time Frame |
|---|---|---|
| Exhaled 13CO2 Concentration | We recorded change in 13CO2/12CO2 ratio (delta over baseline or ΔOB, in units of ‰) between pre- and post-nebulization samples | Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to Bacterial RNAseq Counts |
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Inclusion Criteria:
Cohort A Only: be a man or woman age 18-65, inclusive, with suspected bacterial pneumonia on presentation to the ED based on clinical signs and symptoms AND be planned for outpatient treatment
OR
Cohort B Only: be a man or woman age 18-85, inclusive, with a diagnosis of suspected bacterial pneumonia in the ED based on findings of a positive chest x-ray and clinical signs and symptoms AND be planned for admission to the hospital ward/floor
be capable of providing a spontaneous or induced sputum sample for analysis
be capable of completing the breath test according to the clinical judgement of the investigator
be able to understand the study procedures, agree to participate in the study program, and voluntarily provide written informed consent
Exclusion Criteria:
have a known allergy to urea or any excipient in the nebulized solution
be pregnant or have a positive urine pregnancy test
have evidence of active oral infection, such as abscess or dense exudate, that requires antibiotic therapy
have known diagnosis of cystic fibrosis or bronchiectasis
have a known or suspected acute asthma exacerbation on presentation to the ED
have received treatment with oral or intravenous (IV) antibiotics in the preceding 2 days prior to screening, unless antibiotic failure is suspected
OR
have received treatment in the ED with oral or IV antibiotics greater than 4 hours prior to breath test
have an acute illness or other condition that, as determined by the investigator, would preclude participation in the study
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Henry Ford Health System | Detroit | Michigan | 48202 | United States |
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All subjects provided written informed consent prior to participation. Subjects were screened for eligibility, including medical history, vital signs, and ability to perform breath sampling. No randomization was performed; subjects were assigned to outpatient or inpatient cohorts based on clinical treatment plan.
Subjects were recruited from the emergency departments of University of New Mexico Health Sciences Center and Henry Ford Hospital. Eligible participants presented with clinical suspicion for community-acquired pneumonia and were screened for outpatient (Cohort A) or inpatient (Cohort B) treatment enrollment.
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| ID | Title | Description |
|---|---|---|
| FG000 | Outpatient Treatment Cohort (Cohort A) | Subjects with suspected bacterial pneumonia planned for outpatient treatment who received the 13C-urea breath test. |
| FG001 | Inpatient Treatment Cohort (Cohort B) | Subjects with suspected bacterial pneumonia planned for inpatient hospital admission who received the 13C-urea breath test. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
All participants who enrolled and completed breath testing are included in the baseline analysis population. No exclusions were made. Participant totals reflect completion at both study sites.
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| ID | Title | Description |
|---|---|---|
| BG000 | Outpatient Treatment Cohort (Cohort A) | Subjects with suspected bacterial pneumonia planned for outpatient treatment who received the 13C-urea breath test. |
| BG001 | Inpatient Treatment Cohort (Cohort B) |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Age in years at time of study enrollment. |
| 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 | Adverse Events | Any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. | Posted | Count of Participants | Participants | Within 24-48 hours of breath test |
|
From immediately after 13C-urea breath test to 24-48 hours post-dose
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Outpatient Treatment Cohort (Cohort A) | Subjects with suspected bacterial pneumonia planned for outpatient treatment who received the 13C-urea breath test. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Coughing | Respiratory, thoracic and mediastinal disorders | Systematic Assessment | brief coughing, which resolved spontaneously |
Small sample size, observational design, and limited follow-up period may limit generalizability. Study was primarily designed to assess safety and feasibility, not diagnostic efficacy.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Justin Baca | University of New Mexico Health Sciences Center | 505-272-5062 | jtbaca@salud.unm.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 20, 2017 | Apr 28, 2025 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form: Cohort B | Apr 30, 2018 | Apr 28, 2025 | ICF_001.pdf |
| ICF | No | No | Yes | Informed Consent Form: Cohort A | Aug 13, 2017 | Apr 28, 2025 | ICF_002.pdf |
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| ID | Term |
|---|---|
| D018410 | Pneumonia, Bacterial |
| ID | Term |
|---|---|
| D001424 | Bacterial Infections |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D011014 | Pneumonia |
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Open label evaluation of breath test for safety and detection of urease producing pathogens in two cohorts of emergency department patients with suspected bacterial pneumonia.
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Care Providers will not be provided with the results of the breath test, and will treat patients according to the current standards of care
We recorded change in 13CO2/12CO2 ratio (delta over baseline or ΔOB, in units of ‰) between pre- and post-nebulization samples and compared with subject's causative pathogen based upon sputum or blood culture results |
| Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to CURB-65 Score in Urease-Positive Pneumonia | Number of participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to CURB-65 Score in Urease-Positive Pneumonia | Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to Pneumonia Severity Index in Urease-Positive Pneumonia. | Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to Pneumonia Severity Index in Urease-Positive Pneumonia. | Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants Meeting Sensitivity Criterion of ¹³C-Urea Breath Test for Urease-Producing Pathogens | This exploratory outcome was designed to assess whether the ¹³C-urea breath test (Δ¹³CO₂) is associated with the presence of urease-producing pathogens. Correlation between exhaled ¹³CO₂ levels and pathogen abundance (based on RNAseq bacterial counts) was to be evaluated using Spearman's correlation, with a pre-defined significance threshold of ρ > 0.75. | Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants Meeting Specificity Criterion of ¹³C-Urea Breath Test for Urease-Producing Pathogens | This exploratory outcome was designed to assess the specificity of the ¹³C-urea breath test (Δ¹³CO₂) for detecting urease-producing pathogens. Specificity was defined as the proportion of participants without urease-producing pathogens (based on RNAseq bacterial profiles) who also did not meet the predefined breath test threshold. The planned analysis used Spearman correlation (ρ) between ¹³CO₂ enrichment and bacterial abundance, with ρ < 0.75 indicating a negative test result. | Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants With Breath Test Positive and Confirmed Urease-Producing Pathogen (PPV Criterion) | This exploratory outcome measured the number of participants who met the criteria for positive predictive value of the ¹³C-urea breath test. A participant was considered to meet the PPV criterion if they had a positive breath test result (Spearman ρ > 0.75 between Δ¹³CO₂ and bacterial abundance) and also had RNAseq-confirmed presence of at least one urease-producing pathogen. | Collected at 6 minutes after nebulization and measured within 7 days of collection |
| Number of Participants Meeting Negative Predictive Value Criterion of ¹³C-Urea Breath Test for Urease-Producing Pathogens | This exploratory outcome was designed to evaluate the number of participants meeting the negative predictive value (NPV) criterion of the ¹³C-urea breath test for detecting urease-producing pathogens. A participant was considered to meet the NPV criterion if they had a negative breath test result defined as a Spearman correlation coefficient (ρ) ≤ 0.75 between Δ¹³CO₂ and bacterial abundance and RNAseq-confirmed absence of urease-producing pathogens. | Collected at 6 minutes after nebulization and measured within 7 days of collection |
Subjects with suspected bacterial pneumonia planned for inpatient hospital admission who received the 13C-urea breath test.
| BG002 | Total | Total of all reporting groups |
| Mean |
| Standard Deviation |
| Years |
|
| Sex: Female, Male | Number and percentage of participants who self-identified as female or male at enrollment. | Count of Participants | Participants | No |
|
| Race (NIH/OMB) | Race data were collected for inpatient participants but not outpatient participants. | Race data were collected for inpatient participants but not outpatient participants. | Count of Participants | Participants | No |
|
| Ethnicity (NIH/OMB) | Ethnicity data were collected for inpatient participants but not outpatient participants. | Ethnicity data were collected for inpatient participants but not outpatient participants. | Count of Participants | Participants | No |
|
| Region of Enrollment | All participants were enrolled at U.S. clinical sites (University of New Mexico Health Sciences Center and Henry Ford Hospital). | Count of Participants | Participants | No |
|
| Units | Counts |
|---|---|
| Participants |
|
|
| Primary | Serious Adverse Events | Death, disability, incapacitation, escalation of level of care, prolongation of hospitalization, birth defect, or intervention to prevent the above. | Posted | Count of Participants | Participants | Within 24-48 hours of breath test |
|
|
|
| Primary | Suspected Adverse Reaction | Any adverse event for which there is a reasonable possibility that the adverse event was caused by the study drug. | Posted | Count of Participants | Participants | Within 24-48 hours of breath test |
|
|
|
| Primary | Serious Suspected Adverse Reaction | Any Suspected Adverse Reaction that is determined to be serious, based on the outcomes of a Serious Adverse Event; i.e. death, life-threatening, causes or prolongs inpatient hospitalization, causes a persistent of significant incapacity or substantial disruption of the ability to conduct normal life functions, or a congenital abnormality/birth defect. | Posted | Count of Participants | Participants | Within 24-48 hours of breath test |
|
|
|
| Secondary | Exhaled 13CO2 Concentration | We recorded change in 13CO2/12CO2 ratio (delta over baseline or ΔOB, in units of ‰) between pre- and post-nebulization samples | We recorded change in 13CO2/12CO2 ratio (delta over baseline or ΔOB, in units of ‰) between pre- and post-nebulization samples | Posted | Mean | Standard Deviation | Percent change | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to Bacterial RNAseq Counts | We recorded change in 13CO2/12CO2 ratio (delta over baseline or ΔOB, in units of ‰) between pre- and post-nebulization samples and compared with subject's causative pathogen based upon sputum or blood culture results | The change in 13CO2/12CO2 ratio (delta over baseline or ΔOB, in units of ‰) between pre- and post-nebulization samples was compared to RNAseq bacterial counts. Positive relationships and/or correlations were tested using Spearman's rank correlations. A Spearman value above 0.75 was selected as the cutoff, above which results would be determined to be a positive outcome. A spearman correlation > 0.75 for any bacteria, the subject would be a positive outcome. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to CURB-65 Score in Urease-Positive Pneumonia | Number of participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to CURB-65 Score in Urease-Positive Pneumonia | Linear regression and Spearman correlation was used to determine if CURB65 score correlated with the change in 13CO2 divided by the baseline 13CO2. A spearman correlation > 0.75 and/or a coefficient of determination > .70 would mean the subject was listed as a positive outcome in the data table. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to Pneumonia Severity Index in Urease-Positive Pneumonia. | Number of Participants With ¹³CO₂/¹²CO₂ Ratio Correlated (ρ > 0.75) to Pneumonia Severity Index in Urease-Positive Pneumonia. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants Meeting Sensitivity Criterion of ¹³C-Urea Breath Test for Urease-Producing Pathogens | This exploratory outcome was designed to assess whether the ¹³C-urea breath test (Δ¹³CO₂) is associated with the presence of urease-producing pathogens. Correlation between exhaled ¹³CO₂ levels and pathogen abundance (based on RNAseq bacterial counts) was to be evaluated using Spearman's correlation, with a pre-defined significance threshold of ρ > 0.75. | Participants with both breath test data and RNAseq-based bacterial abundance profiles were included in this analysis. Urease-producing pathogens were identified based on taxonomy and literature-reported activity. The outcome was defined as the number of participants with a Spearman correlation coefficient greater than 0.75 between Δ¹³CO₂ and pathogen abundance. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants Meeting Specificity Criterion of ¹³C-Urea Breath Test for Urease-Producing Pathogens | This exploratory outcome was designed to assess the specificity of the ¹³C-urea breath test (Δ¹³CO₂) for detecting urease-producing pathogens. Specificity was defined as the proportion of participants without urease-producing pathogens (based on RNAseq bacterial profiles) who also did not meet the predefined breath test threshold. The planned analysis used Spearman correlation (ρ) between ¹³CO₂ enrichment and bacterial abundance, with ρ < 0.75 indicating a negative test result. | Participants without RNAseq-detected urease-producing pathogens and with available breath test data were included in this analysis. A specific breath test response was defined as Spearman ρ > 0.75 between Δ¹³CO₂ and pathogen abundance. Participants not meeting this criterion were considered test-negative. The outcome measured the proportion of participants correctly classified as negative by the breath test. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants With Breath Test Positive and Confirmed Urease-Producing Pathogen (PPV Criterion) | This exploratory outcome measured the number of participants who met the criteria for positive predictive value of the ¹³C-urea breath test. A participant was considered to meet the PPV criterion if they had a positive breath test result (Spearman ρ > 0.75 between Δ¹³CO₂ and bacterial abundance) and also had RNAseq-confirmed presence of at least one urease-producing pathogen. | Participants with both ¹³C-urea breath test results and RNAseq bacterial profiling were included in this analysis. Positive breath test results were defined by Spearman correlation ρ > 0.75 between Δ¹³CO₂ and bacterial abundance. Urease-producing pathogens were identified based on taxonomic classification and known enzymatic activity. The outcome was the count of participants meeting both conditions. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| Secondary | Number of Participants Meeting Negative Predictive Value Criterion of ¹³C-Urea Breath Test for Urease-Producing Pathogens | This exploratory outcome was designed to evaluate the number of participants meeting the negative predictive value (NPV) criterion of the ¹³C-urea breath test for detecting urease-producing pathogens. A participant was considered to meet the NPV criterion if they had a negative breath test result defined as a Spearman correlation coefficient (ρ) ≤ 0.75 between Δ¹³CO₂ and bacterial abundance and RNAseq-confirmed absence of urease-producing pathogens. | Participants with both ¹³C-urea breath test data and RNAseq bacterial profiles were included in this analysis. Breath test negativity was pre-defined as Spearman ρ ≤ 0.75. Participants without detectable urease-producing pathogens based on RNAseq taxonomic analysis were considered pathogen-negative. The outcome represents the number of participants who were both test-negative and pathogen-negative. | Posted | Count of Participants | Participants | Collected at 6 minutes after nebulization and measured within 7 days of collection |
|
|
|
| 0 |
| 15 |
| 0 |
| 15 |
| 5 |
| 15 |
| EG001 | Inpatient Treatment Cohort (Cohort B) | Subjects with suspected bacterial pneumonia planned for inpatient hospital admission who received the 13C-urea breath test. | 0 | 60 | 0 | 60 | 0 | 60 |
|
| Nausea | Gastrointestinal disorders | Systematic Assessment | nausea, which was mild and self-limited |
|
| Syncope | Cardiac disorders | Systematic Assessment | syncope occurred 24 hours after nebulization |
|
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| D012141 |
| Respiratory Tract Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| Native Hawaiian or Other Pacific Islander |
|
| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
| Unknown or Not Reported |
|