Counter-Regulatory Hormonal and Stress Systems in Patients With COVID-19

NCT ID: NCT05736900

Last Updated: 2023-03-14

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 200 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-09-10
• Study Completion Date: 2021-06-12

Brief Summary

The COVID-19 pandemic is associated with a highly variable presentation, ranging from patients who are asymptomatic or experience only mild symptoms to others with acute respiratory syndrome (ARDS) who require ventilatory support and carry a high risk of severe adverse outcomes and mortality. The most vulnerable population are older adults, usually people with chronic medical conditions and more often men than women.. Nevertheless, infection with SARS-CoV-2 can have deadly consequences even among those without any clear pre-existing medical conditions. Differences in adaptive immune responses and ensuing inflammatory reactions are proposed to contribute to the variable vulnerability to severe disease among patients infected with SARS-CoV-19. It is also possible that inter-individual differences in responsiveness of counter-regulatory hormonal and stress systems may further contribute to variable outcomes in infected patients, and that this may involve modulation of inflammatory responses. The hypothalamo-pituitary adrenal (HPA) axis in particular is a critical regulator of adaptive responses of metabolic and immune systems to various stressors, including. Sex-differences and age-related declines in adrenal cortical production of glucocorticoids and androgens as well as responsiveness of the HPA axis and immune function to stressors are particularly in older men. Such factors may contribute to the high morbidity associated with SARS-CoV-2 infection in elderly males.Among other important hormonal counter-regulatory systems, the renin angiotensin aldosterone system (RAAS) is prominently and directly impacted by SARS-CoV-2. Specifically both SARS-CoV-2 and SARS-CoV angiotensin-converting enzyme 2 (ACE2) to gain entry into cells. Tissue distrubtions of ACE2 match to viral distributions and systemic-wide impacts of SARS-CoV-2 or SARS-CoV beyond the lungs to kidneys, pancreas heart and other tissues. Studies in rats have shown that ACE2 is expressed in substantially higher amounts in alveolar epithelium, bronchiolar epithelium, endothelium and smooth muscle cells of pulmonary vessels of younger than older animals and among the latter group in higher amounts in females than males. Should the same apply to humans such differences may underly the predominance of symptomatic and more severe infections with both SARS-CoV-2 and SARS-CoV in older than younger patients, particularly male

Detailed Description

The evidence outlined above altogether favors the possibility that inbalance of the RAAS involving upregulated ACE and and angiotensin II and downregulated ACE2 and angiotensin 1-7 might be involved in the susceptibility of SARS-CoV-2 infected patients to more severe outcomes. Given links between the RAAS and the HPA axis with inflammatory processes [38-40], it is also possible that alterations in adrenal steroidal systems might further contribute to the highly variable responses to SARS-CoV-2 infection. This clinical protocol will therefore examine RAAS and the HPA stress system in SARS-CoV-2 infected patients with the objective of identifying differences in these counter-regulatory hormonal and stress systems that might explain progression to more severe disease in infected patients. With this and associated patient data (e.g., age, sex, comorbidities, medications) the plan is to also include application of artificial intelligence-based machine learning approaches to develop algorithms for prognostic prediction of disease outcomes. Given the forecasted numbers of deaths and secondary impacts on health even amongst those not infected, as well as the estimated more than one trillion dollar hit to the world economy, it is clearly important to identify effective treatments that may also be relevant to possible future outbreaks resistant to vacines developed based on the current pandemic. With this in mind the associated data should better facilitate identification of disease mechanisms that underly the more severe clinical phenotypes, thereby enabling educated identification of most appropriate therapeutic approaches for successful management of infected patients. Finally there is some evidence from the earlier SARS-CoV epidemic that infection with these coronaviruses may have health consequences well beyond the acute infection stage. By long-term follow-up, that also allows for inclusion of additional patients at follow-up, this protocol will further address concerns about chronic impacts on health among patients infected with the virus.

Conditions

COVID-19

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Patients with COVID-19

Patients admitted as in-patients with SARS-CoV-2 Infection

Group Type: OTHER

Blood sampling

Intervention Type: DIAGNOSTIC_TEST

One samples of 5 mL blood is taken into a Serum tube for measurement of the RAAS-Biomarkers. After allowing to coagulate between 30 min and 60 min at room temperature, samples are centrifuged at 3000g for 10 min at room temperature.

Interventions

Blood sampling

One samples of 5 mL blood is taken into a Serum tube for measurement of the RAAS-Biomarkers. After allowing to coagulate between 30 min and 60 min at room temperature, samples are centrifuged at 3000g for 10 min at room temperature.

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• Adult (age > 18 years)
• Patients who meet on one or more of the following criteria for the screening test according to the CDC guidelines:
• Have fever or lower respiratory symptoms (cough, shortness of breath) and close contact with a confirmed COVID-19 case within the past 14 days; OR Have fever and lower respiratory symptoms (cough, shortness of breath) and a negative rapid flu test
• Patients with previous documented history of SARS-CoV-2 infection withn appropriate retrospectively collected andv available data.

Exclusion Criteria

• Patients with impaired mental capacity that precludes informed consent
• Subjects who need medications that may interfere with or invalidate outcome parameters and that can not be stopped without significant risk (e.g., steroids, oral contraceptives)
• Severe or terminal co-morbidity which seriously interferes with possible treatment or health related quality of life
• Pregnancy

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

OTHER

Sponsor Role: lead

Responsible Party

Mingrone Geltrude

professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

geltrude mingrone

Role: PRINCIPAL_INVESTIGATOR

Policlinico A. Gemelli IRCCS

Locations

Mingrone Geltrude

Roma, , Italy

Countries

Italy

References

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub 2020 Mar 11.

Reference Type: BACKGROUND

PMID: 32171076 (View on PubMed)

Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, Pan P, Wang W, Hu D, Liu X, Zhang Q, Wu J. Coronavirus infections and immune responses. J Med Virol. 2020 Apr;92(4):424-432. doi: 10.1002/jmv.25685. Epub 2020 Feb 7.

Reference Type: BACKGROUND

PMID: 31981224 (View on PubMed)

Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020 Jun;16(6):297-298. doi: 10.1038/s41574-020-0353-9.

Reference Type: BACKGROUND

PMID: 32242089 (View on PubMed)

Sternberg EM, Chrousos GP, Wilder RL, Gold PW. The stress response and the regulation of inflammatory disease. Ann Intern Med. 1992 Nov 15;117(10):854-66. doi: 10.7326/0003-4819-117-10-854.

Reference Type: BACKGROUND

PMID: 1416562 (View on PubMed)

Other Identifiers

3223

Identifier Type: -

Identifier Source: org_study_id