CovidResearchTrials by Shray Alag

CovidResearchTrials Covid 19 Research using Clinical Trials (Home Page)

Alvelestat (MPH996) Plus Aerosolized 13 cis retinoic acidWiki

Developed by Shray Alag
Clinical Trial MeSH HPO Drug Gene SNP Protein Mutation

Correlated Drug Terms (2)

Name (Synonyms) Correlation
drug505 Hydroxychloroquine Wiki 0.11
drug850 Placebo Wiki 0.09

Correlated MeSH Terms (7)

Name (Synonyms) Correlation
D055371 Acute Lung Injury NIH 0.13
D012127 Respiratory Distress Syndrome, Newborn NIH 0.13
D012128 Respiratory Distress Syndrome, Adult NIH 0.11
D003141 Communicable Diseases NIH 0.11
D007239 Infection NIH 0.07
D045169 Severe Acute Respiratory Syndrome NIH 0.06
D018352 Coronavirus Infections NIH 0.05

Correlated HPO Terms (0)

Name (Synonyms) Correlation

There is one clinical trial.

Clinical Trials

1 Combination With Alvelestat and Isotretinoin May Enhances Neutralizing Antibodies in COVID -19 Infected Patients Better Than COVID-19 Inactivated Vaccines

Unfortunately, COVID-19 vaccination will be restricted to healthy people with strong immunity and It will not be given to patients with History of contact with a SARS-CoV-2 infection (positive in nucleic acid test). In addition to the COVID-19 viral antigens lead to stimulate antibodies formation of IgM in acute phase and IgG type in chronic phase which is facilitate viral entry and fusion with infected cell through uptake of the virus-IgG complex via the Fc family of receptors and later viral fusion with antigen presenting cells like macrophages, B cells, monocytes via FcR family, and vascular endothelium through the neonatal Fc receptor (nFcR) instead of antibodies induced viral agglutination and this is known as antibody dependent enhancement (ADE)(2). There are various hypotheses on how ADE happens and there is a likelihood that more than one mechanism exists. In one such pathway, some cells of the immune system lack the usual receptors on their surfaces that the virus uses to gain entry, but they have Fc receptors that bind to one end of antibodies. The virus binds to the antigen-binding site at the other end, and in this way gains entry to and infects the immune cell. Dengue virus can use this mechanism to infect human macrophages, if there was a preceding infection with a different strain of the virus, causing a normally mild viral infection to become life-threatening.(3) An ongoing question in the COVID-19 pandemic is whether—and if so, to what extent—COVID-19 receives ADE from prior infection with other coronaviruses. ADE can hamper vaccine development, as a vaccine may cause the production of antibodies which, via ADE, worsen the disease the vaccine is designed to protect against. Vaccine candidates for Dengue virus and feline infectious peritonitis virus (a cat coronavirus) had to be stopped because they elicited ADE.(4) ADE in coronavirus infection can be caused by high mutation rate of the gene that encodes spike (S) protein. A thorough analysis of amino acid variability in SARS-CoV-2 virus proteins, that included the S-protein, revealed that least conservative amino acids are in most exposed fragments of S-protein including receptor binding domain (RBD).(5) High neutrophils in covid-19 infection may be the reason of delayed antibody response and severe complications.Currently, only limited information is available on the host innate immune status of SARS-CoV-2 infected patients. In one report where 99 cases in Wuhan were investigated, increased total neutrophils (38%), reduced total lymphocytes (35%),increased serum IL-6 (52%) and increased c-reactive protein (84%) were observed.25 In a separate report also from Wuhan, it revealed that in 41 patients, increased total neutrophils, decreased total lymphocytes in patients of ICU vs. non-ICU care were found to be statistically different. Increased neutrophils and decreased lymphocytes also correlate with disease severity and death.(10) B cells/plasma cells produce SARS-CoV-2 specific antibodies that may help neutralize viruses.(11)Humoral immune response, especially production of neutralizing antibody, plays a protective role by limiting infection at later phase and prevents reinfection in the future. In SARS-CoV, both T and B cell epitopes were extensively mapped for the structural proteins, S, N, M and E protein.(12) Whether the kinetic/titer of specific antibody correlates with disease severity remains to be investigated.(14)Delayed antibodies response and secretion after covid -19 symptoms onset is responsible for antibody dependent enhancement (ADE) A study shows the first seroconversion day of IgA was 2 days after onset of initial symptoms, and the first seroconversion day of IgM and IgG was 5 days after onset. The positive rate of antibodies in the 183 samples was 98.9%, 93.4% and 95.1%, for IgA, IgM and IgG, respectively. The seroconversion rate for IgA, IgM or IgG was 100% 32 days after symptom onset. According to the cumulative seroconversion curve, the median conversion time for IgA, IgM and IgG was 13, 14 and 14 days, respectively. (6) Because this immune response takes a while to show up, antibody tests will be negative for those newly infected with COVID-19, which is why they're not used for diagnosis. "If it's the beginning of the infection, you don't pick it up, it's something that only develops later," Dr. Melanie Ott, a virologist and immunologist at the Gladstone Institutes So, the principal investigator expects that delayed antibodies response and delayed immunoglobulin class switching are the main reason for antibodies inactivity and non-specificity in the highly mutated COVID-19 infection. Finally, according to this protocol the principal investigator will treat with two potent antibody and immunity inducing drug and the mechanism of action will be discussed in Detailed Description

NCT04396067 COVID -19 Drug: Alvelestat (MPH996) Plus Aerosolized 13 cis retinoic acid Other: Placebo

Primary Outcomes

Description: To evaluate the effect of alvelestat (MPH996) administered twice daily (bid) for 12 weeks on blood markers of neutrophil elastase activity, within-individual % change in plasma desmosine/isodesmosine will be measured.

Measure: Within-individual % change in plasma desmosine/isodesmosine

Time: baseline, week 2

Description: To evaluate the safety and tolerability of alvelestat (MPH996) administered twice daily (bid) for 2 weeks treatment numbers and % of subjects who experience at least 1 treatment-emergent adverse event will be measured.

Measure: Numbers and % of subjects who experience at least 1 treatment-emergent adverse event

Time: baseline, week 2

Secondary Outcomes

Description: Proportion of lung injury score decreased or increased after treatment

Measure: lung injury score

Time: at 7and 14 days

Description: Serum levels of CRP, ESR ,IL-1,IL-6,TNF and Type I interferon

Measure: Serum levels of CRP, ESR ,IL-1,IL-6,TNF and Type I interferon

Time: at day 7 and 14 after randimization

Description: Serum level of COVID19 RNA

Measure: Serum level of COVID19 RNA

Time: at day 7 and 14

Description: less than 250 ng/mL, or less than 0.4 mcg/mL of blood sample

Measure: d-dimers

Time: within 14 days

Description: lymphocyte counts

Measure: Absolute lymphocyte counts

Time: at day 7 and 14 after randimization

Description: To determine the immune correlates of viral clearance (Antibody Titres sufficient for viral clearance and neutralizing ) against future exposure to SARS-CoV-2

Measure: The immune correlates of protection against future exposure to SARS-CoV-2

Time: within 14 days

Description: Number of CD4 HLA-DR+ and CD38+, CD8 lymphocytes

Measure: Immunological profile

Time: within 14 days

Measure: Total duration of mechanical ventilation, ventilatory weaning and curarisation

Time: at day 7 and 14

Description: Kidney failure, hypersensitivity with cutaneous or hemodynamic manifestations, aseptic meningitis, hemolytic anemia, leuko-neutropenia, transfusion related acute lung injury (TRALI)

Measure: Occurrence of adverse event related to immunoglobulins

Time: at day 14

Description: serum levels of IgG and IgM against COVID-19

Measure: IgG, IgA and IgM against COVID-19

Time: at day 7 and 14

Description: ACE2 expression in patients with COVID-19 infection

Measure: ACE2 expression in patients with COVID-19 infection

Time: at day 7 and 14

Measure: All cause mortality rate [

Time: at day 7 and 14

Measure: Ventilation free days

Time: at 14 days

Measure: ICU free days

Time: at 14 days

No related HPO nodes (Using clinical trials)