Macrolides for KCNJ5 - Mutated Aldosterone-Producing Adenoma (MAPA): A Study Of Personalized Diagnosis of Primary Aldosteronism With Implications For Treatment
试验速览
- 阶段
- 不适用
- 入组人数
- 342
- 试验地点
- 1
- 主要终点
- Study 1: Change in Relative Aldosterone Secretion Index (RASI).
研究概览
简要总结
This study evaluates if :
1 ) the plasma aldosterone concentration and blood pressure change in response to roxithromycin could be useful for the screening of PA patients carrying a KCNJ5-mutated APA; 2) the change of PAC in response to mutated KCNJ5 channel is truly occurring in KCNJ5-mutated APA.
详细描述
Aldosterone-producing adenoma (APA) cause primary aldosteronism (PA), the main curable cause of endocrine hypertension, is in up to 66% of all cases investigated with adrenal vein sampling (AVS). Mutations in the KCNJ5 potassium channel involve up to 70% of APA and cause the most florid PA phenotypes. The recent finding that macrolide antibiotics specifically inhibit in vitro the altered function of mutated KCNJ5 channels has opened new horizons for the diagnosis and treatment of APA with KCNJ5 mutations in that it can allow identification and target treatment of PA patients harbouring a mutated APA. Thus, the aim of the present study was to investigate if clarithromycin and roxithromycin, two macrolides that potently blunt mutated Kir3.4 channel function in vitro, affect plasma aldosterone concentration in adrenal vein blood during AVS and in peripheral blood, respectively, in PA patients with a mutated APA.
The investigators designed two proof of concept studies. In study A: consecutive patients with an unambiguous biochemical evidence of PA will be exposed to a single dose of 250 mg clarithromycin during AVS, to assess its effect on the relative aldosterone secretion index (RASI) in adrenal vein blood from the gland with and without APA. In study B: consecutive hypertensive patients submitted to the work-up for hypertension will receive a single oral dose of 150 mg roxithromycin. The experimental endpoints will be the change induced by roxithromycin of plasma aldosterone concentration (PAC) and other steroids, direct active renin concentration (DRC), serum K+, systolic and diastolic blood pressure.
The investigators expect to prove that: i) clarithromycin allows identification of mutated APA before adrenalectomy and sequencing of tumour DNA; ii) the acute changes of PAC, DRC, and blood pressure in peripheral venous blood after roxithromycin can be a proxy for the presence of an APA with somatic mutations.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •A signed and dated informed consent form
- •A diagnosis of hypertension defined either as:
- •Use of antihypertensive drug (s) Arterial hypertension: in untreated patients this must be confirmed by daytime ambulatory blood pressure monitoring (ABPM), or home blood pressure monitoring, with blood pressure higher or equal to 135 mmHg for systolic blood pressure and/or higher or equal to 85 mmHg for diastolic blood pressure.
- •Normal observation of ECG QT interval.
排除标准
- •History of allergy/intolerance to any macrolides;
- •Refusal of the patient to undergo dynamic testing;
- •Refusal of the patient to undergo AVS and/or contraindications to the general anesthesia that is required for laparoscopic adrenalectomy (for objective 2);
- •Suspicion of cortisol-aldosterone co-secreting adenoma
- •Pregnancy
- •Family history of sudden death
- •Family history of syncope
- •Family history of Long QT syndrome and or torsade de point
- •Congenital or drug-induced Long QT syndrome
研究组 & 干预措施
Clarithromycin
250 mg clarithromycin diluted in 250 ml saline will be administered as a slow infusion (45 min) in a peripheral vein during AVS. This dose of clarithromycin should yield peak plasma concentrations of 2.78 mcg/mL (on average)13, which are higher than the IC50 measured in vitro (0.53-1.29 mcg/mL).
干预措施: Clarithromycin (Drug)
结局指标
主要结局
Study 1: Change in Relative Aldosterone Secretion Index (RASI).
时间窗: Baseline and after 45min clarithromycin infusion.
Within-patient change from baseline of the RASI in adrenal vein blood draining the gland with and without the APA.
Study 2: Change in plasma aldosterone concentration (PAC).
时间窗: Baseline and after 60 and 120 minutes roxitromycin administration
Within-patient change from baseline of PAC in peripheral venous blood in patients undergoing screening for PA.
次要结局
未报告次要终点
研究者
Gian Paolo Rossi, MD, FAHA, FACC
Director of Arterial Hypertension Unit - DIMED
University Hospital Padova