Double-blind controlled trial of lecithinized superoxide dismutase in patients with idiopathic interstitial pneumonia - short term evaluation of safety and tolerability

Koichiro Kamio, Arata Azuma, Ken Ohta, Yukihiko Sugiyama, Toshihiro Nukiwa, Shoji Kudoh, Tohru Mizushima

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis or fibrotic nonspecific interstitial pneumonia are irreversible progressive pulmonary diseases that often have fatal outcomes. Although the etiology of idiopathic interstitial pneumonias is not yet fully understood, anti-fibrotic and anti-inflammatory agents have shown limited therapeutic effectiveness. Reactive oxygen species and their cytotoxic effects on the lung epithelial cells have been reported to participate in the pathophysiology of the disease. Because superoxide dismutase catalyzes the detoxification of reactive oxygen species, we developed lecithinized superoxide dismutase for the treatment of patients with idiopathic interstitial pneumonias. Methods: A multicenter, randomized, placebo-controlled trial was conducted as a pilot study to investigate the safety and effectiveness of 40 or 80 mg lecithinized superoxide dismutase in patients with progressive idiopathic interstitial pneumonias who presented with either idiopathic pulmonary fibrosis or corticosteroid-resistant fibrotic nonspecific interstitial pneumonia and showed arterial oxygen tension compatible with stage III or IV on the Japanese severity grading scale for idiopathic interstitial pneumonias. Before and following infusion of lecithinized superoxide dismutase for 28 days, the primary endpoint of forced vital capacity and the secondary endpoints of lactate dehydrogenase, surfactant protein-A, surfactant protein-D and Krebs von den Lungen-6 levels were measured in the serum. Results: The primary endpoint of forced vital capacity did not improve significantly in the lecithinized superoxide dismutase groups in comparison with the placebo group. The secondary endpoints of lactate dehydrogenase and surfactant protein-A levels were significantly attenuated by 28 days in the higher-dose (80 mg) group. However, these changes returned to the baseline levels by 56 days after the cessation of lecithinized superoxide dismutase. Adverse events and mortality in the drug-treated groups did not differ from those in the placebo group.Conclusions: Treatment with lecithinized superoxide dismutase is safe and improves the levels of serum markers such as lactate dehydrogenase and surfactant protein-A in patients with advanced idiopathic interstitial pneumonias with severe respiratory dysfunction. Considering the results of the current study, further investigations into the effects and treatment potential of long-term administration of lecithinized superoxide dismutase may be warranted.Trial registration: University hospital Medical Information Network (UMIN) clinical trials registry no. 000000752.

Original languageEnglish
Article number86
JournalBMC Pulmonary Medicine
Volume14
Issue number1
DOIs
Publication statusPublished - 2014 May 17

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Idiopathic Interstitial Pneumonias
Safety
Pulmonary Surfactant-Associated Protein A
L-Lactate Dehydrogenase
Idiopathic Pulmonary Fibrosis
Interstitial Lung Diseases
Vital Capacity
Placebos
Reactive Oxygen Species
Pulmonary Surfactant-Associated Protein D
Fatal Outcome
Information Services
Therapeutics
lecithinized superoxide dismutase
Lung Diseases
Superoxide Dismutase
Registries
Arterial Pressure
Adrenal Cortex Hormones
Anti-Inflammatory Agents

Keywords

  • Fibrotic nonspecific interstitial pneumonia
  • Idiopathic interstitial pneumonia
  • Idiopathic pulmonary fibrosis
  • Lactate dehydrogenase
  • Lecithinized human Cu
  • Multicenter double-blind clinical study
  • Surfactant protein-A
  • Zn-superoxide dismutase

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Double-blind controlled trial of lecithinized superoxide dismutase in patients with idiopathic interstitial pneumonia - short term evaluation of safety and tolerability. / Kamio, Koichiro; Azuma, Arata; Ohta, Ken; Sugiyama, Yukihiko; Nukiwa, Toshihiro; Kudoh, Shoji; Mizushima, Tohru.

In: BMC Pulmonary Medicine, Vol. 14, No. 1, 86, 17.05.2014.

Research output: Contribution to journalArticle

Kamio, Koichiro ; Azuma, Arata ; Ohta, Ken ; Sugiyama, Yukihiko ; Nukiwa, Toshihiro ; Kudoh, Shoji ; Mizushima, Tohru. / Double-blind controlled trial of lecithinized superoxide dismutase in patients with idiopathic interstitial pneumonia - short term evaluation of safety and tolerability. In: BMC Pulmonary Medicine. 2014 ; Vol. 14, No. 1.
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N2 - Background: Idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis or fibrotic nonspecific interstitial pneumonia are irreversible progressive pulmonary diseases that often have fatal outcomes. Although the etiology of idiopathic interstitial pneumonias is not yet fully understood, anti-fibrotic and anti-inflammatory agents have shown limited therapeutic effectiveness. Reactive oxygen species and their cytotoxic effects on the lung epithelial cells have been reported to participate in the pathophysiology of the disease. Because superoxide dismutase catalyzes the detoxification of reactive oxygen species, we developed lecithinized superoxide dismutase for the treatment of patients with idiopathic interstitial pneumonias. Methods: A multicenter, randomized, placebo-controlled trial was conducted as a pilot study to investigate the safety and effectiveness of 40 or 80 mg lecithinized superoxide dismutase in patients with progressive idiopathic interstitial pneumonias who presented with either idiopathic pulmonary fibrosis or corticosteroid-resistant fibrotic nonspecific interstitial pneumonia and showed arterial oxygen tension compatible with stage III or IV on the Japanese severity grading scale for idiopathic interstitial pneumonias. Before and following infusion of lecithinized superoxide dismutase for 28 days, the primary endpoint of forced vital capacity and the secondary endpoints of lactate dehydrogenase, surfactant protein-A, surfactant protein-D and Krebs von den Lungen-6 levels were measured in the serum. Results: The primary endpoint of forced vital capacity did not improve significantly in the lecithinized superoxide dismutase groups in comparison with the placebo group. The secondary endpoints of lactate dehydrogenase and surfactant protein-A levels were significantly attenuated by 28 days in the higher-dose (80 mg) group. However, these changes returned to the baseline levels by 56 days after the cessation of lecithinized superoxide dismutase. Adverse events and mortality in the drug-treated groups did not differ from those in the placebo group.Conclusions: Treatment with lecithinized superoxide dismutase is safe and improves the levels of serum markers such as lactate dehydrogenase and surfactant protein-A in patients with advanced idiopathic interstitial pneumonias with severe respiratory dysfunction. Considering the results of the current study, further investigations into the effects and treatment potential of long-term administration of lecithinized superoxide dismutase may be warranted.Trial registration: University hospital Medical Information Network (UMIN) clinical trials registry no. 000000752.

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KW - Lactate dehydrogenase

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KW - Surfactant protein-A

KW - Zn-superoxide dismutase

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