LILIADE-COVID: Low Dose of IL-2 In Acute Respiratory DistrEss Syndrome Related to COVID-19

Sponsor

Assistance Publique - Hôpitaux de Paris (Other)

Overall Status

Completed

CT.gov ID

NCT04357444

Collaborator

Iltoo Pharma (Industry)

Enrollment

Location

Arms

5.4

Actual Duration (Months)

5.6

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose is to demonstrate the efficacy of low-dose interleukin 2 (Ld-IL2) administration in improving clinical course and oxygenation parameters in patients with SARS-CoV2-related ARDS.

Condition or Disease	Intervention/Treatment	Phase
COVID 19	Drug: 1: ILT101 Drug: 2: Placebo Comparator	Phase 2

Detailed Description

About 25% of hospitalized patients with SARS-CoV2 infection presented life-threatening respiratory conditions. Of these, 60% met ARDS criteria leading to death in 25% to 63% of the cases. SARS-CoV2-related ARDS is caused by a massive inflammatory cell infiltration leading to dysregulated cytokine/chemokine responses with lung immunopathological changes. To date, there is no treatment available.

Regulatory T cells (Treg) are a subpopulation of CD4+ T cells playing a crucial role in the control of immune responses, in part by preventing excessive inflammation. Depletion of Treg cells in models of lung infection or after berylium exposure exacerbated lung inflammation. In contrast, a beneficial role for Treg during early ARDS and its resolution has been observed.

Low-dose interleukin 2 (Ld-IL2) is the first therapy driving Treg-specific expansion and activation. Ld-IL2 was successfully tested in a wide range of preclinical models of inflammatory diseases, including beryllium-induced lung inflammation. Moreover, Ld-IL2 has been shown to be safe and free of serious adverse events when administered in patients with various autoimmune diseases. Importantly, in our previous work, we observed only very low concentrations of IL-2 in the blood (0.1 pg/mL [0.0-2.0]) as well as in the BAL supernatant (0.8 pg/mL [0.4-1.3]) collected from patients during the early phase of ARDS, suggesting that additional IL-2 could be beneficial for Treg expansion/activation.

Our objective is therefore to investigate the therapeutic benefit of Ld-IL2 as a Treg inducer for controlling SARS-CoV2-related ARDS.

After admission of patients to the intensive care unit at one of the recruiting centers, the eligibility criteria will be checked by the investigating physician and participation in the study will be proposed to the patient or parent/family member/trusted person. If the patient is unable to consent and there is no parent/family member/trusted person, the patient may be included in the emergency procedure.

After inclusion (J0), the patient will be randomized to one of the 2 treatment arms (low dose IL-2 or placebo).

The experimental treatment will be daily administered to the patient from D1 to D10.

The patient will be monitored daily until D28 during hospitalization.

Study Design

Study Type:

Interventional

Actual Enrollment :

30 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

Low Dose of IL-2 In Acute Respiratory DistrEss Syndrome Related to COVID-19

Actual Study Start Date :

Oct 23, 2020

Actual Primary Completion Date :

Nov 2, 2020

Actual Study Completion Date :

Apr 5, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: 1: ILT101 ILT-101 in Subcutaneous route	Drug: 1: ILT101 Subcutaneous injections, once-daily administration for 10 consecutive days.
Placebo Comparator: 2: Placebo Comparator Placebo in subcutaneous injections every day during 10 days	Drug: 2: Placebo Comparator placebo in Subcutaneous route

Arm

Intervention/Treatment

Experimental: 1: ILT101

ILT-101 in Subcutaneous route

Drug: 1: ILT101

Subcutaneous injections, once-daily administration for 10 consecutive days.

Placebo Comparator: 2: Placebo Comparator

Placebo in subcutaneous injections every day during 10 days

Drug: 2: Placebo Comparator

placebo in Subcutaneous route

Outcome Measures

Primary Outcome Measures

The PaO2/FiO2 ratio at D11 [at Day11]

Secondary Outcome Measures

Changes in Tregs between Baseline and Day 7 (expressed in %) [at Day0 and Day7]
Number of days alive with oxygen therapy within 28 days [at Day28]
Maximal oxygen rate within 28 days [at Day28]
Number of days alive free of invasive or non-invasive ventilation within 28 days [At Day28]
Number of days alive outside ICU within 28 days [at Day28]
Number of days alive outside hospital within 28 days [at Day28]
Time (in days) from randomization to death [through study completion at day 28]
Mortality rate at D28 [at Day28]
Difference between CRP levels at randomization and at Day 7 (or at the time of discharge if occurs before Day 7) [at Day0 and Day7 or at the time of discharge]
Use of antibiotics for respiratory (proved or suspected) infection within 28 days [at Day28]
Number of prone positioning sessions [throughout the follow up period at day 28]
Changes in Tregs during the different visits between baseline and day 28 [at Day0, 5, 7, 11, 14 and Day28]
Cytokines analysis on plasma samples at Day 0, 7 and 14 [at Day 0, 7 and 14]
To evaluate selected immune and inflammatory markers: Serum concentrations of cytokines and soluble factors related to the immune response and inflammatory processes will be evaluated and compare to baseline by multiplex immunoprofiling to analyse a larger number of molecules including at least IFNα2, IFNγ, IL-1α, IL-1β, IL-1RA, IL-2, IL-6, IL-8, IL-10, IL-17, TNFα, TNFβ, VEGF-A, TGF-beta, S-RAGE, SP-A, SP-D, Angiopoétine 1 and KGF.
Tregs numbers during induction period and throughout the follow up period at day 5, 7, 11, 14 and 28 compared to baseline before the first IL-2 injection. [at Day0, 5, 7, 11, 14 and Day28]
Tregs percentages during induction period and throughout the follow up period at day 5, 7, 11, 14 and 28 compared to baseline before the first IL-2 injection. [at Day0, 5, 7, 11, 14 and Day28]
Deep Immunophenotyping of Cellular components in blood samples at Day 0, 7, and 14 [at Day0, 7 and Day14]
Cellular components will be analysed by flow cytometry covering (i) most of the innate and adaptive immune cells including Tregs, T helper cell subsets including follicular helper cells, B cell subsets, NK cell subsets, (ii) the associated relevant markers of activation/function/differentiation, tissue migration, as well as (iii) unconventional lymphoid cells (NKT/MAIT, innate lymphoid cells), myeloid-derived suppressor cells, classical and non-classical monocytes and dendritic cells (mDC1/2, pDC).
T cell repertoire on Treg, after sorting from blood at Day 7 and Day 14 and compared to baseline [at Day0, 7 and Day14]
T cell repertoire on Teff (CD4 and CD8) after sorting from blood at Day 7 and Day 14 and compared to baseline [at Day0, 7 and Day14]
Single cells sequencing will be performed in BAL at Day 7 and Day 14 and compared to baseline. [at Day0, 7 and Day14]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male or female, age ≥ 18 years
Laboratory (RT-PCR) confirmed infection with SARS-CoV2
Patient is either under invasive or non-invasive mechanical ventilation (including high flow nasal oxygen therapy).
Diagnosis of ARDS according to the Berlin definition of ARDS
Onset of ARDS <96 hours
Patient with French Social Security System
A written informed consent by the designated substitute decision maker, if present. In the event of absence, the patient can be included by investigator's decision alone.

Exclusion Criteria:

Previous history of ARDS in the last month
Chronic respiratory diseases requiring long-term oxygen therapy and/or long-term respiratory assistance
History of organ allograft.
Active cancer
Liver cirrhosis with basal Child and Pugh of C
Pulmonary fibrosis
Patient with end-of-life decision
Patient not expected to survive for 24 hours
Woman known to be pregnant, lactating or with a positive (urine or serum test) or indeterminate (serum test) pregnancy test
Patient already enrolled in another interventional pharmacotherapy protocol on COVID-19
Patient with known hypersensitivity to natural or recombinant Interleukin-2 or to any of the excipients
Presence of any of the following abnormal laboratory values at screening: absolute neutrophil count (ANC) less than 1.5x109/L, AST or ALT greater than 5 x ULN, platelets <50,000 per mm3
Use of chronic oral corticosteroids > 10 mg prednisone equivalent a day for a non-COVID-19-related condition
Current uncontrolled autoimmune disease
Patients with uncontrolled suspected or known active systemic bacterial or fungal infections
Patient with severe, uncontrolled pre-existing (chronic) organ failure (myocardial, hepatic or renal)
Vaccination with live attenuated vaccines in the month preceding the inclusion
Patient with burns to ≥ 15% of their total body surface area
Patient receiving extra-corporeal membrane oxygenation, high-frequency oscillatory ventilation or any form of extra-corporeal lung support
Patient under legal protection (protection of the court, or in curatorship or guardianship).