PRospective Evaluation of Interstitial Lung DIsease Progression With Quantitative CT

Summary

The interstitial lung diseases (ILD) are a heterogenous group of conditions with varying degrees of inflammation and scarring (fibrosis) of the lungs. ILD progression is unpredictable, making prognostication challenging. A proportion of patients will develop inexorably progressive disease termed progressive fibrosing ILD (PF-ILD).

Forced vital capacity (FVC), a lung function variable, is routinely used to monitor disease progression. However FVC can be a poor disease marker as it can be influenced by patient effort and can be difficult to perform. High resolution computed tomography (HRCT) is a necessary investigation for suspected fibrotic-ILD, making it a promising tool for research.

A quantitative-CT (qCT) approach uses computer software to analyse HRCT scans and has advantage over visual radiologist assessments which are limited by inter/intra-observer variance. The investigators will undertake a feasibility study to determine whether baseline and longitudinal qCT can predict and quantify disease progression in fibrotic-ILD.

The endothelial glycocalyx (EG) is a mesh-like layer that lines the small blood vessels. Injury to this layer has been implicated in non-thoracic fibrotic diseases. Telomeres are repetitive genetic sequences which cap chromosomes preventing their damage during cell replication. Prematurely shortened leucocyte telomere lengths (LTL) have been demonstrated in a wide range of ILDs. We will evaluate role of measuring EG health and LTL in disease prognostication.

Adult participants with fibrotic-ILD from 3 centres in England will be recruited alongside healthy controls. Case (disease) participants will undergo investigations at 0, 6 and 12 months from recruitment including:

* HRCT with quantitative analysis (qCT)
* Lung function testing
* EG and LTL measurement
* Health related quality of life assessments

The primary outcome will assess the correlation of disease progression status measured by standard of care (FVC) with baseline qCT and EG assessment. Healthy controls will only undergo EG assessment at all time points. Feasibility outcomes will be assessed including recruitment, consent and attrition rates.

The results will inform a subsequent multi-centre study to assess the clinical benefit of disease monitoring with the measures assessed in this study.

Conditions

• Interstitial Lung Disease

Interventions

DIAGNOSTIC_TEST

HRCT Thorax

HRCT Thorax at 0, 6 and 12 months

DEVICE

Glycocheck Endothelial Glycocalyx Assessment

Measure of EG degradation using GlycoCheck Microvascular Health Score at 0, 6 and 12 months

DIAGNOSTIC_TEST

Blood biomarkers

Endothelial glycocalyx degradation blood biomarkers and angiogenesis markers at 0, 6 and 12 months

DIAGNOSTIC_TEST

Peripheral leucocyte telomere length

HT-STELA (High-throughput single telomere length assessment) at 0, 6 and 12 months

DIAGNOSTIC_TEST

Pulmonary function testing

Pulmonary Function Tests (Spirometry and Gas Transfer) and 6-minute walk distance at 0, 6 and 12 months

DIAGNOSTIC_TEST

Patient reported outcome measures

Electronic collection of patient reported outcome measures

Sponsors & Collaborators

• North Bristol NHS Trust

  collaborator OTHER

• Royal United Hospitals Bath NHS Foundation Trust

  collaborator OTHER

• Royal Devon and Exeter NHS Foundation Trust

  collaborator OTHER

• University of Exeter

  lead OTHER

Principal Investigators

• Giles Dixon · University of Exeter

Eligibility

Min Age

18 Years

Max Age

85 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2023-06-01

Primary Completion

2024-10-31

Completion

2024-10-31

Countries

• United Kingdom

Study Locations