Improving Quality of Life and Daily Life Activities With Bioarginine in Patients With COPD

NCT05412160 | Completed

• 1 other identifier: BIOCOPD2022
• Study Type: interventional
• Target: 153
• Locations: 1 country
• Sites: 1

Brief Summary

Different studies have suggested that COPD is associated with elevated alveolar NO and increased expression of NOS2 in alveolar walls, small airway epithelium and vascular smooth muscle. Furthermore, arginase activity in COPD is shown to correlate inversely with total NO metabolite in sputum and with pre- and post- bronchodilator FEV1; at the same time ADMA levels in serum is shown to be correlated with airway resistance and ADMA in COPD airways was documented to be able to shift the L-arginine metabolism towards the arginase pathway. As demonstrated in a guinea pig model, the arginase inhibition can shift the L-ornitine: L-citrulline ratio towards L-citrulline, preventing neutrophilia, mucus hypersecretion and collagen synthesis. Thus, increasing substrate availability for NOS by arginase inhibition or supplementation of L-arginine or L-citrulline or a combination thereof, may represent a window of opportunity in patients with COPD. The present study was constructed in order to investigate as a primary objective whether in symptomatic patients with COPD, daily bioarginine on top of chronic inhaled therapy can improve patients' respiratory symptoms and dyspnea during daily life activities. The secondary objective of the study is to determine whether there is any correlation between improvement in respiratory symptoms and distance walked at the 6MWT and lung function parameters. In order to do so, the investigators designed a multi center, interventional, prospective, randomized, controlled vs placebo, proof of concept study: COPD patients will be randomized to receive BioArginine twice daily on top of chronic inhaled therapy or to continue their chronic Inhaled therapy plus placebo for 6 weeks. In order to evaluate the impact on respiratory symptoms and dyspnea the CRQ (Chronic Respiratory disease Questionnaire) and the LCADL (London Chest Activities of daily Living) Scale, as well as the 6MWT, will be used.

Conditions

COPD; Dyspnea; Argininemia

Keywords

COPD; Arginine

Outcome Measures

Primary Outcomes (1)

• To compare changes in CRQ from baseline and after 6 weeks in the interventional arm compared with the control group

  Patients will undergo the assesment of the Chronic Respitatory Qestionnaire at the time of study erollment and after 6 weeks of treatment with bioarginine or placebo. The questionnaire contains 20 questions which can be divided into four domains: * Dyspnoea (5 questions), The dyspnoea domain is "individualised" which means that it is made up of five activities chosen by a patient to cause the greatest shortness of breath. The patient then rates the dyspnoea on these self-selected activities during subsequent administrations of the CRQ. * Fatigue (4 questions), * Emotional functioning (7 questions), * Mastery (4 questions). * Answers can be scored on a seven point scale ranging from 1 which indicates maximum impairment to 7 which indicates no impairment. The results are expressed as the mean score for each domain and the mean overall score. * The minimally important difference was found to be an improvement (or deterioration) of 0.5

  6 weeks

Secondary Outcomes (3)

• To compare changes in LCADL from baseline and after 6 weeks in the interventional arm compared with the control group

  6 weeks

• To compare changes in the distance covered during the 6MWT from baseline and after 6 weeks in the interventional arm compared with the control group

  6 weeks

• To compare changes in the dyspnea domain of the CRQ from baseline and after 6 weeks in the interventional arm compared with the control group

  6 weeks

Study Arms (2)

ARM A - BioArginine receivers

EXPERIMENTAL

Patients will be randomized to receive BioArginine C™ twice daily on top of usual chronic inhaled therapy

Drug: Arginine

ARM B - placebo receivers

PLACEBO COMPARATOR

Patients will be randomized to receive placebo twice daily on top of usual chronic inhaled therapy

Drug: Placebo

Interventions

Arginine DRUG

During the first assessment the patients will be randomized to receive BioArginine C™ twice daily on top of chronic inhaled therapy or to continue their chronic Inhaled therapy plus placebo for 6 weeks. The main purpose is to compare changes in CRQ from baseline and after 6 weeks in the interventional arm compared with the control group in order to evaluate whether in symptomatic patients with COPD, daily bioarginine on top of chronic inhaled therapy can improve respiratory symptoms and dyspnea. The secondary objective of the study is to determine whether there is any correlation between improvement in respiratory symptoms and distance walked at the 6MWT and lung function parameters.

ARM A - BioArginine receivers

Placebo DRUG

During the first assessment the patients will be randomized to receive BioArginine C™ twice daily on top of chronic inhaled therapy or to continue their chronic Inhaled therapy plus placebo for 6 weeks. The main purpose is to compare changes in CRQ from baseline and after 6 weeks in the interventional arm compared with the control group in order to evaluate whether in symptomatic patients with COPD, daily bioarginine on top of chronic inhaled therapy can improve respiratory symptoms and dyspnea. The secondary objective of the study is to determine whether there is any correlation between improvement in respiratory symptoms and distance walked at the 6MWT and lung function parameters.

ARM B - placebo receivers

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \> 40 years old
• Smoke history \>10 pack years (PYs)
• Forced expiratory volume (FEV1 70-40% predicted)
• COPD Assessment Test score \>= 10
• Stable Inhaled therapy in the three months prior to study enrollment

You may not qualify if:

• Exacerbations in the three months prior to study enrolment
• Dementia and inability to perform study test bundles
• Interstitial lung disease
• History of asthma
• Patients unable to perform a 6MWT or necessitating a walker to ambulate
• Long term oxygen therapy (excluding patients on nocturnal O2 therapy)
• Patients enrolled In pulmonary rehabilitation programs during the study or that have completed a pulmonary rehabilitation program in the 6 months before study enrollment

Sponsors & Collaborators

• University of Milan: lead

Study Sites (1)

L. Sacco Hospital

Milan, Italy, 20157, Italy

Location

Related Publications (3)

• Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989 Dec;10(4):407-15. doi: 10.1016/0197-2456(89)90005-6.

  PMID: 2691207 BACKGROUND

• Bisca GW, Proenca M, Salomao A, Hernandes NA, Pitta F. Minimal detectable change of the London chest activity of daily living scale in patients with COPD. J Cardiopulm Rehabil Prev. 2014 May-Jun;34(3):213-6. doi: 10.1097/HCR.0000000000000047.

  PMID: 24531202 BACKGROUND

• Garrod R, Bestall JC, Paul EA, Wedzicha JA, Jones PW. Development and validation of a standardized measure of activity of daily living in patients with severe COPD: the London Chest Activity of Daily Living scale (LCADL). Respir Med. 2000 Jun;94(6):589-96. doi: 10.1053/rmed.2000.0786.

  PMID: 10921765 BACKGROUND

Related Links

• CRQ questionnaire

MeSH Terms

Conditions

Pulmonary Disease, Chronic Obstructive; Dyspnea; Hyperargininemia

Interventions

Arginine

Condition Hierarchy (Ancestors)

Lung Diseases, Obstructive; Lung Diseases; Respiratory Tract Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Respiration Disorders; Signs and Symptoms, Respiratory; Signs and Symptoms; Urea Cycle Disorders, Inborn; Brain Diseases, Metabolic, Inborn; Brain Diseases, Metabolic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Amino Acid Metabolism, Inborn Errors; Metabolism, Inborn Errors; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Metabolic Diseases; Nutritional and Metabolic Diseases

Intervention Hierarchy (Ancestors)

Amino Acids, Basic; Amino Acids; Amino Acids, Peptides, and Proteins; Amino Acids, Diamino; Amino Acids, Essential

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: June 6, 2022
• First Posted: June 9, 2022
• Study Start: January 18, 2023
• Primary Completion: December 1, 2024
• Study Completion: December 30, 2024
• Last Updated: May 4, 2026

Record last verified: 2025-06

Locations

IT (1)