Sarcoidosis is a common interstitial lung disease of unknown cause for which current therapies are often ineffective and/or inaccessible. The ultimate goal of this project is to deliver a safe alternative to current therapies that will be wel-tolerated and immediately available to sarcoidosis patients. In this regard, chronic exposure to nicotine-containing (tobacco) products is consistently shown to reduce the risk of developing sarcoidosis, and recent studies, including our pilot clinical trial, indicate that nicotine has potnt immune modulating effects that could alter the course of pulmonary sarcoidosis. We hypothesize that nicotine treatment will be efficacious for the treatment of pulmonary sarcoidosis. The Clinical Trial Pilot Study proposed herein will provide data required for the planning of subsequent, definitive multi-institutional trials to assess clinical efficacy. Namely, Aim 1 will assess changes in forced vital capacity (FVC) in response to nicotine treatment.
Aim 2 will determine if nicotine treatment reduces the burden of lung disease, using objective radiographic criteria, compared to conventional therapies alone.
This aim will employ a novel computerized lung CT image analysis tool that is demonstrated to sensitively detect various manifestations of pulmonary sarcoidosis.
Aim 3 will consider alternative clinical endpoints for a future Phase II and III studies, including improvements in fatigue and disease-specific symptoms.
Aim 4 will assess the safety and tolerability of sustained-release transdermal nicotine in the pulmonary sarcoidosis population. In this regard, nicotine has an extensive track record of safety in patients with obstructive lung disease (e.g., smoking-related), and was well tolerated in our previous pilot study. However, study subject compliance and safety will be important determinants used for the design of future clinical efficacy studies. The participating centers, Ohio State University and Cleveland Clinic Foundation, have large sarcoidosis patient populations and extensive experience with sarcoidosis clinical trials, and are well-qualified to complete this study.

Public Health Relevance

The proposed project is relevant to the public because current treatments for pulmonary sarcoidosis are inadequate and nicotine represents a promising alternative to current therapies. Furthermore, nicotine is already approved for the treatment of other human conditions, and could be rapidly repurposed for the treatment of sarcoidosis. Thus, the proposed research is relevant to the part of the NIH's mission that pertains to developing fundamental knowledge that will reduce the burdens of illness and disability.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Planning Grant (R34)
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Clinical Trials Review Committee (CLTR)
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Eu, Jerry Pc
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Ohio State University
Internal Medicine/Medicine
Schools of Medicine
United States
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Le, Van; Crouser, Elliott D (2018) Potential immunotherapies for sarcoidosis. Expert Opin Biol Ther 18:399-407
Crouser, Elliott D; Fingerlin, Tasha E; Yang, Ivana V et al. (2017) Application of ""Omics"" and Systems Biology to Sarcoidosis Research. Ann Am Thorac Soc 14:S445-S451
Crouser, Elliott D (2016) In-silico modeling of granulomatous diseases. Curr Opin Pulm Med 22:500-8
Georas, Steve N; Chapman, Timothy J; Crouser, Elliott D (2016) Sarcoidosis and T-Helper Cells. Th1, Th17, or Th17.1? Am J Respir Crit Care Med 193:1198-200