Critically ill patients often present with respiratory disease, or develop respiratory disease associated with the initial illness or as a consequence of their stay on the intensive therapy unit (ITU) – or both. One example of respiratory disease affecting critically patients is acute respiratory distress syndrome (ARDS). Taking ARDS as an example of severe and acute inflammatory respiratory disease, it is clear that there is an immediate need for novel clinical tools to identify specific and targetable biological processes in a timely fashion, so as to inform real-time clinical decision making. The SNAP-IT Phase II study aims to further test the clinical application of our Neutrophil Activation Probe (NAP), primarily through demonstrating the reliability of the technique, but also importantly in terms of its ability to predict and stratify the severity and outcome from critical respiratory illness.
Using a catheter passed through a bronchoscope, a microdose of an imaging agent called Neutrophil Activation Probe (NAP) will be applied to the lungs. A microscope fibre (fibre based endomicrosocopy, FE) will then be passed through the bronchoscope to see if the agent has labelled cells in the alveolar spaces. If the microscope fibre (FE) detects increased light, this can be indicative of the presence of inflammation and an inflammatory cell known as the activated neutrophil – the activated neutrophil plays a role in the development of acute lung disease such as pneumonia and adult respiratory distress syndrome.
The procedure will involve a ‘fast’ (under 10 mins) bronchoscopy and bedside immediate imaging, results obtained within 2 minutes. We wish to validate the technology to provide a bedside, safe, fast test to assess the distal lung in mechanically ventilated patients.
We have so far recruited and dosed two patients on ICU. As we continue, we hope to demonstrate the test reliability of NAP/FE in terms of precision (i.e. within one procedure, within individual lung segments as identified as normal or abnormal by chest radiology) and accuracy (i.e. within normal or abnormal lung segments among different patients).