SFX-01 in hospitalised patients with community-acquired pneumonia during the COVID-19 pandemic: a double-blind, randomised, placebo-controlled trial

Merete B. Long, Hani Abo-Leyah, Yan Hui Giam, Thenmalar Vadiveloo, Rebecca C. Hull, Holly R. Keir, Thomas Pembridge, Daniela Alferes De Lima, Lilia Delgado, Sarah K. Inglis, Chloe Hughes, Amy Gilmour, Marek Gierlinski, Benjamin J.M. New, Graeme MacLennan, Albena T. Dinkova-Kostova, James D. Chalmers (Lead / Corresponding author)

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Abstract

Introduction Sulforaphane can induce the transcription factor, Nrf2, promoting antioxidant and anti-inflammatory responses. In this study, hospitalised patients with community-acquired pneumonia (CAP) were treated with stabilised synthetic sulforaphane (SFX-01) to evaluate impact on clinical status and inflammation. 

Methods Double-blind, randomised, placebo-controlled trial of SFX-01 (300 mg oral capsule, once daily for 14 days) conducted in Dundee, UK, between November 2020 and May 2021. Patients had radiologically confirmed CAP and CURB-65 (confusion, urea >7 mmol·L-1, respiratory rate ⩾30 breaths·min-1, blood pressure <90 mmHg (systolic) or ⩽60 mmHg (diastolic), age ⩾65 years) score ⩾1. The primary outcome was the seven-point World Health Organization clinical status scale at day 15. Secondary outcomes included time to clinical improvement, length of stay and mortality. Effects on Nrf2 activity and inflammation were evaluated on days 1, 8 and 15 by measurement of 45 serum cytokines and mRNA sequencing of peripheral blood leukocytes. 

Results The trial was terminated prematurely due to futility with 133 patients enrolled. 65 patients were randomised to SFX-01 treatment and 68 patients to placebo. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was the cause of CAP in 103 (77%) cases. SFX-01 treatment did not improve clinical status at day 15 (adjusted OR 0.87, 95% CI 0.41–1.83; p=0.71), time to clinical improvement (adjusted hazard ratio (aHR) 1.02, 95% CI 0.70–1.49), length of stay (aHR 0.84, 95% CI 0.56–1.26) or 28-day mortality (aHR 1.45, 95% CI 0.67–3.16). The expression of Nrf2 targets and pro-inflammatory genes, including interleukin (IL)-6, IL-1β and tumour necrosis factor-α, was not significantly changed by SFX-01 treatment. At days 8 and 15, respectively, 310 and 42 significant differentially expressed genes were identified between groups (false discovery rate adjusted p<0.05, log2 FC >1). 

Conclusion SFX-01 treatment did not improve clinical status or modulate key Nrf2 targets in patients with CAP primarily due to SARS-CoV-2 infection.

Original languageEnglish
Article number00917-2023
JournalERJ Open Research
Volume10
Issue number2
Early online date29 Feb 2024
DOIs
Publication statusPublished - 11 Mar 2024

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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