title: Simvastatin to modify neutrophil function in older patients with septic pneumonia (SNOOPI): study protocol for a randomised placebo-controlled trial.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is considered the leading cause of death from infectious disease in developed countries, while complications of CAP - sepsis being the most common and challenging - increase the risk of mortality. During the progression of sepsis, a state of neutrophil 'paralysis' develops resulting in the impairment of neutrophil anti-microbial functions including: chemotaxis, production of reactive oxygen species, and formation of neutrophil extracellular traps (NETs). Mechanisms underlying defective neutrophil function remain elusive although NET formation has been implicated in the immunosuppression and increased rates of sepsis observed in neonates. There is, however, increasing evidence that statins are able to modulate neutrophil function in sepsis as several systematic reviews have concluded that statins have a role in improving infection-related outcomes and mortality while, in vitro, statins have also been shown to boost NET formation in healthy individuals.
  
  
  METHODS
  The 'SNOOPI' trial is a phase 4, randomised placebo-controlled trial. The aim of this study is to determine whether oral treatment with simvastatin compared to placebo optimises neutrophil anti-microbial functions in elderly patients with septic pneumonia improving patient outcomes in the elderly. The primary outcome will be NET production within 72 to 96 hours of treatment with simvastatin or placebo measured in response to a number of inflammatory mediators, including IL8, f-Met-Leu-Phe and lipopolysaccharide. Secondary outcomes include neutrophil migratory capacity; reactive oxygen species production; neutrophil phagocytic capacity; safety and tolerability of simvastatin administration within this patient group; biological markers of neutrophil activation, the inflammatory response, alveolar epithelial and endothelial injury; systemic endothelial function biomarkers and pulmonary extracellular matrix degradation. This study aims to recruit 60 patients admitted into Queen Elizabeth Hospital Birmingham NHS-Foundation Trust.
  
  
  CONCLUSIONS
  This study will investigate the ability of in vivo simvastatin therapy to modulate neutrophil anti-microbial functions in CAP-associated sepsis.
  
  
  BACKGROUND
  EudraCT number: 2012-003343-29 (Trial Registered: 26 November 2012).
authors.forename: Hannah
authors.initials: H
authors.lastname: Greenwood
authors.forename: Jaimin
authors.initials: J
authors.lastname: Patel
authors.forename: Rahul
authors.initials: R
authors.lastname: Mahida
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Dhruv
authors.initials: D
authors.lastname: Parekh
authors.forename: Rachel C A
authors.initials: RC
authors.lastname: Dancer
authors.forename: Heena
authors.initials: H
authors.lastname: Khiroya
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sapey
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK. d.thickett@bham.ac.uk.
authors.forename: David R
authors.initials: DR
authors.lastname: Thickett
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D004739:England; D065206:Extracellular Traps / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000097:blood; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects* / Q000276:immunology / Q000378:metabolism / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D017382:Reactive Oxygen Species / Q000097:blood; D012107:Research Design; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D019821:Simvastatin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators; D017382:Reactive Oxygen Species; D019821:Simvastatin