Valproic Acid-associated Hypoalbuminemia in Medically Fragile Patients

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

90 participants

Study Classification

OBSERVATIONAL

Study Start Date

2009-02-28

Study Completion Date

2010-12-31

Brief Summary

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The purpose of this study is to investigate potential mechanisms of valproic acid-associated low serum albumin in medically fragile pediatric and young adult epileptic patients of a long-term care facility.

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Detailed Description

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Valproic acid (VPA) is a long-chain fatty acid frequently used as an antiepileptic agent in pediatric and adult seizure patients. Other adverse effects that have been associated with VPA use include hepatic steatosis, altered mitochondrial function and decreased concentrations of serum proteins. The exact mechanism or mechanisms by which VPA induces these associated adverse drug effects are not fully understood though multiple theories have been postulated including impaired vesicle transport within the hepatocyte, inhibition of hepatic synthetic metabolic pathways and renal protein loss. Decreased serum albumin concentrations with concomitant VPA use have been identified in multiple studies. Albumin synthesis is sensitive to tryptophan concentrations (other amino acids are also able to stimulate albumin synthesis), oncotic pressure near the synthetic site, and energy supply while albumin release from the hepatocyte is sensitive to intrahepatocellular potassium concentrations. Based on available literature, VPA appears to inhibit an enzyme(s) either directly or indirectly involved with albumin synthesis or albumin gene expression. VPA is known to inhibit the urea cycle, including patients with ornithine-transcarbamylase (OTC) deficiency, possibly by inhibiting mitochondrial carbamoyl-phosphate synthase. Oratz et al discussed the potential correlation between the urea cycle and albumin synthesis identified after the administration of various amino acids increased both albumin and urea synthesis. Ornithine is an intermediate amino acid within the urea cycle and it is also a precursor to polyamines which have been shown to increase the degree of aggregation of polysomes, responsible for protein synthesis, bound to the endoplasmic reticulum. Thus, VPA may indirectly inhibit protein synthesis by interfering with the urea cycle leading to decreased ornithine concentrations and subsequently a decrease in polyamine concentrations and a decrease in the number of bound polysomes resulting in alterations in albumin synthesis and release. The purpose of this study is to investigate potential mechanisms of VPA-associated hypoalbuminemia in medically fragile pediatric and young adult epileptic patients of a long-term care facility.

Conditions

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Hypoalbuminemia

Study Design

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Observational Model Type

CASE_CONTROL

Study Groups

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1

Resident of Hattie Larlham long-term care facility receiving VPA

Specimen collection

Intervention Type PROCEDURE

A blood sample and a spot urine sample will be obtained from all eligible patients receiving VPA at the start of the study.

2

Control AED patients will be recruited based on similar AED regimens excluding VPA, length of time on AED (number of months to \>1 year), age, and gender; one control patient per VPA patient.

No interventions assigned to this group

3

Control non-AED patients will be recruited based on age and gender; one control patient per VPA patient.

No interventions assigned to this group

Interventions

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Specimen collection

A blood sample and a spot urine sample will be obtained from all eligible patients receiving VPA at the start of the study.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Resident of Hattie Larlham long-term care facility receiving VPA for \> 3 months at the start of the study
* Resident of Hattie Larlham long-term care facility matched to a resident receiving VPA for \> 3 month based on concomitant AED, length of time on AED, age, and gender
* Resident of Hattie Larlham long-term care facility not receiving AED matched to a resident receiving VPA for \> 3 month based on age and gender

Exclusion Criteria

* Received albumin products within the past 1 month
* Receiving VPA for \< 3 months or discontinuation of VPA therapy within the past four weeks
* Medical need for specific protein supplementation
* Diagnosed with protein-losing nephropathy or enteropathy

Eligible Sex

ALL

Accepts Healthy Volunteers

No