Half-life of Plasma Phytosterols in Very Low Birth Weight Preterm Infants With Parenteral Nutrition-associated Cholestasis

NCT ID: NCT02947594

Last Updated: 2018-01-24

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

37 participants

Study Classification

OBSERVATIONAL

Study Start Date

2014-01-31

Study Completion Date

2017-02-28

Brief Summary

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Parenteral nutrition-associated cholestasis (PNAC) is one of the most common complications resulting from administration of parenteral nutrition in neonates. Excess intravenous intake of vegetable oil-based lipid emulsions containing phytosterols is felt to be a major contributing factor. To date, no information is available on plasma phytosterols half-lives in very-low-birth-weight (VLBW) preterm infants with PNAC. In a prospective cohort study, plasma phytosterols (campesterol, stigmasterol and sitosterol) of VLBW preterm infants with PNAC will be measured by gas chromatography-mass spectrometry (GC-MS) during PN administration and also after the stop of intravenous lipid infusion. Plasma phytosterols half-lives will be calculated from the monoexponential decay curves. Blood samples will be weekly collected from 1st to 12th week of life during routine metabolic tolerance analysis or gas-analysis in order to avoid burden of additional phlebotomy. Samples will be collected in ethylenediaminetetraacetic acid-tubes and immediately centrifugated. Plasma will be stored in pyrogallol added-tubes at -20°C until analysis. Saponification reaction will be done using 5-alpha-cholestane as internal standard.

Detailed Description

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Conditions

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Liver Disease

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* 24 weeks \< gestational age \< 32 weeks;
* 500 g ≤ birth weight \< 1250 g;
* parenteral nutrition with vegetable oil-based lipid emulsions from the first hours of life;
* diagnosis of cholestasis during vegetable oil-lipid infusion (plasma conjugated bilirubin value \> 1 mg/dl)
* parental consent;

Exclusion Criteria

* severe malformations;
* inborn errors of metabolism;
* severe congenital sepsis;
* normal liver functions (plasma conjugated bilirubin under 1 mg/dl during vegetable oil-lipid infusion).
Minimum Eligible Age

24 Weeks

Maximum Eligible Age

32 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Università Politecnica delle Marche

OTHER

Sponsor Role lead

Responsible Party

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Virgilio Paolo Carnielli

MD, Phd, Professor of Neonatal Pediatrics at Polytechnical University of Marche (Ancona, Italy)

Responsibility Role PRINCIPAL_INVESTIGATOR

References

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Zaloga GP. Phytosterols, Lipid Administration, and Liver Disease During Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2015 Sep;39(1 Suppl):39S-60S. doi: 10.1177/0148607115595978. Epub 2015 Jul 15.

Reference Type BACKGROUND
PMID: 26177665 (View on PubMed)

Savini S, D'Ascenzo R, Biagetti C, Serpentini G, Pompilio A, Bartoli A, Cogo PE, Carnielli VP. The effect of 5 intravenous lipid emulsions on plasma phytosterols in preterm infants receiving parenteral nutrition: a randomized clinical trial. Am J Clin Nutr. 2013 Aug;98(2):312-8. doi: 10.3945/ajcn.112.056556. Epub 2013 Jun 12.

Reference Type BACKGROUND
PMID: 23761482 (View on PubMed)

Nghiem-Rao TH, Tunc I, Mavis AM, Cao Y, Polzin EM, Firary MF, Wang X, Simpson PM, Patel SB. Kinetics of phytosterol metabolism in neonates receiving parenteral nutrition. Pediatr Res. 2015 Aug;78(2):181-9. doi: 10.1038/pr.2015.78. Epub 2015 Apr 21.

Reference Type BACKGROUND
PMID: 25897540 (View on PubMed)

El Kasmi KC, Anderson AL, Devereaux MW, Vue PM, Zhang W, Setchell KD, Karpen SJ, Sokol RJ. Phytosterols promote liver injury and Kupffer cell activation in parenteral nutrition-associated liver disease. Sci Transl Med. 2013 Oct 9;5(206):206ra137. doi: 10.1126/scitranslmed.3006898.

Reference Type BACKGROUND
PMID: 24107776 (View on PubMed)

Weingartner O, Teupser D, Patel SB. The Atherogenicity of Plant Sterols: The Evidence from Genetics to Clinical Trials. J AOAC Int. 2015 May-Jun;98(3):742-749. doi: 10.5740/jaoacint.SGEWeingartner. Epub 2015 May 19.

Reference Type BACKGROUND
PMID: 25942705 (View on PubMed)

Bhattacharyya AK, Connor WE, Lin DS, McMurry MM, Shulman RS. Sluggish sitosterol turnover and hepatic failure to excrete sitosterol into bile cause expansion of body pool of sitosterol in patients with sitosterolemia and xanthomatosis. Arterioscler Thromb. 1991 Sep-Oct;11(5):1287-94. doi: 10.1161/01.atv.11.5.1287.

Reference Type BACKGROUND
PMID: 1911714 (View on PubMed)

Lin HJ, Wang C, Salen G, Lam KC, Chan TK. Sitosterol and cholesterol metabolism in a patient with coexisting phytosterolemia and cholestanolemia. Metabolism. 1983 Feb;32(2):126-33. doi: 10.1016/0026-0495(83)90216-0.

Reference Type BACKGROUND
PMID: 6827984 (View on PubMed)

Salen G, Tint GS, Shefer S, Shore V, Nguyen L. Increased sitosterol absorption is offset by rapid elimination to prevent accumulation in heterozygotes with sitosterolemia. Arterioscler Thromb. 1992 May;12(5):563-8. doi: 10.1161/01.atv.12.5.563.

Reference Type BACKGROUND
PMID: 1576118 (View on PubMed)

Ellegard L, Sunesson A, Bosaeus I. High serum phytosterol levels in short bowel patients on parenteral nutrition support. Clin Nutr. 2005 Jun;24(3):415-20. doi: 10.1016/j.clnu.2005.01.001.

Reference Type BACKGROUND
PMID: 15896428 (View on PubMed)

Other Identifiers

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DG469

Identifier Type: -

Identifier Source: org_study_id

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