Erythrocyte Glutamine Level Relation to Pulmonary Hypertension Risk in Beta Thalassemia Major Children

NCT ID: NCT03133169

Last Updated: 2019-08-28

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

80 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-06-01

Study Completion Date

2019-08-26

Brief Summary

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The study will investigate the relation between erythrocyte glutamine/glutamate ratio and pulmonary hypertension risk in Egyptian thalassemic children in Assiut University Children Hospital

Detailed Description

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Conditions

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Thalassemia in Children Pulmonary Hypertension Hemolysis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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on chelation

patients with B-thalassemia major samples of which will be examined for renal and liver function, Erythrocyte Glutamine level, ferritin level and complete blood picture. Also Echo will be done for measuring the Tricuspid regurge velocity.

group 1: cases on chelation: deferasirox 500mg oral tablet with initial dose 20 mg/kg guided by ferritin level

Diagnostic Test: blood sample

Diagnostic Test: Tricuspid regurge velocity

blood sample

Intervention Type DIAGNOSTIC_TEST

blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level

Tricuspid regurge velocity

Intervention Type DIAGNOSTIC_TEST

Tricuspid regurge velocity will be measured by doppler echocardiography denoting the pulmonary hypertension risk in children

No chelation

group 2: cases without chelation

Diagnostic Test: blood sample

Diagnostic Test: Tricuspid regurge velocity

blood sample

Intervention Type DIAGNOSTIC_TEST

blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level

Tricuspid regurge velocity

Intervention Type DIAGNOSTIC_TEST

Tricuspid regurge velocity will be measured by doppler echocardiography denoting the pulmonary hypertension risk in children

splenectomy

group 3: cases with splenectomy

Diagnostic Test: blood sample

Diagnostic Test: Tricuspid regurge velocity

blood sample

Intervention Type DIAGNOSTIC_TEST

blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level

Tricuspid regurge velocity

Intervention Type DIAGNOSTIC_TEST

Tricuspid regurge velocity will be measured by doppler echocardiography denoting the pulmonary hypertension risk in children

no splenectomy

group 4: cases without splenectomy Diagnostic Test: blood sample Diagnostic Test: Tricuspid regurge velocity

blood sample

Intervention Type DIAGNOSTIC_TEST

blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level

Tricuspid regurge velocity

Intervention Type DIAGNOSTIC_TEST

Tricuspid regurge velocity will be measured by doppler echocardiography denoting the pulmonary hypertension risk in children

Interventions

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blood sample

blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level

Intervention Type DIAGNOSTIC_TEST

Tricuspid regurge velocity

Tricuspid regurge velocity will be measured by doppler echocardiography denoting the pulmonary hypertension risk in children

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Established diagnosis of Thalassemia.
* PH risk documented by doppler echocardiography, defined as tricuspid regurge velocity (TRV) equal to or greater than 2.5 m/s

Exclusion Criteria

* Acute crisis or hospitalization within 1 month of enrollment
* Hepatic dysfunction (SGPT greater than 3X normal)
* Renal dysfunction (Creatinine greater than 2X normal)
* Patients on sildenafil (Viagra), calcium channel blockers or other drugs for the control of PH.
Minimum Eligible Age

10 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Fatma Sami

Pediatric Resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fahim M Fahim, PhD

Role: PRINCIPAL_INVESTIGATOR

Children Hospital, Assiut University

Fatma S AbdElshafi, bachelor's

Role: PRINCIPAL_INVESTIGATOR

Children Hospital, Assiut University

Eman F. Mohamed, PhD

Role: PRINCIPAL_INVESTIGATOR

Children Hospital, Assiut University

Locations

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Assiut University

Asyut, , Egypt

Site Status

Countries

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Egypt

References

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Gladwin MT, Sachdev V, Jison ML, Shizukuda Y, Plehn JF, Minter K, Brown B, Coles WA, Nichols JS, Ernst I, Hunter LA, Blackwelder WC, Schechter AN, Rodgers GP, Castro O, Ognibene FP. Pulmonary hypertension as a risk factor for death in patients with sickle cell disease. N Engl J Med. 2004 Feb 26;350(9):886-95. doi: 10.1056/NEJMoa035477.

Reference Type BACKGROUND
PMID: 14985486 (View on PubMed)

Morris CR, Kuypers FA, Kato GJ, Lavrisha L, Larkin S, Singer T, Vichinsky EP. Hemolysis-associated pulmonary hypertension in thalassemia. Ann N Y Acad Sci. 2005;1054:481-5. doi: 10.1196/annals.1345.058.

Reference Type BACKGROUND
PMID: 16339702 (View on PubMed)

Morris CR, Vichinsky EP. Pulmonary hypertension in thalassemia. Ann N Y Acad Sci. 2010 Aug;1202:205-13. doi: 10.1111/j.1749-6632.2010.05580.x.

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Reference Type BACKGROUND
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Morris CR. Mechanisms of vasculopathy in sickle cell disease and thalassemia. Hematology Am Soc Hematol Educ Program. 2008:177-85. doi: 10.1182/asheducation-2008.1.177.

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Fung EB, Harmatz P, Milet M, Ballas SK, De Castro L, Hagar W, Owen W, Olivieri N, Smith-Whitley K, Darbari D, Wang W, Vichinsky E; Multi-Center Study of Iron Overload Research Group. Morbidity and mortality in chronically transfused subjects with thalassemia and sickle cell disease: A report from the multi-center study of iron overload. Am J Hematol. 2007 Apr;82(4):255-65. doi: 10.1002/ajh.20809.

Reference Type BACKGROUND
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Machado RF, Gladwin MT. Pulmonary hypertension in hemolytic disorders: pulmonary vascular disease: the global perspective. Chest. 2010 Jun;137(6 Suppl):30S-38S. doi: 10.1378/chest.09-3057.

Reference Type BACKGROUND
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Janda S, Shahidi N, Gin K, Swiston J. Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis. Heart. 2011 Apr;97(8):612-22. doi: 10.1136/hrt.2010.212084. Epub 2011 Feb 25.

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De Castro LM, Jonassaint JC, Graham FL, Ashley-Koch A, Telen MJ. Pulmonary hypertension associated with sickle cell disease: clinical and laboratory endpoints and disease outcomes. Am J Hematol. 2008 Jan;83(1):19-25. doi: 10.1002/ajh.21058.

Reference Type BACKGROUND
PMID: 17724699 (View on PubMed)

Anthi A, Machado RF, Jison ML, Taveira-Dasilva AM, Rubin LJ, Hunter L, Hunter CJ, Coles W, Nichols J, Avila NA, Sachdev V, Chen CC, Gladwin MT. Hemodynamic and functional assessment of patients with sickle cell disease and pulmonary hypertension. Am J Respir Crit Care Med. 2007 Jun 15;175(12):1272-9. doi: 10.1164/rccm.200610-1498OC. Epub 2007 Mar 22.

Reference Type BACKGROUND
PMID: 17379852 (View on PubMed)

Hebbel RP. Reconstructing sickle cell disease: a data-based analysis of the "hyperhemolysis paradigm" for pulmonary hypertension from the perspective of evidence-based medicine. Am J Hematol. 2011 Feb;86(2):123-54. doi: 10.1002/ajh.21952.

Reference Type BACKGROUND
PMID: 21264896 (View on PubMed)

Morris CR. Vascular risk assessment in patients with sickle cell disease. Haematologica. 2011 Jan;96(1):1-5. doi: 10.3324/haematol.2010.035097. No abstract available.

Reference Type BACKGROUND
PMID: 21193426 (View on PubMed)

Mok E, Hankard R. Glutamine supplementation in sick children: is it beneficial? J Nutr Metab. 2011;2011:617597. doi: 10.1155/2011/617597. Epub 2011 Nov 14.

Reference Type BACKGROUND
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Xu H, Pearl RG. Effect of l-glutamine on pulmonary hypertension in the perfused rabbit lung. Pharmacology. 1994 Apr;48(4):260-4. doi: 10.1159/000139188.

Reference Type BACKGROUND
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Morris CR, Suh JH, Hagar W, Larkin S, Bland DA, Steinberg MH, Vichinsky EP, Shigenaga M, Ames B, Kuypers FA, Klings ES. Erythrocyte glutamine depletion, altered redox environment, and pulmonary hypertension in sickle cell disease. Blood. 2008 Jan 1;111(1):402-10. doi: 10.1182/blood-2007-04-081703. Epub 2007 Sep 11.

Reference Type BACKGROUND
PMID: 17848621 (View on PubMed)

Niihara Y, Matsui NM, Shen YM, Akiyama DA, Johnson CS, Sunga MA, Magpayo J, Embury SH, Kalra VK, Cho SH, Tanaka KR. L-glutamine therapy reduces endothelial adhesion of sickle red blood cells to human umbilical vein endothelial cells. BMC Blood Disord. 2005 Jul 25;5:4. doi: 10.1186/1471-2326-5-4.

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Machado RF, Farber HW. Pulmonary hypertension associated with chronic hemolytic anemia and other blood disorders. Clin Chest Med. 2013 Dec;34(4):739-52. doi: 10.1016/j.ccm.2013.08.006. Epub 2013 Oct 17.

Reference Type BACKGROUND
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Other Identifiers

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GlnThalassemia

Identifier Type: -

Identifier Source: org_study_id

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