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

• Sponsor: Assiut University (Other)
• Overall Status: Completed
• CT.gov ID: NCT03133169
• Collaborator: (none)
• Enrollment: 80
• Location: 1
• Actual Duration (Months): 26.8
• Patients Per Site Per Month: 3

Study Details

Study Description

Brief Summary

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

Condition or Disease	Intervention/Treatment	Phase
Thalassemia in Children; Pulmonary Hypertension; Hemolysis	Diagnostic Test: blood sample; Diagnostic Test: Tricuspid regurge velocity

Study Design

• Study Type: Observational
• Actual Enrollment: 80 participants
• Observational Model: Cohort
• Time Perspective: Cross-Sectional
• Official Title: Erythrocyte Glutamine Level Relation to Pulmonary Hypertension Risk in Beta Thalassemia Major Children in Assiut University Children Hospital
• Actual Study Start Date: Jun 1, 2017
• Actual Primary Completion Date: Aug 25, 2019
• Actual Study Completion Date: Aug 26, 2019

Arms and Interventions

Arm	Intervention/Treatment
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	Diagnostic Test: blood sample; blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level; Diagnostic Test: Tricuspid regurge velocity; 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	Diagnostic Test: blood sample; blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level; Diagnostic Test: Tricuspid regurge velocity; 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	Diagnostic Test: blood sample; blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level; Diagnostic Test: Tricuspid regurge velocity; 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	Diagnostic Test: blood sample; blood sample for measuring liver and kidney function, CBC, ferritin level and erythrocyte glutamine level; Diagnostic Test: Tricuspid regurge velocity; Tricuspid regurge velocity will be measured by doppler echocardiography denoting the pulmonary hypertension risk in children

Outcome Measures

Primary Outcome Measures

1. Erythrocyte glutamine level [2 months]

   marker for oxidative stress

2. Tricuspid regurge velocity [2 months]

   Measures the risk of pulmonary hypertension

Secondary Outcome Measures

1. Plasma glutamine level [2 months]

   Assess the glutamine level at each visit

2. Liver function tests [2 months]

   Evaluates the state of liver

3. Renal function tests [2 months]

   Evaluates the state of kidney

4. Ferritin level [2 months]

   measuring the iron overload

Eligibility Criteria

Criteria

• Ages Eligible for Study: 10 Years to 18 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

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.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Assiut University	Assiut		Egypt

Sponsors and Collaborators

• Assiut University

Investigators

• Principal Investigator: Fahim M Fahim, PhD, Children Hospital, Assiut University
• Principal Investigator: Fatma S AbdElshafi, bachelor's, Children Hospital, Assiut University
• Principal Investigator: Eman F. Mohamed, PhD, Children Hospital, Assiut University

Study Documents (Full-Text)

None provided.

More Information

Publications

• 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. Epub 2007 Mar 22.
• 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.
• 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.
• 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.
• 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. Review.
• 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. Review. Erratum in: Heart. 2011 Jul;97(13):1112.
• Kuypers FA. Membrane lipid alterations in hemoglobinopathies. Hematology Am Soc Hematol Educ Program. 2007:68-73. Review.
• 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. Review.
• 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.
• 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.
• 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.
• 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. Epub 2007 Sep 11.
• 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.
• 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. Review.
• Morris CR. Vascular risk assessment in patients with sickle cell disease. Haematologica. 2011 Jan;96(1):1-5. doi: 10.3324/haematol.2010.035097.
• 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.
• Walter PB, Fung EB, Killilea DW, Jiang Q, Hudes M, Madden J, Porter J, Evans P, Vichinsky E, Harmatz P. Oxidative stress and inflammation in iron-overloaded patients with beta-thalassaemia or sickle cell disease. Br J Haematol. 2006 Oct;135(2):254-63.
• Xu H, Pearl RG. Effect of l-glutamine on pulmonary hypertension in the perfused rabbit lung. Pharmacology. 1994 Apr;48(4):260-4.

• Responsible Party: Fatma Sami, Pediatric Resident, Assiut University
• ClinicalTrials.gov Identifier: NCT03133169
• Other Study ID Numbers: GlnThalassemia
• First Posted: Apr 28, 2017
• Last Update Posted: Aug 28, 2019
• Last Verified: Aug 1, 2019

• Individual Participant Data (IPD) Sharing Statement: Undecided
• Plan to Share IPD: Undecided
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Fatma Sami, Pediatric Resident, Assiut University: Thalassemia; Glutamine/glutamate ratio; Pulmonary hypertension
• Additional relevant MeSH terms: Hypertension, Pulmonary; Hypertension; Thalassemia; beta-Thalassemia; Hemolysis

Study Results

No Results Posted as of Aug 28, 2019