Oxidative Stress and Fatty Acids in Hepatitis C

Sponsor

Johane Allard (Other)

Overall Status

Completed

CT.gov ID

NCT00444002

Collaborator

Canadian Association of Gastroenterology (Industry)

105

Enrollment

Location

Duration (Months)

1.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Hepatitis C virus infection (HCV) is a major health concern in Canada and worldwide. Chronic HCV can cause progressive liver damage leading to inflammation, scarring and, in some cases, cirrhosis or liver cancer. It has been shown that fat accumulation in the liver can accelerate the disease progression and is therefore a risk factor in HCV patients.

However, the exact mechanism(s) by which fat accumulation in the liver is involved in disease progression are not clear yet. It is possible that the presence of fat provides a liver susceptible to a second injurious process which leads to scarring. Candidates for this second "hit" may include insulin resistance, leading to accumulation of fat within the liver cells and secondly oxidation of these lipids. In turn, lipid peroxidation can lead to production of reactive oxygen species (unstable molecules that can damage cells) and cytokines (signal molecules that promote inflammation) resulting in more oxidative stress and liver damage.

Aim of the study is to find out, whether patients with HCV and fatty liver have increased oxidative stress and inflammation than patients with HCV without fatty liver, and whether this is associated with a different nutritional status.

Condition or Disease	Intervention/Treatment	Phase
Hepatitis C Hepatic Steatosis

Detailed Description

Hypothesis: Patients with Hepatitis C and steatosis are more oxidatively stressed than those without steatosis. This is associated with 1) increased liver lipid peroxides and cytokines (TNF-alpha, TGF-beta); 2) altered unsaturated fat status (intake, tissue storage as measured in red blood cells); 3) reduced antioxidant status.

Objectives: To assess oxidative stress and nutritional status in patients with Hepatitis C and steatosis on liver biopsy and to compare the results to the same parameters measured in patients with Hepatitis C and no steatosis.

Measurements:

Primary outcome: Liver lipid peroxides (LPO)

Secondary outcomes:

Liver: TNF-alpha; liver pathology and immunohistochemistry for adducts of malondialdehyde (MDA), a product of lipid peroxidation (LP), alpha-smooth muscle actin (alpha-SMA), a marker of hepatic stellate cell activation; and transforming growth factor (TGF-beta), a profibrogenic cytokine involved in fibrogenesis, liver fatty acid composition (substrate for lipid peroxidation).

Oxidative stress and nutrition: Plasma lipid peroxides, plasma antioxidant vitamins, antioxidant status and power, and red blood cell fatty acid composition, 7 day food record, anthropometry.

Other measurements:

Insulin resistance parameters such as blood glucose, insulin, c-peptide, hemoglobin A1c (HbA1c) Blood lipid profile, liver enzymes (as part of standard medical assessment) Subject demographics and medical history will also be recorded.

Study Design

Study Type:

Observational

Actual Enrollment :

105 participants

Observational Model:

Case-Only

Time Perspective:

Cross-Sectional

Official Title:

Hepatitis C Infection With Liver Steatosis Compared to Hepatitis C Infection Without Liver Steatosis: Is There a Difference in Lipid Peroxidation and Indicators of Inflammation?

Study Start Date :

Jul 1, 2005

Actual Primary Completion Date :

Jul 1, 2008

Actual Study Completion Date :

Jul 1, 2010

Arms and Interventions

Arm	Intervention/Treatment
Hepatitis C - Steatosis Patients with chronic Hep C infection undergoing liver biopsy with >=5% steatosis on liver biopsy
Hepatitis C - no steatosis Patients with chronic Hep C infection without steatosis on liver biopsy (<5% of hepatocytes involved)

Outcome Measures

Primary Outcome Measures

Lipid peroxidation (LPO) in the liver [Single time point]
LPO by commercially available kit

Secondary Outcome Measures

Hepatic fatty acid composition [Single time point]
Fatty acid and lipid composition measured by gas chromatography and mass spectrometry
Antioxidant power in the liver [Single time point]
Antioxidant power (AOP) measured by test kit
Plasma vitamin C [Single time point]
Plasma vitamin C by colorimetric assay
Tocopherols in plasma [Single time point]
alpha- and gamma-tocopherol in plasma by gas chromatography

Other Outcome Measures

Insulin resistance [Single time point]
Homeostasis model assessment of insulin resistance
Dietary intake [single time point]
Macro- and micronutrient intake by 3-day food protocols

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male and female patients, age >18 y
Established hepatitis C infection as confirmed by positive serology and positive hepatitis C RNA in serum
Convincing evidence of negligible alcohol consumption (<20g of ethanol per day) obtained from a detailed history, confirmed by at least one close relative
Absence of any other possible cause for liver dysfunction.
Undergoing routing liver biopsy (usually pre-treatment)

Exclusion Criteria:

Findings highly suggestive of liver disease of other etiology (e.g. other viral hepatitis, auto-immune chronic hepatitis, primary biliary cirrhosis and genetic liver diseases such as hemochromatosis, alpha-1 antitrypsin deficiency, Wilsons disease and biliary obstruction)
Anticipated need for liver transplantation in one year or complications of liver disease such as recurrent variceal bleeding, spontaneous porto- systemic encephalopathy, resistant ascites or bacterial peritonitis
Concurrent medical illnesses contraindicating a liver biopsy (history of unexplained bleeding, hemophilia or abnormal coagulation results as per routine laboratory work-up or other reasons judged by the hepatologist to contraindicate a percutaneous liver biopsy)
Medications known to precipitate steatohepatitis (corticosteroids, high dose estrogens, methotrexate, amiodarone, calcium channel blockers, sulfasalazine or cloxacillin) in the 6 months prior to entry
Antioxidant vitamin or n-3 supplementation, ursodeoxycholic acid or any other experimental drug in the 6 months prior to study entry
Pregnant or lactating