Effects of Uridine Supplementation on Metabolic Side Effects of Stavudine and Zidovudine - Full Text View

Sponsor:	National Center for Complementary and Alternative Medicine (NCCAM)
Information provided by:	National Center for Complementary and Alternative Medicine (NCCAM)
ClinicalTrials.gov Identifier:	NCT00471614

Purpose

The purpose of this study is to determine whether uridine supplementation will improve insulin sensitivity and overall carbohydrate metabolism in HIV-positive subjects who are currently undergoing treatment with antiretroviral regimens containing stavudine or zidovudine and who have evidence of impaired mitochondrial function and insulin resistance.

Condition	Intervention	Phase
HIV Infections Insulin Resistance Hyperlactatemia	Drug: NucleomaxX (contains uridine)	Phase II

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator), Placebo Control, Parallel Assignment, Efficacy Study
Official Title:	Uridine Supplementation, Mitochondrial Function, and Glucose Metabolism in HIV

Resource links provided by NLM:

MedlinePlus related topics: AIDS Dietary Supplements

Drug Information available for: Uridine

U.S. FDA Resources

Further study details as provided by National Center for Complementary and Alternative Medicine (NCCAM):

Primary Outcome Measures:

Change in insulin sensitivity as measured by euglycemic hyperinsulinemic clamp (with simultaneous stable isotope tracer studies) [ Time Frame: 2 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Change in body composition (DEXA and CT imaging) [ Time Frame: 2 months ] [ Designated as safety issue: Yes ]
Change in insulin secretion (frequently sampled intravenous glucose tolerance test) [ Time Frame: 2 months ] [ Designated as safety issue: No ]
Change in resting energy expenditure (indirect calorimetry) [ Time Frame: 2 months ] [ Designated as safety issue: No ]
Change in markers of oxidative stress [ Time Frame: 2 months ] [ Designated as safety issue: No ]
Change in mtDNA levels (measured in muscle biopsy) [ Time Frame: 2 months ] [ Designated as safety issue: No ]
Change in HIV disease markers [ Time Frame: 2 months ] [ Designated as safety issue: Yes ]
Adverse effects [ Time Frame: continuously ] [ Designated as safety issue: Yes ]
Laboratory based toxicity [ Time Frame: continuously ] [ Designated as safety issue: Yes ]
Adherence [ Time Frame: continuously ] [ Designated as safety issue: No ]

Estimated Enrollment:	20
Study Start Date:	April 2007
Estimated Study Completion Date:	December 2009
Estimated Primary Completion Date:	August 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental NucleomaxX	Drug: NucleomaxX (contains uridine) Escalated doses of NucleomaxX tid
2: Placebo Comparator Placebo	Drug: NucleomaxX (contains uridine) Escalated doses of NucleomaxX tid

Detailed Description:

Treatment of HIV infection with nucleoside analogue reverse transcriptase inhibitors (NRTIs) has been associated with numerous toxicities that have been attributed to impaired mitochondrial function secondary to a reduction in the levels of mitochondrial DNA (mtDNA). Abnormalities in mitochondrial function have been implicated in the development of insulin resistance in patients with HIV infection and have also been hypothesized to underlie many of the pathophysiologic features of type 2 diabetes mellitus in non-HIV infected individuals.

Uridine, a pyrimidine nucleoside that plays an essential role in the synthesis of RNA and other key physiologic processes, has been proposed as a therapy for NRTI-induced mitochondrial dysfunction. Uridine supplementation protected bone marrow cells from the toxicity of zidovudine, normalized the growth of neurons exposed to NRTIs, and abrogated mitochondrial toxicity of NRTIs in HepG2 cells in vitro. A food supplement called NucleomaxX®, extracted from the stem of sugar cane, raises plasma uridine concentrations to levels known to prevent mitochondrial toxicity in vitro. In a recent case report, oral administration of uridine, given in the form of NucleomaxX®, ameliorated the mitochondrial toxicity caused by stavudine and led to improvements in myalgias and liver and muscle enzymes, despite continuing treatment with stavudine. In a clinical study of 14 HIV-infected patients treated with stavudine or zidovudine, NucleomaxX® led to improved hepatic mitochondrial function as assessed by the 13C-methionine breath test.

We will perform a randomized double-blind placebo-controlled study in 20 HIV-positive subjects who are currently undergoing treatment with antiretroviral regimens containing stavudine or zidovudine and who have evidence of impaired mitochondrial function and insulin resistance. Subjects will be hospitalized in the SFGH CTSI Clinical Research Center (CCRC) for 6 days to undergo comprehensive metabolic studies. Subjects will then be randomized, in a 1:1 fashion, to receive either NucleomaxX® or placebo for two months, after which they will repeat the 6-day CCRC-based assessments. This study is designed to test the hypothesis that, in comparison to placebo, uridine supplementation will enhance mitochondrial function, and this will be associated with concomitant improvements in glucose and lipid metabolism.

Eligibility

Ages Eligible for Study:	18 Years to 65 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Confirmed HIV-1 infection
HIV-1 RNA <10,000 copies/mL within 30 days of study entry
Treatment with stavudine or zidovudine for at least 12 months prior to entry and no plan to discontinue for the duration of the study
Stable antiretroviral regimen for at least 3 months prior to entry and no plan to change antiretroviral therapy for the duration of the study
Mitochondrial dysfunction as evidenced by a fasting plasma lactate level > 1.5 mmol/L
Insulin resistance as evidenced by a HOMA-IR > 2.77 as calculated from fasting blood samples (for glucose and insulin) obtained during the screening visit
Karnofsky performance score >= 80
Women who are on stable regimens of hormonal contraceptives or hormone replacement therapy for at least 6 months prior to enrollment may participate
Men who are on stable doses of testosterone replacement therapy for 6 months prior to enrollment may participate
Subjects on a stable dose of lipid lowering agents for 6 months prior to enrollment may participate

Exclusion Criteria:

Serum creatinine and blood urea nitrogen > 1.5 upper limit of normal (ULN)
Direct bilirubin >2 X ULN
AST (SGOT) or ALT (SGPT) >5 x ULN
Hgb < 8.5 g/dL
Abnormal hepatitis B or C serology
A clinical diagnosis of diabetes mellitus or a fasting glucose > 126 mg/dl
Physical or functional obstruction to food intake or impaired absorption
A clinically suspected concomitant treatable infection that has not yet been treated
An opportunistic infection within the preceding 30 days
Ascites
Pregnancy
Treatment with growth hormone, anabolic steroids (including supraphysiologic doses of testosterone), glucocorticoids, insulin, sulfonylureas, metformin, thiazolidinediones, or appetite stimulants within preceding 6 months
Dementia, active drug or alcohol abuse or dependence, or other conditions that would preclude adherence to the protocol or the ability to provide informed consent.
Any other condition that, in the opinion of the investigators, would put the subject at risk

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00471614

Contacts

Contact: Madhu N Rao, MD	415-206-6381	madhu.rao@ucsf.edu
Contact: Kathleen Mulligan, PhD	415-206-5882	kathleen.mulligan@ucsf.edu

Locations

United States, California
University of California San Francisco	Recruiting
San Francisco, California, United States, 94110

Sponsors and Collaborators

National Center for Complementary and Alternative Medicine (NCCAM)

Investigators

Principal Investigator:

Morris Schambelan, MD

University of California, San Francisco

More Information

Publications:

Walker UA, Venhoff N. Uridine in the prevention and treatment of NRTI-related mitochondrial toxicity. Antivir Ther. 2005;10 Suppl 2:M117-23. Review.

Walker UA, Venhoff N, Koch EC, Olschewski M, Schneider J, Setzer B. Uridine abrogates mitochondrial toxicity related to nucleoside analogue reverse transcriptase inhibitors in HepG2 cells. Antivir Ther. 2003 Oct;8(5):463-70.

Sommadossi JP, Carlisle R, Schinazi RF, Zhou Z. Uridine reverses the toxicity of 3'-azido-3'-deoxythymidine in normal human granulocyte-macrophage progenitor cells in vitro without impairment of antiretroviral activity. Antimicrob Agents Chemother. 1988 Jul;32(7):997-1001.

Keilbaugh SA, Hobbs GA, Simpson MV. Anti-human immunodeficiency virus type 1 therapy and peripheral neuropathy: prevention of 2',3'-dideoxycytidine toxicity in PC12 cells, a neuronal model, by uridine and pyruvate. Mol Pharmacol. 1993 Oct;44(4):702-6.

Banasch M, Goetze O, Knyhala K, Potthoff A, Schlottmann R, Kwiatek MA, Bulut K, Schmitz F, Schmidt WE, Brockmeyer NH. Uridine supplementation enhances hepatic mitochondrial function in thymidine-analogue treated HIV-infected patients. AIDS. 2006 Jul 13;20(11):1554-6.

Walker UA, Langmann P, Miehle N, Zilly M, Klinker H, Petschner F. Beneficial effects of oral uridine in mitochondrial toxicity. AIDS. 2004 Apr 30;18(7):1085-6. No abstract available.

Responsible Party:	University of California, San Francisco ( Morris Schambelan, MD )
Study ID Numbers:	R21 AT003374-01A1
Study First Received:	May 8, 2007
Last Updated:	August 22, 2008
ClinicalTrials.gov Identifier:	NCT00471614 History of Changes
Health Authority:	United States: Food and Drug Administration

Keywords provided by National Center for Complementary and Alternative Medicine (NCCAM):

HIV
AIDS
uridine

mitochondria
insulin resistance
Treatment Experienced

Additional relevant MeSH terms:

RNA Virus Infections
Sexually Transmitted Diseases, Viral
Metabolic Diseases
Slow Virus Diseases
Immune System Diseases
Acquired Immunodeficiency Syndrome
Infection
Immunologic Deficiency Syndromes

Virus Diseases
Hyperinsulinism
HIV Infections
Sexually Transmitted Diseases
Lentivirus Infections
Insulin Resistance
Glucose Metabolism Disorders
Retroviridae Infections

ClinicalTrials.gov processed this record on November 30, 2009