4-Methylumbelliferone as a Treatment for Chronic HBV/HCV

The recruitment status of this study is unknown because the information has not been verified recently.
Verified April 2006 by MTmedical Institute of Health.
Recruitment status was  Active, not recruiting
Sponsor:
Collaborators:
The University of Texas Health Science Center at San Antonio
BioMonde Preparations Limited
Information provided by:
MTmedical Institute of Health
ClinicalTrials.gov Identifier:
NCT00225537
First received: June 30, 2005
Last updated: September 7, 2006
Last verified: April 2006
  Purpose

Open-label studies, anecdotal reports, and in vitro scientific research indicate that 4-methylumbelliferone (active ingredient of the dietary supplement Heparvit®) may prevent and reverse the symptoms and complications of chronic infection with hepatitis B virus (HBV)and hepatitis C virus (HCV). This effect has been observed among naïve patients as well as those who are non-responders to interferon, commonly used as first-line therapy for HBV and HCV. In order to scientifically address the efficacy of this 4-methylumbelliferone on chronic viral hepatitis, a randomized, placebo-controlled, blinded study is needed.

It is hypothesized that 4-methylumbelliferone may reduce the impact and aggressiveness of HBV and HCV upon the liver, thereby slowing the progression to potentially life threatening liver diseases such as cancer and cirrhosis. This is a preliminary study designed to determine any indications under controlled conditions that may warrant further detailed clinical studies.


Condition Intervention Phase
Chronic Hepatitis C
Chronic Hepatitis B
Drug: 4-Methylumbelliferone (Heparvit®)
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: Evaluation of 4-Methylumbelliferone for Treatment of Chronic Hepatitis B (HBV) and Chronic Hepatitis C (HCV)

Resource links provided by NLM:


Further study details as provided by MTmedical Institute of Health:

Primary Outcome Measures:
  • Reduction of virus in blood to undetectable levels;
  • Normalization of serum ALT and AST.

Secondary Outcome Measures:
  • Reduced viral loads; Improvement of serum ALT and AST;
  • Improvement in general health status;
  • Improvement in serum marker of hepatic fibrosis;
  • Loss of HBeAg/seroconversion to HBeAb (for HBV patients).

Estimated Enrollment: 160
Study Start Date: September 2005
Estimated Study Completion Date: August 2007
  Hide Detailed Description

Detailed Description:

(i). Chronic hepatitis B

Chronicity of HBV following acute infection is strongly age-related; the majority (90%) of infants acquiring HBV perinatally go on to develop chronic infection, while most persons who acquire HBV later in life resolve their infection [ref 1]. Patients with chronic HBV have a 15-25% lifetime risk of liver cirrhosis and hepatic cancer. An estimated 5,000 people die each year from complications of chronic HBV infection (cirrhosis and hepatocellular carcinoma).

Three drugs have been approved by the Food and Drug Administration (FDA) for treatment of chronic HBV: interferon-α (IFN-α), lamivudine, and adefovir dipivoxil. Only one-third of chronic HBV patients develop a sustained response to IFN-α treatment, and adverse effects are common [ref 2]. Use of the newer orally-administered nucleoside analogues (lamivudine or adefovir dipivoxil) typically causes rapid initial clearance of virus and is associated with fewer adverse effects; however, seroconversion rates are low, and long-term therapy with lamivudine (required for sustained responses) frequently results in resistance [ref 2]. Adefovir dipivoxil has, so far, not shown the high rate of resistance observed with lamivudine, but it is expected that resistance will eventually develop [ref 3]. In summary, major problems with currently approved therapy of HBV include expense, toxicity, and development of resistance.

(ii). Chronic hepatitis C

Chronic viral hepatitis due to hepatitis C is an enormous medical problem, affecting approximately 170 million people worldwide (WHO) [ref 4]. In the U.S., an estimated 2.7 million people suffer from chronic HCV, with 10,000-12,000 deaths per year attributable to the disease (ref 5). Chronic HCV infections in the U.S. are usually acquired through injectable drug use, sexual contact, or receipt of contaminated blood products (before antibody screening was initiated in 1990). Most persons exposed to HCV (75%) develop asymptomatic chronic infection. Eventually, 15%-20% will die of cirrhosis and liver cancer without intervention [ref 4].

Only two drugs are licensed for treatment of chronic hepatitis C: IFN-α (standard or pegylated) and ribavirin. Sustained responses to IFN-α monotherapy have occurred in up to 35% of patients; higher responses can be observed with combination treatment (pegylated IFN-α and ribavirin) [ref 6,7]. Responses to combination therapy is closely linked with HCV genotype (types 2 and 3 most responsive). A significant number of patients relapse or do not respond to standard treatment, and retreatment is typically less effective than initial therapy [ref 8].

(iii). 4-methlyumbelliferone

Umbelliferones (7-hydroxycoumarins) [ref 9] are substances present in many species of plants, especially umbelliferae, fabaceae, and oleaceae, which include such common plants as manna ash, sweet woodruff, German chamomile, celery, parsley, and others. In nature, umbelliferones help protect plants from cellular damage, infestation, trauma, and infection. Their 7-hydroxycoumarin derivatives (4-methylumbelliferones) [ref 10] are used in liver therapy, as reagents, plant growth factors, sunscreens, choleretics, and spasmolytics. They are also used as light-protective agents, in the calibration of medical lasers, and in analytical chemistry for the quantitation of nitric acid.

Products containing 4-methylumbelliferone as their active substance have been available in the USA and Europe since 1990, as dietary supplements (under trade names Heparvit®, Heparmed®, DetoxPro®). These products are promoted as supporting liver function and improving detoxification. In many parts of Europe, products containing 4-methylumbelliferone are also available as drugs, and used as spasmolytics and choleretics [ref 11] (improving liver detoxification systems through increased bile production).

7-hydroxycoumarins are also natural metabolites in the body that play important roles in the metabolism of ethanol, chemotherapeutic drugs, acetaminophen, anabolic steroids, and other hepatotoxic drugs [ref 12]. Indeed, measurement of concentrations of 4-methylumbelliferyl glucuronide (a metabolic product of 4-methylumbelliferone) is a common assay for determining the level of toxicity of liver-toxic drugs [ref 13].

The broad potential medical benefits of 4-methylumbelliferone as a hepatoprotectant, anti-inflammatory agent, chemotherapeutic agent, and antiviral substance have been described [ref 13,14]. More recent studies indicate that 4-methylumbelliferone (and other 7-hydroxycoumarin derivatives) may be effective against Helicobacter pylori [ref 15], several types of cancer [ref 15-19], and Alzheimer’s disease [ref 20].

  Eligibility

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

Inclusion Criteria:

  • Serum ALT at least 1.5x the upper limit of normal
  • For chronic HBV: Known positive serum HBeAg for at least 6 months; Presence of HBV DNA in serum
  • For chronic HCV: Presence of anti-HCV in serum within 6 months of enrollment; Positive serum HCV RNA (enrollment)
  • Written informed consent

Exclusion Criteria:

  • Treatment (within past 3 months) with interferon, ribavirin, lamivudine, entecavir, or adefovir dipivoxil
  • Current treatment with any drug or dietary supplement that could affect serum transaminase values (e.g., milk thistle)
  • Pregnancy or inability to practice contraception in patients capable of bearing or fathering children
  • Decompensated liver disease (as indicated by total bilirubin >4 mg/dL; albumin <3 g/dL; prolonged (>2 sec over control) prothrombin time; or history of bleeding esophageal varices, ascites or hepatic encephalopathy)
  • Active alcohol use, drug abuse, and/or psychiatric problems that, in the investigator's opinion, could interfere with participation in the study
  • Hepatitis D infection (for HBV-infected patients)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00225537

Locations
United States, Texas
University Health Center Downtown "Brady/Green", 527 North Leona,
San Antonio, Texas, United States, 78207
Sponsors and Collaborators
MTmedical Institute of Health
The University of Texas Health Science Center at San Antonio
BioMonde Preparations Limited
Investigators
Principal Investigator: Charles T Leach, Prof. M.D. University of Texas Health Science Center : Department of Pediatrics
Principal Investigator: Anastacio M Hoyumpa, Prof. M.D. University of Texas Health Science Center : Medicine -Gastroenterolog
Study Director: Dubravko Pavlin, PhD University of Texas Health Science Center San Antonio
  More Information

Publications:
1: Epidemiology and Prevention of Vaccine-Preventable Diseases, 7th ed, Eds W. Atkinson, C. Wolfe, 2003, Department of Health and Human Services, Centers for Disease Control and Prevention.
12: O’Kennedy R, Thornes RD, editors. Coumarins: Biology, Applications and Mode of Action. West Sussex, England: John Wiley & Sons; 1997. ISBN: 0-471-96997-4
20: Sun S, Kong LY, Zhang HQ, He SA, Niwa M. The asymmetric synthesis of linear dihydropyrano-coumarins for Alzheimer’s disease. Heterocycles 2004;63:271-82.

ClinicalTrials.gov Identifier: NCT00225537     History of Changes
Other Study ID Numbers: UTHSCSA 045-900-246
Study First Received: June 30, 2005
Last Updated: September 7, 2006
Health Authority: United States: Food and Drug Administration

Keywords provided by MTmedical Institute of Health:
hcv
hbv
methylumbelliferone
liver
hepatitis
viral
heparvit
hiv
aids

Additional relevant MeSH terms:
Hepatitis
Hepatitis A
Hepatitis B
Hepatitis, Chronic
Hepatitis C
Hepatitis B, Chronic
Hepatitis C, Chronic
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Hepadnaviridae Infections
DNA Virus Infections
Flaviviridae Infections

ClinicalTrials.gov processed this record on August 28, 2014