Oxidative Stress and Fatty Acids in Hepatitis C

This study has been completed.
Sponsor:
Collaborator:
Canadian Association of Gastroenterology
Information provided by (Responsible Party):
Johane Allard, University Health Network, Toronto
ClinicalTrials.gov Identifier:
NCT00444002
First received: March 6, 2007
Last updated: January 9, 2014
Last verified: January 2014
  Purpose

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
Hepatitis C
Hepatic Steatosis

Study Type: Observational
Study Design: 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?

Resource links provided by NLM:


Further study details as provided by University Health Network, Toronto:

Primary Outcome Measures:
  • Lipid peroxidation (LPO) in the liver [ Time Frame: Single time point ] [ Designated as safety issue: No ]
    LPO by commercially available kit


Secondary Outcome Measures:
  • Hepatic fatty acid composition [ Time Frame: Single time point ] [ Designated as safety issue: No ]
    Fatty acid and lipid composition measured by gas chromatography and mass spectrometry

  • Antioxidant power in the liver [ Time Frame: Single time point ] [ Designated as safety issue: No ]
    Antioxidant power (AOP) measured by test kit

  • Plasma vitamin C [ Time Frame: Single time point ] [ Designated as safety issue: No ]
    Plasma vitamin C by colorimetric assay

  • Tocopherols in plasma [ Time Frame: Single time point ] [ Designated as safety issue: No ]
    alpha- and gamma-tocopherol in plasma by gas chromatography


Other Outcome Measures:
  • Insulin resistance [ Time Frame: Single time point ] [ Designated as safety issue: No ]
    Homeostasis model assessment of insulin resistance

  • Dietary intake [ Time Frame: single time point ] [ Designated as safety issue: No ]
    Macro- and micronutrient intake by 3-day food protocols


Enrollment: 105
Study Start Date: July 2005
Study Completion Date: July 2010
Primary Completion Date: July 2008 (Final data collection date for primary outcome measure)
Groups/Cohorts
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)

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.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Patients with chronic Hep C infection undergoing routine pre-treatment liver biopsy

Criteria

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
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00444002

Locations
Canada, Ontario
University Health Network (Toronto General Hospital & Toronto Western Hospital)
Toronto, Ontario, Canada
Sponsors and Collaborators
Johane Allard
Canadian Association of Gastroenterology
Investigators
Principal Investigator: Johane P Allard, MD, FRCPC University Health Network, Toronto General Hospital
  More Information

Additional Information:
Publications:
Responsible Party: Johane Allard, Prof. Dr., University Health Network, Toronto
ClinicalTrials.gov Identifier: NCT00444002     History of Changes
Other Study ID Numbers: 05-0305 AE
Study First Received: March 6, 2007
Last Updated: January 9, 2014
Health Authority: Canada: Ethics Review Committee

Keywords provided by University Health Network, Toronto:
Hepatitis C
Steatosis
Oxidative Stress
Antioxidants
Inflammation
Fatty acids

Additional relevant MeSH terms:
Fatty Liver
Hepatitis
Hepatitis A
Hepatitis C
Inflammation
Liver Diseases
Digestive System Diseases
Hepatitis, Viral, Human
Virus Diseases
Enterovirus Infections
Picornaviridae Infections
RNA Virus Infections
Flaviviridae Infections
Pathologic Processes

ClinicalTrials.gov processed this record on April 14, 2014