Role Of Angiogenic Factors In The Development Of Hepatorenal Syndrome

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00734136
Recruitment Status : Terminated (Insufficient findings for data analysis)
First Posted : August 14, 2008
Last Update Posted : February 18, 2009
Beth Israel Deaconess Medical Center
Dr. Vikas Sukhatme
Information provided by:
Lahey Clinic

Brief Summary:
This Study will look at the effect of substances called "angiogenic factors"(development of new blood vessels) have on the development of severe liver disease. The results may help to understand the factors involved in the repair and regeneration of liver tissue and to see if different types of liver disease are associated with different types of factors, especially in the severe liver disease called hepatorenal syndrome.

Condition or disease Intervention/treatment Phase
Hepatorenal Syndrome Renal Failure Liver Diseases Procedure: Blood Draws and a hepatectomy specimen Procedure: Blood draw - pre operative standard of care Not Applicable

Detailed Description:

Renal dysfunction in patients who also suffer from end stage liver disease is associated with increased morbidity and mortality comparted to patients suffering from liver disease alone. If frank renal failure develops in a patient with cirrhosis and ascites, the median survival time from onset of renal failure is approximately 2 weeks. Kidney dysfunction may be transient, secondary to pooling of blood in the splanchnic bed and consequent reduction in renal blood flow. In this instance, liver transplantation and restoration of normal circulatory patterns will result in return of normal renal function.

Currently, there is no diagnostic test to differentiate between temporary and permanent renal dysfunction in the presence of end stage liver disease. As a result, the number of combined liver-kidney transplant occuring has steadily increased. Slightly more than 20%(8 of 38) of the liver transplants performed by our service in 2004 have been combined liver-kidney transplants. The double procedure increases the length of anesthesia exposure and surgical time, and the presence of the transplanted kidney may require increased immunosuppression in comparison to a liver-only transplant.

We plan to examine the role of angiogenic factors in the abnormal blood flow patterns known to be associated with hepatorenal syndrome.

Specimen analysis: Circulating levels of cytokines and growth factors will be measured using commercially available ELISAs. Matrix metalloproteins will be measured by quantitative electrophoresis.

Expression of A20 will be determined by extraction of total RNA from whole blood using Trizol and run in standard Northern blot methodology. RNA will by hybridized with [³²P]-dATP labeled A20 probes and glyceraldehyde-3-phosphate dehydrogenase(GAPDH) or β-actin probes to correct for uneven loading. Similar RNA extraction will be performed on liver tissue obtained at time of surgery. Microarray analysis will be performed on the extract to identify specific genes that may be involved in the pathogenesis of HRS.

Results of laboratory analyses will be correlated with clinical parameters and attempts will be made to identify specific cytokines or up-regulated genes with particular phases or degree or renal dysfunction in patients with liver disease. Similar analyses will be performed in patients with other types of hepatic disease.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 100 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Role Of Angiogenic Factors In The Development Of Hepatorenal Syndrome
Study Start Date : May 2005
Actual Primary Completion Date : July 2005
Actual Study Completion Date : February 2009

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Liver Diseases
U.S. FDA Resources

Arm Intervention/treatment
50 surgical subjects undergoing either liver transplantation or hepatic resection
Procedure: Blood Draws and a hepatectomy specimen

Pre operative blood draw(1.5 ml serum, 1.5 ml EDTA)(approximately 2 teaspoons).

Blood draw during surgery(1.5 ml serum, 1.5 ml EDTA)from Hepatic Artery, Hepatic Vein, and Portal Vein.

Wedge section of Hepatectomy specimen following resection in surgical subjects(tested for the same factors)

50 Subjects with Liver disease who are are not surgical candidates
Procedure: Blood draw - pre operative standard of care
Pre-operative blood draw(1.5 ml serum, 1.5 ml EDTA)(approximately 2 teaspoons) from peripheral vein

Primary Outcome Measures :
  1. Analysis of Blood samples for angiogenic factors [ Time Frame: 1 week ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Sign informed consent
  • Subjects who present for Liver Transplantation
  • Subjects who present for Hepatic resection
  • Subjects with Non-Surgical Liver Disease

Exclusion Criteria:

  • Absence of Liver Disease

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00734136

United States, Massachusetts
Lahey Clinic, Inc.
Burlington, Massachusetts, United States, 01805
Sponsors and Collaborators
Lahey Clinic
Beth Israel Deaconess Medical Center
Dr. Vikas Sukhatme
Principal Investigator: Mary Ann Simpson, Ph.D. Lahey Clinic, Inc.

Responsible Party: Mary Ann Simpson, Ph.D., Lahey Clinic, Inc. Identifier: NCT00734136     History of Changes
Other Study ID Numbers: 2005-040
First Posted: August 14, 2008    Key Record Dates
Last Update Posted: February 18, 2009
Last Verified: February 2009

Keywords provided by Lahey Clinic:
Angiogenic Factors
Hepatorenal Syndrome
Liver Disease
Renal Failure
Liver Cirrhosis

Additional relevant MeSH terms:
Liver Diseases
Renal Insufficiency
Hepatorenal Syndrome
Pathologic Processes
Digestive System Diseases
Kidney Diseases
Urologic Diseases
Angiogenesis Inducing Agents
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs