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The Effects of Atazanavir-induced Hyperbilirubinemia During Human Endotoxemia

This study has been completed.
Information provided by (Responsible Party):
Radboud University Identifier:
First received: June 5, 2009
Last updated: August 13, 2015
Last verified: July 2015
Excessive inflammation, production of free radicals and vascular injury are considered the main contributors to the development of organ dysfunction in patients with severe infections and sepsis. The endogenously produced unconjugated bilirubin is one of the most powerful anti-oxidants of the human body and the administration of bilirubin in animal experiments has been shown to protect from inflammation-induced death. However, bilirubin for human administration is not yet available. Therefore, we wish to exploit one of the side effects of atazanavir, a registered drug currently used as a protease inhibitor in HIV infected patients. Atazanavir inhibits the enzyme UPD glucuronosyl transferase enzyme (UGT1A1) and therefore increases endogenously produced bilirubin levels moderately. To study the effect of hyperbilirubinemia during inflammation we will apply the human endotoxemia model. The human endotoxemia model permits elucidation of key players in the immune response to a gram negative stimulus in vivo, therefore serving as a useful tool to investigate potential novel therapeutic strategies in a standardized setting. We hypothesize that atazanavir-induced hyperbilirubinemia has beneficial anti-inflammatory and vascular effects during human endotoxemia.

Condition Intervention
Multi Organ Dysfunction Syndrome
Drug: Atazanavir
Drug: E. coli endotoxin

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Investigator)
Primary Purpose: Treatment
Official Title: The Effects of Atazanavir-induced Hyperbilirubinemia on the Innate Immune Response During Human Endotoxemia. A Parallel Double Blind Placebo Controlled Pilot Study.

Resource links provided by NLM:

Further study details as provided by Radboud University:

Primary Outcome Measures:
  • The effect of atazanavir-induced hyperbilirubinemia on systemic activation of the innate immune response by measurement of various cytokines induced by a lipopolysaccharide (LPS) challenge. [ Time Frame: before and at several time points until 24 hrs after endotoxin administration ]

Secondary Outcome Measures:
  • To determine if the attenuated vascular response to endothelium dependent vasodilators and vasoconstrictors during endotoxemia can be prevented by atazanavir-induced hyperbilirubinemia. [ Time Frame: before and until 6 hours after endotoxin administration ]
  • To detect the effects of human endotoxemia on gastric perfusion measured by tonometry in the presence or absence of atazanavir-induced hyperbilirubinemia. [ Time Frame: Before and at several time points up to 9 hours after endotoxin administration ]
  • To determine if atazanavir induced hyperbilirubinemia can attenuate subclinical renal damage (determined by several markers of acute kidney injury) known to occur during human endotoxemia. [ Time Frame: Before and at several time points up to 24 hours after endotoxin administration ]
  • To determine the effect of atazanavir induced hyperbilirubinemia on heme oxygenase induction and activity during human endotoxemia. [ Time Frame: before and at several time points up to 24 hours after endotoxin administration ]

Enrollment: 30
Study Start Date: May 2009
Study Completion Date: July 2015
Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Placebo
placebo medication: 2 capsules taken twice daily for 4 consecutive days and thereafter infusion of 2 ng/kg E.coli endotoxin intravenously
Drug: E. coli endotoxin
2 ng/kg E. coli reference endotoxin 11:H 10:K negative intravenously
Active Comparator: Atazanavir
Atazanavir 150 mg, 2 capsules taken twice daily for 4 consecutive days and thereafter infusion of 2 ng/kg E.coli endotoxin intravenously
Drug: Atazanavir
capsules of 150 mg, 2 capsules, twice daily on 4 consecutive days
Other Name: Reyataz
Drug: E. coli endotoxin
2 ng/kg E. coli reference endotoxin 11:H 10:K negative intravenously


Ages Eligible for Study:   18 Years to 35 Years   (Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Healthy male volunteers

Exclusion Criteria:

  • Use of any medication or anti-oxidant vitamin supplements.
  • History of allergic reaction to atazanavir.
  • Smoking.
  • Previous spontaneous vagal collapse.
  • History, signs or symptoms of cardiovascular disease.
  • (Family) history of myocardial infarction or stroke under the age of 65 years.
  • Cardiac conduction abnormalities on the ECG consisting of a 2nd degree atrioventricular block or a complex bundle branch block.
  • Hypertension (defined as RR systolic > 160 or RR diastolic > 90).
  • Hypotension (defined as RR systolic < 100 or RR diastolic < 50).
  • Renal impairment (defined as plasma creatinin >120 μmol/l).
  • Liver enzyme abnormalities or positive hepatitis serology.
  • Subjects with a total bilirubin level above 15 μmol/L and a normal direct bilirubin level suggesting Gilbert Syndrome.
  • Positive HIV serology or any other obvious disease associated with immune deficiency.
  • Febrile illness in the week before the LPS challenge.
  • Participation in a drug trial or donation of blood 3 months prior to the LPS challenge.
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Please refer to this study by its identifier: NCT00916448

Radboud University Nijmegen Medical Centre
Nijmegen, Gelderland, Netherlands, 6500 HB
Sponsors and Collaborators
Radboud University
Principal Investigator: Peter Pickkers, MD, PhD Radboud University Nijmegen Medical Centre, The Netherlands
  More Information

Responsible Party: Radboud University Identifier: NCT00916448     History of Changes
Other Study ID Numbers: ATV LPS study
Study First Received: June 5, 2009
Last Updated: August 13, 2015

Keywords provided by Radboud University:
Multi organ dysfunction syndrome
Oxidative Stress
Heme oxygenase

Additional relevant MeSH terms:
Pathologic Processes
Systemic Inflammatory Response Syndrome
Atazanavir Sulfate
HIV Protease Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents processed this record on April 28, 2017