Identification of Patients With High Probability of Poorly Responding to Therapy With Mycophenolic Acid Prodrugs

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: NCT00978965
Recruitment Status : Active, not recruiting
First Posted : September 17, 2009
Last Update Posted : December 27, 2017
Information provided by (Responsible Party):
Guerkan SENGOELGE, Medical University of Vienna

Brief Summary:

This study is designed to define groups of patients (among patients with a heart or kidney graft or a glomerular disease and nephrotic range proteinuria) who would either not profit from a therapy with mycophenolate-mofetil (MMF) or need a higher than conventional dose to respond.

Mainly there are 2 possible explanations for inter-patient differences in responsiveness to MMF therapy:

  1. Based on a mutation (in this study single nucleotide polymorphisms-SNPs-) in the inosine monophosphate dehydrogenase 2 (IMPDH 2) transcript as the target enzyme of mycophenolic acid (MPA) pathway, MMF cannot exert its effect.
  2. Based on a high enzyme activity of IMPDH 2 a higher MMF dose than in the conventional regimens is needed.

To study the significance of these possible explanations there are 4 objectives in this study:

Objective 1: Since there are no data on SNPs with functional relevance in IMPDH 2 transcript, we will first sequence all 14 exons of this gene in their entirety in 100 gender and age matched healthy individuals.

Objective 2: The functional relevance of a detected SNP will be tested in vitro in a lymphocyte proliferation assay using various MPA concentrations.

Objective 3: These functionally relevant SNPs will be searched in patients with kidney graft in a retrospective as well as prospective manner.

Objective 4: Parallel to the genotyping experiments, IMPDH 2 activity and MPA plasma levels will be measured in all patients recruited in the study prospectively.

An association between these SNPs or various IMPDH 2 activity / MPA plasma levels with MMF responsiveness will be examined.

Objective 5: Strongyloides IgG titers are screened to evaluate the prevalence of helminth carriers in patients with immunosuppressive therapy.

Condition or disease Intervention/treatment
Renal Transplantation Genetic: MPA SNP

Study Type : Observational
Estimated Enrollment : 250 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Identification of Patients With High Probability of Not or Poorly Responding to Mycophenolate-mofetil (Cellcept®) or Mycophenolate-natrium (Myfortic®) Therapy
Study Start Date : October 2009
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : December 2018

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Group/Cohort Intervention/treatment
All patients Genetic: MPA SNP
Functional relevant MPA SNP will be sought in patients DNA isolated from leucocytes

Primary Outcome Measures :
  1. Detection of functionally relevant SNPs in IMPDH 2 gene. [ Time Frame: 6 months ]
  2. The association of detected SNPs in inosine monophosphate dehydrogenase-2 transcript or high IMPDH 2 activity with the lack of response to MPA therapy defined as - number of biopsy proven acute rejections in the first year after transplantation [ Time Frame: 12 months per patient ]

Secondary Outcome Measures :
  1. Screening for strongyloides IgG titers [ Time Frame: 12 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients with a de novo kidney transplantation

Inclusion Criteria:

  • patients with a de novo kidney graft and age >18 and < 75

Exclusion Criteria:

  • pregnancy
  • panel of antigens reactivity > 40%

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): NCT00978965

Department of Medicine III, Division of Nephrology
Vienna, Austria, A-1090
Sponsors and Collaborators
Medical University of Vienna
Principal Investigator: Gürkan Sengölge, MD Medical University of Vienna

Responsible Party: Guerkan SENGOELGE, Assoc. Prof. Priv.-Doz. Dr., Medical University of Vienna Identifier: NCT00978965     History of Changes
Other Study ID Numbers: MPASNPVienna
First Posted: September 17, 2009    Key Record Dates
Last Update Posted: December 27, 2017
Last Verified: December 2017

Keywords provided by Guerkan SENGOELGE, Medical University of Vienna:
kidney transplantation
single nucleotide polymorphism

Additional relevant MeSH terms:
Mycophenolic Acid
Antibiotics, Antineoplastic
Antineoplastic Agents
Antibiotics, Antitubercular
Antitubercular Agents
Anti-Bacterial Agents
Anti-Infective Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action