RA-2 13-cis Retinoic Acid (Isotretinoin) - Full Text View

Purpose

Men with infertility and normal hormone levels have few options for fertility treatment. Previous research work has suggested that men with infertility may have low levels of the active form of Vitamin A, called retinoic acid, in their testes. We think that giving men with low sperm counts retinoic acid may increase their sperm counts and improve their chances of fathering a pregnancy. We want to see if retinoic acid administration over twenty weeks can increase sperm production and help infertile men become fathers without the need for In vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). We also want to see if adding calcitriol with retinoic acid will improve sperm motility in a sub-set of subjects.

Condition	Intervention	Phase
Male Infertility Klinefelter's Syndrome Y-chromosome Microdeletions	Drug: 13-cis retinoic acid Drug: Calcitriol	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Intervention Model: Parallel Assignment Masking: No masking Primary Purpose: Treatment
Official Title:	A Pilot Trial of 13-cis Retinoic Acid (Isotretinoin) for the Treatment of Men With Oligoasthenoteratozoospermia

Resource links provided by NLM:

Genetics Home Reference related topics: CATSPER1-related nonsyndromic male infertility Klinefelter syndrome Y chromosome infertility sensorineural deafness and male infertility

MedlinePlus related topics: Infertility

Drug Information available for: Tretinoin Isotretinoin Calcitriol

Genetic and Rare Diseases Information Center resources: Partial Deletion of Y Y Chromosome Infertility

U.S. FDA Resources

Further study details as provided by John Amory, University of Washington:

Primary Outcome Measures:

Total motile sperm [ Time Frame: Up to 20-weeks ]
Total motile sperm count in men treated with 13-cis retinoic acid

Secondary Outcome Measures:

13-cis retinoic acid serum level [ Time Frame: 20-weeks ]
Concentration level of 13-cis retinoic acid in the serum of treated men
Number of Participants with Serious and Non-Serious Adverse effects associated with treatment with 13-cis retinoic acid [ Time Frame: 20-weeks ]
Number of adverse effects per subject associated with treatment with 13-cis retinoic acid
13-cis retinoic acid Seminal Plasma Concentration [ Time Frame: Up to 20-weeks ]
13-cis retinoic acid concentration in semen of treated men
To determine if the additions of calcitriol with 13-cis retinoic acid can improve sperm motility [ Time Frame: 20 weeks ]
improved sperm motility


Estimated Enrollment:	20
Study Start Date:	August 2014
Estimated Study Completion Date:	December 2018
Estimated Primary Completion Date:	December 2017 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: 13-cis retinoic acid 20mg 13-cis retinoic acid twice daily (BID) with meals for 20 weeks	Drug: 13-cis retinoic acid Accutane is used for the treatment of severe acne Other Names: Accutane Isotretinoin
Experimental: Calcitriol 0.25 mcg oral calcitriol 025 mcg BID subjects 11-20 for 20 weeks	Drug: Calcitriol Calcitriol is a form of vitamin D given twice daily (BID) Other Name: 1,25-dihydroxyvitamin D3

Detailed Description:

This is a 20 week, unblinded, two-arm pilot study to determine the impact of therapy with 13-cis retinoic acid and calcitriol on sperm indices in infertile men. Twenty infertile men, ages 21-60 with abnormal sperm analyses will be enrolled for 20-week and given 20 mg 13-cis retinoic acid, twice daily. Subjects#11-#20 will also be administered calcitriol to see if adding calcitriol with Accutane will improve sperm motility. All subjects will be closely followed for side effects related to treatment. The impact of treatment on indices of spermatogenesis will be determined by monthly seminal fluid analyses.

Eligibility


Ages Eligible for Study:	21 Years to 60 Years (Adult)
Sexes Eligible for Study:	Male
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Subjects will be infertile men (no pregnancy with partner with normal cycles and normal hysterosalpingogram despite >1 year of unprotected intercourse).
Abnormal sperm analyses with a total, motile sperm count of less than 10 million sperm as assessed by semen analysis on two occasions separated by one week.
In the opinion of the investigator, is able to comply with the protocol, understand and sign an informed consent and HIPAA (Health Insurance Portability and Accountability Act ) form.

Exclusion Criteria:

Men participating in another clinical trial
Men not living in the catchment area of the clinic
Clinically significant abnormal findings at screening
Known genetic infertility (e.g. Klinefelter syndrome or Y-chromosome microdeletions),
Hypogonadotropic hypogonadism (that might respond to gonadotropin injections),
The use of anabolic steroids, illicit drugs, or the consumption of more than 4 alcoholic beverages daily
Severe mental health problems requiring medications
Current therapy with retinoic acid (e.g. Accutane) or vitamin A.
Score of greater than 15 on the Patient health questionnaire (PHQ9).
Abnormal serum chemistry values according to local laboratory normal values which indicate liver or kidney dysfunction. Other abnormal lab values may also be exclusionary, at the discretion of the investigator
Men with a personal history of serious psychiatric disorders
Men currently receiving tetracycline containing medications
Men currently receiving phenytoin
Men with a history of inflammatory bowel disease
Men with a history of bone disease
Men who have used isotretinoin within eight weeks of the start of dosing
Men with elevated serum triglycerides

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: NCT02061384

Locations


United States, Washington
University of Washington Medical Center
Seattle, Washington, United States, 98195

Sponsors and Collaborators

University of Washington

Investigators


Principal Investigator:	John K Amory, MD, MPH	University of Washington

More Information

Publications:

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de Kretser DM. Male infertility. Lancet. 1997 Mar 15;349(9054):787-90. Review.

Schlegel PN. Nonobstructive azoospermia: a revolutionary surgical approach and results. Semin Reprod Med. 2009 Mar;27(2):165-70. doi: 10.1055/s-0029-1202305. Epub 2009 Feb 26. Review.

Napoli JL. Retinoic acid: its biosynthesis and metabolism. Prog Nucleic Acid Res Mol Biol. 1999;63:139-88. Review.

Center for Disease Control. Infertility Facts,m accessed at http://www.ede.gov/nchs/fastats/fertile.htm (June 3, 2013)

Doyle TJ, Braun KW, McLean DJ, Wright RW, Griswold MD, Kim KH. Potential functions of retinoic acid receptor A in Sertoli cells and germ cells during spermatogenesis. Ann N Y Acad Sci. 2007 Dec;1120:114-30. Epub 2007 Sep 28.

Koubova J, Menke DB, Zhou Q, Capel B, Griswold MD, Page DC. Retinoic acid regulates sex-specific timing of meiotic initiation in mice. Proc Natl Acad Sci U S A. 2006 Feb 21;103(8):2474-9. Epub 2006 Feb 6.

Anderson EL, Baltus AE, Roepers-Gajadien HL, Hassold TJ, de Rooij DG, van Pelt AM, Page DC. Stra8 and its inducer, retinoic acid, regulate meiotic initiation in both spermatogenesis and oogenesis in mice. Proc Natl Acad Sci U S A. 2008 Sep 30;105(39):14976-80. doi: 10.1073/pnas.0807297105. Epub 2008 Sep 17.

Chung SS, Wang X, Wolgemuth DJ. Expression of retinoic acid receptor alpha in the germline is essential for proper cellular association and spermiogenesis during spermatogenesis. Development. 2009 Jun;136(12):2091-100. doi: 10.1242/dev.020040.

Dufour JM, Kim KH. Cellular and subcellular localization of six retinoid receptors in rat testis during postnatal development: identification of potential heterodimeric receptors. Biol Reprod. 1999 Nov;61(5):1300-8.

Lohnes D, Kastner P, Dierich A, Mark M, LeMeur M, Chambon P. Function of retinoic acid receptor gamma in the mouse. Cell. 1993 May 21;73(4):643-58.

Lufkin T, Lohnes D, Mark M, Dierich A, Gorry P, Gaub MP, LeMeur M, Chambon P. High postnatal lethality and testis degeneration in retinoic acid receptor alpha mutant mice. Proc Natl Acad Sci U S A. 1993 Aug 1;90(15):7225-9.

Kastner P, Mark M, Leid M, Gansmuller A, Chin W, Grondona JM, Décimo D, Krezel W, Dierich A, Chambon P. Abnormal spermatogenesis in RXR beta mutant mice. Genes Dev. 1996 Jan 1;10(1):80-92.

Ghyselinck NB, Vernet N, Dennefeld C, Giese N, Nau H, Chambon P, Viville S, Mark M. Retinoids and spermatogenesis: lessons from mutant mice lacking the plasma retinol binding protein. Dev Dyn. 2006 Jun;235(6):1608-22.

Hoting VE, Schütte B, Schirren C. [Isotretinoin treatment of acne conglobata. Andrologic follow-up]. Fortschr Med. 1992 Aug 20;110(23):427-30. German.

Vogt HJ, Ewers R. [13-cis-Retinoic acid and spermatogenesis. Spermatological and impulse cytophotometric studies]. Hautarzt. 1985 May;36(5):281-6. German.

Török L, Kádár L, Kása M. Spermatological investigations in patients treated with etretinate and isotretinoin. Andrologia. 1987 Nov-Dec;19(6):629-33.

Nya-Ngatchou JJ, Arnold SL, Walsh TJ, Muller CH, Page ST, Isoherranen N, Amory JK. Intratesticular 13-cis retinoic acid is lower in men with abnormal semen analyses: a pilot study. Andrology. 2013 Mar;1(2):325-31. doi: 10.1111/j.2047-2927.2012.00033.x. Epub 2012 Nov 29.

Lieberman LS. WHO laboratory manual for the examination of human semen and sperm-cervicle mucus interaction, 3rd edition. By WHO Special Programme of Research, Development and Research Training in Human Reproduction. viii + 107 pp. Cambridge: Cambridge University Press, 1992. $29.95 (paper). Am J Hum Biol. 1993;5(5):594-595. doi: 10.1002/ajhb.1310050517.

Christiansen C, Christensen MS, Rødbro P, Hagen C, Transbøl I. Effect of 1,25-dihydroxy-vitamin D3 in itself or combined with hormone treatment in preventing postmenopausal osteoporosis. Eur J Clin Invest. 1981 Aug;11(4):305-9.

Riggs BL, Nelson KI. Effect of long term treatment with calcitriol on calcium absorption and mineral metabolism in postmenopausal osteoporosis. J Clin Endocrinol Metab. 1985 Sep;61(3):457-61.

Falch JA, Odegaard OR, Finnanger AM, Matheson I. Postmenopausal osteoporosis: no effect of three years treatment with 1,25-dihydroxycholecalciferol. Acta Med Scand. 1987;221(2):199-204.

Caniggia A, Nuti R, Lore F, Martini G, Turchetti V, Righi G. Long-term treatment with calcitriol in postmenopausal osteoporosis. Metabolism. 1990 Apr;39(4 Suppl 1):43-9.

Ott SM, Chesnut CH 3rd. Calcitriol treatment is not effective in postmenopausal osteoporosis. Ann Intern Med. 1989 Feb 15;110(4):267-74.

Gallagher JC, Fowler SE, Detter JR, Sherman SS. Combination treatment with estrogen and calcitriol in the prevention of age-related bone loss. J Clin Endocrinol Metab. 2001 Aug;86(8):3618-28.


Responsible Party:	John Amory, Professor, General Internal Medicine, University of Washington
ClinicalTrials.gov Identifier:	NCT02061384 History of Changes
Other Study ID Numbers:	STUDY00000564
Study First Received:	February 10, 2014
Last Updated:	May 25, 2017

Keywords provided by John Amory, University of Washington:


Infertility

Additional relevant MeSH terms:


Klinefelter Syndrome Infertility Infertility, Male Chromosome Deletion Sex Chromosome Aberrations Sex Chromosome Disorders of Sex Development Genital Diseases, Male Genital Diseases, Female Disorders of Sex Development Urogenital Abnormalities Sex Chromosome Disorders Chromosome Disorders Congenital Abnormalities Genetic Diseases, Inborn Gonadal Disorders	Endocrine System Diseases Hypogonadism Monosomy Aneuploidy Chromosome Aberrations Pathologic Processes Calcitriol Dihydroxycholecalciferols Tretinoin Isotretinoin Calcium Channel Agonists Membrane Transport Modulators Molecular Mechanisms of Pharmacological Action Vasoconstrictor Agents Vitamins

ClinicalTrials.gov processed this record on July 21, 2017

RA-2 13-cis Retinoic Acid (Isotretinoin) (RA-2)