Reproductive Capacity and Iron Burden in Thalassemia (Fertility thal)
The improved long-term survival of thalassemia major (TM) patients has resulted in increased focus on the ability to preserve fertility. While the association of iron toxicity with vital organ dysfunction, heart and liver, has been extensively investigated, the correlation of reproductive capacity and extent of iron overload is not well understood. Despite remarkable progress in methodology for prediction of reproductive status and intervention for preserving fertility, implementation in thalassemia is lacking.
The investigators hypothesize that iron toxicity to the anterior pituitary occurring in the process of transfusional iron loading is directly associated with a decline in gonadal function. The investigators expect pituitary MRI measurements of iron deposition as well as markers of oxidative damage to correlate with the functional studies of pituitary-gonadal axis performed in this study. This cross sectional study will examine the relation of pituitary iron deposition and pituitary volume; serum iron and oxidative stress measures, liver iron concentration (LIC), cardiac iron and chelation adequacy with pituitary and gonadal reproductive hormone levels (and spermatogenesis in adult male patients), in order to better define the association of iron burden and chelation patterns with fertility potential, in thalassemia patients with iron overload. The study will assess whether the current chelation treatment regimens, in particular during the pubertal developmental age, are adequate for preserving fertility and could lead to improved chelation routines for preventing the high prevalence of compromised fertility. In addition, by utilizing state-of-the-art markers for fertility status, findings from this study may improve current methods for screening for hypogonadism and reproductive potential and allow earlier intervention.
The investigators propose to examine 26-30 patients, 12 years and older, with measures of fertility potential, and correlate them to their current iron burden parameters and to the cumulative iron effect as indicated by past iron overload patterns and chelation history.
|THALASSEMIA MAJOR||Other: Blood Draw/Semen Exam Other: Retrospective data/Chart Review/Relevant Clinical Results Other: Pituitary MRI|
|Study Design:||Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
|Official Title:||Reproductive Capacity and Association to Iron Burden and Chelation Patterns in Thalassemia Major Patients|
- Laboratory studies for pituitary and gonadal function and for iron level measures [ Time Frame: Up to 12 months ]
Each patient's pituitary iron and pituitary volume will be correlated with each hormone levels: LH, FSH, estrogen and AMH (Females), testosterone Inhibin B and (males).
We will then evaluate potential associations using Pearson correlations. Univariate analyses on all variables and it's relation with iron, will also be conducted.
- Retrospective analysis of annual LIC and of type and dose of iron chelation agent in the parallel time period [ Time Frame: Up to 12 months ]We will evaluate potential associations using Pearson correlations of each measure: Mean LIC with each of the fertility hormone levels and with pituitary volume and height. Mean ferritin with each of the fertility hormone levels and with pituitary volume and height. NTBI with each of the fertility hormone levels and with pituitary volume and height. Oxidative measures (Vit C, Vit E, GSH/GSSG) with each of the fertility hormone levels and with pituitary volume and height. Regression analysis will be utilized to assess correlation of pituitary iron, LIC and cardiac iron. We will compute descriptive statistics for all measures by group. We will assess differences between the 2 groups using Student's t-test for continuous data and chi-square or Fisher's exact for categorical. A detailed retrospective analysis of LIC and chelation patterns (type of chelator and average dose) on these 2 groups will also be performed and fertility measures will be compared.
- Pituitary MRI and Male: Semen analysis [ Time Frame: Up to 12 months ]Pituitary iron and pituitary volume will be correlated with sperm count and with DNA breakage in males (≥18 years old) who have these test results. Statistical methods as detailed under primary objective, will be utilized.
|Study Start Date:||June 2013|
|Estimated Study Completion Date:||June 2018|
|Estimated Primary Completion Date:||June 2018 (Final data collection date for primary outcome measure)|
Laboratory Studies for Pituitary-Gonadal Function
Females: We expect to enroll approximately 15 females ages 12 years and older.
Males: We expect to enroll approximately 15 males ages 12 years and older.
Other: Blood Draw/Semen Exam
1. Obtain levels of LH/FSH, Estradiol, and AMH in all enrolled women. Males: We expect to enroll approximately 15 males ages 12 years and older.
Other Name: Screening for biomarkers and correlations with iron load
Data on iron burden and chelation history
Retrospective data, as listed in this section, will be obtained from chart review and results of relevant clinical data.
Other: Retrospective data/Chart Review/Relevant Clinical Results
MRI has been shown to demonstrate well the changes related to iron toxicity in the pituitary gland.
Other: Pituitary MRI
MRI has been shown to demonstrate well the changes related to iron toxicity in the pituitary gland. An MRI protocol was optimized at Children's Hospital and Research Center Oakland (CHRCO) and Texas Children's Hospital. Utilizing 1.5 T clinical scanner to evaluate the iron accumulation in the anterior pituitary. The total data acquisition time is approximately 32 minutes. No sedation will be given.
MRI data will be sent to Dr. Wang, department of Radiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas. Quantification of R2, pituitary height and volume will be conducted.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02308904
|Contact: Sylvia T Singer, MD||510-428-3169||TSinger@mail.cho.org|
|United States, California|
|UCSF Benioff Children's Hospital Oakland||Recruiting|
|Oakland, California, United States, 94609|
|Contact: Sylvia T Singer, MD 510-428-3169 TSinger@mail.cho.org|