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Atherothrombosis Markers in Diabetics (MADI)

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: NCT02898467
Recruitment Status : Unknown
Verified September 2016 by Centre Hospitalier Universitaire de la Réunion.
Recruitment status was:  Not yet recruiting
First Posted : September 13, 2016
Last Update Posted : September 13, 2016
Academic Health Science Centres
Information provided by (Responsible Party):
Centre Hospitalier Universitaire de la Réunion

Brief Summary:
Intraplaque hemorrhage is the driving force of atherothrombotic plaque vulnerability to rupture and associated clinical complications. Polymorphonuclear neutrophils (PMNs) represent about 70% of leukocytes and may constitute a source of proteases and oxidants that favour plaque rupture. Our objective is to evaluate PMN activation in atherosclerotic plaque of non-diabetic versus type 2 diabetic patients. For this purpose, investigators will quantify the presence of cell-free DNA, that reflect the formation of neutrophil extracellular traps (NETs) in carotid endarterectomy samples.

Condition or disease Intervention/treatment
Diabetes Atherothrombosis Cardiovascular Disease Other: diabetics Other: non-diabetics

Detailed Description:
Atherothrombotic plaques of type 2 diabetic patients are characterized by increased neovascularization and associated intraplaque hemorrhage relative to non-diabetic patients that could account for a major incidence of clinical complications. In parallel, Type 2 diabetic patients are characterized by an increased intracellular oxidative stress in circulating PMNs leading to a primed phenotype. PMN priming could be triggered via their receptor for advanced glycation endproducts. In particular, glycated albumin may activate NADPH oxidase and thus promote the production of reactive oxygen species. Under strong activation, PMNs have been described to release NETs that are constituted by externalized nucleosomes associating DNA, histones and enzymes initially present in granules (such as myeloperoxidase, matrix metalloproteinase 9 or elastase). Our hypothesis is that in diabetic conditions, PMNs could be activated within atherothrombotic plaques and thus represent a trigger for plaque rupture. In the present study, we will evaluate PMN activation in carotid plaques of diabetic vs non-diabetic patients as well as in plasma samples of the same patients. For this purpose, all patients that will undergo carotid surgery by endarterectomy will be enrolled in our study and blood samples will be collected the day before the surgery for preparation of plasma and serum. The endarterectomy sample will be collected, dissected into culprit area of the plaque (CP) and the adjacent non-complicated plaque (NCP), incubated separately in culture medium for 24h at 37°C. The resulting conditioned medium will be aliquoted and stored at -80°C for the different assessments. A representative section of the CP will be saved at the moment of dissection for histological evaluation (presence of neovessels/intraplaque hemorrhage, calcifications, lipids, etc). Markers of neutrophil activation, of intraplaque hemorrhage, of glycation and of oxidative stress will be quantified in both conditioned medium and plasma.

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Study Type : Observational
Estimated Enrollment : 100 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Comparison of Atherothrombosis Markers From Aortic Atheroma in Diabetic and Non-diabetic Patients
Study Start Date : October 2016
Estimated Primary Completion Date : November 2018
Estimated Study Completion Date : June 2019

Group/Cohort Intervention/treatment
Type 2 diabetic patients exhibiting fasting glycemia value over 7 mmol/L or glycated hemoglobin value over 6.5% or type 2 diabetic patients under oral anti-diabetic treatment or type 2 diabetic patient under insulin treatment and in which diabetes has been diagnosed after the age of 45 y
Other: diabetics
additional blood and urine collection during usual medical care endarterectomy samples during usual medical care

patients without diagnosed diabetes exhibiting fasting glycemia value under 7 mmol/L
Other: non-diabetics
additional blood and urine collection during usual medical care endarterectomy samples during usual medical care

Primary Outcome Measures :
  1. Neutrophile activation assessed by free DNA levels in atherothrombotic plaques [ Time Frame: On day 1 (day of the surgery) ]
    Ability of cfDNA concentration in the conditioned medium to discriminate atherothrombotic plaques from diabetic vs non-diabetic patients

Secondary Outcome Measures :
  1. Neutrophile activation assessed by other makers than free DNA levels in atherothrombotic plaques [ Time Frame: On day 1 (day of the surgery) ]
    Evaluation of PMN activation by assays other than cfDNA (myeloperoxidase, elastase/antielastase complexes, MMP9/neutrophil-gelatinase associated lipocalin NGAL) in the conditioned media and in plasma

  2. Intraplaque hemorrhage and oxidative stress assessed in plasma and aortic tissue [ Time Frame: From day 0 (day before the surgery) to day 1 (day of the surgery) ]
    Evaluation of markers reflecting the presence of intraplaque hemorrhage and of oxidative stress in conditioned medium and in plasma (CD163, heme, carbonylated proteins, glycated albumin...)

  3. Correlation between plasma and atherothrombotic plaque markers assessement [ Time Frame: From day 0 (day before the surgery) to day 1 (day of the surgery) ]
    Correlations between markers released by the plaque and plasma markers (evaluation of the impact of atherothrombosis at a circulating level)

  4. Atherothrombosis characterization assessed by histological analysis [ Time Frame: On day 1 (day of the surgery) ]
    Histological characterization of plaques assessed by quantification of neovessels, calcification, lipids composition

Other Outcome Measures:
  1. Banking of biological samples [ Time Frame: From day 0 (day before the surgery) to day 1 (day of the surgery) ]
    Constitution of a biobank available for different assays of markers and for the discovery of new biomarkers of plaques in type 2 diabetic patients (open approaches, such as differential proteomics)

Biospecimen Retention:   Samples With DNA
plasma and serum samples carotid endarterectomy samples urinary samples

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Diabetics and non-diabetics with planned endartectomy

Inclusion Criteria:

  • Adult patients with planned endarterectomy
  • Affiliated to social security rights
  • Signed inform consent

Exclusion Criteria:

  • pregnancy
  • Autoimmune disease, chronic inflammatory disease, neoplasia
  • Type 1 diabetes

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): NCT02898467

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Contact: CHRISTINE JUHEL, PHD +262262359949

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Department of endocrinology, University Hospital Reunion Island - Felix Guyon Site
Saint Denis de La Réunion, France, 97405
Sponsors and Collaborators
Centre Hospitalier Universitaire de la Réunion
Academic Health Science Centres
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Responsible Party: Centre Hospitalier Universitaire de la Réunion Identifier: NCT02898467    
Other Study ID Numbers: 2013/CHU/06
First Posted: September 13, 2016    Key Record Dates
Last Update Posted: September 13, 2016
Last Verified: September 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Additional relevant MeSH terms:
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Cardiovascular Diseases