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Vitamin D to Improve Endothelial Function in SLE

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ClinicalTrials.gov Identifier: NCT01911169
Recruitment Status : Completed
First Posted : July 30, 2013
Results First Posted : October 27, 2017
Last Update Posted : October 27, 2017
Sponsor:
Information provided by (Responsible Party):

July 22, 2013
July 30, 2013
April 21, 2016
October 27, 2017
October 27, 2017
June 2011
January 2014   (Final data collection date for primary outcome measure)
Change at Week 16 in % Flow Mediated Dilation in Those Who Did and Did Not Replete Vitamin D [ Time Frame: from zero to sixteen weeks ]
Measures were be performed with a Phillips iU22 Ultrasound system and a L9-3 9 mHz probe in 2D mode by a single operator using EKG gating. Baseline measures of brachial artery diameter will be made after the 10 minutes of rest. The blood pressure cuff, placed on the ipsilateral forearm, was inflated to 50 mmHg above the patient's systolic blood pressure for five minutes and then released. Endothelium-dependent FMD was measured continuously during and for three minutes after cuff release. Subjects rested for 10 minutes. Then, endothelium-independent dilation was measured 3 minutes after administration of 0.4 mg of sublingual nitroglycerine. The outcome (%FMD) was the difference between the average endothelium dependent diameter after cuff deflation and the average baseline diameter. The absolute difference between the % FMD at baseline and 16 week follow up was reported.
change in flow mediated dilation [ Time Frame: from zero to sixteen weeks ]
Measures will be performed with a Phillips iU22 Ultrasound system and a L9-3 9 mHz probe in 2D mode by a single operator using EKG gating. Baseline measures of brachial artery diameter will be made after the 10 minutes of rest. The blood pressure cuff, placed on the ipsilateral forearm, will be inflated to 50 mmHg above the patient's systolic blood pressure for five minutes and then released. Endothelium-dependent FMD will be measured continuously during and for three minutes after cuff release. Subjects will rest for 10 minutes. Then, endothelium-independent dilation will be measured 3 minutes after administration of 0.4 mg of sublingual nitroglycerine.
Complete list of historical versions of study NCT01911169 on ClinicalTrials.gov Archive Site
Change in Interferon Signature [ Time Frame: from zero to sixteen weeks ]
This outcome was not measured as planned
Change in Interferon Signature [ Time Frame: from zero to sixteen weeks ]
endothelial cells will be incubated with patient serum and assayed for interferon gene expression
Not Provided
Not Provided
 
Vitamin D to Improve Endothelial Function in SLE
Vitamin D Repletion to Improve Endothelial Function in Lupus Patients

Determine the effect of vitamin D repletion on flow mediated dilation (FMD, a measure of endothelial function) in vitamin D deficient systemic lupus erythematosus (SLE) patients. The investigators will enroll vitamin D deficient SLE patients and randomize them to receive either 400 IU or 5,000 IU of cholecalciferol (D3) daily and measure change in FMD as a measure of EC function at baseline and after 16 weeks of repletion.

Determine mechanisms by which vitamin D repletion may improve endothelial function in vitamin D deficient SLE patients and in vitro.

Determine effect of oral D3 repletion on the Type I interferon signature in WISH and ECs cultured with pre and post plasma from D3 treated lupus patients.

Determine effect of D3 repletion on the number of circulating apoptotic and non-apoptotic EC and EPC ex vivo.

Determine effect of exogenous 1,25(OH)D on IFN gene signature in WISH and ECs stimulated by pretreatment SLE plasma in vitro.

Determine the effects of exogenous 1,25(OH)D on the phenotype of ECs cultured with pretreatment lupus plasma.

This study is designed to efficiently test our hypothesis and begin to define interferon-dependent pathways through which vitamin D repletion can restore clinical and in vitro endothelial function.

Specific Aim 1. Determine the effect of vitamin D repletion on changes in flow mediated dilation (FMD) in vitamin D deficient SLE patients. The investigators hypothesize that 25(OH)D repletion will improve endothelial function in 25(OH)D deficient lupus patients. For this pilot study, the investigators have opted to use a Randomized Phase II screening design (36). The screening design is meant to provide preliminary comparisons of an experimental treatment to an appropriate control, with the idea that the pilot study would provide valuable information to aid in the design of a definitive Phase III evaluation, should the experimental treatment prove promising in the Phase II trial. The trial is designed to determine the effect of vitamin D repletion with D3 on FMD in vitamin D deficient SLE subjects. Approximately 50 SLE subjects will be screened for total 25(OH) vitamin D (25(OH)D) levels and inclusion/exclusion criteria. However, screening will continue only until 32 participants have been enrolled that have total serum 25(OH)vitamin D levels ≤ 20 ng/ml and meet inclusion/exclusion criteria. A baseline FMD, interferon (IFN) signature assays, and levels of circulating non- and apoptotic endothelial cells (EC) and endothelial progenitor cell (EPC) will be performed at the baseline visit. Participants will be will be randomized into two equal groups of 16 to receive one of two daily oral D3 doses previously used in supplementation trials with no evidence of harm. Group 1 (controls) will receive 400 international units (IU) of D3 daily. Group 2 will receive 5,000 IU daily. Studies of supplementation in subjects deficient in vitamin D demonstrate that supplementation with 1,000, 5,000, and 10,000 IU daily result in increases in 25(OH)D of 4.8, 36.7, and 63.8 ng/mL without evidence of toxicity (37). In this study, steady state levels were achieved at 90 days. As shown in our preliminary studies, 4,000 IU daily is safe and effective at repletion in our lupus clinic population. Some subjects had not achieved steady state at 90 days, so the invesitgators have chosen to dose for 16 weeks. The primary endpoint will be a change in FMD after 16 weeks of vitamin D repletion. The secondary endpoint will be the reduction in IFN signature and level of circulating apoptotic ECs/EPCs in response to vitamin D repletion from baseline to 16 weeks.

Specific Aim 2. Determine mechanisms by which vitamin D repletion may improve endothelial function in vitamin D deficient SLE patients and in vitro.

2.1 Determine effect of oral vitamin D3 repletion on the Type I interferon signature in WISH and ECs cultured with pre and post plasma from D3 treated lupus patients. The investigators hypothesize that the plasma-induced IFN gene signature will reduce with 25(OH)D repletion.

2.2 Determine effect of D3 repletion on the number of circulating apoptotic and non-apoptotic EC and EPC ex vivo. The investigators hypothesize that D3 repletion will reduce the number of apoptotic EC and EPC and increase the number of non-apoptotic EPC in association with improved FMD.

2.3 Determine effect of exogenous 1,25(OH)D on IFN gene signature in WISH and ECs stimulated by pretreatment SLE plasma in vitro. This aim is designed to address the specific question of whether the effect of vitamin D is at least partially due to a direct rather than indirect effect on endothelial response to SLE plasma IFN.

2.4 Determine the effects of exogenous 1,25(OH)D on the phenotype of ECs cultured with pretreatment lupus plasma. This aim was designed to probe the functional significance of vitamin D repletion and reduction of the IFN response on the endothelial phenotype.

Interventional
Phase 2
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
  • Atherosclerosis
  • Systemic Lupus Erythematosus
Drug: Cholecalciferol
5,000 International units versus 400 international units as an active comparator
Other Names:
  • vitamin D3
  • Wegman's made by International Vitamin Corporation
  • Experimental: Vitamin D 5000
    5,000 IU vitamin D (cholecalciferol) given orally daily
    Intervention: Drug: Cholecalciferol
  • Active Comparator: Vitamin D 400
    cholecalciferol 400 IU daily by mouth
    Intervention: Drug: Cholecalciferol
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
9
January 2014
January 2014   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Diagnosis of SLE per 1997 American College of Rheumatology Criteria(at least 4 criteria present)
  • Documented Vitamin D deficiency
  • Able to give informed consent

Exclusion Criteria:

  • Using tobacco products
  • Pregnant/Planning pregnancy
  • Known Hypercalcemia (Serum Ca >10.4)
  • Known Hypercalcuria (Calcium/Creatinine >0.8)
  • Chronic active lupus nephritis or end stage renal disease or kidney stones
  • Known Hyperparathyroidism
  • Known chronic viral/mycobacterial infections
  • Uncontrolled medical disease - Pl judgment
  • Current drug or alcohol abuse
  • Anticipated poor compliance/known neuropsychiatric disorders
  • Hx of cardiovascular events (i.e. Ml, PVD, CVE)
  • Subjects taking medications known to affect FMD in lupus subjects such as but not limited to fish oil, statins, will remain on stable doses throughout the study.
Sexes Eligible for Study: All
18 Years to 80 Years   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01911169
00009197
Yes
Not Provided
Plan to Share IPD: Yes
Plan Description:

Published - 1. Kamen DL, Oates JC.A Pilot Study to Determine if Vitamin D Repletion Improves Endothelial Function in Lupus Patients. Am J Med Sci 2015;350:302-7.

data available upon request

Jim C. Oates, Medical University of South Carolina
Medical University of South Carolina
Not Provided
Principal Investigator: James Oates, MD Medical University of South Carolina
Medical University of South Carolina
September 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP