apolipoprotein ciii reduction via colchicine

Conditions: Hypertriglyceridemia; Gout; Pericarditis

Summary: the aim of this trial will be to determine an effect-size for the administration of chronic low-dose colchicine in the reduction of serum levels of triglycerides (tg), very-low density lipoproteins (vldl), and apolipoprotein ciii (apociii) in human subjects over a period of 4-6 weeks.

the aim of this proposal will be to show, in a translational fashion, a relationship between colchicine and reduction of factors affecting triglyceride metabolism, especially apociii and vldl levels. we envision colchicine as playing a role in identifying and elucidating a new mechanism for lowering tg levels, which may have a great impact on targeting patients who have not met non-hdl goals according to adult treatment panel iii (atpiii guidelines) or at risk for hypertriglyceridemia-induced pancreatitis \[11\]. we will accomplish this by conducting a prospective cohort clinical trial of low-dose colchicine in hypertriglyceridemic patients to assess percent (%) reduction of apociii, vldl, and tg. secondary endpoints will be to observe the effects of colchicine on apoa, apob, hdl, low-density lipoprotein (ldl), and total cholesterol (tc).

Eligibility criteria:
inclusion criteria: * acute new-onset pericarditis or recurrent pericarditis (≥2 following criteria) * sharp and pleuritic chest pain improved or relieved by sitting up and leaning forward * a pericardial friction rub * electrocardiogram (ekg) findings of diffuse st-segment elevations or pr depression * new or worsening pericardial effusion visualized on echocardiogram. or •acute gouty arthritis (according to the acr; ≥1 of following criteria: * joint fluid containing urate crystals * tophus proved to contain urate crystals by chemical means * polarized light microscopy * presence of six of the following in the absence of crystal identification: * \>1 attack of acute arthritis * maximum inflammation developed in 1 day * monoarthritis attack * redness observed over joints * 1st metatarsal joint painful or swollen * unilateral 1st metatarsal joint attack * unilateral tarsal joint attack * tophus (suspected) * hyperuricemia * asymmetric swelling within a joint visible on physical examination or radiography * subcortical cysts without erosions visible on radiography * monosodium urate monohydrate microcrystals in joint fluid during attack * joint fluid culture negative for organisms during attack. if n \< 10 after 3 weeks of trial initiation, then employ enrollment strategy #2 enrollment strategy #2: * history of hypertriglyceridemia (tg ≥ 150 mg/dl) and * age ≥ 18 years old * capable of providing informed consent * capable of taking colchicine 0.6-1.2 mg/day orally for 6 weeks * capable of providing a blood sample exclusion criteria: * colchicine use \< 8 weeks from baseline vap panel * pregnant or female of child bearing age * on corticosteroid therapy or corticosteroid use \< 4 weeks from baseline vap panel * history of statin myopathy or hepatotoxicity * history of colchicine intolerance or hypersensitivity * severe end-stage renal disease (egfr ≤ 20 ml/min/1.73 m2) or requiring dialysis * hepatic impairment (child-pugh class b or c) * myopericarditis (if tni is elevated on presentation of acute pericarditis) * inflammatory bowel disease * tuberculous, neoplastic, or purulent pericarditis

Keywords: colchicine hypertriglyceridemia apolipoprotein ciii