Clinical trial NCT01847651: Brain Muscle Axis During Treatment of Hepatic Encephalopathy With L-ornithine L-aspartate
Official title: LOLA in Hepatic Encephalopathy Brain Muscle Axis During Treatment of Hepatic Encephalopathy With L-ornithine L-aspartate A Phase iv Randomised Double Blind Placebo- Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Hepatic Encephalopathy
Minimal Hepatic Encephalopathy
Cirrhosis
Keywords: hepatic encephalopathy
minimal hepatic encephalopathy
cirrhosis
lateral vastus
muscle biopsy
L ornithine L aspartate
functional magnetic resonance imaging
magnetic resonance spectroscopy
cognitive testing
Paper and pencil Hepatic Encephalopathy score (PHES)
Cogstate
urine metabonomics
plasma metabonomics
muscle metabonomics
Lead sponsor: Imperial College London
Sponsor class: OTHER
First posted: 2013-05-07
Enrollment: 42
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Patients with cirrhosis of the liver may suffer from a condition called hepatic encephalopathy which in its mildest form as mental slowing and impaired reaction times in driving and machinery operation. Left untreated it may lead to deep coma. The cause is not fully understood but is though to be related to the inability of a damaged liver to filter out toxins such as ammonia in the blood, which then accumulate within the brain and result in altered function and swelling within certain brain cells,astrocytes. These patients also suffer from muscle loss, which is associated with a poor outcome. L-ornithine L-aspartate(LOLA) is a licensed drug in Germany and has been shown to promote ammonia elimination from the body in the form of urea. Some experimental studies have suggested that LOLA also potentially attenuates muscle loss by incorporating ammonia into muscle in the form of glutamine. The aim of this study is to determine cognitive and nutritional effects of 12 weeks of LOLA administration and its effect on brain muscle structure and function in patients with cirrhosis.

Detailed description: This is a Phase IV randomised double blind, placebo controlled study. Thirty four patients with cirrhosis will be studied with psychometric tests, clinical brain magnetic resonance imaging(MRI),including functional MRI) and magnetic resonance spectroscopy (MRS) and muscle MRI of leg muscle before (time 0)during (4weeks)and after LOLA or placebo treatment at 12 weeks. Samples will also be taken for ex vivo MRS of blood and urine to identify potential biomarkers. Histological analysis and MRS would also be performed on the muscle tissue at the same time points.

Hypotheses Primary objective

1) Improvement in mental state by paper and pencil based Psychometric Hepatic Encephalopathy Score (PHES) and Cogstate Research test (computer based cognitive research assessment tool)

Secondary objectives

1. Brain volume reduction due to reduction in brain swelling measured by MRI and improvement in the chemical structure of the brain due to (cerebral osmolytes)measured by in vivo MR Spectroscopy (MRS)scanning of the brain.
2. Improvement in brain function
3. Improvement in muscle function (muscle metabolome normalisation) and increased muscle size (fat free mass), measured in vivo by MRI scanning and by in vitro mass spectroscopy and NMR spectroscopy and histological analysis of muscle samples.
4. Improvement in the chemical profile of key chemicals in the blood and urine, measured with in vitro NMR spectroscopy

Eligibility criteria: Inclusion Criteria:

* Ambulant patients of any Child-Pugh stage cirrhosi and PHEs defined MHe or grade 1 encephalopathy

Exclusion Criteria:

* Previous episodes of overt HE without a clear precipitant
* Recurrent excessive alcohol consumption (abstinence for those with alcoholic liver disease otherwise less than 28 units per week)
* Severe coagulopathy (INR\>2, platelets \<60 000/uL, Fibrinogen \<1mg/dl)
* known myopathy or myositis, taruma to lower extremities within 3 months)
* Renal dysfunction with a serum creatinine\>3mg/dl (265micromol/L)
* Ferromagnetic implants
* Recent intestinal haemorrhage within 1 month
* Claustrophobia
* Weight \>120kg
* Major psychoactive medication such as antipsychotic agents
* Known cerebrovascular disease or pre-existing neurological conditions
* Age less than 18 or greater than 65.

Primary outcomes:
measure: Improvement in mental state on paper and pencil Hepatic Encephalopathy score (PHES) testing and Cogstate testing (computer based cognitive assessment research tool)
timeFrame: At 0, 4 and 12 weeks
Secondary outcomes:
measure: Brain Volume
timeFrame: At 0 , 4 and 12 weeks
measure: Brain chemical structure
timeFrame: 0, 4, 12 weeks
measure: Improvement in brain function measured by functional MRI
timeFrame: 0, 4, 12 weeks
measure: Improvement in Muscle Function and increase in muscle size
timeFrame: 0, 4 and 12 weeks
measure: Improvement of plasma and urine metabolome
timeFrame: 0, 4 and 12 weeks
Other outcomes:
Locations:
city: London
country: United Kingdom
facility: Liver unit St Mary's Hospital, 10th floor QEQM Wing, South Wharf Road
Study officials:
affiliation: Imperial College London
name: Simon D Taylor-Robinson, MD FRCP
role: PRINCIPAL_INVESTIGATOR
References: