Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT03554668 |
| Other study ID # |
REC reference 17/EE/0270 |
| Secondary ID |
225557 |
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
January 15, 2018 |
| Est. completion date |
June 1, 2019 |
Study information
| Verified date |
April 2020 |
| Source |
Glasgow Royal Infirmary |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
We wish to determine to what extent magnesium, thiamine and transketolase activity are
affected by the Systemic Inflammatory Response (SIR). The knee arthroplasty model affords the
ideal study design, as surgery generates an inflammatory response.
Blood samples are drawn preoperatively and for up to four days post operatively, and again at
three months post-operation.
Description:
Thiamine and magnesium play a critical role in glucose metabolism and deficiency results in
the accumulation of anaerobic metabolites including lactate (1-3).
Thiamine requires magnesium to be converted to its active form, thiamine pyrophosphate (TPP)
(4). TPP also requires magnesium to achieve activation of TPP dependent enzymes during
metabolism of glucose (5, 6). The 'gold standard' for the measurement of thiamine status is
the measurement of Erythrocyte Transketolase Activity (ETKA)(4, 7-9), and this enzyme's
activity is dependent on the presence both thiamine pyrophosphate and magnesium (8, 10). ETKA
may therefore represent a 'functional marker' of magnesium status (7, 9, 11, 12).
Studies indicate that low plasma thiamine and magnesium are associated with a range of
disease processes, many of which are inflammatory (13-17). Other lipid-soluble vitamins and
minerals are known to decrease during the systemic inflammatory response (18, 19), however
this relationship is not proven for magnesium. The systemic inflammatory response may
therefore confound the interpretation of plasma thiamine and magnesium in the context of
sepsis, surgery or autoimmune disease. Elective knee arthroplasty, provokes an inflammatory
response and therefore provides an excellent controlled model for understanding the body's
response to a systemic insult (19).
Obesity is reported to be associated with magnesium deficiency (17, 20). Intracellular
magnesium plays a key role in regulating insulin action, insulin-mediated-glucose-uptake and
vascular tone (21-23). Several epidemiologic studies have shown that adults and children
consuming a western type diet are consuming 30 - 50% of the RDA for magnesium (24, 25). This
deficiency appears to be predominantly subclinical and therefore not routinely investigated.
Obesity is also associated with thiamine and magnesium depletion (17, 20, 26, 27). Magnesium
deficiency is also associated with a CRP rise (28-30). Thiamine status is proven to affect
lactate concentrations in the blood (2, 3). Lactate accumulation is known to precede the
onset of insulin resistance and be characteristically found in patients with obesity related
diabetes (31-37).
It is therefore possible that an underlying quiescent magnesium and / or thiamine deficiency
may mediate insulin resistance. Thiamine, and its more lipid soluble derivative,
benfothiamine, have already shown some promise in the treatment of diabetic complications.
The therapeutic potential is intriguing, however the relation between acute changes in the
systemic inflammatory response and thiamine and magnesium concentrations, require
clarification. Failure to prove the reliability of the thiamine and magnesium measurements in
the context of the systemic inflammatory response may lead to patients receiving treatment
for a measured deficiency of red cell thiamine and serum magnesium concentrations, which is
unreliable. If the therapeutic potential of combined treatment with thiamine and magnesium
for the optimization of ETKA function is to be realized (8), it is essential that the
erythrocyte and plasma values used to determine thiamine status are definitively established
in the context of the systemic inflammatory response. The knee arthroplasty model affords the
ideal study design for this as there is a strong association between obesity and knee
osteoarthritis (38, 39).
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adjunctive therapy in cardiac surgery: a randomized, double-blind, placebo-controlled,
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of human transketolase. Biochemistry (Mosc). 2010;75(7):873-80.
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Oxidative Stress, Endoplasmic Reticulum Stress, and Autophagy. Mol Neurobiol. 2016.
14. Georgiopoulos G, Chrysohoou C, Vogiatzi G, Magkas N, Bournelis I, Bampali S, et al.
Vitamins in Heart Failure: Friend or Enemy? Curr Pharm Des. 2017.
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admission to the intensive care unit: risk factors and prognostic significance. Am J
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2010;68(6):333-40.
18. Ghashut RA, McMillan DC, Kinsella J, Talwar D. Erythrocyte concentrations of B1, B2, B6
but not plasma C and E are reliable indicators of nutrition status in the presence of
systemic inflammation. Clin Nutr ESPEN. 2017;17:54-62.
19. Gray A, McMillan DC, Wilson C, Williamson C, O'Reilly DS, Talwar D. The relationship
between the acute changes in the systemic inflammatory response, lipid soluble
antioxidant vitamins and lipid peroxidation following elective knee arthroplasty. Clin
Nutr. 2005;24(5):746-50.
20. Kerns JC, Arundel C, Chawla LS. Thiamin deficiency in people with obesity. Adv Nutr.
2015;6(2):147-53.
21. Barbagallo M, Dominguez LJ. Magnesium and type 2 diabetes. World J Diabetes.
2015;6(10):1152-7.
22. Mastrototaro L, Tietjen U, Sponder G, Vormann J, Aschenbach JR, Kolisek M. Insulin
Modulates the Na+/Mg2+ Exchanger SLC41A1 and Influences Mg2+ Efflux from Intracellular
Stores in Transgenic HEK293 Cells. J Nutr. 2015;145(11):2440-7.
23. Voma C, Etwebi Z, Soltani DA, Croniger C, Romani A. Low Hepatic Mg(2+) Content promotes
Liver dysmetabolism: Implications for the Metabolic Syndrome. J Metab Syndr. 2014;3(4).
24. NHANES. What We Eat in America , NHANES 2013-2014, individuals 2 years and over
(excluding breast-fed children) AveragThiamine and Magnesium
https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1314/Table_1_NIN_GEN_13.pdf:
www.ars.usda.gov/nea/bhnrc/fsrg. ; 2013 - 2014 [Average daily consumption of Thiamine
and Magnesium 2013-4].
25. Altura BM, Shah NC, Shah GJ, Zhang A, Li W, Zheng T, et al. Short-term Mg deficiency
upregulates protein kinase C isoforms in cardiovascular tissues and cells; relation to
NF-kB, cytokines, ceramide salvage sphingolipid pathway and PKC-zeta: hypothesis and
review. Int J Clin Exp Med. 2014;7(1):1-21.
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micronutrient status in morbidly obese patients before undergoing bariatric surgery:
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27. Farhanghi MA, Mahboob S, Ostadrahimi A. Obesity induced magnesium deficiency can be
treated by vitamin D supplementation. J Pak Med Assoc. 2009;59(4):258-61.
28. Welch AA, Kelaiditi E, Jennings A, Steves CJ, Spector TD, MacGregor A. Dietary Magnesium
Is Positively Associated With Skeletal Muscle Power and Indices of Muscle Mass and May
Attenuate the Association Between Circulating C-Reactive Protein and Muscle Mass in
Women. J Bone Miner Res. 2016;31(2):317-25.
29. Zuza EP, Barroso EM, Fabricio M, Carrareto AL, Toledo BE, J RP. Lipid profile and
high-sensitivity C-reactive protein levels in obese and non-obese subjects undergoing
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31. Crawford SO, Hoogeveen RC, Brancati FL, Astor BC, Ballantyne CM, Schmidt MI, et al.
Association of blood lactate with type 2 diabetes: the Atherosclerosis Risk in
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34. Chen YD, Varasteh BB, Reaven GM. Plasma lactate concentration in obesity and type 2
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38. Guenther D, Schmidl S, Klatte TO, Widhalm HK, Omar M, Krettek C, et al. Overweight and
obesity in hip and knee arthroplasty: Evaluation of 6078 cases. World J Orthop.
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