Cerebrotendinous Xanthomatosis (CTX) Clinical Trial
Official title:
Evaluation of Carotid IMT and Atherogenic Risk Factors in Patients With Cerebrotendinous Xanthomatosis
The aim of the proposed study is to evaluate the risk for cardiovascular disease and
'atherogenic' features of the serum in CTX and to determine preclinical atherosclerosis. The
study will include an extensive assessment of lipoprotein profile and carotid artery
intima-media thickness (cIMT) measurement.
Lipid and lipoprotein profiles will include novel tests such as direct measurements of
apolipoprotein A1,B,C2,C3 plasma levels, lipoprotein (a) levels, highly sensitive C-reactive
protein levels and PLAC test that measures the levels of lipoprotein-associated
phospholipase A2-a vascular-specific inflammatory enzyme implicated in the formation of
atherosclerosis
Protocol 09-2009 EVALUATION OF CAROTID IMT AND ATHEROGENIC RISK FACTORS IN PATIENTS WITH
CEREBROTENDINOUS XANTHOMATOSIS
ABSTRACT Cerebrotendinous xanthomatosis (CTX) is a rare disease characterized by
xanthomatous lesions in many tissues, mainly in the brain. Mutation in the gene of sterol
27-hydroxylase-an enzyme in bile acid synthesis causes CTX. The impaired synthesis of
chenodeoxycholic acid from cholesterol results in elevated plasma and bile cholestanol.
The natural course of CTX is progressive neurologic deterioration from childhood through
adulthood leading to diffuse damage of the central and peripheral nervous systems and
eventually to death.
Cardiovascular involvement in CTX is probably high: different clinical manifestations of
cardiovascular disease (CVD) were reported in 10.4% of patients with CTX. The precise
mechanism of the atherosclerosis in CTX is unknown and may be related to cholestanol
accumulation in the vascular subendothelial space.
Abnormalities in the lipoprotein profile were not described in the literature, and
cholesterol levels are within normal limits in CTX. Extensive evaluation for CVD risk
factors in the CTX patient group have not been conducted apart from a small number of
publications.
The aim of the proposed study is to evaluate the risk for cardiovascular disease and
'atherogenic' features of the serum in CTX and to determine preclinical atherosclerosis. The
study will include an extensive assessment of lipoprotein profile and carotid artery
intima-media thickness (cIMT) measurement.
Lipid and lipoprotein profiles will include novel tests such as direct measurements of
apolipoprotein A1,B,C2,C3 plasma levels, lipoprotein (a) levels, highly sensitive C-reactive
protein levels and PLAC test that measures the levels of lipoprotein-associated
phospholipase A2-a vascular-specific inflammatory enzyme implicated in the formation of
atherosclerosis.
This would be the first attempt to conduct such an extensive evaluation in the CTX patients
group.
Research Plan:
Study Design and Methods
Subjects The study population will constitute of all 17 CTX diagnosed patients that will be
recruited from the CTX outpatient clinic at the Parkinson's disease and movement disorders
Clinic in the Sagol Neuroscience Center, at the Chaim Sheba Medical Center. Patients will be
contacted by phone and by mail and be invited to participate.
Control group will consist of age and gender matched healthy individuals. All patients or
their legal guardians will sign an informed consent.
Detailed Plan of the Study
All study participants will undergo an evaluation that will include one clinic visit :
Visit 1
- A detailed medical history, including demographic data, past medical history, smoking
history, use of medications, and family history of dyslipidemia and atherosclerotic
cardiovascular disease.
- Physical examination including height and weight measurements, blood pressure, BMI,
waist and hip circumference.
- Blood samples
1. Fasting Lipid profile:
Total cholesterol, HDL-cholesterol, direct LDL-cholesterol and Triglycerides (TG)
2. Apolipoprotein profile:
1. apolipoprotein A1
2. apolipoprotein B
3. apolipoprotein C2
4. apolipoprotein C3
c. lipoprotein (a) [Lp(a)] d. C-Reactive Protein -hsCRP e. Lipoprotein-associated
Phospholipase A2 (Lp-PLA2) f. Apo E genotyping g. Plasma cholestanol level h. Fasting
plasma glucose and Insulin
- 12 lead electrocardiogram (ECG)
- cIMT assessment.
Methods:
- Laboratory studies
- Blood samples will be taken after an overnight fast
- Total cholesterol, HDL-cholesterol and TG in plasma will be determined by colorimetric
enzymatic procedures (Olympus, Ireland).
- Apolipoprotein A1, B, C2, C3 and Lp(a) serum concentrations will be determined by the
immuno-turbidimetric procedure . (Olympus, Ireland).
- Direct LDL- will be determined by enzymatic color test. (Olympus, Ireland).
- HsCRP- will be determined by turbidimetric immunoassay(Olympus, Ireland)
- Lp-PLA2 (PLAC® Test) - The PLAC Test measures Lp-PLA2 (lipoprotein-associated
phospholipase A2), a vascular-specific inflammatory enzyme implicated in the formation
of rupture-prone plaque. Turbidimetric Immunoassay for the Quantitative Determination
of Lp-PLA2 in Human Plasma (diaDexus, Inc. CA .USA) The Olympus AU 400 autoanalyzer
will be used for all the above-mentioned measurements.
- Apo E genotyping- Apo E genotypes of genomic DNA from blood will be determined by a
single nucleotide primer extension Elisa assay. (Pronto Diagnostics, Tel Aviv, Israel )
- Plasma cholestanol level- will be measured by high-performance liquid chromatography
with ultraviolet detection (Halperin et al , ref 10 )
- Glucose -will be measured by the glucose oxidase method (Olympus AU2700, Hamburg,
Germany).
- Insulin- will be measured by a chemiluminiscent immunometric method (Immulite 2000,
Diagnostic Products Corporation, Los Angeles, CA).
- ECG-12 lead electrocardiogram will be done. (Mac 1100,GE medical systems, Germany)
Carotid artery Intima-media thickness : Patients will undergo a color-coded duplex
examination of neck vessels using a 10MHz linear array ultrasound (Hitachi medical
corporation, Tokyo, Japan). IMT will be evaluated on the common carotid arteries (CCAs) over
≈1.5 cm proximal to the flow divider, according to standardized guidelines. In brief, IMT
will be measured at the thickest plaque-free point on the near and far walls with a
specially designed computer program. CCA wall thickness will be defined as the mean of the
maximum wall thickness of the near and far walls bilaterally. Ultrasound images of the
distal 1 cm of the far wall of each common carotid artery will be obtained and compared with
values from a normative data set (age and sex matched). Mean CIMT values from the far walls
of the right and left common carotid arteries will be reported
;
Observational Model: Case-Only, Time Perspective: Prospective
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Recruiting |
NCT02638220 -
Cerebrotendinous Xanthomatosis (CTX) Prevalence Study
|