Chronic Kidney Diseases Clinical Trial
— RENOCLASTEOfficial title:
Effect of Active Vitamin D and Etelcalcetide on Human Osteoclasts in Patients With Chronic Kidney Disease
Verified date | March 2020 |
Source | Hospices Civils de Lyon |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
The optimal management of mineral and bone disorders associated to chronic kidney disease
(CKD-MBD) is a daily challenge for nephrologists. Its consequences may be immediate
(biological abnormalities such as hypocalcemia, hyperphosphatemia, hyperparathyroidism, etc.)
or delayed (fractures, renal osteodystrophy, vascular calcifications, increased
morbi-mortality and growth retardation in the youngest patients). CKD-MBD is defined by the
association of one or more of the following abnormalities: 1/ disturbances in calcium,
phosphate, PTH or vitamin D metabolism, 2/ bone and growth abnormalities, and 3/
calcifications of vessels or soft tissues .
Three main bone characteristics can be modified by CKD, namely turnover, mineralization and
volume. They should therefore be carefully assessed to distinguish between the different
sub-types of renal osteodystrophy, as defined in the 2006 K-DIGO guidelines on the TMV
classification . The primary bone lesion in pediatric CKD, at least in pediatric patients
reaching end-stage renal disease without any previous management, is the
high-turnover/hyperparathyroidism, because of high circulating PTH levels with low 1-25
vitamin D levels. Conversely, low turnover (or adynamic bone) may be observed in dialysis
children receiving too much calcium and/or vitamin D analogs. All these lesions are
deleterious on the long-term, increasing both the risk of growth retardation, fractures and
vascular calcifications .
In order to better understand the complex pathophysiology of renal osteodystrophy, biomarkers
of bone and phosphate/calcium metabolism may be used, but their interpretation may be
challenging in the context of CKD. The gold standard remains bone biopsy at the iliac crest
with histomorphometry, but it is rarely performed in Europe .
The research team of this study has developed and validated a unique non-invasive technique
to differentiate circulating human monocytes into mature and functional osteoclasts, using
only 15 mL of total blood (instead of conventional techniques they used to use, with 200 to
250 mL of total blood). They propose to use this innovative tool in the specific setting of
CKD.
The current management of CKD-MBD consists mainly of correcting native vitamin D deficiency,
decreasing phosphate levels (using nutritional management and phosphate-binders), and
decreasing PTH levels (using active vitamin D, calcimimetics such as cinacalcet and
etelcalcetide, and/or surgical parathyroidectomy) . Active vitamin D analogs and
calcimimetics are cornerstone of this management.
The first working hypothesis is the following: when CKD progresses and glomerular filtration
rate (GFR) decreases, 1-25-D is able to inhibit osteoclastic differentiation, however to a
lesser extent to what is observed in healthy controls with normal renal function.
The second working hypothesis is therefore the following: etecalcetide could be an inhibitor
of osteoclastic resorption and a stimulator of osteoblastogenesis. When CKD worsens and GFR
decreases, etelcalcetide inhibits osteoclastic differentiation, however to a lesser extent to
what is observed in subjects with normal renal function.
Aims In Vitro
1. Effects of 1-25-D and etecalcetide on human osteoclastogenesis and osteoclastic
resorption (in cells obtained from CKD patients at different stages of CKD)
2. Effects of 1-25-D and etecalcetide on murine osteoblastogenesis and mineralization
Status | Completed |
Enrollment | 21 |
Est. completion date | October 22, 2018 |
Est. primary completion date | October 22, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 2 Years to 18 Years |
Eligibility |
Inclusion Criteria: - Child of age> 2 years old and <18 years old. - Child over 10 kg having a blood sample as part of the treatment (due to regulatory constraints for blood volume taken by 30-day period of 40 mL in children over 10 kg) - Child with chronic kidney disease followed in the pediatric nephrology department of the "Hôpital Mère Enfant" in Bron. - Child and parent / holder of parental authority who has been informed of the study and does not object to participate Exclusion Criteria: - Bone damage associated with genetic renal disease known to induce specific bone involvement: oxalosis, cystinosis, Pierson syndrome, paracellin mutation, dominant polycystic disease - Treatment in progress that may have a specific impact on the bone: growth hormone, bisphosphonates, teriparatide. |
Country | Name | City | State |
---|---|---|---|
France | Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques - Hôpital Femme Mère Enfant - Bron. | Bron |
Lead Sponsor | Collaborator |
---|---|
Hospices Civils de Lyon |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Active vitamin D action on osteoclasts | Patients' cells will be used to ex vivo. Osteoclastic biology will be analyzed according to two components: differentiation and resorption activity. | 1 day | |
Primary | Etecalcetide action on osteoclasts | Patients' cells will be used to ex vivo. Osteoclastic biology will be analyzed according to two components: differentiation and resorption activity. | 1 day |
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