Longitudinal Study of Mitochondrial Hepatopathies

End Stage Liver Disease Clinical Trial

— MITOHEP  

Official title:

Longitudinal Study of Mitochondrial Hepatopathies

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT01148550
• Other study ID #: MITOHEP Study-ChiLDReN Network
• Secondary ID: U01DK103149U01DK
• Status: Recruiting
• Start date: August 18, 2010
• Est. completion date: May 2024

Study information

• Verified date: October 2023
• Source: Arbor Research Collaborative for Health
• Contact: Terese Howell, BS, CCRC
• Phone: 734-476-5340
• Email: terri.howell[@]arborresearch.org
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The specific aims of this study are (1) to determine the clinical phenotypes and natural history of hepatic RC and FAO disorders, (2) to determine the correlation between genotype and phenotype, (3) to determine if circulating biomarkers reflect diagnosis and predict liver disease progression and survival with the native liver, (4) to determine the clinical outcome of these disorders following liver transplantation, and (5) to develop a repository of serum, plasma, urine, tissue and DNA specimens that will be used in ancillary studies. To accomplish these aims, the ChiLDREN investigators at clinical sites (currently 15 sites) will prospectively collect defined data and specimens in a uniform fashion at fixed intervals in a relatively large number of subjects. Clinical information and DNA samples to be collected from subjects and their parents will enhance the potential for meaningful research in these disorders. A biobank of subject specimens and DNA samples will be established for use in ancillary studies to be performed in addition to this study.

Description:

This study will be conducted as part of the NIH-supported Childhood Liver Disease Research and Education Network (ChiLDREN). ChiLDREN is investigating rare cholestatic liver diseases of childhood: alpha-1 antitrypsin deficiency (A1AT), Alagille's Syndrome (AGS), progressive familial intrahepatic cholestasis (PFIC), bile acid synthesis defects and mitochondrial hepatopathies (all previously studied by the Cholestatic Liver Disease Consortium [CLiC]); biliary atresia (previously studied by the Biliary Atresia Research Consortium [BARC]); neonatal hepatitis; and cystic fibrosis liver disease, which is studied by a new branch of ChiLDREN known as the Cystic Fibrosis Liver Disease (CFLD) Network. In this protocol, mitochondrial hepatopathies in children and young adults will be investigated. The focus will be on respiratory chain defects (RC) and defects of fatty acid oxidation (FAO). There is little known about the full spectrum of severity and long-term natural history of mitochondrial hepatopathies. Moreover, these disorders have not been subject to prospective, rigorous clinicopathological scrutiny.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 67
• Est. completion date: May 2024
• Est. primary completion date: May 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A to 18 Years

Eligibility

Subjects in Group 1 (Mitochondrial Hepatopathy group) must meet all of the following

inclusion criteria:

1. Children and young adults with suspected or documented hepatic RC defector FAO defect from birth to 18 years old (through 18 years).

2. Both sexes, all races and ethnic groups.

3. Participants must meet one of the following sets of criteria (A or B):

A. Potential subjects presenting with acute or chronic liver disease or acute liver failure but who have not had a liver transplant must meet one of Clinical Criteria 1 and one of

Clinical Criteria 2 listed below:

1. Clinical Criteria 1 (any one of the following)

• 1.Acute liver failure, defined as severe liver dysfunction and either 1) INR >1.5 or prothrombin time > 15 seconds with encephalopathy or 2) INR > 2.0 or prothrombin time > 20 seconds with or without encephalopathy; occurring within 8 weeks of onset of illness; with no known underlying chronic liver disease, or
• 2.Acute liver disease defined as elevated AST or ALT >1.25 ULN and CK <1000u/L or conjugated bilirubin >2.0 mg/dl and >20% of total bilirubin, or
• 3.Chronic liver disease defined as:
• elevated ALT or AST (>1.25 ULN) for > 6 months, or
• conjugated hyperbilirubinemia (conjugated [direct] > 2.0 mg/dl and > 20% of total bilirubin) for > 6 months or
• clinical stigmata of chronic liver disease, including chronic hepatomegaly, clinical findings or complications of cirrhosis or portal hypertension, impaired liver synthetic function, intractable pruritus explainable only by liver disease or end-stage liver disease, or
• abnormal liver histology including hepatic fibrosis or cirrhosis, microvesicular steatosis, canalicular cholestasis, ballooned granular red hepatocytes (AKA oncocytes), intralobular collapse/regeneration And

2. Clinical Criteria 2 (any one of the following):

• 1.Prior history of extra-hepatic organ involvement accompanied by any one or more of the signs and symptoms associated with mitochondrial dysfunction (e.g. hypotonia, neuro-developmental delay, seizure disorder requiring treatment with valproic acid, nystagmus, cardiomyopathy, renal tubulopathy, bone marrow failure, myopathy, hearing loss), or
• 2.Lactic acidosis (arterial blood or free-flowing venous blood level >2.5 mmol/L or >22.5 mg/dl at any age and increased lactate:pyruvate ratio [>25.0]) or
• 3.Hypoglycemia (blood glucose <45 mg/dl on any measurement) and hypoketonuria (<1+ for urine ketones by dipstick on urine specimen obtained within 4 hours after collecting blood with low glucose concentration), or
• 4.Abnormal acyl carnitine profile, or
• 5.Documented biochemical (enzymatic) or genetic diagnosis B. Potential participants who have undergone a liver transplantation because of acute liver failure or end stage liver disease due to suspected or confirmed mitochondrial hepatopathy; the transplantation may have been performed at a non-ChiLDREN medical center or at a ChiLDREN Clinical Site. Participants will meet Criteria 1 and either criteria 2 or criteria

3 below:

• 1.Previous liver transplantation, AND
• 2.Suspected mitochondrial liver disease, based upon meeting one or more of the

following criteria:

• Had a prior history of extra-hepatic organ involvement accompanied by signs and symptoms associated with mitochondrial dysfunction (e.g., hypotonia, neuro-developmental delay, seizure disorder requiring treatment with valproic acid, nystagmus, cardiomyopathy, renal tubulopathy, bone marrow failure, myopathy, hearing loss), OR
• A prior history of lactic acidosis (arterial blood or free-flowing venous blood level >2.5 mmol/L or >22.5 mg/dl at any age and increased lactate:pyruvate ratio [>25.0]), OR
• A prior history of hypoglycemia (blood glucose <45 mg/dl on any measurement) and hypoketonuria (=1+ for urine ketones by dipstick on urine specimen obtained within 4 hours after collecting blood with low glucose concentration), OR
• A prior history of an abnormal acyl carnitine profile, OR
• Documented biochemical (enzymatic) or genetic diagnosis of a mitochondrial disorder
• 3.A documented (confirmed) mitochondrial disorder based upon the confirmation criteria specified in protocol. Subjects in Group 2 (Suspected Mitochondrial Hepatopathy not meeting Group 1 enrollment

criteria) must meet the following inclusion criteria:

1. Children and young adults with suspected hepatic RC defect or FAO defect between birth through 18 years but who do not meet clinical inclusion criteria listed above for acute or chronic liver disease or acute liver failure.

2. Both sexes, all races and ethnic groups.

Subjects in either Group 1 or 2 must not have any of the following exclusion criteria:

1. Inability to comply with the longitudinal follow-up described below.

2. Failure of a family/patient to sign the informed consent/assent document or the HIPAA authorization form.

3. Known Medium Chain Acyl CoA Dehydrogenase deficiency (MCAD).

4. Other known causes of liver disease.

Related Conditions & MeSH terms

• Acute Liver Failure
• Disorder of Fatty Acid Oxidation
• End Stage Liver Disease
• Hepatic Insufficiency
• Liver Diseases
• Liver Failure
• Liver Failure, Acute
• Mitochondrial Diseases
• Respiratory Chain Deficiencies, Mitochondrial

Locations

Country	Name	City	State
Canada	Hospital for Sick Children	Toronto	Ontario
United States	Children's Healthcare of Atlanta - Emory University	Atlanta	Georgia
United States	Children's Hospital Colorado	Aurora	Colorado
United States	Johns Hopkins School of Medicine	Baltimore	Maryland
United States	Ann & Robert H. Lurie Children's Hospital	Chicago	Illinois
United States	Children's Hospital Medical Center	Cincinnati	Ohio
United States	Texas Children's Hospital (Baylor College of Medicine)	Houston	Texas
United States	Riley Hospital for Children	Indianapolis	Indiana
United States	Children's Hospital Los Angeles	Los Angeles	California
United States	Mount Sinai Medical Center	New York	New York
United States	The Children's Hospital of Philadelphia	Philadelphia	Pennsylvania
United States	UPMC Children's Hospital of Pittsburgh	Pittsburgh	Pennsylvania
United States	Washington University School of Medicine	Saint Louis	Missouri
United States	University of Utah	Salt Lake City	Utah
United States	University of California at San Francisco (UCSF)	San Francisco	California
United States	Seattle Children's Hospital	Seattle	Washington

Sponsors (3)

Lead Sponsor	Collaborator
Arbor Research Collaborative for Health	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), University of Michigan

Countries where clinical trial is conducted

United States,  Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Listing for liver transplant	Listing for liver transplant	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Primary	Liver transplantation	Liver transplantation	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Primary	Involvement of other organ systems known to be associated with mitochondrial diseases	Involvement of other organ systems known to be associated with mitochondrial diseases	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Primary	Death	Death	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Secondary	Growth failure	Growth failure (defined as weight or length Z-score for age < -2)	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Secondary	Worsening liver function	Worsening liver function (defined as PELD >10)	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Secondary	Complications of portal hypertension	Complications of portal hypertension	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Secondary	Neurodevelopmental outcome	Neurodevelopmental outcome	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable
Secondary	Health related Quality of Life	Health related Quality of Life	Measured/assessed at baseline, 6 months, Years 1 through 10, and at time of liver transplant, liver or muscle biopsy or hospitalization for critical illness if applicable

External Links

•   Childhood Liver Disease Research Network (ChiLDReN) website