Reactive Oxygen Species in the Pathogenesis of Diabetic Complications

Type 1 Diabetes Clinical Trial

Official title:

The Role of the Glucosamine Pathway and Reactive Oxygen Species in the Pathogenesis of Diabetic Complications

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00703989
• Other study ID #: 2004-582
• Secondary ID: JDRF grant #8-20
• Status: Completed
• Phase: N/A
• Start date: February 2005
• Est. completion date: February 2008

Study information

• Verified date: June 2008
• Source: Albert Einstein College of Medicine
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathy and incipient nephropathy in these models. In cultured vascular cells, it also reduces aldose reductase gene expression, activity, and sorbitol levels. It does so by activating the enzyme transketolase. α-lipoic acid, a potent antioxidant, has also been reported to reduce both diabetic microvascular and macrovascular complications in animal models. To determine whether benfotiamine in combination with α-lipoic acid would normalize markers of ROS-induced pathways of complications in humans, we performed a pilot study in subjects with Type 1 diabetes using one daily dose of benfotiamine in combination with α-lipoic acid.

Description:

The glycemic status of study patients was assessed by measuring baseline values of HbA1c, fructosamine, and fasting plasma glucose. Mean HbA1c was 8.7+ 0.7%, mean fructosamine was 421+29 mg/dl (normal range 174-286 mg/dl), and mean fasting blood glucose was 198+44 mg/dl.

At day 0, subjects levels of markers of two benfotiamine-sensitive pathways were determined:

intracellular advanced glycation endproduct (AGE) formation, as reflected by a marker of increased intracellular methylglyoxal adducts in endothelial cells, angiopoietin 2 and hexosamine pathway activity, measured by determination of N-acetylglucosamine-modified protein in circulating monocytes. PKC activity in circulating monocytes could not be measured because the amount of blood required exceeded that approved by the Committee on Clinical Investigations. Serum levels of 6-keto-PGF-1 , a stable product produced by the nonenzymatic hydration of the antiatherogenic mediator prostacyclin were also determined. Subjects then took benfotiamine 300 mg twice a day, (Advanced Orthomolecular Research, Calgary, AB,CANADA) and slow-release α-lipoic acid (600 mg twice a day) (MRI, San Francisco, CA) for 28 days. Blood was obtained at day 0, day 15, and day 28.

Data were analyzed using 1-factor analysis of variance to compare the means of all the groups. The Tukey−Kramer multiple comparisons procedure was used to determine which pairs of means were different.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 21
• Est. completion date: February 2008
• Est. primary completion date: October 2006
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Male
• Age group: 18 Years to 45 Years

Eligibility

Inclusion Criteria:

• Male

• Type 1 diabetes duration between zero and fifteen years

• current insulin therapy

Exclusion Criteria:

• Female

• proliferative retinopathy

• microalbuminuria

• symptomatic diabetic neuropathy

• cardiovascular disease

• taking medications

• smoking

Related Conditions & MeSH terms

• Diabetes Complications
• Type 1 Diabetes

Intervention

Dietary Supplement:
• benfotiamine, a-lipoic acid
benfotiamine 300 mg twice a day, (Advanced Orthomolecular Research, Calgary, AB,CANADA) and slow-release a-lipoic acid (600 mg twice a day) (MRI, San Francisco, CA) for a total duration of four weeks

Locations

Country	Name	City	State
United States	GCRC, Albert Einstein College of Medicine	Bronx	New York

Sponsors (3)

Lead Sponsor	Collaborator
Albert Einstein College of Medicine	Juvenile Diabetes Research Foundation, National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

References & Publications (1)

Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005 Jun;54(6):1615-25. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	intracellular advanced glycation endproducts		four weeks
Primary	hexosamine pathway		four weeks
Primary	prostacyclin synthase activity		four weeks