Vitamin D and Bisphosphonates in the Treatment of Sickle Cell Disease

NCT02972138 | Completed

• 1 other identifier: Vit.D-Bisph-SCD
• Study Type: observational
• Target: 80
• Locations: 1 country
• Sites: 3

Brief Summary

Sickle cell disease (SCD) is a worldwide distributed hereditary red cell disorder, which affects approximately 75,000 individuals in the United States and almost 20,000- 25,000 subjects in Europe, this latter mainly related to the immigration fluxes from endemic areas such as Sub-Saharian Africa to European countries. Studies of global burden disease have pointed out the invalidating impact of SCD on patient quality of life. This requires the development of new therapeutic options to treat sickle cell related acute and chronic complications. SCD is caused by a point mutation in the β-globin gene resulting in the synthesis of pathological hemoglobin S (HbS). HbS displays peculiar biochemical characteristics, polymerizing when deoxygenated with associated reduction in cell ion and water content (cell dehydration), increased red cell density and further acceleration of HbS polymerization. Pathophysiological studies have shown that dense, dehydrated red cells play a central role in acute and chronic clinical manifestations of SCD, in which intravascular sickling in capillaries and small vessels leads to vaso-occlusion and impaired blood flow with ischemic/reperfusion injury. In microcirculation, vaso-occlusive events (VOC) result from a complex and still partially known scenario, involving the interactions between different cell types, including dense red cells, reticulocytes, abnormally activated endothelial cells, leukocytes, platelets and plasma factors. Target organs, such as bone or lung, are involved in both acute and chronic clinical manifestations of SCD, related to their peculiar anatomic organization mainly characterized by sluggish circulation and relative local hypoxia. VOCs combined with marrow hyperplasia and inflammation has been suggested to contribute to the development of sickle bone disease (SBD). Recently, it has been proposed a possible role of vitamin D deficiency in SBD, which appears to be subordinated to the primary defect in bone homeostasis. In a humanized mouse model for SCD, we recently reported that SBD is due to imbalance between osteoblast/osteoclast activity induced by recurrent VOCs. In addition, we show that zoledronic acid prevents bone impairment related to SCD, reducing osteoclast activity and improving osteoblast performance.

Conditions

Sickle Cells Disease

Keywords

Sickle-cells Disease; bisphosphonates; Vitamine D

Outcome Measures

Primary Outcomes (1)

• Incidence of vertebral fracture

  5 years follow up

Secondary Outcomes (2)

• severity of vertebral fracture

  5 years follow up

• Incidence of non-vertebral fracture

  5 years follow up

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

Patients with sickle cell disease older than 18 years of age and younger than 50 years of age

You may qualify if:

• Young adult patients with sickle cell disease (older than 18 years of age) and younger than 50 years of age

You may not qualify if:

• Women with positive pregnant test, patients with history of heart, renal and liver failure, patients taking drugs influencing bone metabolisms within the two years before the beginning of the study (i.e.: glucocorticoids, hormonal replacement)
• Patients in meonopause, patients with traumatic vertebral fracture
• Patients with hypo/hyperthyroidism
• Patients with hyperparathyroidism
• Patients with osteomalacia, patients with history of Paget disease
• Patients with Cushing syndrome
• Patients with malabsorption diseases (i.e.: caeliac disease)
• Patients with history of cancer

Sponsors & Collaborators

• Società Italiana Talassemie ed Emoglobinopatie: lead

Study Sites (3)

Ospedali Galliera - S.S.D. Microcitemia, anemie congenite e dismetabolismo del ferro

Genova, 16128, Italy

Location

Ospedali Galliera - S.S.D. Ortogeriatria per intensità di cure

Genova, 16128, Italy

Location

Università degli Studi di Verona

Verona, 37129, Italy

Location

Related Publications (19)

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• Vinchi F, De Franceschi L, Ghigo A, Townes T, Cimino J, Silengo L, Hirsch E, Altruda F, Tolosano E. Hemopexin therapy improves cardiovascular function by preventing heme-induced endothelial toxicity in mouse models of hemolytic diseases. Circulation. 2013 Mar 26;127(12):1317-29. doi: 10.1161/CIRCULATIONAHA.112.130179. Epub 2013 Feb 27.

  PMID: 23446829 BACKGROUND

• Hebbel RP, Vercellotti G, Nath KA. A systems biology consideration of the vasculopathy of sickle cell anemia: the need for multi-modality chemo-prophylaxsis. Cardiovasc Hematol Disord Drug Targets. 2009 Dec;9(4):271-92. doi: 10.2174/1871529x10909040271.

  PMID: 19751187 BACKGROUND

• Hebbel RP. Adhesion of sickle red cells to endothelium: myths and future directions. Transfus Clin Biol. 2008 Feb-Mar;15(1-2):14-8. doi: 10.1016/j.tracli.2008.03.011. Epub 2008 May 23.

  PMID: 18501652 BACKGROUND

• Platt OS. The acute chest syndrome of sickle cell disease. N Engl J Med. 2000 Jun 22;342(25):1904-7. doi: 10.1056/NEJM200006223422510. No abstract available.

  PMID: 10861328 BACKGROUND

• Lal A, Fung EB, Pakbaz Z, Hackney-Stephens E, Vichinsky EP. Bone mineral density in children with sickle cell anemia. Pediatr Blood Cancer. 2006 Dec;47(7):901-6. doi: 10.1002/pbc.20681.

  PMID: 16317761 BACKGROUND

• Dalle Carbonare L, Innamorati G, Valenti MT. Transcription factor Runx2 and its application to bone tissue engineering. Stem Cell Rev Rep. 2012 Sep;8(3):891-7. doi: 10.1007/s12015-011-9337-4.

  PMID: 22139789 BACKGROUND

• Bruzzaniti A, Baron R. Molecular regulation of osteoclast activity. Rev Endocr Metab Disord. 2006 Jun;7(1-2):123-39. doi: 10.1007/s11154-006-9009-x.

  PMID: 16951988 BACKGROUND

• Dalle Carbonare L, Zanatta M, Gasparetto A, Valenti MT. Safety and tolerability of zoledronic acid and other bisphosphonates in osteoporosis management. Drug Healthc Patient Saf. 2010;2:121-37. doi: 10.2147/DHPS.S6285. Epub 2010 Aug 19.

  PMID: 21701624 BACKGROUND

• Dalle Carbonare L, Arlot ME, Chavassieux PM, Roux JP, Portero NR, Meunier PJ. Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res. 2001 Jan;16(1):97-103. doi: 10.1359/jbmr.2001.16.1.97.

  PMID: 11149495 BACKGROUND

• Nouraie M, Cheng K, Niu X, Moore-King E, Fadojutimi-Akinsi MF, Minniti CP, Sable C, Rana S, Dham N, Campbell A, Ensing G, Kato GJ, Gladwin MT, Castro OL, Gordeuk VR. Predictors of osteoclast activity in patients with sickle cell disease. Haematologica. 2011 Aug;96(8):1092-8. doi: 10.3324/haematol.2011.042499. Epub 2011 May 5.

  PMID: 21546502 BACKGROUND

• Neves FS, Oliveira LS, Torres MG, Toralles MB, da Silva MC, Campos MI, Campos PS, Crusoe-Rebello I. Evaluation of panoramic radiomorphometric indices related to low bone density in sickle cell disease. Osteoporos Int. 2012 Jul;23(7):2037-42. doi: 10.1007/s00198-011-1810-z. Epub 2011 Oct 18.

  PMID: 22006042 BACKGROUND

• Nur E, Mairuhu W, Biemond BJ, van Zanten AP, Schnog JJ, Brandjes DP, Otten HM; CURAMA study group. Urinary markers of bone resorption, pyridinoline and deoxypyridinoline, are increased in sickle cell patients with further increments during painful crisis. Am J Hematol. 2010 Nov;85(11):902-4. doi: 10.1002/ajh.21856.

  PMID: 20882525 BACKGROUND

• Miller RG, Segal JB, Ashar BH, Leung S, Ahmed S, Siddique S, Rice T, Lanzkron S. High prevalence and correlates of low bone mineral density in young adults with sickle cell disease. Am J Hematol. 2006 Apr;81(4):236-41. doi: 10.1002/ajh.20541.

  PMID: 16550513 BACKGROUND

Study Officials

• Luca G Dalle Carbonare, MD

  Università degli studi di Verona

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 28, 2016
• First Posted: November 23, 2016
• Study Start: January 1, 2010
• Primary Completion: December 1, 2015
• Study Completion: September 1, 2017
• Last Updated: October 6, 2017

Record last verified: 2015-12

Locations

IT (3)