Genetic and Biochemical Markers of Interferon-Induced Depression.

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00252538
First received: November 9, 2005
Last updated: July 9, 2014
Last verified: July 2014
  Purpose

The purpose of this study is to identify predictors and associated biochemical markers of interferon-induced depression. It is hypothesized that genetic variation in genes related to the serotonergic system may predict vulnerability to interferon-induced depression.


Condition Intervention
Depression
Drug: interferon-alpha

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: Genetic and Biochemical Markers of Interferon-Induced Depression.

Resource links provided by NLM:


Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • genotype and phenotype (as measured by Beck Depression Inventory-II). [ Time Frame: The proposed enrollment began after funding notification and enrollment will last for a period of 40 months and until end of study. ] [ Designated as safety issue: No ]

Biospecimen Retention:   Samples With DNA

Blood samples are being collected to determine the variability in the development of depressive symptoms induced by interferon. Thus, we plan to measure specific genetic polymorphisms [i.e., in the serotonin (5-HT) transporter gene-linked polymorphic region (5-HTTLPR), in the promoter of the 5-HT1A receptor subtype, and an intronic tryptophan hydroxylase polymorphism]. Tryptophan, 5-HT, and cortisol blood levels will also be measured.


Enrollment: 36
Study Start Date: April 2006
Study Completion Date: September 2009
Primary Completion Date: September 2009 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
Group 1
Research participants are: 1) male or female, 2) age 18 or older, 3) chronically infected with the hepatitis C virus, 4) candidates for interferon therapy, 4) not on antidepressant treatment , and 5) not currently abusing any substances such as alcohol or intravenous drugs, or having abused in the past 6 months
Drug: interferon-alpha
This is an observational study only. The patients are on interferon alpha therapy for HCV, but prescribing interferon is not a part of this research study protocol.

Detailed Description:
  1. Objective of project: Interferon-a (IFN)-induced depression is a common complication of its use in treating patients for hepatitis C (HCV), with reports of up to 44% of patients experiencing these depressive side effects. The central hypothesis of the proposed research is that polymorphisms in specific serotonergic genes are associated with a propensity to develop IFN-induced depression. Further, IFN-induced decreases in tryptophan and serotonin (5-HT) levels are putatively related to the emergence of depressive symptoms during IFN therapy. The objective of this proposal is to identify predictors of IFN-induced depression such that depressive side effects can be better managed and treated thus permitting patients to complete a full course of IFN therapy.
  2. Research plan: We plan to test our hypothesis and accomplish the objectives of this application by pursuing the following two specific objectives:

    1. to evaluate the role of genetic loci that may contribute to the vulnerability to IFN using association analyses. Vulnerability is operationalized as the maximal Beck Depression Inventory-II (BDI-II) score, co-varying for pre-treatment BDI-II scores, and
    2. to identify the effects and time course of antiviral therapy on potential biomarkers of IFN-induced depression, including tryptophan, 5-HT, and cortisol levels. Changes in biochemical levels will be compared to depressive symptomology and genetic vulnerability.
  3. Methodology: Patients will be asked to participate in a prospective study in which they will be monitored during the course of IFN therapy for symptoms of depression and for biochemical changes measured in their blood. 120 HCV patients initiating IFN therapy will be recruited (3/month for 40 months) from the Portland VA and the Long Beach VA Medical Centers. Following baseline assessments, subjects will be followed every 2 weeks for a period of 4 months. The development of major depression, depressive symptoms, and related IFN-induced side effects will be monitored using rating scales. For genetic and biochemical measures, blood samples will be collected prior to and during IFN therapy. Patients will be tested for genetic polymorphisms in the 5-HT transporter, 5-HT1A receptor subtype, and tryptophan hydroxylase.

    Analyses. Using linear regression, genotype will be the independent variable, and co-varying for baseline BDI-II score, the maximal BDI-II score will be examined as a dependent variable. An ANOVA for repeated measures will be performed to determine the effects of IFN therapy on tryptophan, 5-HT, and cortisol levels. In addition, the Mann-Whitney test will be used to determine if there are significant relationships between the development of depression and changes in neurotransmitter or neuroendocrine levels.

  4. Findings, results or conclusions reached to date: In preliminary studies we found that 33% of HCV patients on IFN therapy developed major depressive disorder during the course of treatment. In addition, preliminary pilot results suggest that the 5-HT transporter polymorphism short allele and the "C" allele for the tryptophan hydroxylase A799C polymorphism may increase vulnerability to IFN-induced depression.
  5. Clinical relevance: There are currently no known, reliable predictors of IFN-induced depression. The chronic disease of HCV infection collectively affects approximately 4 million Americans and 200 million people worldwide. IFN is the only clinically approved medication whose long-term use can reduce the risk of a fatal outcome and even be curative in some individuals. However, side effects associated with IFN therapy represent a major obstacle to adequate treatment for patients with HCV, often resulting in the discontinuation IFN therapy.
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

120 patients initiating interferon therapy will be recruited from the Portland, Minneapolis, and Long Beach VAMCs. The study is limited to only those participants who are currently mentally healthy at baseline and eligible to receive interferon therapy. Research participants are: 1) male or female, 2) age 18 or older, 3) chronically infected with the hepatitis C virus, 4) candidates for interferon therapy, 4) not on antidepressant treatment , and 5) not currently abusing any substances such as alcohol or intravenous drugs, or having abused in the past 6 months

Criteria

Inclusion Criteria:

  1. Serum positive for hepatitis C
  2. Age 18 or older
  3. Not pregnant and using adequate contraception
  4. Hepatologist-determined patient is a candidate for interferon therapy
  5. Written/signed informed consent specific for this protocol has been obtained prior to entry

Exclusion Criteria:

  1. Diagnosis of active: depression, psychotic symptoms, or bipolar disorder (or history of bipolar disorder) during the previous 3 months
  2. On antidepressant medications for any reason
  3. Currently abusing any substances such as alcohol or intravenous drugs, or having abused in the past 6 months.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00252538

Locations
United States, California
VA Medical Center, Long Beach
Long Beach, California, United States, 90822
United States, Minnesota
VA Medical Center, Minneapolis
Minneapolis, Minnesota, United States, 55417
United States, Oregon
VA Medical Center, Portland
Portland, Oregon, United States, 97201
Sponsors and Collaborators
Investigators
Principal Investigator: Peter Hauser, MD VA Medical Center, Long Beach
  More Information

Additional Information:
Publications:
Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT00252538     History of Changes
Other Study ID Numbers: MHBA-20-04F
Study First Received: November 9, 2005
Last Updated: July 9, 2014
Health Authority: United States: Federal Government

Keywords provided by Department of Veterans Affairs:
Cortisol
Depression
Hepatitis C
Interferon
Polymorphism
Serotonin
Tryptophan

Additional relevant MeSH terms:
Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders
Interferon-alpha
Interferon Alfa-2a
Interferons
Antiviral Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Immunologic Factors
Physiological Effects of Drugs
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors
Antineoplastic Agents

ClinicalTrials.gov processed this record on July 23, 2014