Zinc and Inflammation in Sepsis

This study has been completed.
Sponsor:
Collaborator:
UK Intensive Care Society
Information provided by (Responsible Party):
University of Aberdeen
ClinicalTrials.gov Identifier:
NCT01328509
First received: March 31, 2011
Last updated: July 4, 2013
Last verified: July 2013
  Purpose

The purpose of the proposed project is to investigate measures of zinc status in relation to oxidative stress and inflammation in patients with sepsis. We hypothesise that zinc depletion can modulate inflammatory responses, leading to increased oxidative stress and mitochondrial dysfunction.

Sepsis is a severe infection is the leading cause of death in critically ill patients [1]. Zinc deficiency impairs overall immune function and resistance to infection [2]. In vitro exposure of monocytes to lipopolysaccharide (LPS) leads to decreased cellular zinc content [3] and zinc redistribution has been shown in human volunteers in response to LPS [4]. Zinc depletion occurs in hospitalized patients including those with infections, the elderly, alcoholics, trauma or burns [5-8], conditions which are common among critically ill patients with sepsis. In a mouse model of sepsis, zinc depletion prior to sepsis resulted in more inflammation and more severe organ injury and increased mortality [9]. In patients with sepsis, early feeding with zinc resulted in faster recovery of organ function compared with control [10]. Zinc status is likely to be compromised in the critically ill and that zinc depletion may affect inflammatory responses and recovery.

Although zinc is not an antioxidant itself, it binds to metallothionein [11] and zinc supplementation decreases oxidative stress [12]. Oxidative stress has been consistently reported in patients with sepsis [13-15]. We have recently shown that protection of mitochondrial function with antioxidants can reduce organ damage in rats [16]. Pentraxin-3 is an inflammatory marker which is regulated in part by antioxidants and plays a key role in innate immunity [17].

The consequences of zinc deficiency may relate, in part, to its effects on nuclear factor NFκB, a transcription factor crucial to the signalling networks involved in sepsis [18]. Higher NFκB activity is associated with increased mortality in patients with sepsis [19,20]. It is likely that compromised antioxidant defences and inflammation occurs as a consequence of zinc deficiency.

We propose to measure plasma zinc and metallothionein mRNA status in relation to inflammatory markers including key cytokines, pentraxin-3, markers of oxidative stress and antioxidant status in patients with sepsis.


Condition
Sepsis

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Zinc and Inflammation in Sepsis

Resource links provided by NLM:


Further study details as provided by University of Aberdeen:

Primary Outcome Measures:
  • Plasma zinc concentration [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    Plasma zinc will be measured in patients with sepsis and non-spetic critically ill control patients.


Secondary Outcome Measures:
  • Interleukin-6 [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    The relationship between IL-6 and plasma zinc

  • Pentraxin-3 [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    The relationship between PTX-3 and plasma zinc

  • Plasma lipid peroxide [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    The relationship between LPO and plasma zinc

  • Plasma total antioxidant capacity [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    The relationship between TAC and plasma zinc

  • Metallothionein mRNA [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    Change in MTmRNA in mononuclear leucocytes in relation to plasma zinc and inflammatory markers

  • Nuclear factor kappa B [ Time Frame: 14 days ] [ Designated as safety issue: No ]
    Change in NFkB in nuclear extracts from mononuclear cells in relation to plasma zinc


Biospecimen Retention:   Samples Without DNA

Peripheral whole blood will be sampled from an indwelling arterial line and plasma will be separated. Peripheral blood mononuclear cells will be separated using single density gradient centrifugation and RNA extracted. Nuclear extracts of MNC will also be prepared.


Enrollment: 39
Study Start Date: January 2012
Study Completion Date: May 2013
Primary Completion Date: May 2013 (Final data collection date for primary outcome measure)
Groups/Cohorts
Sepsis
Patients with sepsis
Control
Patients with no clinical evidence of sepsis, but who are critically ill

Detailed Description:

Following ethical approval consent will be sought from either the patient, or assent from a near relative. Successive patients admitted to the Intensive Care Unit at Aberdeen Royal Infirmary who fulfil the following criteria for sepsis, given below, within a 24h time window, will be included.

  • Clinical suspicion or evidence of acute infection
  • SIRS defined by two or more of the following:

    1. Core temperature <36 degrees C or >38 degrees C
    2. Tachycardia; heart rate > 90 beats/min.
    3. Tachypnoea; respiratory rate > 20 breaths/min or mechanical ventilation
    4. White blood count >12 x 109/l or <4 x 109/l

In this pilot study we will recruit 20 patients with sepsis and 20 critically ill patients with no clinical suspicion of sepsis. Patients will be excluded if they are <16 years, pregnant or lactating, HIV positive, receiving corticosteroids or other known immuno-modulatory drugs (including statins), have cancer or autoimmune disorders or if consent/assent is refused.

Blood samples will be obtained on Days 1,2, 5, 10 and 14 of the ICU stay. Peripheral whole blood will be sampled from an indwelling arterial line and plasma will be separated for analysis of plasma zinc using atomic absorption spectroscopy. Plasma interleukin-6 (IL-6) and pentraxin-3 (PTX3) will be measured using enzyme immunoassay and total antioxidant capacity and lipid hydroperoxides will be measured colourimetrically [17]. Peripheral blood mononuclear cells (MNC) will be separated using single density gradient centrifugation, RNA extracted and metallothionein mRNA measured using qPCR [21]. Nuclear extracts of MNC will be prepared and nuclear factor kappa B (NFκB)activation measured using an enzyme immunoassay [17].

  Eligibility

Ages Eligible for Study:   16 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Successive patients admitted to the Intensive Care Unit at Aberdeen Royal Infirmary who fulfil the following criteria for sepsis, given below, within a 24h time window.

• .

Criteria

Patients with sepsis

Inclusion Criteria:

  • admitted to ICU with clinical suspicion or evidence of acute infection PLUS two or more of the following:

    1. Core temperature <36 degrees C or >38 degrees C
    2. Tachycardia; heart rate > 90 beats/min.
    3. Tachypnoea; respiratory rate > 20 breaths/min or mechanical ventilation
    4. White blood count >12 x 10 9/l or <4 x 10 9/l

      Control patients

  • admitted to ICU with no clinical evidence or suspicion of infection

Exclusion Criteria:

  • under 16 years old
  • pregnant or lactating
  • HIV positive
  • receiving corticosteroids or other known immuno-modulatory drugs
  • treated with statins in the last month
  • have cancer
  • have autoimmune disorders
  • consent/assent is refused
  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: NCT01328509

Locations
United Kingdom
Aberdeen Royal Infirmary
Aberdeen, Scotland, United Kingdom, AB41 8TK
Sponsors and Collaborators
University of Aberdeen
UK Intensive Care Society
Investigators
Principal Investigator: Helen Galley, PhD University of Aberdeen
Principal Investigator: Nigel Webster, PhD University of Aberdeen
  More Information

Publications:
1. Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546-54.
2. Rink L, Gabriel P. Zinc and the immune system. Proc Nutr Soc 2000; 59: 541-2.
17. Lowes DA, Hill Al, Sheth CC, Webster NR, Gow NAR, Galley HF. Regulation of pentraxin3-by antioxidants. Br J Anaesth 2009; 103: 833-9

Responsible Party: University of Aberdeen
ClinicalTrials.gov Identifier: NCT01328509     History of Changes
Other Study ID Numbers: 11/AL/0137
Study First Received: March 31, 2011
Last Updated: July 4, 2013
Health Authority: United Kingdom: Research Ethics Committee

Keywords provided by University of Aberdeen:
Zinc

Additional relevant MeSH terms:
Inflammation
Sepsis
Toxemia
Pathologic Processes
Infection
Systemic Inflammatory Response Syndrome

ClinicalTrials.gov processed this record on July 28, 2014