Etidronate for Arterial Calcifications Due to Deficiency in CD73 (ACDC)

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2014 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by:
National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:
NCT01585402
First received: April 24, 2012
Last updated: March 14, 2014
Last verified: February 2014
  Purpose

Background:

  • Arterial Calcifications due to Deficiency in CD73 (ACDC) is a rare genetic disease. People with ACDC develop calcium deposits in the arteries and joints of the fingers, wrists, ankles and feet. These deposits cause severe pain in the hands and feet, even when the person is at rest, and may lead to loss of the affected hand or foot. Currently, there are no standard treatments for ACDC.
  • Etidronate is a drug that helps to slow or stop the natural process that dissolves bone tissue. It is approved to treat Paget s disease, a condition in which the bones are soft and weak and may be deformed, painful, or easily broken. It is also used to treat high blood calcium levels. Researchers want to see if it can be used to treat the symptoms of ACDC and improve pain and blood flow in the hands and feet.

Objectives:

- To see if etridronate is a safe and effective treatment for ACDC.

Eligibility:

- People between 18 and 80 years of age who have been diagnosed with ACDC.

Design:

  • Participants will be screened with a physical exam and medical history. They will also have imaging studies, including x-rays and DEXA bone scans, before starting treatment. Blood and urine samples will be collected. An exercise tolerance test will also be given.
  • Participants will take etridronate by mouth once a day for 14 days every 3 months. They will be assigned an individualized 6-month drug schedule to follow. Participants should not eat foods that are high in calcium for at least 2 hours after taking the study drug.
  • Participants will have regular study visits throughout the treatment period. These visits will involve imaging studies, full dental exams, and blood and urine tests. Participants will also have exercise tolerance tests and arm and leg blood pressure tests to measure pain and blood flow.
  • Participants may also provide tissue samples for further study.
  • Treatment will continue for up to 3 years as long as the side effects are not severe and the condition does not become worse. Participants will have a final follow-up visit after stopping treatment.

Condition Intervention Phase
Arterial Calcification Due to CD73-Deficiency (ACDC)
Drug: Etidronate
Procedure: MRI
Procedure: CT Scan
Procedure: ABI
Procedure: Treadmill
Procedure: Dexa Scan
Procedure: Hand X-ray
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: An Open-label, Non-Randomized, Single-Arm Pilot Study to Evaluate the Effectiveness of Etidronate Treatment for Arterial Calcifications Due to Deficiency in CD73 (ACDC)

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • This study will examine the effectiveness etidronate in attenuating the progression of lower extremity arterial calcification and improved vascular blood flow in subjects diagnosed with the rare disease, ACDC

Secondary Outcome Measures:
  • Functional improvement in treadmill test results; Decrease in hand pain based on Rheumatoid Arthritis assessment tool; Changes in hand joint calcification based on hand x-ray

Estimated Enrollment: 20
Study Start Date: April 2012
Estimated Study Completion Date: March 2017
Estimated Primary Completion Date: March 2017 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Etidronate
    20mg/kg oral 14days on / 10 weeks off cyclical drug schedule
    Procedure: MRI
    Visit on day 0 and visit at 36 month
    Procedure: CT Scan
    Baseline visit, and visit on day 0, visit at 12, 24 , 36 months
    Procedure: ABI
    At baseline and visit 1-7 every 6 months
    Procedure: Treadmill
    visit 1-7 every 6 months
    Procedure: Dexa Scan
    Visit1, 3, 5, 7 every 12 months
    Procedure: Hand X-ray
    Visit1, 3, 5, 7 every 12 months
Detailed Description:

We have recently identified a novel genetic disease affecting nine known adults in whom de novo vascular calcifications develop in the lower extremity arteries and juxta-articular joint capsules of the fingers, wrists, ankles and feet. This rare disease results from bi-allelic mutations in the gene ecto-5-prime-nucleotidase (NT5E), encoding the CD73 protein. CD73, an enzyme involved in the extracellular ATP metabolic pathway, converts extracellular AMP to adenosine and inorganic phosphate. The clinical symptoms of this rare disease, termed ACDC (Arterial Calcifications due to Deficiency in CD73), include claudication of the calves, thighs, and buttocks, chronic ischemic pain of the feet at rest with threat of potential limb loss, and debilitating rheumatoid pain in the wrists and hands. Radiological and histological evaluations do not resemble classic atherosclerotic vascular calcification, since the calcification and dysplasia in ACDC occur in the medial portion of the arterial blood vessel wall. Data from patient-specific cell lines indicate increased activity of tissue non-specific alkaline phosphatase (TNAP), a key mediator of pathological ectopic tissue calcification, and thus reveals a potential therapeutic target.

To date, no effective therapy exists for ACDC patients. However, since bisphosphonates are potent competitive inhibitors of TNAP activity and are widely used to modulate bone metabolism, they may beneficially alter vascular calcification. In addition, our preliminary in vitro studies demonstrate the effectiveness of etidronate, a nitrogen-containing bisphosphonate, in lowering TNAP activity in cells isolated from ACDC patients. Etidronate, and bisphophonates in general, have proven safe and well tolerated by most patients.

This protocol provides for the administration of etidronate to ACDC patients, for whom no alternative treatment is available. Patients will be examined at the NIH Clinical Center bi-annually for 3 years. The primary objective of this clinical study is to test the effectiveness of etidronate in attenuating the progression of lower extremity arterial calcification and vascular blood flow based on CT calcium score and Ankle brachial index (ABI).

  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA

Inclusion and exclusion criteria are to be assessed at Screening and Baseline prior to starting study drug. Each subject must meet the following criteria to be enrolled in this study:

  • Subjects must be diagnosed with ACDC based on genetic tests confirming mutation(s) in NT5E and evidence of lower extremity arterial calcifications.
  • Either gender and any ethnic background or race
  • Age 18-80 years
  • Willingness and legal ability to give and sign informed study consent
  • Willingness to travel to NIH and local sites for scheduled protocol studies and treatment

EXCLUSION CRITERIA

Subjects who meet any of the following criteria will be excluded from the study:

  • Subjects not diagnosed with ACDC
  • Subjects < 18 or > 80 years of age
  • Subjects who are unable or unwilling to sign an informed consent
  • Severe renal impairment (creatinine clearance of < 30ml/min)
  • Longstanding diabetes mellitus (more than 10 years)
  • Known abnormality of the esophagus that would interfere with the passage of the drug
  • Known sensitivity to etidronate
  • Pregnancy
  • Any other medical or social condition that, in the opinion of the Principal Investigator, might put the subject at risk of harm during the study or might adversely affect the interpretation of the study data.
  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: NCT01585402

Contacts
Contact: Dorothy J Tripodi, R.N. (301) 496-3431 tripodid@nhlbi.nih.gov
Contact: Manfred Boehm, M.D. (301) 435-7211 mb454z@nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)    800-411-1222 ext TTY8664111010    prpl@mail.cc.nih.gov   
Sponsors and Collaborators
Investigators
Principal Investigator: Manfred Boehm, M.D. National Heart, Lung, and Blood Institute (NHLBI)
  More Information

Additional Information:
Publications:
ClinicalTrials.gov Identifier: NCT01585402     History of Changes
Other Study ID Numbers: 120110, 12-H-0110
Study First Received: April 24, 2012
Last Updated: March 14, 2014
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
NT5E
Biphosphonates
Vascular Calcifications
Joint Capsule Calcifications
Inherited Disease

Additional relevant MeSH terms:
Calcinosis
Calcium Metabolism Disorders
Metabolic Diseases
Etidronic Acid
Bone Density Conservation Agents
Physiological Effects of Drugs
Pharmacologic Actions

ClinicalTrials.gov processed this record on July 20, 2014