The Effect of Arginine and Citrulline Supplementation on Endothelial Dysfunction in Mitochondrial Diseases

• ClinicalTrials.gov Identifier: NCT02809170
• Recruitment Status: Completed
• First Posted: June 22, 2016
• Last Update Posted: March 18, 2020
• Sponsor: Tawam Hospital
• Information provided by (Responsible Party): Ayman El-Hattab, Tawam Hospital

Study Description

Brief Summary:

Mitochondrial diseases occur due to inadequate energy production. In addition, nitric oxide (NO) deficiency occurs in mitochondrial diseases. The endothelial layer of blood vessels functions in maintaining blood vessels patency through producing NO which relaxes vascular smooth muscles and therefore maintains the patency of blood vessels and adequate blood perfusion. In mitochondrial diseases, endothelial cells fail to perform their normal function in maintaining the patency of blood vessels (endothelial dysfunction) because of the inability to produce enough NO. Endothelial dysfunction results in decreased blood perfusion in different organs which can contribute to the complications seen in mitochondrial diseases. The amino acids arginine and citrulline act as NO precursors and can increase NO production. In this study we hypothesize that due to the inability to produce enough NO patients with mitochondrial diseases have endothelial dysfunction that will improve after arginine or citrulline supplementation. The investigators will assess endothelial function using peripheral arterial tonometry before and after arginine or citrulline supplementation. The investigators expect that arginine and citrulline supplementation will improve endothelium function. This will support the therapeutic use of arginine and citrulline in mitochondrial diseases.

Condition or disease	Intervention/treatment	Phase
Mitochondrial Diseases	Dietary Supplement: Arginine; Dietary Supplement: Citrulline	Not Applicable

Detailed Description:

The investigators will study 10 children with mitochondrial diseases and 10 healthy control children. The investigators will study control children to be able compare the results of children with mitochondrial diseases to control healthy children. Therefore, the investigators will study control children only once to compare these results to the results of children with mitochondrial diseases at baseline. To assess the effect of arginine and citrulline on children with mitochondrial diseases, the investigators need to assess children with mitochondrial diseases four times. First time as baseline. Then children with mitochondrial diseases will be randomized to receive either oral arginine or citrulline at a dose of 500 mg/kg/day divided in 3 doses daily for 2 weeks after which a second assessment will be performed. Oral arginine or citrulline will be discontinued and after a two-week washout period another baseline assessment will be done. After that, the child will be started on oral citrulline (if the participant received arginine the first time) or arginine (if the participant received citrulline the first time) at a dose of 500 mg/kg/day divided in 3 doses daily for 2 weeks after which a fourth assessment will be done.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 9 participants
• Allocation: Randomized
• Intervention Model: Crossover Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: The Effect of Arginine and Citrulline Supplementation on Endothelial Dysfunction in Mitochondrial Diseases
• Study Start Date: June 2016
• Actual Primary Completion Date: June 2019
• Actual Study Completion Date: June 2019

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Arginine; Endothelial function will be assessed before and after arginine supplementation	Dietary Supplement: Arginine; Arginine is an amino acids
Active Comparator: Citrulline; Endothelial function will be assessed before and after citrulline supplementation	Dietary Supplement: Citrulline; Citrulline is an amino acid

Outcome Measures

Primary Outcome Measures :

1. Reactive hyperemic index (RHI) [ Time Frame: 2 year ]
   Reactive hyperemic index (RHI) which reflects endothelial function will be measured using the EndoPAT instrument

Secondary Outcome Measures :

1. Plasma concentration levels of arginine and citrulline [ Time Frame: 2 year ]
   Plasma arginine and citrulline levels will also be measured

Eligibility Criteria

• Ages Eligible for Study: 3 Years to 18 Years (Child, Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

1. Diagnosis of mitochondrial disease with multi-organ disease involving neurological and/or muscular systems.
2. The diagnosis must be confirmed either molecularly (identifying mutations known to be associated with mitochondrial diseases) or by respiratory chain assay abnormalities.

Exclusion Criteria:

1. Have acute illness or physical disability interfering with ability to undergo the study procedures.
2. Known to have other factors that are known to result in endothelial dysfunction including hypertension, hyperlipidemia, and diabetes.

Contacts and Locations

Locations

United Arab Emirates

Tawam Hospital

Al Ain, United Arab Emirates

Sponsors and Collaborators

Tawam Hospital

Investigators

• Principal Investigator: Ayman W El-Hattab, MD; Tawam Hospital

More Information

• Responsible Party: Ayman El-Hattab, Consultant, Genetics and Metabolic, Tawam Hospital
• ClinicalTrials.gov Identifier: NCT02809170
• Other Study ID Numbers: CED 343-14
• First Posted: June 22, 2016
• Last Update Posted: March 18, 2020
• Last Verified: March 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes

Additional relevant MeSH terms:

Mitochondrial Diseases; Metabolic Diseases