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The Role of Sodium Chloride and the Treg/Th17 Axis in Autoimmune Hepatitis

Primary Purpose

Autoimmune Hepatitis

Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Low Salt Diet
Liberal salt diet
Sponsored by
Yale University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Autoimmune Hepatitis focused on measuring Autoimmune hepatitis, Liver dysfunction, Elevated serum auto antibodies

Eligibility Criteria

1 Year - 65 Years (Child, Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Adults 18-50 years of age
  • Children 1-17 years of age
  • ALT and/or ALP/GGT level > 2X upper limit of normal
  • ANA or SMA >/= 1:40
  • ANA or SMA >/= 1:80
  • or LKM >/= 1:40
  • or SLA positive
  • IgG > upper limit of normal

Exclusion Criteria:

  • Chronic hepatitis C
  • Decompensated Liver Disease

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Experimental

    Arm Label

    Low salt/ Liberal salt Diet

    Liberal salt/Low salt diet

    Arm Description

    Cross-over trial of liberal salt and low salt diet.

    Cross-over trial of low salt and liberal salt diet

    Outcomes

    Primary Outcome Measures

    Change from baseline in production of pathogenic TH17 cells.
    Measuring TH17 cells by flow cytometry and qRT-PCR. There are no known normal ranges. The investigator will calculate the change by observing the difference from baseline values.

    Secondary Outcome Measures

    Change from baseline in regulatory T cell function.
    Measuring T cell function by flow cytometry. There are no known normal ranges. The investigator will calculate the change by observing the difference from baseline values.

    Full Information

    First Posted
    November 4, 2013
    Last Updated
    July 27, 2021
    Sponsor
    Yale University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02050646
    Brief Title
    The Role of Sodium Chloride and the Treg/Th17 Axis in Autoimmune Hepatitis
    Official Title
    The Role of Sodium Chloride and the Treg/Th17 Axis in Autoimmune Hepatitis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2021
    Overall Recruitment Status
    Completed
    Study Start Date
    August 27, 2013 (Actual)
    Primary Completion Date
    August 2019 (Actual)
    Study Completion Date
    June 2021 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Yale University

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study is to determine whether a salt restriction diet improves immune parameters in patients with autoimmune hepatitis.
    Detailed Description
    The etiology of autoimmune hepatitis (AIH) is unknown although both genetic and environmental factors are thought to be involved. A defect in immune regulation affecting regulatory T cells (Tregs) has been demonstrated in AIH. Tregs function in the maintenance of immune homeostasis by controlling autoreactive immune responses to self-antigens. Rationale: the western diet has been postulated as a potential environmental risk factor for the increasing incidence of autoimmune diseases in developed countries. Data from the investigators' laboratory also suggests that increased dietary salt intake might represent an environmental risk factor for the development of autoimmune diseases through the induction of pathogenic Th17 cells. The dramatic in vitro effects of high salt on the induction of pathogenic Th17 cells from naïve human CD4 cells {Kleinewietfeld, Hafler. Nature. 2013 Apr 25;496(7446):518-22. doi: 10.1038/nature11868.}, and block of in vitro Treg suppression, in line with in vivo effects on worsening murine experimental autoimmune encephalomyelitis (EAE), have prompted the investigators to examine the effects of increased dietary sodium chloride in a human in vivo system. The investigators hypothesize that excess dietary salt may function as an environmental trigger that favors induction and expansion of pathogenic Th17 cells and leads to functional impairment of Tregs, thereby favoring development of autoimmunity. The investigators aim to study their established in vitro model in humans by altering the salt intake in patients over a 20-day period.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Autoimmune Hepatitis
    Keywords
    Autoimmune hepatitis, Liver dysfunction, Elevated serum auto antibodies

    7. Study Design

    Primary Purpose
    Basic Science
    Study Phase
    Not Applicable
    Interventional Study Model
    Crossover Assignment
    Masking
    Care ProviderInvestigator
    Allocation
    Randomized
    Enrollment
    16 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Low salt/ Liberal salt Diet
    Arm Type
    Experimental
    Arm Description
    Cross-over trial of liberal salt and low salt diet.
    Arm Title
    Liberal salt/Low salt diet
    Arm Type
    Experimental
    Arm Description
    Cross-over trial of low salt and liberal salt diet
    Intervention Type
    Other
    Intervention Name(s)
    Low Salt Diet
    Intervention Description
    On Day 0, patients will be randomized to one of the two crossover liberal/low or low/liberal salt diet groups. Each subject will complete two controlled dietary phases: 10-days of low salt diet, a washout period of 3-days, and 10-days of liberal salt diet.
    Intervention Type
    Other
    Intervention Name(s)
    Liberal salt diet
    Intervention Description
    On Day 0, patients will be randomized to one of the two crossover liberal/low or low/liberal salt diet groups. Each subject will complete two controlled dietary phases: 10-days of low salt diet, a washout period of 3-days, and 10-days of liberal salt diet.
    Primary Outcome Measure Information:
    Title
    Change from baseline in production of pathogenic TH17 cells.
    Description
    Measuring TH17 cells by flow cytometry and qRT-PCR. There are no known normal ranges. The investigator will calculate the change by observing the difference from baseline values.
    Time Frame
    26 days
    Secondary Outcome Measure Information:
    Title
    Change from baseline in regulatory T cell function.
    Description
    Measuring T cell function by flow cytometry. There are no known normal ranges. The investigator will calculate the change by observing the difference from baseline values.
    Time Frame
    26 days

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    1 Year
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Adults 18-50 years of age Children 1-17 years of age ALT and/or ALP/GGT level > 2X upper limit of normal ANA or SMA >/= 1:40 ANA or SMA >/= 1:80 or LKM >/= 1:40 or SLA positive IgG > upper limit of normal Exclusion Criteria: Chronic hepatitis C Decompensated Liver Disease
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Udeme Ekong, MD, MPH
    Organizational Affiliation
    Yale University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

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    The Role of Sodium Chloride and the Treg/Th17 Axis in Autoimmune Hepatitis

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