Does Taurine Supplementation Improve Vascular Function and Orthostatic Responses in Long COVID?
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Millions of people have been infected by SARS-CoV-2, or COVID-19, and recent estimates suggest that up to 13% have developed Long COVID [1]. The World Health Organization defines Long COVID as "the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation." SARS-CoV-2 is known to use angiotensin converting enzyme 2 (ACE2) to enter cells [2], and ACE2 is located in endothelial cells throughout the cardiovascular system contributing to significant vascular dysfunction [3]. Indeed, vascular function, as measured by flow-mediated dilation (FMD) has been shown to be impaired in otherwise healthy young COVID-19 survivors just 3-4 weeks after infection [4] and persists for at least 6 months in patients who were hospitalized [5]. Recent work has shown a significant correlation between low plasma taurine levels (a naturally occurring amino acid which can help regulate cardiovascular and inflammation) and Long COVID symptoms, and the recovery of taurine levels was associated with fewer adverse events [6]. Notably, twelve weeks of taurine supplementation has been shown to improve blood pressure and vascular function in pre-hypertension [7]. These improvements could, in turn, improve orthostatic tolerance (i.e. lightheadedness while upright, a common symptom in Long COVID). Thus, the purpose of the current proposal is to compare Long COVID patients who are or who are not taking 12-wks taurine supplementation, measuring vascular and orthostatic responses. We hypothesize that those Long COVID patients taking taurine will have better vascular function and orthostatic responses.
Participants: Drawing on the results of Sun et al. (2016) [7] to calculate a sample size, we used an expected change in FMD of 3.2±4.7% with taurine supplementation, resulting in a sample size of 19. To account for potential participant drop-out, we intend to recruit 30 Long COVID patients aged 18-65, including 15 males and 15 females. As this is a pilot project, we will re-evaluate our sample sizes/statistical power when approximately 8 males and 8 females have been completed [8]. Duration and type of symptoms will be recorded using the Symptom Burden Questionnaire for Long COVID. Autonomic function will be assessed with the COMPASS-31 questionnaire and people with symptoms of orthostatic intolerance and/or vasomotor impairment will be recruited. Sex and gender will be self-identified and used as covariates. Any co-morbidities and medication use will be recorded but not excluded.
Study Design: This will be an observational study where half of the participants will already be taking taurine supplements and the other half will not. Each lab assessment will take approximately 60 minutes. Participants will come to York University at baseline and after 12 weeks of time has passed. During the first visit, they will be loaned a Polar heart rate monitor and instructed in its use for home data collection.
- Vascular function: Resting brachial artery FMD will be measured with Duplex ultrasound imaging according to international guidelines [9]. Briefly, five minutes of forearm vascular occlusion using a blood pressure cuff will be applied while brachial artery diameter and flow are measured before, during and for 3 minutes after cuff occlusion. Peak hyperemic brachial arterial velocity will also be measured using Doppler ultrasound immediately after cuff release. Analysis of FMD will be done with edge-detection software (Quipu) to expedite the analysis and reduce measurement error [10]. Concurrently an EndoPAT device will also be used to measure endothelial function.
- Orthostatic responses (during supine rest and 5-min 70o head-up tilt): Cardiovascular and respiratory measures: Heart rate will be measured by ECG, blood pressure/cardiac output will be monitored using a beat-by-beat non-invasive blood pressure device (NexFin), brain blood flow will be assessed with transcranial Doppler ultrasound, and respiratory rate will be assessed using a Respitrace. Heart Rate Variability (HRV): HRV provides an indicator of the autonomic control of heart rate (i.e. parasympathetic and sympathetic balance [11]) and will be analyzed using LabChart Pro 8.0 software in the supine and upright postures. Resting HRV will also be assessed using a Polar heart rate device at home, weekly. The heart rate data will be emailed to the students for analysis.
Analysis plan: Each variable described above will be measured before and after the 12-wks time period. To test the study hypotheses, repeated measures analysis of variance will be used to examine differences over time (SPSS). Sex, gender, and symptom duration will be covariates.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Heather Edgell, PhD
- Phone Number: 22927 14167362100
- Email: edgell@yorku.ca
Study Locations
-
-
Ontario
-
Toronto, Ontario, Canada, M3J1P3
- Recruiting
- York University
-
Contact:
- Heather Edgell
- Phone Number: 22927 4167362100
- Email: edgell@yorku.ca
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Participants will have had symptoms of Long COVID post-infection for at least 3 months
Exclusion Criteria:
- Inability to undergo tilt table testing for 5 minutes
- Inability to transport selves to York University from their homes
- Inability to speak English, or provide a translator
- Blood clotting disorders
Study Plan
How is the study designed?
Design Details
Number of groups / cohorts
Cohorts and Interventions
Group / CohortGroup / Cohort |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Taurine supplementation
Long COVID patients will self-administer 12-wks of taurine supplementation
|
Participants will self-administer 12-wks taurine supplementation
|
|
Time control
Long COVID patients who are not taking taurine supplementation
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Orthostatic responses
Time Frame: Baseline and 12-weeks
|
Measure cardiovascular and cerebrovascular responses to upright tilt using beat to beat blood pressure, ECG, and transcranial Doppler.
|
Baseline and 12-weeks
|
|
Vascular function
Time Frame: Baseline and 12-weeks
|
Flow-mediated dilation and EndoPAT response.
These techniques concurrently measure endothelial function using the same protocol.
|
Baseline and 12-weeks
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Heart rate variability
Time Frame: Over the course of 12 weeks
|
Variability of resting heart rate will be measured in lab using ECG and at home using a polar heart rate strap.
|
Over the course of 12 weeks
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Publications and helpful links
General Publications
- Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65. No abstract available.
- Hoffmann M, Kleine-Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, Schiergens TS, Herrler G, Wu NH, Nitsche A, Muller MA, Drosten C, Pohlmann S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Apr 16;181(2):271-280.e8. doi: 10.1016/j.cell.2020.02.052. Epub 2020 Mar 5.
- Thijssen DH, Black MA, Pyke KE, Padilla J, Atkinson G, Harris RA, Parker B, Widlansky ME, Tschakovsky ME, Green DJ. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Heart Circ Physiol. 2011 Jan;300(1):H2-12. doi: 10.1152/ajpheart.00471.2010. Epub 2010 Oct 15.
- Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, Mehra MR, Schuepbach RA, Ruschitzka F, Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020 May 2;395(10234):1417-1418. doi: 10.1016/S0140-6736(20)30937-5. Epub 2020 Apr 21. No abstract available.
- Wittes J, Brittain E. The role of internal pilot studies in increasing the efficiency of clinical trials. Stat Med. 1990 Jan-Feb;9(1-2):65-71; discussion 71-2. doi: 10.1002/sim.4780090113.
- Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R; International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002 Jan 16;39(2):257-65. doi: 10.1016/s0735-1097(01)01746-6.
- Sun Q, Wang B, Li Y, Sun F, Li P, Xia W, Zhou X, Li Q, Wang X, Chen J, Zeng X, Zhao Z, He H, Liu D, Zhu Z. Taurine Supplementation Lowers Blood Pressure and Improves Vascular Function in Prehypertension: Randomized, Double-Blind, Placebo-Controlled Study. Hypertension. 2016 Mar;67(3):541-9. doi: 10.1161/HYPERTENSIONAHA.115.06624. Epub 2016 Jan 18.
- Khoramjoo M, Wang K, Srinivasan K, Gheblawi M, Mandal R, Rousseau S, Wishart D, Prasad V, Richer L, Cheung AM, Oudit GY. Plasma taurine level is linked to symptom burden and clinical outcomes in post-COVID condition. PLoS One. 2024 Jun 5;19(6):e0304522. doi: 10.1371/journal.pone.0304522. eCollection 2024.
- Oikonomou E, Souvaliotis N, Lampsas S, Siasos G, Poulakou G, Theofilis P, Papaioannou TG, Haidich AB, Tsaousi G, Ntousopoulos V, Sakka V, Charalambous G, Rapti V, Raftopoulou S, Syrigos K, Tsioufis C, Tousoulis D, Vavuranakis M. Endothelial dysfunction in acute and long standing COVID-19: A prospective cohort study. Vascul Pharmacol. 2022 Jun;144:106975. doi: 10.1016/j.vph.2022.106975. Epub 2022 Mar 3.
- Ratchford SM, Stickford JL, Province VM, Stute N, Augenreich MA, Koontz LK, Bobo LK, Stickford ASL. Vascular alterations among young adults with SARS-CoV-2. Am J Physiol Heart Circ Physiol. 2021 Jan 1;320(1):H404-H410. doi: 10.1152/ajpheart.00897.2020. Epub 2020 Dec 11.
- Ballering AV, van Zon SKR, Olde Hartman TC, Rosmalen JGM; Lifelines Corona Research Initiative. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. 2022 Aug 6;400(10350):452-461. doi: 10.1016/S0140-6736(22)01214-4.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Post-Infectious Disorders
- COVID-19
- Pathologic Processes
- Chronic Disease
- Disease Attributes
- Respiratory Tract Infections
- Infections
- RNA Virus Infections
- Virus Diseases
- Respiratory Tract Diseases
- Lung Diseases
- Pneumonia, Viral
- Pneumonia
- Coronavirus Infections
- Coronaviridae Infections
- Nidovirales Infections
- Pathological Conditions, Signs and Symptoms
- Post-Acute COVID-19 Syndrome
Other Study ID Numbers
Other Study ID Numbers
- Edgell Long COVID trial
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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