- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01367821
Immune Function in Patients With Obstructive Jaundice
Quorum Sensing Signal Molecules (QSSMs) and Immune Dysfunction in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for Obstructive Jaundice
Study Overview
Status
Detailed Description
Obstructive jaundice (OJ) is a condition where a blockage of flow of bile from the liver leads to the accumulation of bile products in the blood resulting in yellowing and itching of the skin. Common causes of OJ include gallstones and also tumours of the pancreas or bile duct. Relieving this type of jaundice and treating the underlying cause can include endoscopic or surgical procedures. It is known however, that patients with OJ have increased surgical risks than non-jaundiced patients who undergo the same operations. Studies have shown that surgery for severe OJ is associated with a postoperative mortality in the region of 10-15% and morbidity rates of 30-65%. Complications related to bacterial infection are common and patients developing severe infections may require treatment with broad spectrum antibiotics with care in intensive or high dependency units.
Although antibiotics have proved invaluable in treating postoperative infections they carry the potential for adverse effects. Antibiotics can suppress normal gut bacteria and allow disease causing bacteria to proliferate, such as Clostridium difficile. This usually manifests as mild-to-moderate diarrhoea but can occasionally cause life-threatening bowel inflammation. The widespread use of antibiotics is also central to the development of bacterial strains with antibiotic resistance. This clinical problem also has economic, political and environmental implications for the National Health Service. Adherence to measures of infection control, education and antibiotic policy can minimise antibiotic resistance; however the limits surrounding such approaches have led to a demand for novel or alternative strategies.
It has recently been discovered that bacteria are able to communicate by producing specialised molecules known as quorum sensing signalling molecules (QSSMs). An accumulation of QSSMs in their surrounding environment allow for the bacteria to quantify the size of colonies. At specific colony sizes the concentration of QSSMs reaches a critical threshold leading to the activation of genes that cause an infection. Disruption of quorum sensing has been shown to reduce the severity of infection in animal studies and this has led to the development of inhibitors of quorum sensing as a possible strategy in antibacterial therapy.
Previous work conducted at the University of Nottingham has demonstrated that QSSMs also influence the number and function of a specific type of immune cell known as 'antigen presenting cells'. These cells are pivotal in allowing the immune system to recognise components of bacteria as foreign and thereby mount the appropriate response. It was found that large numbers of these types of cells underwent programmed cell death (cell suicide) in the presence of QSSMs compared to when QSSMs were absent. This mirrors the situation in blood sampled from patients with severe infections where there is a greater proportion of cell deaths among antigen presenting cells than other types of immune cell.
It is likely that the susceptibility to infectious complications in patients with obstructive jaundice is due to the interplay of various factors. The absence of intestinal bile has implications for the integrity of the bowel wall as a barrier, changes in gut microflora flora and translocation of both bacteria and their products. In addition, it is clear that a form of immune dysfunction occurs, which dampens the normal response following exposure to bacterial products. This immune dysfunction may avert powerful inflammatory cascades resulting in life-threatening multi organ dysfunction but at the expense of conditions that favour bacterial survival. QSSMs represent good candidates for the mediators of this immune dysfunction and although there is a compelling case for their involvement in the pathogenesis of sepsis, definitive evidence to support their role in infective processes in OJ is currently lacking.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Locations
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Nottinghamshire
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Nottingham, Nottinghamshire, United Kingdom, NG7 2UH
- Recruiting
- Queen's Medical Centre
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Contact:
- Abeed H Chowdhury, MBChB MRCS
- Phone Number: 441158231144
- Email: abeed.chowdhury@nottingham.ac.uk
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Principal Investigator:
- Abeed H Chowdhury, MBChB MRCS
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Sub-Investigator:
- Guruprasad Aithal, MD MRCP
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Sub-Investigator:
- Dileep N Lobo, FRCS FACS
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Obstructive jaundice
- Willing to participate and able to give informed consent
- Alcohol abstinence during study
Exclusion Criteria:
- Acute Physiology and Chronic Health Evaluation (APACHE) II Score ≥8
- Severe neutropaenia
- Smokers/substance abuse
- Diabetes Mellitus
- Oral/IV Steroids
- On regular antibiotics
- Patients with active cholangitis
- Patients who have a history liver transplantation or chronic liver disease
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
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Healthy volunteers
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Patients with obstructive jaundice
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in monocyte cytokine responses to endotoxin stimulation
Time Frame: Baseline (pre ERCP) and post ERCP days 1, 7, 14 and 30
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Evaluation of monocyte cytokine responses to endotoxin stimulation at specified time points
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Baseline (pre ERCP) and post ERCP days 1, 7, 14 and 30
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in concentration of systemic quorum sensing signaling molecules
Time Frame: Baseline (pre ERCP) and post ERCP days 1, 7, 14 and 30
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Evaluation of the presence of quorum sensing signalling molecules in the systemic circulation at specified time points
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Baseline (pre ERCP) and post ERCP days 1, 7, 14 and 30
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Abeed H Chowdhury, MBChB MRCS, University of Nottingham
Publications and helpful links
General Publications
- Blamey SL, Fearon KC, Gilmour WH, Osborne DH, Carter DC. Prediction of risk in biliary surgery. Br J Surg. 1983 Sep;70(9):535-8. doi: 10.1002/bjs.1800700910.
- Han XC, Li JL, Han G. Surgical mortality in patients with malignant obstructive jaundice: a multivariate discriminant analysis. Hepatobiliary Pancreat Dis Int. 2003 Aug;2(3):435-40.
- Povoski SP, Karpeh MS Jr, Conlon KC, Blumgart LH, Brennan MF. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg. 1999 Aug;230(2):131-42. doi: 10.1097/00000658-199908000-00001.
- Wang Q, Gurusamy KS, Lin H, Xie X, Wang C. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005444. doi: 10.1002/14651858.CD005444.pub2.
- Diggle SP, Crusz SA, Camara M. Quorum sensing. Curr Biol. 2007 Nov 6;17(21):R907-10. doi: 10.1016/j.cub.2007.08.045. No abstract available.
- Martin CA, Hoven AD, Cook AM. Therapeutic frontiers: preventing and treating infectious diseases by inhibiting bacterial quorum sensing. Eur J Clin Microbiol Infect Dis. 2008 Aug;27(8):635-42. doi: 10.1007/s10096-008-0489-3. Epub 2008 Mar 6.
- Williams P. Bacillus subtilis: a shocking message from a probiotic. Cell Host Microbe. 2007 Jun 14;1(4):248-9. doi: 10.1016/j.chom.2007.05.010.
- Boontham P, Robins A, Chandran P, Pritchard D, Camara M, Williams P, Chuthapisith S, McKechnie A, Rowlands BJ, Eremin O. Significant immunomodulatory effects of Pseudomonas aeruginosa quorum-sensing signal molecules: possible link in human sepsis. Clin Sci (Lond). 2008 Dec;115(11):343-51. doi: 10.1042/CS20080018.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 10040 (Other Identifier: Fred Hutch/University of Washington Cancer Consortium)
- 10/H0408/53 (Other Identifier: Nottingham Research Ethics Committee 2)
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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