Broccoli In Osteoarthritis (BRIO)

A Dietary Intervention Trial to Examine the Effect of Broccoli Bioactives (Specifically Sulforaphane) on Osteoarthritis (OA)

To determine whether dietary sulforaphane (SFN), naturally available from eating broccoli, improves pain in people with knee osteoarthritis (OA), the trial will compare broccoli soup (rich in SFN) with a soup, which does not contain broccoli (control), but looks and tastes the same. Sixty-four participants with moderate osteoarthritis, chosen at random, will either have the broccoli or the control soup. The participants will eat the soup once-a-day, for 4 days-a-week for 3 months.

Study Overview

• Status: Completed
• Conditions: Osteoarthritis
• Intervention / Treatment: Dietary supplement: Sulforaphane; Dietary supplement: Placebo

Detailed Description

This is the first clinical trial to test the benefits of eating broccoli on pain and physical function in knee osteoarthritis (OA).

Many fruits and vegetables in the normal human diet contain substances that may improve human health or disease. There is increasingly strong laboratory data that indicate that exposure to these substances at the levels found in the diet influence the way in which osteoarthritis develops. Sulforaphane (SFN) is a naturally occurring substance found in vegetables such as broccoli and is known to have helpful effects on cartilage cells. Sulforaphane derived from broccoli, has a potential role in limiting pain and cartilage destruction in OA.

The investigators have shown that:

• SFN can stop inflammation in mice with OA
• SFN blocks the production of the enzymes which break down cartilage in OA, both in cell cultures and in pieces of cartilage
• SFN enters the joint in participants provided with a high broccoli diet ahead of a knee replacement and alters the types of proteins present in the joint fluid

The investigators aim to discover for the first time in man, whether a broccoli-rich diet will improve pain and physical function in participants with knee osteoarthritis. The study will provide the much-needed preliminary data that will allow the investigators to design a clinical trial to prove that broccoli can be recommended as a helpful food for people with OA.

The trial will compare broccoli soup (rich in SFN) with a soup, which does not contain broccoli (control), but looks and tastes the same. Sixty-four participants with moderate osteoarthritis will either have the broccoli or the control soup, chosen at random. The participants will eat the soup once-a-day, for 4 days-a-week for 3 months. The investigators will measure pain and physical function at the start of the trial, at 6 weeks and at 12 weeks and look at the changes in these. The investigators will also take blood samples and collect urine to measure SFN levels.

• Study Type: Interventional
• Enrollment (Actual): 24
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Norfolk
    • Norwich, Norfolk, United Kingdom, NR4 7UY
      • Norfolk & Norwich University Hospital
  • West Yorkshire
    • Leeds, West Yorkshire, United Kingdom, LS7 4SA
      • Chapel Allerton Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 48 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Current knee pain, defined as pain in either knee, in the (one) month before Visit 1, for which the patient gives a severity score of at least 4 on a 0-10 numeric rating scale (NRS).
2. The target knee should fulfil the criteria of the American College of Rheumatology (ACR) for knee osteoarthritis defined as knee pain for most days of the prior month and at least one of the following three factors: age over 50 years; morning stiffness of less than 30 minutes; knee crepitus on motion.
3. Kellgren Lawrence grade 2-3
4. Stable analgesic usage (if using) for 4 weeks prior to trial entry and throughout the trial duration
5. Able to adhere to the study visit schedule and other protocol requirements (willing to consume soup intervention).
6. Willing to provide 24 hour urine collection samples (x3)
7. Capable of giving informed consent and the consent must be obtained prior to any screening procedures.

Exclusion Criteria:

1. The presence of any inflammatory arthritis (e.g. gout, reactive arthritis, rheumatoid arthritis, psoriatic arthritis, seronegative spondylarthropathy) or fibromyalgia or metabolic bone disease.
2. Any clinically significant uncontrolled concurrent illness, which, in the opinion of the Investigator, would impair ability to give informed consent or take part in or complete this clinical study.
3. Known or suspected intolerance or hypersensitivity to the investigational product (broccoli) or standardised meal (see section 9.2), closely related compounds, or any of the stated ingredients.
4. Use of an investigational product within 30 days prior to 'run in' period or active enrolment in another drug or vaccine clinical study.
5. Significant knee injury or any knee surgery within the 6 months preceding enrolment in the study.
6. A history of partial or complete joint replacement surgery in the signal knee at any time, listed for knee surgery, or anticipating knee surgery during the study period.
7. Poor tolerability of venepuncture or lack of adequate venous access for required blood sampling during the study period
8. Nutritional deficiency
9. Use of anticoagulant medication (see notes for inclusion exclusion criteria)
10. Use of intra-articular hyaluronic acid in the signal knee within the 3 months preceding enrolment in the study.
11. Use of intra-articular, intra-muscular or oral corticosteroids in the 2 months preceding enrolment.
12. Commencement of non-pharmacological interventions within two months preceding enrolment.
13. Persons less than 50 years
14. Pregnant/lactating women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; 32 participants with moderate osteoarthritis will eat soup with the active ingredient once-a-day for 4 days-a-week for 3 months.	Dietary supplement: Sulforaphane; Intervention soup with dietary sulforaphane
Active Comparator: Control; 32 participants with moderate osteoarthritis will eat soup without the active ingredient once-a-day for 4 days-a-week for 3 months.	Dietary supplement: Placebo; Control soup without dietary sulforaphane

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
WOMAC (Western Ontario and McMaster Universities Arthritis Index)	Change in the WOMAC (Western Ontario and McMaster Universities Arthritis Index) pain subscale.	Baseline and 12 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
WOMAC (Western Ontario and McMaster Universities Arthritis Index): Pain	Pain (5 items): during walking, using stairs, in bed, sitting or lying, and standing upright	6 weeks
WOMAC (Western Ontario and McMaster Universities Arthritis Index): Physical Function	Physical Function (17 items): using stairs, rising from sitting, standing, bending, walking, getting in / out of a car, shopping, putting on / taking off socks, rising from bed, lying in bed, getting in / out of bath, sitting, getting on / off toilet, heavy domestic duties, light domestic duties	6 & 12 weeks
WOMAC (Western Ontario and McMaster Universities Arthritis Index): Stiffness	Stiffness (2 items): after first waking and later in the day	6 & 12 weeks
11 Point Pain Numerical Rating Scale (NRS): Average overall knee pain severity in the index knee over the past 1 week	Minimum score '0' to maximum score '10' Lower numerical value is the better outcome	6&12 weeks
11 Point Pain Numerical Rating Scale (NRS): Worst knee pain severity in the index knee over the past 1 week	Minimum score '0' to maximum score '10' Lower numerical value is the better outcome	6&12 weeks
11 Point Pain Numerical Rating Scale (NRS): Global disease activity over the past 1 week	Minimum score '0' to maximum score '10' Lower numerical value is the better outcome	6&12 weeks
11 point pain Numerical Rating Scale (NRS): Satisfaction with index knee function over the past 1 week	Minimum score '0' to maximum score '10' Lower numerical value is the better outcome	6&12 weeks
11 point pain Numerical Rating Scale (NRS): Average pain in other joints over the past 1 week	Minimum score '0' to maximum score '10' Lower numerical value is the better outcome	6&12 weeks
Pain in other joints	Joint manikin	6&12 weeks
Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)	Self-Assessment	6&12 weeks
Rescue analgesics/NSAIDs	Use of rescue analgesics/NSAIDs	6&12 weeks

Collaborators and Investigators

• Sponsor: University of East Anglia
• Collaborators: University of Leeds
• Investigators: Study Director: Alexander MacGregor, PhD, University of East Anglia

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2019
• Primary Completion (Actual): December 1, 2021
• Study Completion (Actual): December 1, 2021

Study Registration Dates

• First Submitted: March 14, 2019
• First Submitted That Met QC Criteria: March 14, 2019
• First Posted (Actual): March 18, 2019

Study Record Updates

• Last Update Posted (Actual): May 17, 2022
• Last Update Submitted That Met QC Criteria: May 16, 2022
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Keywords: Sulforaphane
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Physiological Effects of Drugs; Antineoplastic Agents; Protective Agents; Anticarcinogenic Agents; Sulforaphane
• Other Study ID Numbers: BRIO Protocol V4.0

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No