NAC Effect on Iron Overload and Blood Transfusion in β-thalassemia Major

August 22, 2023 updated by: Asmaa Adel Saber morsi, Assiut University

The Effect of N_acetylcystein as an Antioxidant on Iron Overload and Frequency of Blood Transfusion in β-thalassemia Major Patients at Assiut Childern Hospital University

The effect of N_acetylcystein as an antioxidant on iron overload and frequency of blood transfusion in β-thalassemia major patients at Assiut Childern Hospital University And its cosubmitted for partial fulfillment of master degree in Pediatrics

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Beta thalassemia major it menifests after 6 months of life by severe anemia requiring life-long blood transfusion,which is the the gold standard therapy causing many complications including iron overload which associated to a certain extent with the generation of labile iron in the pathological red blood cell (RBC). The appearance of such forms of iron at the inner and outer cell surfaces exposes the cell to formation of reactive oxygen species (ROS),particularly the hydroxyl radical (·OH) serving as a Fenton reagent, Hydroxyl radical facilitated by membraneassociated iron might be particularly harmful because radical generation would be relatively sequestered from the cell antioxidant capacity and occur directly adjacent to lipid and protein membrane components exceeding cellular defense capacities causing oxidtive stress with prematre cell damage which is the main pathophysiological process in thalassemia . the fact that iron plays a major role in the generation of ROS implies that iron chelators can also serve as antioxidants. Obviously, chelation of iron is one of the major therapeutic goals in thalassemia. Consequently, the orally administered iron chelator deferiprone was able to remove free iron from β- thalassemic red cell membranes in a dose-related fashion, Deferiprone alleviated membrane damage possibly mediated by catalytic iron, such as In a few patients with Hb E/β thalassemia in Thailand, following administration of deferiprone alone for an average of 50 weeks, Hb levels increased concomitant with a decrease in transfusion requirement One possible explanation for this finding is that deferiprone acted like an antioxidant by removing excess free iron from the cells and, as a result, ROS generation was decreased. However, the antioxidant effect of this iron chelator by itself was not sufficient to neutralize the damage induced by ROS Moreover, oral administration of other antioxidant such as vitamin E, which is a lipid antioxidant, exhibited improvement in oxidant-antioxidant balance in the plasma . Another antioxidant that acts primarily on proteins is n_acetylcysteine, which improved certain parameters resulting from oxidative damage to sickle RBCs. here we will give the N_acetylcysteine orally in dose 10mg\kg\day to the thalassemic patients for 6 months and observing its effect as antioxidant on iron overload and the frequency in blood transfusion The ultimate purpose of all these observations is to try to design a combination of antioxidants consisting of an iron chelator, such as deferiprone, vitamin E as antioxidant for the lipids, and N-acetylcysteine as antioxidant for the proteins to decrease the deleterious effect of ORS.

Study Type

Interventional

Enrollment (Estimated)

100

Phase

  • Phase 1

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

3 years to 16 years (Child)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • thalassemia major children .
  • On oral iron chelation .

Exclusion Criteria:

  • change in the dose of iron chelation within 3 months before enrollement or during study period .
  • Liver impairment
  • Renal impairment
  • patients not adeherent to therapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: N_acetylcystein as antioxidant on iron and frequency of blood transfusion in thalassemia major
N_acetylcystein administration on single oral dose 10mg /kg for 6 months and it's effect on iron and frequency of blood transfusion before and after its use.
Drug: n-acetylcystine
Single daily oral administration of N_acetylcystein on dose 10mg /kg/day
Other Names:
  • acetylcystein

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Serum ferritin level
Time Frame: 6 months from the baseline
Measuring serum ferritin level (mg/dl) before and after 6 months of acetylcystein administration.
6 months from the baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

March 23, 2024

Primary Completion (Estimated)

April 30, 2024

Study Completion (Estimated)

April 30, 2024

Study Registration Dates

First Submitted

January 7, 2023

First Submitted That Met QC Criteria

March 9, 2023

First Posted (Actual)

March 21, 2023

Study Record Updates

Last Update Posted (Actual)

August 23, 2023

Last Update Submitted That Met QC Criteria

August 22, 2023

Last Verified

March 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NAC as antioxidant

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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