Lactoferrin in Treatment of Fe Deficient Anemia In Cirrhosis

Not Applicable

Recruiting

• Conditions: Iron Deficiency Anemia; Chronic Liver Failure
• Interventions: Drug: Lactoferrin + Iron Supplement; Drug: Iron Supplement

• Registration Number: NCT04335058
• Lead Sponsor: Post Graduate Institute of Medical Education and Research, Chandigarh

Brief Summary

Iron deficiency and altered homeostasis due to inflammation and decreased iron utilization are main factors involved in anemia in liver disease. Lactoferrin is a first line defence protein for protection against microbial infections and subsequent development of systemic disease as seen with systemic inflammatory response syndrome (SIRS) and sepsis. Lactoferrin with iron has been shown to be efficacious with anemia in chronic disease, in pregnancy and in cancer patients with fewer side effects than oral iron alone. High exposure to iron is associated with increased inflammation which is associated with worse cardiovascular outcomes. Lactoferrin can help reduce the total iron dose and hepatic inflammation.

Detailed Description

Lactoferrin is a highly conserved, monomeric 80 kDa single polypeptide chain contained in most mammalian exocrine secretions, such as milk, saliva and tears, bronchial, and intestinal secretions. LTF is also found in the secondary granules of neutrophils a glycoprotein present in milk, has been demonstrated to possess a multitude of biological functions. Lactoferrin in Inflammation and Sepsis The antimicrobial activity of LTF is well documented and consists of two mechanisms: one is iron dependent and deals with high affinity of LTF to iron (bacteriostatic), and the other one is due to LTF affinity to lipopolysaccharide (LPS) to function as a direct bactericidal agent for Gram-negative organisms. Small changes, such as single nucleotide polymorphisms, can affect outcomes against pathogenic agents . LTF interacts with cell surface receptors involved in "danger signal" recognition \[e.g., toll-like receptor (TLR)4, CD14, and CD22\]. At the molecular level, LTF seems to reduce LPS-induced monocyte activation and subsequent production of pro-inflammatory mediators. Lactoferrin in Anemia in Liver Disease The hepatic expression of the hepcidin gene is regulated by signals which reflect body iron status and erythropoietic activity. The regulation of hepcidin by iron status includes a signal from the circulating transferrin via hepatocellular transferrin receptor (TfR2). Like transferrin, lactoferrin will deliver iron to hepatocytes but unlike transferrin, lactoferrin cannot deliver iron to erythroid cells. Lactoferrin does not interact with TfR1 or TfR2.

Study Timeline

• Study Start: 2020-01-01
• Study First Submitted: 2020-03-23
• Study First Submitted QC: 2020-04-02
• Study First Posted: 2020-04-06
• Status Verified: 2023-04
• Last Update Submitted: 2023-04-28
• Last Update Posted: 2023-05-01
• Primary Completion: 2023-10
• Study Completion: 2023-12

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 130

Inclusion Criteria

1. Age 18-75 years
2. Either gender
3. Patients with chronic liver disease with iron deficiency anemia with transferrin saturation<20% and Hemoglobin in Non-pregnant women (15 years of age and above) <12g/dl and in men <13g/dl -

Exclusion Criteria

1. Those who do not consent to participate in the study
2. Inability to obtain informed consent from patient or relatives
3. Severe preexisting cardiopulmonary disease
4. Renal dysfunction (S. Creatinine ≥ 2mg/dL)
5. Pregnancy/Lactation
6. Post liver transplant patients
7. HIV infection
8. Patients who are on psychoactive drugs, like sedatives or antidepressants
9. Patients who are too sick to carry out the protocol

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group A: Lactoferrin plus oral iron	Lactoferrin + Iron Supplement	Treated for 2 months regularly with oral administration of 100 mg Lactoferrin tablet twice a day before meals with oral administration of 100 mg of elemental iron capsules, one capsule twice daily on an empty stomach, at least 1 hour before or 2 hours after meals
Oral iron alone	Iron Supplement	Oral administration of 100 mg of elemental iron capsules, one capsule twice daily on an empty stomach, at least 1 hour before or 2 hours after meals

Primary Outcome Measures

Name	Time	Method
Correction of Anemia	3 months	Number of participants achieving Hemoglobin level \> 12 g/dl

Secondary Outcome Measures

Name	Time	Method
Reduction in Inflammatory markers	3 months	IL-1, Hepcidin, Transferrin saturation measured

Trial Locations

Locations (1)

Postgraduate Institute of Medical Education and Research; 🇮🇳 Chandigarh, India