Impact of Propionic Acid on Regulatory T Cell Function in Children With CKD
- Conditions
- CKD (Chronic Kidney Disease) Stage 5D
- Interventions
- Other: PlaceboDietary Supplement: Sodium propionate
- Registration Number
- NCT05858437
- Lead Sponsor
- Charite University, Berlin, Germany
- Brief Summary
Pro-Kids is a multi-center, double-blind, randomized and placebo-controlled intervention study in children with chronic kidney disease. The investigators address the effect of a dietary food supplementation of propionic acid on the immune system and the function of the intestinal barrier in CKD patients treated with hemodialysis.
- Detailed Description
Chronic inflammation is a major risk factor of cardiovascular disease progression in CKD, irrespective of confounding comorbidities. Based on current knowledge, microbially-derived metabolites such as short chain fatty acids (SCFA) play an important role in the regulation of chronic inflammatory processes in CKD patients. Children with CKD are known to have reduced serum levels of the SCFA propionic acid (PA), as a consequence of both gut microbial dysbiosis and reduced fiber intake. In animal and human studies the impact of PA on function and abundance of regulatory T cells (Treg) has been demonstrated. Consequently, the investigators aim to normalize the PA serum levels by oral PA food supplementation in hemodialysis patients in order to mitigate chronic inflammation.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 16
- Body weight: > 30kg
- CKD G5 treated with hemodialysis
- Continuous hemodialysis treatment for > 3 months
- Clinical stable condition
- Manifestation of CKD within childhood (<18 years)
- Disease or dysfunctions, which disqualifies the patient
- Incapacity of contract or any other circumstances, which prohibit the patient or his legal guardians from understanding setup, meaning and entity of the study
- Acute infections
- Immunosuppressive therapy within the last 12 weeks before the start of the study
- Pre-/pro- or postbiotic or antibiotic therapy within the last 4 weeks before the start of the study
- Planned or unplanned hospitalization within in last 4 weeks before the start of the study or during study
- Malignant diseases
- Pregnancy
- chronic gastrointestinal or hepatic diseases (for example chronic inflammatory bowel disease
- alcohol- or drug abuse
- parallel participation on other interventional trials
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Intervention Placebo The control-group receives a placebo instead of propionate. The placebo contains maltodextrin and the same amount of sodium chloride as compared to the PA intervention. The placebo is taken twice per day for 28 days. PA Intervention Sodium propionate The group which receives the PA as a dietary food supplement. A single capsule contains 500mg of sodiumpropionate, which is taken twice daily for 28 days.
- Primary Outcome Measures
Name Time Method Change in count of regulatory T-cells from baseline to week 4 Baseline visit (week 0) in comparison to week 4 Analysis of Treg counts in whole blood (absolute quantification) and peripheral blood mononuclear cells (PBMC; relative quantification) by flow cytometry.
- Secondary Outcome Measures
Name Time Method Cholesterol levels Baseline visit (week 0); Week 2; Week 4; Week 12 Cholesterol levels will be assessed using standard clinical lab values.
Immune cell phenotyping of peripheral blood mononuclear cells (PBMC) Baseline visit (week 0); Week 2; Week 4; Week 12 Patients PBMC will be thawed and immune cells we be analyzed using multicolor flow cytometry and mass cytometry. By using a broad range of different antibodies combined in several panels the investigators will analyse distinct T cell subtypes including markers of activation, but also other immune cells (including B cells, dendritic cells, monocytes, natural killer cells). Data will reported in relation to parent populations (e.g. T heller cells in % of T cells).
Single cell RNA sequencing of immune cells Baseline visit (week 0); Week 4 Analysis of the transcriptome of immune cells using cellular indexing of transcriptomes and epitopes (CITEseq)
Taxonomy of the fecal microbiome Baseline visit (week 0); Week 4 The taxonomy of the fecal microbiome will be anayzed using 16S RNA amplicon sequencing.
T regulatory cell (Treg) suppression assay Baseline visit (week 0); Week 4 The suppressive capacity of patients Treg will be analyzed by co-cultivation with conventional, stimulated T cells (Tconv) in different proportions (Treg:Tconv). The proliferation of Tconv will be reported.
Propionic acid serum levels and targeted metabolomics Baseline visit (week 0); Week 2; Week 4; Week 12 Analysis of PA serum levels and other microbially-derived metabolites by GC-MS and LC-MS
Intestinal barrier function Baseline visit (week 0); Week 2; Week 4; Week 12 Analysis of biomarkers for intestinal barrier function, such as sCD14, zonulin-1 and LPS
Cardiovascular Phenotyping Baseline visit (week 0); Week 2; Week 4; Week 12 Analysis of blood pressure over time.
Trial Locations
- Locations (1)
Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité-Universitätsmedizin Berlin
🇩🇪Berlin, Germany