Hydroxy Urea, Omega 3, Nigella Sativa,Honey on Oxidative Stress and Iron Chelation in Pediatric Major Thalassemia

• ClinicalTrials.gov Identifier: NCT04292314
• Recruitment Status: Completed
• First Posted: March 3, 2020
• Last Update Posted: January 27, 2021
• Sponsor: Beni-Suef University
• Collaborators: Maternity and Children Hospital, Makkah; Beni-Suef Health insurance hospital; University of Arizona
• Information provided by (Responsible Party): Mohamed Medhat Abdelwahab Gamaleldin, Beni-Suef University

Study Description

Brief Summary:

The aim of the present study is evaluating the strength of combination therapy of hydroxy urea, omega 3, nigella sativa and honey on antioxidant-oxidant status (OXIDATIVE STRESS) in response to reactive oxygen species production (LIPID PEROXIDATION) and their effect on iron intoxication (IRON CHELATION) in pediatric major thalassemia.

Condition or disease	Intervention/treatment	Phase
Iron Overload; Oxidative Stress; Thalassemia Major	Drug: Omega 3; Drug: Nigella Sativa Oil; Drug: Hydroxyurea; Drug: Honey; Drug: Deferoxamine; Procedure: blood transfusion session	Phase 2; Phase 3

Detailed Description:

Beta thalassemia is a blood disorder that reduces the production of hemoglobin. Hemoglobin is the iron-containing protein in red blood cells that carries oxygen to cells throughout the body. In people with beta thalassemia, low levels of hemoglobin lead to a lack of oxygen in many parts of the body. Affected individuals also have a shortage of red blood cells (anemia), which can cause pale skin, weakness, fatigue, and more serious complications. People with beta thalassemia are at an increased risk of developing abnormal blood clots. Beta thalassemia is classified into two types depending on the severity of symptoms: thalassemia major (also known as Cooley's anemia) and thalassemia intermedia. Of the two types, thalassemia major is more severe.

Beta-thalassemia syndromes are a group of hereditary blood disorders. It is characterized by reduced beta globin chain synthesis, resulting in reduced Hb in red blood cells (RBC), decreased RBC production and anemia.

Homozygotes for beta-thalassemia may develop either thalassemia major or thalassemia intermedia. Individuals with thalassemia major usually come to medical attention within the first 2 years and require regular blood transfusion to survive.

Affected infants with thalassemia major fail to thrive and become progressively pale. Feeding problems, diarrhea, irritability, recurrent bouts of fever, and enlargement of the abdomen, caused by splenomegaly, may occur. If a regular transfusion program that maintains a minimum Hb concentration of 95-105 g/L is initiated, then growth and development are normal until the age of 10-11 years. After the age of 10-11 years, affected individuals are at risk of developing severe complications related to posttransfusional iron overload, depending on their compliance with chelation therapy.

Complications of iron overload include growth retardation and failure of sexual maturation and also those complications observed in adults with hemachromatosis -associated hereditary hemochromatosis (HH): involvement of the heart (dilated myocardiopathy and pericarditis), liver (chronic hepatitis, fibrosis, and cirrhosis), and endocrine glands (resulting in diabetes mellitus and insufficiency of the parathyroid, thyroid, pituitary, and, less commonly, adrenal glands).

The underlying basis of b-thalassemia pathology is the diminished b-globin synthesis leading to a-globin accumulation and premature apoptotic destruction of erythroblasts, causing oxidative stress-induced ineffective erythropoiesis.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 350 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment

Intervention Model Description

Four experimental groups, one control group.

Each experimental group receives different experimental treatments plus traditional treatment in the hospital and the control group receives only traditional treatment.

• Masking: Double (Participant, Care Provider)
• Primary Purpose: Treatment
• Official Title: Impact of Combination Therapy Between Hydroxy Urea, Omega 3, Nigella Sativa and Honey on Antioxidant-oxidant Status and Reduction of Iron Overload in Pediatric Major Thalassemia
• Actual Study Start Date: November 1, 2019
• Actual Primary Completion Date: December 20, 2020
• Actual Study Completion Date: January 20, 2021

Arms and Interventions

Arm	Intervention/treatment
Experimental: Omega-3 experimental group; 50 patients from each participating hospital that will receive Omega-3 supplementation (300-400mg EPA & 200-300mg DHA) per day for 8 consecutive months up to 10 months. in addition to experimental treatment this group will receive the traditional treatment of deferoxamine/deferasirox plus regular blood transfusion with dose de-escalation methods till efficacy of experimental treatment proved.	Drug: Omega 3; Omega-3 supplementation (300-400mg EPA & 200-300mg DHA) per day for 8 consecutive months up to 10 months; Drug: Deferoxamine; deferoxamine (SubQ infusion: 20 to 40 mg/kg/day over 8 to 12 hours, 6 to 7 nights per week, maximum daily dose: 40 mg/kg/day)for 8 consecutive months up to 10 months.; Procedure: blood transfusion session; Regular blood transfusion session based on patient hematological profile starts from one session every 2 weeks.
Experimental: Nigella sativa experimental group; 50 patients from each participating hospital that will receive Nigella sativa supplementation (1g black seed oil contain 1% thymoquinone) per day for 8 consecutive months up to 10 months. in addition to experimental treatment this group will receive the traditional treatment of deferoxamine/deferasirox plus regular blood transfusion with dose de-escalation methods till efficacy of experimental treatment proved.	Drug: Nigella Sativa Oil; Nigella sativa supplementation (1g black seed oil contain 1% thymoquinone) per day for 8 consecutive months up to 10 months; Drug: Deferoxamine; deferoxamine (SubQ infusion: 20 to 40 mg/kg/day over 8 to 12 hours, 6 to 7 nights per week, maximum daily dose: 40 mg/kg/day)for 8 consecutive months up to 10 months.; Procedure: blood transfusion session; Regular blood transfusion session based on patient hematological profile starts from one session every 2 weeks.
Experimental: Hydroxyurea experimental group; 50 patients from each participating hospital that will receive hydroxyurea medication (5 to 15mg/kg) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of deferoxamine/deferasirox plus regular blood transfusion with dose de-escalation methods until the efficacy of experimental treatment proved.	Drug: Hydroxyurea; hydroxyurea medication (5 to 15mg/kg) per day for 8 consecutive months up to 10 months.; Drug: Deferoxamine; deferoxamine (SubQ infusion: 20 to 40 mg/kg/day over 8 to 12 hours, 6 to 7 nights per week, maximum daily dose: 40 mg/kg/day)for 8 consecutive months up to 10 months.; Procedure: blood transfusion session; Regular blood transfusion session based on patient hematological profile starts from one session every 2 weeks.
Experimental: Natural honey experimental group; 50 patients from each participating hospital that will receive natural honey(2.5 mg/kg dissolved in 250 ml water) per day for 8 consecutive months up to 10 months. in addition to the experimental treatment, this group will receive the traditional treatment of deferoxamine/deferasirox plus regular blood transfusion with dose de-escalation methods until the efficacy of experimental treatment proved.	Drug: Honey; Natural honey(2.5 mg/kg dissolved in 250 ml water) per day for 8 consecutive months up to 10 months.; Other Name: Natural honey formulation; Drug: Deferoxamine; deferoxamine (SubQ infusion: 20 to 40 mg/kg/day over 8 to 12 hours, 6 to 7 nights per week, maximum daily dose: 40 mg/kg/day)for 8 consecutive months up to 10 months.; Procedure: blood transfusion session; Regular blood transfusion session based on patient hematological profile starts from one session every 2 weeks.
Active Comparator: Ordinary hospital treatment group; 50 patients from each participating hospital that will receive the ordinary treatment of iron chelator agent of deferoxamine or deferasirox (SubQ infusion: 20 to 40 mg/kg/day over 8 to 12 hours, 6 to 7 nights per week, maximum daily dose: 40 mg/kg/day)for 8 consecutive months up to 10 months. in addition to iron chelator agent, this group receive regular blood transfusion session.	Drug: Deferoxamine; deferoxamine (SubQ infusion: 20 to 40 mg/kg/day over 8 to 12 hours, 6 to 7 nights per week, maximum daily dose: 40 mg/kg/day)for 8 consecutive months up to 10 months.; Procedure: blood transfusion session; Regular blood transfusion session based on patient hematological profile starts from one session every 2 weeks.

Outcome Measures

Primary Outcome Measures :

1. F 2 -isoprostanes pg/mL [ Time Frame: 3 months ]
   plasma F 2 -isoprostanes Picograms Per Millilitre measured by high pressure liquid chromatography assay
2. Total cholesterol Mg/dl [ Time Frame: 10 months ]
   Total cholesterol milligrams per deciliter
3. HDL cholesterol Mg/dl [ Time Frame: 10 months ]
   HDL cholesterol milligrams per deciliter
4. LDL cholesterol Mg/dl [ Time Frame: 10 months ]
   LDL cholesterol milligrams per deciliter
5. Triglycerides Mg/dl [ Time Frame: 10 months ]
   Triglycerides milligrams per deciliter
6. Serum total iron mcg/dL [ Time Frame: 10 months ]
   Serum total iron micrograms per decilitre
7. % transferrin saturation [ Time Frame: 10 months ]
   transferrin saturation percentage
8. C-reactive protein mg/L [ Time Frame: 10 months ]
   C-reactive protein milligrams per deciliter
9. Serum Ferritin ng/ml [ Time Frame: 10 months ]
   Serum Ferritin Nanograms per milliliter
10. Total Iron Binding Capacity (TIBC) mcg/dL [ Time Frame: 10 months ]
    Total Iron Binding Capacity micrograms per decilitre
11. hemoglobin (Hbg) g/dL [ Time Frame: 10 months ]
    hemoglobin (Hbg) gram/deciliter
12. mean corpuscular hemoglobin (MCH) pg/ml [ Time Frame: 10 months ]
    mean corpuscular hemoglobin (MCH) Picograms Per Millilitre
13. leukocytes count μl [ Time Frame: 10 months ]
    leukocytes in microliter
14. % Chelation activity Fe+++ - thymoquinone complex [ Time Frame: 3 months ]
    Chelation activity of Ferric - thymoquinone complex in percentage measured by high pressure liquid chromatography coupled with gaschromatography - mass spectroscopy analysis
15. % Chelation activity Fe++ - thymoquinone complex [ Time Frame: 3 months ]
    Chelation activity of Ferrous - thymoquinone complex in percentage measured by high pressure liquid chromatography coupled with gaschromatography- mass spectroscopy analysis
16. Lactic acid dehydrogenase U/L [ Time Frame: 10 months ]
    Lactic acid dehydrogenase unit per litter
17. Reticulocyte count % [ Time Frame: 10 months ]
    Reticulocyte count percentage
18. Hb-F level g/dL [ Time Frame: 10 months ]
    hemoglobin- F level in gram per deciliter
19. Reticulocyte absolute count [ Time Frame: 10 months ]
    Reticulocyte absolute count in a cubic milliliter of blood
20. White blood cells count [ Time Frame: 10 months ]
    White blood cells count in a cubic milliliter of blood

Eligibility Criteria

• Ages Eligible for Study: 7 Years to 15 Years (Child)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Any case with full manifestation of β-THALASSEMIA major disease
2. #Aged from 7-15 years old
3. # accompanied with ineffective erythropoiesis
4. # with low hemoglobin level
5. # with iron overload

Exclusion Criteria:

1. The presence of any other chronic illness.
2. Patient age>15 years old or < 7 years old.
3. The presence of concomitant myocardial infarction, stroke, acute chest syndrome.
4. The patient suffers from any other type of anemia.

Contacts and Locations

Locations

Egypt

Faculty of medicine, Beni-suef univeristy - Beni-Suef university hospital

Banī Suwayf, Egypt

Faculty of Pharmacy, Beni-Suef university

Banī Suwayf, Egypt

Health insurance hospital

Banī Suwayf, Egypt

Saudi Arabia

Maternity and Children hospital

Mecca, Saudi Arabia

Sponsors and Collaborators

Beni-Suef University

Maternity and Children Hospital, Makkah

Beni-Suef Health insurance hospital

University of Arizona

Investigators

• Study Director: IVO IBRAHAM [Prof of Pharmacy, Clinical Translational Sciences], Ph.D.; University of Arizona, College of Pharmacy
• Study Director: AHMED A ALBERRY [Assistant prof of clinical pharmacology], Ph.D.; Beni-Suef University, Faculty of medicine
• Study Director: RAGHDA R SAYED [Lecturer of Clinical Pharmacy], Ph.D.; Beni-Suef University, Faculty of Pharmacy
• Principal Investigator: MOHAMED M ABDELWAHAB GAMALELDIN, Ph.D Student; Beni-Suef University, Faculty of Pharmacy
• Study Director: Mohamed H Meabad [Prof of Pediatrics], M.D; Beni-Suef university, Faculty of medicine
• Study Director: Ahmed F Mahmoud Hussein, MS.c; Beni-Suef Health insurance hospital

More Information

• Responsible Party: Mohamed Medhat Abdelwahab Gamaleldin, Dr.Mohamed Medhat Abdelwahab Gamaleldin, Beni-Suef University
• ClinicalTrials.gov Identifier: NCT04292314
• Other Study ID Numbers: TQ/Omega-3 on Thalassemia
• First Posted: March 3, 2020
• Last Update Posted: January 27, 2021
• Last Verified: January 2021

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Mohamed Medhat Abdelwahab Gamaleldin, Beni-Suef University:

thymoquinone; omega3; hydroxyurea; pediatric Thalassemia Major; oxidative stress; iron chelation; iron overload; chelation activity of thymoquinone; antioxidant effect of omega3; anti-hemolysis effect of hydroxyurea

Additional relevant MeSH terms:

Thalassemia; beta-Thalassemia; Iron Overload; Anemia, Hemolytic, Congenital; Anemia, Hemolytic; Anemia; Hematologic Diseases; Hemoglobinopathies; Genetic Diseases, Inborn; Iron Metabolism Disorders; Metabolic Diseases; Hydroxyurea; Deferoxamine; Antineoplastic Agents; Antisickling Agents; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Nucleic Acid Synthesis Inhibitors; Siderophores; Iron Chelating Agents; Chelating Agents; Sequestering Agents