INTRODUCTION: This study will explore the potential role of silymarin (Sm) in patients with chronic hepatitis C (HCV). The majority of HCV patients are unresponsive to interferon-alfa (IFN?) based therapy. There is some evidence to suggest that Sm may ameliorate liver injury by acting as an antioxidant and by altering lymphocyte responses. These effects could influence HCV by modulating fibrosis and/or viremia.
SPECIFIC AIMS : (1) to determine the safety, tolerability and pharmacokinetics (PK) of a single oral dose administration of Sm relative to placebo in HCV patients non-responsive to IFNa based therapy, (2) to evaluate the therapeutic role of various doses of Sm compared to placebo in HCV patients by assessing parameters of liver injury (alanine aminotransferase [ALT]) ,(3) to evaluate the mechanism of Sm in the above cohort by studying the dose response effect of Sm on oxidative stress (OS) markers, immunological and virological responses, and viral kinetics and (4) to define rational dosing criteria constructed from exposure-response relationships based on PK and Pharmodynamic (PD) modeling. METHODS: (i) Part one of this double-blind, placebo-controlled study of safety, and PK/PD parameters in Sm in HCV patients non-responsive to IFN? will assess single dose Sm in an alternating panel, rising dose design, with >7 days between treatments (ii) Based on (i), multiple dose administration of Sm over 4 weeks will be assessed with regard to PK, OS and T-cell function, with the aim of selecting doses for phase II studies in this population, (iii) Two optimal doses based on (ii) will be administered over 48 weeks evaluating ALT response and the above parameters. Primary outcome will be ALT response (decline >50% or to <60 ILJ/mL). Sm and its individual components will be measued by LC/MS/MS, OS by LC/MS/MS quantitation of urinary isoprostanes, immune responsiveness by HCV-specific and phytohemagglutinin-mediated CD4 T cell responses, and viral titers by quantitative reverse transcriptase PCR. Based on a sample size of 160, this study will have a 80% power to detect a 14% difference of response at an alpha error of 0.05. LAY SUMMARY: Many patients take milk thistle for hepatitis C, but we do not know if it is of any help or harm. This study will examine the safety and tolerability of various doses of milk thistle as well as start to explore its role in hepatitis C.

Agency
National Institute of Health (NIH)
Institute
National Center for Complementary & Alternative Medicine (NCCAM)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AT003573-04
Application #
7667797
Study Section
Special Emphasis Panel (ZAT1-SM (01))
Program Officer
Duffy, Linda C
Project Start
2006-08-15
Project End
2011-07-31
Budget Start
2009-08-01
Budget End
2011-07-31
Support Year
4
Fiscal Year
2009
Total Cost
$141,451
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Xie, Ying; Miranda, Sonia R; Hoskins, Janelle M et al. (2017) Role of UDP-Glucuronosyltransferase 1A1 in the Metabolism and Pharmacokinetics of Silymarin Flavonolignans in Patients with HCV and NAFLD. Molecules 22:
Adeyemo, O; Doi, H; Rajender Reddy, K et al. (2013) Impact of oral silymarin on virus- and non-virus-specific T-cell responses in chronic hepatitis C infection. J Viral Hepat 20:453-62
Fried, Michael W; Navarro, Victor J; Afdhal, Nezam et al. (2012) Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial. JAMA 308:274-82
Reddy, K Rajender; Belle, Steven H; Fried, Michael W et al. (2012) Rationale, challenges, and participants in a Phase II trial of a botanical product for chronic hepatitis C. Clin Trials 9:102-12
Schrieber, Sarah J; Hawke, Roy L; Wen, Zhiming et al. (2011) Differences in the disposition of silymarin between patients with nonalcoholic fatty liver disease and chronic hepatitis C. Drug Metab Dispos 39:2182-90
Hawke, Roy L; Schrieber, Sarah J; Soule, Tedi A et al. (2010) Silymarin ascending multiple oral dosing phase I study in noncirrhotic patients with chronic hepatitis C. J Clin Pharmacol 50:434-49