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Published in: Trials 1/2017

Open Access 01-12-2017 | Study protocol

Treatment with L-citrulline in patients with post-polio syndrome: study protocol for a single-center, randomised, placebo-controlled, double-blind trial

Authors: Simone Schmidt, Vanya Gocheva, Thomas Zumbrunn, Daniela Rubino-Nacht, Ulrike Bonati, Dirk Fischer, Patricia Hafner

Published in: Trials | Issue 1/2017

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Abstract

Background

Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute infection by the Poliomyelitis virus. Most often, patients who suffered from polio start to experience gradual new weakening in muscles, a gradual decrease in the size of muscles (muscle atrophy) and fatigue years after the acute illness. L-citrulline is known to change muscular metabolism synthesis by raising nitric oxide (NO) levels and increasing protein synthesis. This investigator-initiated, randomised, placebo-controlled, double-blind, trial aims to demonstrate that L-citrulline positively influences muscle function and increases muscular energy production in patients with PPS.

Methods/design

Thirty ambulant PPS patients will be recruited in Switzerland. Patients will be randomly allocated to one of the two arms of the study (placebo:verum 1:1). After a 24-week run-in phase to observe natural disease history and progression, participants will be treated either with L-citrulline or placebo for 24 weeks. The primary endpoint is change in the 6-min Walking Distance Test. Secondary endpoints will include motor function measure, quantitative muscle force, quantitative muscle magnetic resonance imaging and magnetic resonance spectroscopy and serum biomarker laboratory analysis

Discussion

The aim of this phase IIa trial is to determine if treatment with L-citrulline shows a positive effect on clinical function and paraclinical biomarkers in PPS. If treatment with L-citrulline shows positive effects, this might represent a cost-efficient symptomatic therapy for PPS patients.

Trial registration

ClinicalTrial.gov, ID: NCT02801071. Registered on 6 June 2016.
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Literature
4.
5.
go back to reference Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D’Amelio M, et al. Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors. J Neurol Sci. 2005;236(1–2):31–5.CrossRefPubMed Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D’Amelio M, et al. Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors. J Neurol Sci. 2005;236(1–2):31–5.CrossRefPubMed
6.
go back to reference Dalakas MC. Pathogenetic mechanisms of post-polio syndrome: morphological, electrophysiological, virological, and immunological correlations. Ann N Y Acad Sci. 1995;753(1):167–85.CrossRefPubMed Dalakas MC. Pathogenetic mechanisms of post-polio syndrome: morphological, electrophysiological, virological, and immunological correlations. Ann N Y Acad Sci. 1995;753(1):167–85.CrossRefPubMed
7.
go back to reference Sandberg A, Stålberg E. Changes in macro electromyography over time in patients with a history of polio: a comparison of 2 muscles. Arch Phys Med Rehabil. 2004;85(7):1174–82.CrossRefPubMed Sandberg A, Stålberg E. Changes in macro electromyography over time in patients with a history of polio: a comparison of 2 muscles. Arch Phys Med Rehabil. 2004;85(7):1174–82.CrossRefPubMed
8.
go back to reference Koopman FS, Beelen A, Gilhus NE, de Visser, M, Nollet F. Treatment for postpolio syndrome. The Cochrane Library. 2015. Koopman FS, Beelen A, Gilhus NE, de Visser, M, Nollet F. Treatment for postpolio syndrome. The Cochrane Library. 2015.
9.
go back to reference Levillain O. Expression and function of arginine-producing and consuming-enzymes in the kidney. Amino Acids. 2011;42(4):1237–52.CrossRefPubMed Levillain O. Expression and function of arginine-producing and consuming-enzymes in the kidney. Amino Acids. 2011;42(4):1237–52.CrossRefPubMed
10.
go back to reference Windmueller HG, Spaeth AE. Source and fate of circulating citrulline. Am J Physiol. 1981;241(6):E473–80.PubMed Windmueller HG, Spaeth AE. Source and fate of circulating citrulline. Am J Physiol. 1981;241(6):E473–80.PubMed
11.
go back to reference El-Hattab AW, Hsu JW, Emrick LT, Wong L-JC, Craigen WJ, Jahoor F, et al. Restoration of impaired nitric oxide production in MELAS syndrome with citrulline and arginine supplementation. Mol Genet Metab. 2012;105(4):607–14.CrossRefPubMedPubMedCentral El-Hattab AW, Hsu JW, Emrick LT, Wong L-JC, Craigen WJ, Jahoor F, et al. Restoration of impaired nitric oxide production in MELAS syndrome with citrulline and arginine supplementation. Mol Genet Metab. 2012;105(4):607–14.CrossRefPubMedPubMedCentral
12.
go back to reference Osowska S, Duchemann T, Walrand S, Paillard A, Boirie Y, Cynober L, et al. Citrulline modulates muscle protein metabolism in old malnourished rats. Am J Physiol Endocrinol Metab. 2006;291(3):E582–6.CrossRefPubMed Osowska S, Duchemann T, Walrand S, Paillard A, Boirie Y, Cynober L, et al. Citrulline modulates muscle protein metabolism in old malnourished rats. Am J Physiol Endocrinol Metab. 2006;291(3):E582–6.CrossRefPubMed
13.
go back to reference Nisoli E, Clementi E, Paolucci C, Cozzi V, Tonello C, Sciorati C, et al. Mitochondrial biogenesis in mammals: the role of endogenous nitric oxide. Science. 2003;299(5608):896–9.CrossRefPubMed Nisoli E, Clementi E, Paolucci C, Cozzi V, Tonello C, Sciorati C, et al. Mitochondrial biogenesis in mammals: the role of endogenous nitric oxide. Science. 2003;299(5608):896–9.CrossRefPubMed
14.
go back to reference Brown GC, Borutaite V. Nitric oxide and mitochondrial respiration in the heart. Cardiovasc Res. 2007;75(2):283–90.CrossRefPubMed Brown GC, Borutaite V. Nitric oxide and mitochondrial respiration in the heart. Cardiovasc Res. 2007;75(2):283–90.CrossRefPubMed
15.
go back to reference Moinard C, Nicolis I, Neveux N, Darquy S, Bénazeth S, Cynober L. Dose-ranging effects of citrulline administration on plasma amino acids and hormonal patterns in healthy subjects: the Citrudose pharmacokinetic study. Br J Nutr. 2008;99(04):855–62.CrossRefPubMed Moinard C, Nicolis I, Neveux N, Darquy S, Bénazeth S, Cynober L. Dose-ranging effects of citrulline administration on plasma amino acids and hormonal patterns in healthy subjects: the Citrudose pharmacokinetic study. Br J Nutr. 2008;99(04):855–62.CrossRefPubMed
16.
go back to reference Andersen LK, Knak KL, Witting N, Vissing J. Two- and 6-Minute Walk Tests assess walking capability equally in neuromuscular diseases. Neurology. 2016;86(5):442–5.CrossRefPubMed Andersen LK, Knak KL, Witting N, Vissing J. Two- and 6-Minute Walk Tests assess walking capability equally in neuromuscular diseases. Neurology. 2016;86(5):442–5.CrossRefPubMed
17.
go back to reference Montes J, McDermott MP, Martens WB, Dunaway S, Glanzman AM, Riley S, et al. Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy. Neurology. 2010;74(10):833–8.CrossRefPubMedPubMedCentral Montes J, McDermott MP, Martens WB, Dunaway S, Glanzman AM, Riley S, et al. Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy. Neurology. 2010;74(10):833–8.CrossRefPubMedPubMedCentral
19.
go back to reference Fischmann A, Hafner P, Gloor M, Schmid M, Klein A, Pohlman U, et al. Quantitative MRI and loss of free ambulation in Duchenne muscular dystrophy. J Neurol. 2012;260(4):969–74.CrossRefPubMed Fischmann A, Hafner P, Gloor M, Schmid M, Klein A, Pohlman U, et al. Quantitative MRI and loss of free ambulation in Duchenne muscular dystrophy. J Neurol. 2012;260(4):969–74.CrossRefPubMed
20.
go back to reference Fischmann A, Hafner P, Fasler S, Gloor M, Bieri O, Studler U, et al. Quantitative MRI can detect subclinical disease progression in muscular dystrophy. J Neurol. 2012;259(8):1648–54.CrossRefPubMed Fischmann A, Hafner P, Fasler S, Gloor M, Bieri O, Studler U, et al. Quantitative MRI can detect subclinical disease progression in muscular dystrophy. J Neurol. 2012;259(8):1648–54.CrossRefPubMed
21.
go back to reference Sinclair CDJ, Morrow JM, Yousry TA, Reilly MM, Hanna MG, Golay X, et al. P86 Inter-scan reproducibility of quantitative neuromuscular MRI. Neuromuscul Disord. 2010;20 Suppl 1:S28. Sinclair CDJ, Morrow JM, Yousry TA, Reilly MM, Hanna MG, Golay X, et al. P86 Inter-scan reproducibility of quantitative neuromuscular MRI. Neuromuscul Disord. 2010;20 Suppl 1:S28.
22.
go back to reference Fischmann A, Gloor M, Fasler S, Haas T, Wetzel RR, Bieri O, et al. Muscular involvement assessed by MRI correlates to motor function measurement values in oculopharyngeal muscular dystrophy. J Neurol. 2011;258(7):1333–40.CrossRefPubMed Fischmann A, Gloor M, Fasler S, Haas T, Wetzel RR, Bieri O, et al. Muscular involvement assessed by MRI correlates to motor function measurement values in oculopharyngeal muscular dystrophy. J Neurol. 2011;258(7):1333–40.CrossRefPubMed
23.
go back to reference Wokke BH, Bos C, Reijnierse M, van Rijswijk CS, Eggers H, Webb A, et al. Comparison of Dixon and T1-weighted MR methods to assess the degree of fat infiltration in Duchenne muscular dystrophy patients. J Magn Reson Imaging. 2013;38(3):619–24.CrossRefPubMed Wokke BH, Bos C, Reijnierse M, van Rijswijk CS, Eggers H, Webb A, et al. Comparison of Dixon and T1-weighted MR methods to assess the degree of fat infiltration in Duchenne muscular dystrophy patients. J Magn Reson Imaging. 2013;38(3):619–24.CrossRefPubMed
24.
go back to reference Bonati U, Hafner P, Schädelin S, Schmid M, Naduvilekoot Devasia A, Schroeder J, et al. Quantitative muscle MRI: a powerful surrogate outcome measure in Duchenne muscular dystrophy. Neuromuscul Disord. 2015;25(9):679–85.CrossRefPubMed Bonati U, Hafner P, Schädelin S, Schmid M, Naduvilekoot Devasia A, Schroeder J, et al. Quantitative muscle MRI: a powerful surrogate outcome measure in Duchenne muscular dystrophy. Neuromuscul Disord. 2015;25(9):679–85.CrossRefPubMed
25.
go back to reference Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. PM&R. 2013;5(3):176–81.CrossRef Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct validity of a new rating scale for self-reported impairments in persons with late effects of polio. PM&R. 2013;5(3):176–81.CrossRef
26.
go back to reference Brogårdh C, Lexell J. Test-retest reliability of the Self-Reported Impairments in Persons With Late Effects of Polio (SIPP) Rating Scale. PM&R. 2016;8(5):399–404.CrossRef Brogårdh C, Lexell J. Test-retest reliability of the Self-Reported Impairments in Persons With Late Effects of Polio (SIPP) Rating Scale. PM&R. 2016;8(5):399–404.CrossRef
27.
go back to reference Jackson CE, Barohn RJ, Gronseth G, Pandya S, Herbelin L. Inclusion body myositis functional rating scale: a reliable and valid measure of disease severity. Muscle Nerve. 2008;37(4):473–6.CrossRefPubMed Jackson CE, Barohn RJ, Gronseth G, Pandya S, Herbelin L. Inclusion body myositis functional rating scale: a reliable and valid measure of disease severity. Muscle Nerve. 2008;37(4):473–6.CrossRefPubMed
28.
go back to reference Soares JF, Wu CFJ. Some restricted randomization rules in sequential designs. Commun Stat Theory Methods. 1983;12(17):2017–34.CrossRef Soares JF, Wu CFJ. Some restricted randomization rules in sequential designs. Commun Stat Theory Methods. 1983;12(17):2017–34.CrossRef
29.
go back to reference Bérard C, Payan C, Hodgkinson I, Fermanian J, Group TMCS. A motor function measure scale for neuromuscular diseases. Construction and validation study. Neuromuscul Disord. 2005;15(7):463–70.CrossRefPubMed Bérard C, Payan C, Hodgkinson I, Fermanian J, Group TMCS. A motor function measure scale for neuromuscular diseases. Construction and validation study. Neuromuscul Disord. 2005;15(7):463–70.CrossRefPubMed
30.
go back to reference Finanger EL, Russman B, Forbes SC, Rooney WD, Walter GA, Vandenborne K. Use of skeletal muscle MRI in diagnosis and monitoring disease progression in Duchenne muscular dystrophy. Phys Med Rehabil Clin N Am. 2012;23(1):1–10.CrossRefPubMed Finanger EL, Russman B, Forbes SC, Rooney WD, Walter GA, Vandenborne K. Use of skeletal muscle MRI in diagnosis and monitoring disease progression in Duchenne muscular dystrophy. Phys Med Rehabil Clin N Am. 2012;23(1):1–10.CrossRefPubMed
31.
go back to reference Kinali M, Arechavala-Gomeza V, Cirak S, Glover A, Guglieri M, Feng L, et al. Muscle histology vs MRI in Duchenne muscular dystrophy. Neurology. 2011;76(4):346–53.CrossRefPubMedPubMedCentral Kinali M, Arechavala-Gomeza V, Cirak S, Glover A, Guglieri M, Feng L, et al. Muscle histology vs MRI in Duchenne muscular dystrophy. Neurology. 2011;76(4):346–53.CrossRefPubMedPubMedCentral
Metadata
Title
Treatment with L-citrulline in patients with post-polio syndrome: study protocol for a single-center, randomised, placebo-controlled, double-blind trial
Authors
Simone Schmidt
Vanya Gocheva
Thomas Zumbrunn
Daniela Rubino-Nacht
Ulrike Bonati
Dirk Fischer
Patricia Hafner
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Trials / Issue 1/2017
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-017-1829-3

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