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Etidronate for Arterial Calcifications Due to Deficiency in CD73 (ACDC)

Information source: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Arterial Calcification Due to CD73-Deficiency (ACDC)

Intervention: Etidronate (Drug); MRI (Procedure); CT Scan (Procedure); ABI (Procedure); Treadmill (Procedure); Dexa Scan (Procedure); Hand X-ray (Procedure)

Phase: Phase 1

Status: Recruiting

Sponsored by: National Heart, Lung, and Blood Institute (NHLBI)

Official(s) and/or principal investigator(s):
Manfred Boehm, M.D., Principal Investigator, Affiliation: National Heart, Lung, and Blood Institute (NHLBI)

Overall contact:
Rebecca D Huffstutler, C.R.N.P., Phone: (301) 594-1281, Email: rebecca.huffstutler@nih.gov



- Arterial Calcifications due to Deficiency in CD73 (ACDC) is a rare genetic disease.

People with ACDC develop calcium deposits in the arteries and joints of the fingers, wrists, ankles and feet. These deposits cause severe pain in the hands and feet, even when the person is at rest, and may lead to loss of the affected hand or foot. Currently, there are no standard treatments for ACDC.

- Etidronate is a drug that helps to slow or stop the natural process that dissolves bone

tissue. It is approved to treat Paget s disease, a condition in which the bones are soft and weak and may be deformed, painful, or easily broken. It is also used to treat high blood calcium levels. Researchers want to see if it can be used to treat the symptoms of ACDC and improve pain and blood flow in the hands and feet. Objectives:

- To see if etridronate is a safe and effective treatment for ACDC.


- People between 18 and 80 years of age who have been diagnosed with ACDC.


- Participants will be screened with a physical exam and medical history. They will also

have imaging studies, including x-rays and DEXA bone scans, before starting treatment. Blood and urine samples will be collected. An exercise tolerance test will also be given.

- Participants will take etridronate by mouth once a day for 14 days every 3 months. They

will be assigned an individualized 6-month drug schedule to follow. Participants should not eat foods that are high in calcium for at least 2 hours after taking the study drug.

- Participants will have regular study visits throughout the treatment period. These

visits will involve imaging studies, full dental exams, and blood and urine tests. Participants will also have exercise tolerance tests and arm and leg blood pressure tests to measure pain and blood flow.

- Participants may also provide tissue samples for further study.

- Treatment will continue for up to 3 years as long as the side effects are not severe

and the condition does not become worse. Participants will have a final follow-up visit after stopping treatment.

Clinical Details

Official title: An Open-label, Non-Randomized, Single-Arm Pilot Study to Evaluate the Effectiveness of Etidronate Treatment for Arterial Calcifications Due to Deficiency in CD73 (ACDC)

Study design: Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: This study will examine the effectiveness etidronate in attenuating the progression of lower extremity arterial calcification and improved vascular blood flow in subjects diagnosed with the rare disease, ACDC

Secondary outcome: Functional improvement in treadmill test results; Decrease in hand pain based on Rheumatoid Arthritis assessment tool; Changes in hand joint calcification based on hand x-ray

Detailed description: We have recently identified a novel genetic disease affecting nine known adults in whom de novo vascular calcifications develop in the lower extremity arteries and juxta-articular joint capsules of the fingers, wrists, ankles and feet. This rare disease results from bi-allelic mutations in the gene ecto-5-prime-nucleotidase (NT5E), encoding the CD73 protein. CD73, an enzyme involved in the extracellular ATP metabolic pathway, converts extracellular AMP to adenosine and inorganic phosphate. The clinical symptoms of this rare disease, termed ACDC (Arterial Calcifications due to Deficiency in CD73), include claudication of the calves, thighs, and buttocks, chronic ischemic pain of the feet at rest with threat of potential limb loss, and debilitating rheumatoid pain in the wrists and hands. Radiological and histological evaluations do not resemble classic atherosclerotic vascular calcification, since the calcification and dysplasia in ACDC occur in the medial portion of the arterial blood vessel wall. Data from patient-specific cell lines indicate increased activity of tissue non-specific alkaline phosphatase (TNAP), a key mediator of pathological ectopic tissue calcification, and thus reveals a potential therapeutic target. To date, no effective therapy exists for ACDC patients. However, since bisphosphonates are potent competitive inhibitors of TNAP activity and are widely used to modulate bone metabolism, they may beneficially alter vascular calcification. In addition, our preliminary in vitro studies demonstrate the effectiveness of etidronate, a nitrogen-containing bisphosphonate, in lowering TNAP activity in cells isolated from ACDC patients. Etidronate, and bisphophonates in general, have proven safe and well tolerated by most patients. This protocol provides for the administration of etidronate to ACDC patients, for whom no alternative treatment is available. Patients will be examined at the NIH Clinical Center bi-annually for 3 years. The primary objective of this clinical study is to test the effectiveness of etidronate in attenuating the progression of lower extremity arterial calcification and vascular blood flow based on CT calcium score and Ankle brachial index (ABI).


Minimum age: 18 Years. Maximum age: 80 Years. Gender(s): Both.



Inclusion and exclusion criteria are to be assessed at Screening and Baseline prior to starting study drug. Each subject must meet the following criteria to be enrolled in this study:

- Subjects must be diagnosed with ACDC based on genetic tests confirming mutation(s) in

NT5E and evidence of lower extremity arterial calcifications.

- Either gender and any ethnic background or race

- Age 18-80 years

- Willingness and legal ability to give and sign informed study consent

- Willingness to travel to NIH and local sites for scheduled protocol studies and

treatment EXCLUSION CRITERIA Subjects who meet any of the following criteria will be excluded from the study:

- Subjects not diagnosed with ACDC

- Subjects < 18 or > 80 years of age

- Subjects who are unable or unwilling to sign an informed consent

- Severe renal impairment (estimated creatinine clearance/eGFR of < 30ml/min

calculated using CKD-EPI equation)

- Longstanding diabetes mellitus (more than 10 years)

- Known abnormality of the esophagus that would interfere with the passage of the drug

- Known sensitivity to etidronate

- Pregnancy

- Any other medical or social condition that, in the opinion of the Principal

Investigator, might put the subject at risk of harm during the study or might adversely affect the interpretation of the study data.

Locations and Contacts

Rebecca D Huffstutler, C.R.N.P., Phone: (301) 594-1281, Email: rebecca.huffstutler@nih.gov

National Institutes of Health Clinical Center, 9000 Rockville Pike, Bethesda, Maryland 20892, United States; Recruiting
For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL), Phone: 800-411-1222, Ext: TTY8664111010, Email: prpl@mail.cc.nih.gov
Additional Information

NIH Clinical Center Detailed Web Page

Related publications:

St Hilaire C, Ziegler SG, Markello TC, Brusco A, Groden C, Gill F, Carlson-Donohoe H, Lederman RJ, Chen MY, Yang D, Siegenthaler MP, Arduino C, Mancini C, Freudenthal B, Stanescu HC, Zdebik AA, Chaganti RK, Nussbaum RL, Kleta R, Gahl WA, Boehm M. NT5E mutations and arterial calcifications. N Engl J Med. 2011 Feb 3;364(5):432-42. doi: 10.1056/NEJMoa0912923.

Fleisch H. Bisphosphonates: mechanisms of action. Endocr Rev. 1998 Feb;19(1):80-100. Review.

Itoh F, Kojima M, Furihata-Komatsu H, Aoyagi S, Kusama H, Komatsu H, Nakamura T. Reductions in bone mass, structure, and strength in axial and appendicular skeletons associated with increased turnover after ovariectomy in mature cynomolgus monkeys and preventive effects of clodronate. J Bone Miner Res. 2002 Mar;17(3):534-43.

Starting date: April 2012
Last updated: February 7, 2015

Page last updated: August 20, 2015

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