Trial of Lithium Carbonate for Treatment of Osteoporosis-pseudoglioma Syndrome

Condition(s) targeted: Osteoporosis Pseudoglioma

Intervention: Lithium (Drug)

Phase: N/A

Status: Active, not recruiting

Sponsored by: University of Maryland

Official(s) and/or principal investigator(s):
Elizabeth A Streeten, MD, Principal Investigator, Affiliation: University of Maryland

This is a pilot study of up to 10 patients with Osteoporosis-pseudoglioma syndrome (OPPG) from the Old Order Mennonite community, who will be given lithium for 6 months and have dual energy xray absorptiometry (DXA), peripheral quantitative computerized tomography (pQCT) and lab assessment at baseline and 6 months. Studies in the mouse model of OPPG showed that lithium normalized their bone strength. Controls (n=20) will be recruited from the Old Order Mennonite community, to minimize the effects of environmental and lifestyle factors. The controls will not be given lithium. The age range of participants will be 4-64 years.

Official title: Trial of Lithium Carbonate for Treatment of Osteoporosis Pseudoglioma Syndrome

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

Primary outcome: pQCT of forearm and lower leg

Secondary outcome: Fracture

Detailed description: Osteoporosis-pseudoglioma (OPPG) syndrome is a very rare genetic disorder (approximately 50 cases have been reported worldwide) due to mutations in the LRP5 gene, causing blindness from birth and fragile bones (osteoporosis)in early childhood. The bony fragility can lead to recurrent fractures of major bones such as the hip (femur) and spine, leaving some children in wheelchairs. Treatment to strengthen the bones in OPPG has primarily been with osteoporosis medications used in other fragile bone disorders of childhood and in adults, namely the bisphosphonates (eg. pamidronate, alendronate). These drugs have helped the bone strength in OPPG somewhat but have not prevented all fractures. We have observed fractures of the hip in 3 children with OPPG who we have treated, in spite of their attaining normal bone density (determined by DXA, dual xray absorptiometry) with bisphosphonates. Therefore, new treatments for OPPG are greatly needed and new methods besides DXA are needed to monitor bone strength on treatment. A mouse model of OPPG has been created. In the mouse model of OPPG, lithium dramatically improved their bones, returning them to normal strength and preventing fractures. Lithium, which is used for people with psychiatric disease, is known to lead to higher bone strength and reduced fractures in people who are on it for psychiatric disease. Lithium has been used safely and is approved for children 12 and above. The theory is that lithium will improve bone strength in OPPG in humans, as it has in the mouse, by stimulating bone production bypassing the genetic defect in OPPG. In this study, we plan to treat up to 10 patients with OPPG with lithium for 6 months, monitoring the response of the bones by both DXA and pQCT (peripheral quantitative computed tomography), the latter which gives information about bone quality. An IND has been obtained to use lithium in this study.

Minimum age: 4 Years. Maximum age: 64 Years. Gender(s): Both.

Criteria:

Eligibility Criteria Inclusion Criteria

- Age 4 years or greater

- Diagnosed with osteoporosis pseudoglioma syndrome (OPPG) or a first degree relative

of someone with OPPG. For diagnosis of OPPG, one of the following is required: (1) congenital blindness in a child born into a family with known OPPG where at least one affected family member has had an LRP5 mutation demonstrated or (2) a child with no

known family members with OPPG who has congenital blindness, DXA Z-score < - 2. 0 and

mutation in LRP5 documented

- No contraindications to lithium carbonate

- For women of child bearing age, willing to undergo urine pregnancy test

Exclusion Criteria

- Age under 4 years

- Not diagnosed with osteoporosis pseudoglioma (OPPG) syndrome or a first degree

relative of someone with OPPG, or a member of the Old Order Mennonite community

- Pregnant

- For women of childbearing age, not willing to undergo urine pregnancy test

- Contraindication to Lithium (serum creatinine > 1. 3, known cardiovascular disease

[history of myocardial infarction, heart failure], currently on diuretic or ACE inhibitor)

- Glomerular filtration rate below 80 cc/min

University of Maryland Amish Research Clinic, Lancaster, Pennsylvania 17601, United States

Related publications:

Streeten EA, McBride D, Puffenberger E, Hoffman ME, Pollin TI, Donnelly P, Sack P, Morton H. Osteoporosis-pseudoglioma syndrome: description of 9 new cases and beneficial response to bisphosphonates. Bone. 2008 Sep;43(3):584-90. doi: 10.1016/j.bone.2008.04.020. Epub 2008 May 7.

Clément-Lacroix P, Ai M, Morvan F, Roman-Roman S, Vayssière B, Belleville C, Estrera K, Warman ML, Baron R, Rawadi G. Lrp5-independent activation of Wnt signaling by lithium chloride increases bone formation and bone mass in mice. Proc Natl Acad Sci U S A. 2005 Nov 29;102(48):17406-11. Epub 2005 Nov 17.

Starting date: July 2010
Last updated: December 9, 2013