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Iron DeficiencyNCT04602247

Evaluation of Iron Bioavailability From Iron Chlorophyllin

A study testing SIC, SIC + AA combined and FeSO4 in people with Iron Deficiency, run by Swiss Federal Institute of Technology at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The overall objective of this study is to evaluate the iron absorption from iron chlorophyllin. Iron deficiency is a public health problem in both developing and industrialized countries. There are several approaches to combat iron deficiency. Read more about this study

Who is it for?
Ages 18 to 40 years, women onlyHealthy volunteers can take part
Conditions the study is for
Iron Deficiency
What is being tested?
SIC, SIC + AA combined and FeSO4
Could I receive a placebo?
No, everyone receives an active treatment
How many people
55 participants
Where
1 siteSwitzerland
Study dates
26 Oct 2020to 14 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 40 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • female aged between 18-45 y old;
  • SF <80 µg/L;
  • BMI 18.5-24.9 kg/m2;
  • weight <70 kg;
  • signed informed consent;
  • able to communicate and comprehend English language

Who cannot join

  • anemia (Hb <12 g/dL);
  • inflammation (CRP > 5 mg/L);
  • chronic digestive, renal and/or metabolic disease;
  • chronic medications (except for oral contraceptives);
  • use of vitamin, mineral and pre- and/or probiotic supplements in the previous 2 weeks before study initiation and during the course of the study;
  • blood transfusion, blood donation or significant blood loss over the past 4 months;
Show all 11Show fewer
  • pregnancy (tested in serum at screening) or intention to become pregnant;
  • lactation up to 6 weeks before study initiation;
  • earlier participation in a study using stable isotopes or participation in any clinical study within the last 30 days;
  • smoking;
  • unwilling to use an effective method of contraception.

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • ETH Zürich, Laboratory of Human Nutrition

    Zurich, Canton of Zurich, 8092

Other trials in Switzerland

About this study

Official title: Evaluation of Iron Bioavailability From Iron Chlorophyllin in Young Women Using the Iron Stable Isotopic Method

The overall objective of this study is to evaluate the iron absorption from iron chlorophyllin. Iron deficiency is a public health problem in both developing and industrialized countries. There are several approaches to combat iron deficiency. Most supplements in the present day, to address the problem of iron deficiency, are in the form of iron salts, known as ferrous salts, especially ferrous sulfate. However, we can only usually absorb about 20% of the total iron content in ferrous sulfate. The common strategy of food supplement companies is to increase the amount of iron in the supplements to compensate for the low absorption rate. However, this often causes gastrointestinal side effects. In the present study, we would like to measure the iron bioavailability from sodium iron chlorophyllin, which made up from ferrous salts and chlorophyllin and where we hypothesize that it is absorbed via a different pathway than ferrous sulfate. Via this mechanism, we further hypothesize that sodium iron chlorophyllin will therefore have an enhanced bioavailability and more favorable side effect profile than ferrous sulfate and other iron salts.

Read the detailed description

New approaches to treat iron deficiency include developing novel iron compounds with possible iron absorption routes that increase iron bioavailability and reduce gastrointestinal side effects. Heme iron is considered to be highly bioavailable (10-20%) and less affected by meal composition than non-heme iron. Heme iron is iron (Fe2+) that is bound to the iron protoporphyrin IX prosthetic groups of proteins, mainly hemoglobin and myoglobin, which are present in animal tissue. Heme is released from hemoglobin during digestion so that it can be taken up by the duodenal enterocytes. The intact iron porphyrin is transported across the brush border membrane by the Heme Carrier Protein 1 (HCP1). Once inside the cell, the iron is released, and it is then likely to enter the low molecular weight pool of iron. The use of heme analogues from vegetable origin could provide an alternative iron source of potentially high bioavailability.

Sodium iron chlorophyllin (SIC) is a water-soluble semisynthetic chlorophyll derivative where the magnesium in the porphyrin ring has been substituted by iron. It is a greenish brown pigment that dissolves in water, alcohols, and chloroform, but not ethers. SIC is known to have a superior processing stability to chlorophyll and is commonly used as food colorings in Asian countries including in Korea and Japan, for foods that do not contain meat or fish. Magnesium Chlorophyllin has an E number of E140 and is approved as a food additive in Europe. Currently sodium iron chlorophyllin is present in the Designated Additives List in Japan with a number 261. Designated additives are those designated by the Minister of Health, Labour and Welfare as substances that are unlikely to harm human health based on Article 10 of the Food Sanitation Act.

Given the porphyrin ring heme-like structure of SIC, it may be an alternative delivery route for iron, suitable also for vegetarians and vegans, yet there are few studies investigating the use of SIC for this purpose.

A recent study by Ding et al. 2019 suggests a positive effect of SIC on hemoglobin (Hb) values in iron-deficiency anemia (IDA) in children and adults after 1 month of treatment. They assume that SIC is taken up by the heme carrier protein. The researchers used shengxuening tablets, also known as SXN, which are based on chlorophyll/porphyrin structures extracted from silkworms in which the Mg is replaced by the Fe and then coadjutants are added. This study provided no data on the absorption pathway of the SXN compound. Thus, it remains unclear if it was taken up by the heme transporter or whether it was digested and the Fe released in the gut lumen to join the non heme Fe pool, and thereby improved Hb in the IDA subjects. The authors also describe Xray diffraction assays to assess if the chlorophyllin porphyrin ring contained Fe and not Mg, however these data are not reported.

Miret et al. (2010) studied the stability of heme-analogous SIC absorption using the Caco-2 cell model. The SIC remained stable and only 5% of the Fe from the compound was released at pH 2 to 4. In-house dissolution studies conducted at the Human Nutrition Laboratory (HNL) show only a 2% release of Fe from the compound at similar pH levels. Using solid phase extraction at a higher pH of 7, similar to that in the duodenum, we observed a 5% Fe loss, which may correspond to free iron or iron liberated from any other binding sites on the chlorophyll structure.

Toyoda et al. (2014) performed a toxicity study of SIC performed in male and female rats with oral administration of SIC in their diet at concentrations of 0%, 0.2%, 1.0%, and 5.0% for 13 weeks. No abnormal clinical signs, no mortality and no abnormal hematological changes were observed in any of the groups during the experiment. Based on the histopathology of the parotid glands, the no-observed-adverse-effect level (NOAEL) of SIC in this study was estimated to be 1.0% (609 mg SIC/kg bodyweight (bw)/day for males and 678 mg/kg bw/day for females). In the present study, we will use 6 mg elemental iron, in 100 mg SIC, 0.002% of the equivalent dose administered by Toyoda et al.

SIC has been produced at the HNL with a 75% incorporation of iron into the chlorophyll. Our protocol is based on a Unilever patent that is no longer active, with in-house adaptation. The SIC has a neutral taste and will be presented as a dark green liquid, being the solution of SIC in water.

The goal of this project is to develop a novel iron compound that can be used as a food supplement. The iron content in our SIC will be limited to 6 mg per dose, which therefore does not exceed the 14 mg daily iron dose stipulated as the legal maximum in Switzerland for food supplements. SIC is already used widely as a food colorant and is safe for human consumption.

We propose to test our SIC against a known comparator, ferrous sulfate, to ascertain whether SIC is an effective iron delivery compound. If SIC, as hypothesized, behaves in a similar way to heme, then commonly used enhancers of iron absorption effective on ferrous sulfate, such as ascorbic acid, will not have an effect on the absorption of iron from SIC

Conditions
Iron Deficiency
Being tested
SIC, SIC + AA combined, FeSO4, FeSO4 + AA combined, EP + FeSO4 combined
Keywords
iron deficiency, Iron chlorophyllin
Medical subject headings
Iron Deficiencies

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SICDietary supplement

    Sodium Iron Chlorophyllin, whose bioavailability is to be studied

  • SIC + AA combinedDietary supplement

    Sodium Iron Chlorophyllin and ascorbic acid. The ascorbic acid should not have an effect on Sodium Iron Chlorophyllin

  • FeSO4Dietary supplement

    Ferrous sulfate serves as a positive control, whose iron bioavailability is known

  • FeSO4 + AA combinedDietary supplement

    Ferrous sulfate serves as a positive control and the addition of ascorbic acid, further enhances its bioavailability

  • EP + FeSO4 combinedOther

    Chlorophyllin with an empty porphyrin ring, given along with FeSO4 to study if there is an incorporation of Fe into the porphyrin ring as it passes the gastric system

  • EP + FeSO4 + AA combinedOther

    Chlorophyllin with an empty porphyrin ring, given along with FeSO4 to study if there is an incorporation of Fe into the porphyrin ring as it passes the gastric system. Ascorbic acid is given along with the intervention to see if there is any difference in the fractional iron absorption when compared to EP+ FeSO4

Study groups in NCT04602247
Study groupRoleWhat they receive
SICExperimental100 mg sodium iron chlorophyllin (SIC) containing 6 mg 57 Fe.
Receives: Dietary Supplement: SIC
SIC + AA combinedExperimental100 mg sodium iron chlorophyllin (SIC) containing 6 mg 57 Fe given with 40 mg Ascorbic Acid
Receives: Dietary Supplement: SIC + AA combined
FeSO4Active comparator6mg of FeSO4 given as 4 mg 56Fe and 2mg 58Fe
Receives: Dietary Supplement: FeSO4
FeSO4 + AA combinedActive comparator6mg of FeSO4 given as 4 mg 56Fe and 2mg 58Fe along with 40 mg Ascorbic Acid
Receives: Dietary Supplement: FeSO4 + AA combined
EP + FeSO4 combinedExperimental100 mg of Chlorophyllin without the Magnesium central atom along with 6 mg FeSO4 as 54 Fe
Receives: Other: EP + FeSO4 combined
EP + FeSO4 + AA combinedExperimental100 mg of Chlorophyllin without the Magnesium central atom along with 6 mg FeSO4 as 54 Fe along with 40 mg of Ascorbic Acid
Receives: Other: EP + FeSO4 + AA combined

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Fractional Iron Absorption

    Fractional iron absorption will be calculated based on the shift of the iron isotope ratios in the collected blood samples after the administration of the intervention products .Fractional iron absorption will be measured as erythrocyte incorporation of the naturally occurring iron forms with different masses used to label the iron supplements.

    Measured: day 19

  2. Fractional Iron Absorption

    Fractional iron absorption will be calculated based on the shift of the iron isotope ratios in the collected blood samples after the administration of the intervention products .Fractional iron absorption will be measured as erythrocyte incorporation of the naturally occurring iron forms with different masses used to label the iron supplements.

    Measured: day 37

Secondary outcomes (4)
  1. Hemoglobin

    Iron status marker

    Measured: Day 1, day 19 and day 37 of the study

  2. Plasma Ferritin

    Iron status marker

    Measured: Day 1, day 19 and day 37 of the study

  3. soluble transferrin receptor (sTfR)

    Iron status marker

    Measured: Day 1, day 19 and day 37 of the study

  4. C-Reactive Protein

    Inflammation marker

    Measured: Day 1, day 19 and day 37 of the study

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Oct 2020
  2. Study start26 Oct 2020
  3. Primary completion14 Dec 2020
  4. Study completion14 Dec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Model description
The study will be a single-center, prospective cross-over trial in which each subject receives all test conditions. During the screening, about 2 weeks before the start of the study, women will be assessed for eligibility. Finally, 55 eligible women will be invited to participate. Each subject will complete six iron absorption studies in which they will receive supplemental iron doses of 6 mg iron.The experimental phase will last for 37 days. The labeled iron doses will be administered on days 1, 3, 5, 19, 21 and 23. Since only three isotopes are used in the study, after day 5, there will be a wait period of 14 days to allow for incorporation of the labeled iron into erythrocytes. On day 19, 21 and 23 the other three test doses are administered. Randomization of the interventional products listed above will be set up as such, to ensure that participants do not receive the same isotopes in a given week. On day 1, day 19 and day 37, a venous blood sample will be collected.
Masking
None (open label)
Enrolment
55 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04602247
Sponsor's protocol ID
SIC2020
Status last verified
Mar 2021
First submitted
21 Oct 2020
Last updated
26 Mar 2021
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing SIC, SIC + AA combined and FeSO4 in people with Iron Deficiency, run by Swiss Federal Institute of Technology at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Mar 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Fractional Iron Absorption (time frame: day 19). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Mar 2021.

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