Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis

Authors

Alpha A. Fowler, Virginia Commonwealth UniversityFollow
Aamer A. Syed, Virginia Commonwealth University
Shelley Knowlson, Virginia Commonwealth UniversityFollow
Robin Sculthorpe, Virginia Commonwealth UniversityFollow
Don Farthing, Virginia Commonwealth University
Christine DeWilde, Virginia Commonwealth UniversityFollow
Christine A. Farthing, Virginia Commonwealth UniversityFollow
Terri L. Larus, Virginia Commonwealth UniversityFollow
Erika Martin, Virginia Commonwealth UniversityFollow
Donald F. Brophy, Virginia Commonwealth UniversityFollow
Seema Gupta, Health Diagnostic Laboratory
Bernard J. Fisher, Virginia Commonwealth UniversityFollow
Ramesh Natarajan, Virginia Commonwealth UniversityFollow

Document Type

Article

Original Publication Date

2014

Journal/Book/Conference Title

Journal of Translational Medicine

Volume

2014

DOI of Original Publication

10.1186/1479-5876-12-32

Comments

Originally published at http://dx.doi.org/10.1186/1479-5876-12-32

Date of Submission

September 2014

Abstract

Background Parenterally administered ascorbic acid modulates sepsis-induced inflammation and coagulation in experimental animal models. The objective of this randomized, double-blind, placebo-controlled, phase I trial was to determine the safety of intravenously infused ascorbic acid in patients with severe sepsis.

Methods Twenty-four patients with severe sepsis in the medical intensive care unit were randomized 1:1:1 to receive intravenous infusions every six hours for four days of ascorbic acid: Lo-AscA (50 mg/kg/24 h, n = 8), or Hi-AscA (200 mg/kg/24 h, n = 8), or Placebo (5% dextrose/water, n = 8). The primary end points were ascorbic acid safety and tolerability, assessed as treatment-related adverse-event frequency and severity. Patients were monitored for worsened arterial hypotension, tachycardia, hypernatremia, and nausea or vomiting. In addition Sequential Organ Failure Assessment (SOFA) scores and plasma levels of ascorbic acid, C-reactive protein, procalcitonin, and thrombomodulin were monitored.

Results Mean plasma ascorbic acid levels at entry for the entire cohort were 17.9 ± 2.4 μM (normal range 50-70 μM). Ascorbic acid infusion rapidly and significantly increased plasma ascorbic acid levels. No adverse safety events were observed in ascorbic acid-infused patients. Patients receiving ascorbic acid exhibited prompt reductions in SOFA scores while placebo patients exhibited no such reduction. Ascorbic acid significantly reduced the proinflammatory biomarkers C-reactive protein and procalcitonin. Unlike placebo patients, thrombomodulin in ascorbic acid infused patients exhibited no significant rise, suggesting attenuation of vascular endothelial injury.

Conclusions Intravenous ascorbic acid infusion was safe and well tolerated in this study and may positively impact the extent of multiple organ failure and biomarkers of inflammation and endothelial injury.

Rights

© 2014 Fowler et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Is Part Of

VCU Internal Medicine Publications