Phase I pilot clinical trial of antenatal maternally administered melatonin to decrease the level of oxidative stress in human pregnancies affected by pre-eclampsia (PAMPR): study protocol

Abstract

IntroductionPre-eclampsia is a common pregnancy condition affecting between 3% and 7% of women. Unfortunately, the exact pathophysiology of the disease is unknown and as such there are no effective treatments that exist notwithstanding prompt delivery of the fetus and culprit placenta. As many cases of pre-eclampsia occur in preterm pregnancies, it remains a significant cause of maternal and perinatal morbidity and mortality. Recently, in vitro and animal studies have highlighted the potential role of antioxidants in mitigating the effects of the disease. Melatonin is a naturally occurring antioxidant hormone and provides an excellent safety profile combined with ease of oral administration. We present the protocol for a phase I pilot clinical trial investigating the efficacy and side effects of maternal treatment with oral melatonin in pregnancies affected by preterm pre-eclampsia.Methods and analysisWe propose undertaking a single-arm open label clinical trial recruiting 20 women with preterm pre-eclampsia (24+0–35+6 weeks). We will take baseline measurements of maternal and fetal well-being, levels of oxidative stress, ultrasound Doppler studies and other biomarkers of pre-eclampsia. Women will then be given oral melatonin (10 mg) three times daily until delivery. The primary outcome will be time interval between diagnosis and delivery compared to historical controls. Secondary outcomes will compare the baseline measurements previously mentioned with twice-weekly measurements during treatment and then 6 weeks postpartum.Ethics and disseminationEthical approval has been obtained from Monash Health Human Research Ethics Committee B (HREC 13076B). Data will be presented at international conferences and published in peer-reviewed journals.Trial registration numberACTRN12613000476730 (ANZCTR).

Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early‐onset preeclampsia

“…The full trial protocol was published prospectively . In summary, 20 women with early‐onset (<37 weeks gestation) preeclampsia were recruited from our institution, a university teaching hospital in metropolitan Melbourne.…”

Melatonin as potential inducer of Th17 cell differentiation

“….for wide range of health benefits, including improved quality of life and reduced healthcare costs'' [39]. At least two study protocols of its clinical trials in human pregnancies complicated by fetal growth restriction or preeclampsia are recently published [40,41]. Meanwhile, a prerequisite for the successful pregnancy is forming a temporary maternal tolerance toward the semiallogenic fetus, and a key role in supporting such a tolerance plays a balance of regulatory T cells (Tregs) and Th17, which carry out diametrically opposing functions, namely suppression or propagation of inflammation, respectively [42].…”

A Dormant Microbial Component in the Development of Preeclampsia

“…Among other small molecules, melatonin has shown some promise in the treatment of septic shock, by lowering inflammatory cytokine production (1269) [and see Gitto et al (1270) for neonatal oxidative stress], and a trial is in prospect for PE (1271). …”