To Study the Safety and Efficacy of Simvastatin in Patients With Hepatopulmonary Syndrome in Cirrhosis.
Status:
Not yet recruiting
Trial end date:
2023-10-01
Target enrollment:
Participant gender:
Summary
Hepatopulmonary syndrome (HPS) is a frequent pulmonary complication of end-stage liver
disease that is characterized by decreased arterial oxygenation caused by intrapulmonary
vascular dilatation. Due to the different diagnostic criteria used in different studies, its
prevalence ranges from 4% to 47% in patients with cirrhosis. Main underlaying pathogensis for
HPS being activation of macrophages which are responsible for iNOS, PDGF and VEGF release
contributing to development of intrapulmonary vascular dilatation(IPVD) , and neoangiogenesis
leading to anatomical shunt resulting decreased oxygenation. Sphingosine 1 phosphate (S1P) is
an essential compound produced and secreted by endothelial cells, platelets and RBC's. S1P
prevents adhesion, transmigration and release of inflammatory mediators from macrophages. S1P
levels are decreased in cirrhotics. Simvastatin, a HMG CoA inhibitor has many pleotropic
effects, Of which one is by agonizing the S1P response and improving oxygenation in HPS
patients. Simvastatin at a optimal dose of 40mg/day for 6months. Pre and post simvastatin
treatment related oxygenation changes and concurrently its effect on liver fibrosis will be
evaluated.