Changes of thiamine and magnesium induced by knee arthroplasty
Research type
Research Study
Full title
The relation between acute changes in the systemic inflammatory response, thiamine and magnesium concentrations and transketolase activity after elective knee arthroplasty. (Systemic inflammatory response: Thiamine and Magnesium status (Sir TaM study ))
IRAS ID
225557
Contact name
Donogh Maguire
Contact email
Sponsor organisation
NHS GGC
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Thiamine and magnesium play a critical role in glucose metabolism and deficiency results in the accumulation of anaerobic metabolites including lactate.
Thiamine requires magnesium to be converted to its active form, thiamine pyrophosphate (TPP). TPP also requires magnesium to achieve activation of TPP dependent enzymes during metabolism of glucose. The ‘gold standard’ for the measurement of thiamine status is the measurement of Erythrocyte Transketolase (ETKA), and this enzyme’s activity is dependent on the presence both thiamine pyrophosphate and magnesium. ETKA may therefore represent a ‘functional marker’ of magnesium status.
Studies indicate that low plasma thiamine and magnesium are associated with a range of disease processes, many of which are inflammatory. Other lipid-soluble vitamins and minerals are known to decrease during the systemic inflammatory response, however this relationship is not proven for magnesium. The systemic inflammatory response may therefore confound the interpretation of plasma thiamine and magnesium in the context of sepsis, surgery or autoimmune disease. Elective knee arthroplasty, provokes an inflammatory response and therefore provides an excellent controlled model for understanding the body's response to a systemic insult.
Obesity is reported to be associated with magnesium deficiency. Intracellular magnesium plays a key role in regulating insulin action, insulin-mediated-glucose-uptake and vascular tone.
There is a strong association between obesity and knee osteoarthritis. Obesity is also associated with thiamine and magnesium depletion. Lactate accumulation is known to precede the onset of insulin resistance and be characteristically found in patients with obesity related diabetes.
The relation between acute changes in the systemic inflammatory response and thiamine and magnesium concentrations, requires clarification. Failure to prove the reliability of the magnesium measurement in the context of the systemic inflammatory response may lead to patients receiving treatment for a measured deficiency of serum magnesium concentrations, which is unreliable.REC name
East of England - Cambridgeshire and Hertfordshire Research Ethics Committee
REC reference
17/EE/0270
Date of REC Opinion
11 Aug 2017
REC opinion
Further Information Favourable Opinion