Risk Factors in Early Multiple Sclerosis

Multiple Sclerosis Clinical Trial

— RISEMS  

Official title:

Risk Factors in Early Multiple Sclerosis

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03586986
• Other study ID #: 17-1884
• Status: Recruiting
• Start date: July 26, 2018
• Est. completion date: May 2024

Study information

• Verified date: February 2023
• Source: University of Colorado, Denver
• Contact: John R Corboy, MD
• Phone: 303-724-2187
• Email: john.corboy[@]ucdenver.edu
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The central hypothesis of this protocol is that it is possible, using First Degree Relatives (FDRs) of patients with Multiple Sclerosis (MS) and assessing a variety of both known and unknown risk factors for MS, to define a risk algorithm for earliest signs of development of MS. The plan will be to do an abbreviated brain Magnetic Resonance Imaging (MRI) scan in asymptomatic, young FDRs, analyze blood for a variety of immunological, genetic, neuroaxonal damage, metabolic, viral serology and other markers, and have FDRs fill out a detailed bioscreen questionnaire about lifestyle factors and perform a cognitive screening test. The investigators will then compare the results of the various blood/other studies in FDRs with and without an MRI showing signs signs concerning for MS, as well as age-and sex-matched NON-FDRs who will have blood drawn and fill out the questionnaire. With this preliminary cross-sectional study, the investigators hope to begin to identify a risk stratification model for those at highest risk of developing MS, ie FDRs, with a long-term goal of developing a longitudinal study to increase sensitivity and specificity of the risk model.

Description:

Specific Aims, among asymptomatic first degree relatives (FDRs), aged 18-30, of multiple sclerosis (MS) patients:

1. Determine the prevalence of brain MRI lesions disseminated in space (DIS), consistent with MS

2. Gather data on potential risk factors or early signs related to MS development, including markers for: genes, immunological function, environmental factors, neuroaxonal damage, Vitamin D levels, lipid metabolism, activity levels, mood abnormalities, and cognitive function. From this, develop a risk factor score, incorporating all relevant potential markers of increased risk of DIS.

3. To use this pilot, cross-sectional study as a base for development of a long-term, longitudinal, multi-center study to determine genetic and environmental risks for pre-symptomatic MS

4. To create and maintain a biobank of specimens for future analysis as other potential biomarkers become available.

5. Evaluate for potential dissemination in time (DIT) and dissemination in space (DIS) in asymptomatic FDRs through longitudinal assessment.

Sequences to include

1. Whole brain T1-weighted images acquired using 3-Dimensional fast spoiled-gradient recalled acquisitions (T1-3D-FSPGR) with 1 mm slice thickness and isotropic voxel dimensions.

2. Whole brain 3-Dimensional Double Inversion Recovery (DIR) acquisition with 1.5 mm slice thickness.

3. Whole brain T2-weighted Fluid Attenuated Inversion Recovery (FLAIR ) images with 1 mm slice thickness and isotropic voxel dimensions will be combined with

4. Whole brain T2*-weighted segmented echo-planar imaging (segEPI) images with <=1 mm slice thickness and isotropic voxel dimensions to obtain FLAIR* images.

Blood analysis for:

1. Single Nucleotide Polymorphism analysis of greater than 200 known mutations associated with risk of MS, and do an human leukocyte antigen (HLA) analysis

2. CD20 on CD4+ cell analysis

3. B Cell Anergy analysis Lipid levels

4. Viral serologies (HSV, EBV, CMV, VZV)

5. Neurofilament Light

6. Vitamin D levels

Bioscreen analysis based on that from the Diabetes Autoimmunity Study in the Young (DAISY); and to include the Godin Leisure-Time Exercise Questionnaire (GLTEQ), which has been validated in both adults and children and a validated dietary/food frequency questionnaire. In addition perform a cognitive screen with a Symbol Digit Modality test.

Blood will also be stored for future potential analysis, including peripheral blood mononuclear cells, serum, and Ribonucleic acid (RNA).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 300
• Est. completion date: May 2024
• Est. primary completion date: May 2024
• Gender: All
• Age group: 18 Years to 30 Years

Eligibility

Inclusion Criteria:

• FDR Inclusion Criteria

1. Male and female

2. All races and ethnicities

3. Ages 18-30

4. Must have a parent, sibling or child with MS fulfilling McDonald 2017 criteria

5. No symptoms suggestive of MS on formal screen

6. Ability to undergo a non-contrast MRI and venipuncture, and perform an environmental screen, mood screen and cognitive test

• Non-FDR Inclusion Criteria

1. Male and female

2. All races and ethnicities

3. Ages 18-30

4. Must NOT have a FDR (parent, sibling, child) or second degree relative (grandparent, aunt or uncle) with MS fulfilling McDonald 2017 criteria

5. No symptoms suggestive of MS on formal screen

6. Ability to undergo venipuncture and perform an environmental screen.

Exclusion Criteria:

• FDR Exclusion Criteria

1. Symptoms suggestive of MS on formal screen

2. Prior diagnosis of autoimmune disease that may be associated with CNS dysfunction and MRI lesions, e.g. Sjogren's

• Non-FDR Exclusion Criteria

1. Symptoms suggestive of MS on formal screen

2. Prior diagnosis of autoimmune disease that may be associated with CNS dysfunction and MRI lesions, e.g. Sjogren's

Related Conditions & MeSH terms

• Biomarkers
• Clinically Isolated Syndrome
• Magnetic Resonance Imaging
• Multiple Sclerosis
• Radiologically Isolated Syndrome
• Sclerosis
• Syndrome

Intervention

Diagnostic Test:
• Brain MRI
Perform brain MRI; draw blood; fill out bioscreen questionnaire; perform SDMT

Locations

Country	Name	City	State
United States	University of Colorado Anschutz Medical Campus	Aurora	Colorado

Sponsors (2)

Lead Sponsor	Collaborator
University of Colorado, Denver	Colorado School of Public Health

Country where clinical trial is conducted

United States, 

References & Publications (19)

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Gabelic T, Ramasamy DP, Weinstock-Guttman B, Hagemeier J, Kennedy C, Melia R, Hojnacki D, Ramanathan M, Zivadinov R. Prevalence of radiologically isolated syndrome and white matter signal abnormalities in healthy relatives of patients with multiple sclerosis. AJNR Am J Neuroradiol. 2014 Jan;35(1):106-12. doi: 10.3174/ajnr.A3653. Epub 2013 Jul 25. — View Citation

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Kappos L, Freedman MS, Polman CH, Edan G, Hartung HP, Miller DH, Montalban X, Barkhof F, Radu EW, Metzig C, Bauer L, Lanius V, Sandbrink R, Pohl C; BENEFIT Study Group. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol. 2009 Nov;8(11):987-97. doi: 10.1016/S1474-4422(09)70237-6. Epub 2009 Sep 10. — View Citation

Kavaliunas A, Manouchehrinia A, Stawiarz L, Ramanujam R, Agholme J, Hedstrom AK, Beiki O, Glaser A, Hillert J. Importance of early treatment initiation in the clinical course of multiple sclerosis. Mult Scler. 2017 Aug;23(9):1233-1240. doi: 10.1177/1352458516675039. Epub 2016 Oct 17. — View Citation

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Solomon AJ, Corboy JR. The tension between early diagnosis and misdiagnosis of multiple sclerosis. Nat Rev Neurol. 2017 Sep;13(9):567-572. doi: 10.1038/nrneurol.2017.106. Epub 2017 Aug 11. No abstract available. — View Citation

Solomon AJ, Schindler MK, Howard DB, Watts R, Sati P, Nickerson JP, Reich DS. "Central vessel sign" on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine. Ann Clin Transl Neurol. 2015 Dec 16;3(2):82-7. doi: 10.1002/acn3.273. eCollection 2016 Feb. — View Citation

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* Note: There are 19 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Discovery of Lesions disseminated in space on brain MRI	Lesions disseminated in space on brain MRI. The presence or absence of these lesions will only be measured once at the initial visit.	At the subject's Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the prevalence of specific genetic markers including, single nucleotide polymorphism analysis of more than 200 known mutations and analysis of HLA-DRB1 variants, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the prevalence of immunological markers including, CD4, CD8, CD40, CD19 and CD20 with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the prevalence of vitamin D deficiencies, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the prevalence of lipid markers including, total cholesterol, high and low density lipoproteins, and triglycerides, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the presence of the viral infection Epstein-Barr virus, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the presence of the viral infection Cytomegalovirus, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the presence of the viral infection Herpes Simplex I, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the presence of the viral infection Herpes Simplex II, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the presence of the viral infection Varicella zoster virus, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure the prevalence of CNS damage marker Neurofillament light, with the goal of defining an expanded risk stratification scheme.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will measure activity level, using the Godin Leisure-time Exercise questionnaire, with the goal of defining an expanded risk stratification scheme. Weekly frequencies of strenuous, moderate, and light activities (i.e. number of times per week an individual performs these activities) are multiplied by nine, five, and three, respectively. Total weekly leisure activity is calculated in arbitrary units by summing the products of the separate components, as shown in the following formula: Weekly leisure activity score = (9 × Strenuous) + (5 × Moderate) + (3 × Light). As there is no limit for the number of times a participant can perform an exercise per week, the maximum score is boundless. While, a sedentary individual may exhibit the minimum score of 0.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will evaluate cognitive functions using the Perceived Stress Scale, with the goal of defining an expanded risk stratification scheme. This will be used to evaluate stress domains. Individual scores on the Perceived Stress Scale can range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low stress. Scores ranging from 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will evaluate cognitive functions using University of Colorado's NeuroQol Depression Scale, with the goal of defining an expanded risk stratification scheme. This assessment will be used to evaluate depression domains. The minimum raw score is 8, which represents better (desirable) self-reported health, and the maximum score is 40, which represents worse (undesirable) self-reported health. These raw scores will be converted to T-scores, with 36.9 being the minimum and 75.0 being the maximum T-score.	Within 4 months of the Initial Visit
Secondary	Define risk stratification algorithm for prediction of MS	The investigators will evaluate cognitive functions using University of Colorado's NeuroQol Anxiety Scale, with the goal of defining an expanded risk stratification scheme. This assessment will be used to measure anxiety domains, with the highest raw score of 40 representing worse (undesirable) self-reported anxiety, and a raw score of 8 representing better (desirable) self-reported anxiety. These raw scores will be converted to T-scores, with 36.4 being the minimum and 76.8 being the maximum T-score.	Within 4 months of the Initial Visit