Study of the Metabolism in the Lymphatic Niche of CLL

CLL Clinical Trial

Official title:

Study of the Metabolic Reprogramming of CLL Cells in Ex-vivo Models of the Lymphatic Niche

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05610228
• Other study ID #: 22Laboimmuno01
• Status: Recruiting
• Start date: November 7, 2018
• Est. completion date: December 15, 2022

Study information

• Verified date: November 2022
• Source: Centre Hospitalier Universitaire de Nice
• Contact: Caroline Ruetsch-Chelli
• Phone: 33492039016
• Email: ruetsch-chelli.c[@]chu-nice.fr
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Chronic lymphoid leukemia (CLL) is the most common adult leukemia that is characterized by a malignant monoclonal accumulation of tumoral and quiescent B cells in the peripheral blood. In advanced stages of the disease (Binet stage C), this population invades the bone marrow (BM) and proliferate into the lymphoid organs that results in widespread adenopathy. Richter's transformation is a most aggressive serious complication of CLL (transformation of the disease into an aggressive lymphoma) detected based on TEP/CT (Positron Emission Tomography/ computerized tomography) that shows highly derived glucose consumption by cancer cells. Clinical data from CLL patients with disease acutisation showed hypermetabolic lymphadenopathy with high standardized uptake value (SUV) whereas there is low grade tracer uptake into BM. We supposed that the tumor microenvironment of the lymphatic niche promotes the proliferation and glycolytic activity of CLL cells which become particularly resistant to treatment. The development of an ex-vivo tumor model that reproduces the microenvironment of the lymph node niche appears essential to identify and validate new therapeutic targets because despite the therapeutic arsenal available some patients still relapse or are refractory to treatment. Our objectives are to i / Characterize this niche of resistance by the development of an ex-vivo tumor model and ii / Evaluate in-vitro the effectiveness of the association of current treatments (RFC, Ibrutinib or Venetoclax) with anti-metabolic therapies (inhibitors of glycolysis) Our lab is developing an ex-vivo models of the lymphatic niche in CLL based on co-cultures of leukemic cells from patients stimulated with CpG ODN and IL2 with primary human lymphatic fibroblasts (HLF) (EC 12PP15). This co-culture has never been described in the literature and allows us to study the lymphatic niche of CLL patients. Lymph node (LN) exploration in CLL requires invasive access and does not bring any additional information in initial diagnosis. Then, we validated our co-culture model using complementary approaches: increased viability, proliferation, and resistance to Ibrutinib, associated with increased production of anti-apoptotic proteins such as MCL1 and BCL2 after 48 hours of co-culture. Secondly, we studied the metabolism in this resistance niche. We find an increased production of lactate and an acute consumption of glucose, associated with a strong metabolic activation detected by SEAHORSE and by the production of glycolysis enzymes such as hexokinase 2. Our study constitutes an original project because it characterized the energy metabolism of the CLL lymphatic niche by developing an original ex-vivo model and enhanced our understanding of the contribution of the specific microenvironment in the dissociation of metabolic activity using SUV max in BM and lymphatic niche. Anti-metabolic therapies are efficient on co-culture CLL cells and could be an alternative for refractory or relapsed patients under current treatment.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 30
• Est. completion date: December 15, 2022
• Est. primary completion date: December 15, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 90 Years

Eligibility

Inclusion Criteria:

• Patients for whom the diagnosis of CLL has been established cytologically and phenotypically (Matutes score)

• Patients over 18 years old

• Patients who have signed the non-objection form

• Untreated patients

Exclusion Criteria:

• Patient with a solid cancer that is progressive or in remission for less than 3 years

• HIV positive patients

• Patients with chronic active hepatitis B or C

• History of allogeneic transplant

Related Conditions & MeSH terms

• CLL

Intervention

Other:
• NO intervention
No intervention

Locations

Country	Name	City	State
France	Nice University Hospital	Nice

Sponsors (1)

Lead Sponsor	Collaborator
Centre Hospitalier Universitaire de Nice

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Modelisation of a CLL lymphatic niche by creation of an ex-vivo model	Measure of viability and proliferation of CLL cells by annexin PI with multiparameter: flow cytometry device, western blot and validation of the model by testing current therapy (Ibrutinib, anti BTK inhibitor)	48 months
Primary	Study of metabolism in CLL ex-vivo model	Anlayse of metabolism (ECAR and OCR) by seahorse methods , PCR qnd protein Multiparameter analyse	48 months
Primary	Evaluate in-vitro the effectiveness of the combination of current treatments (RFC, Ibrutinib or Venetoclax) with anti-inflammatory therapies. -metabolic (glycolysis inhibitors)	Viability using multiparameter flow cytometry	48 months