Cardiovascular Structure and Function in the Mucopolysaccharidoses

Inflammation Clinical Trial

Official title:

Cardiovascular Structure and Function in the Mucopolysaccharidoses

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05063435
• Other study ID #: 200107
• Status: Recruiting
• Start date: October 13, 2021
• Est. completion date: March 31, 2025

Study information

• Verified date: August 2023
• Source: Children's Hospital of Orange County
• Contact: Nina Movsesyan, Ph.D.
• Phone: (714) 509-3008
• Email: nmovsesyan[@]choc.org
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This study's investigators previously demonstrated the potential utility of non-invasive carotid ultrasonography to calculate carotid intima media thickness (cIMT) and stiffness (as measured by the three parameters, carotid cross-sectional distensibility [cCSD], carotid cross-sectional compliance [cCSC], and carotid incremental elastic modulus [cIEM]) in people with mucopolysaccharidoses (MPS).

Investigators also studied arterial gene expression in animal models of MPS, and identified upregulation of a number of markers potentially tied to atherosclerosis and inflammation. These include the atherosclerotic marker known as Clusterin (CLU), Cathepsin S, Elastin, and the inflammatory cytokines interleukin 1-α, interleukin 1-β, interleukin 2, and interleukin

6. Other studies have identified elevation in circulating tumor necrosis factor-α correlating with pain and physical disability in certain mucopolysaccharidoses.

Since these studies are cross sectional, and not longitudinal, this study aims to annually measure these previously studied biomarkers (carotid measurements, circulating cytokines, cathepsin S, elastin, and CLU) in a large cohort of MPS patients. This study is a 3-year, prospective, anonymized, longitudinal assessment of cardiovascular structure, function, and circulating biomarkers in patients with mucopolysaccharidoses.

Description:

Specific Aims

1. Annually assess cardiac and carotid structure and function utilizing ultrasonography, in patients with mucopolysaccharidoses

2. Annually measure circulating levels of clusterin, elastin, cathepsin S, lipids, and cytokines in patients with mucopolysaccharidoses

Target enrollment 30 subjects at CHOC Children's Hospital

Study Protocol

Screening

1. Study Investigators will identify eligible patients to participate in the study from their current patient population and future referrals.

2. Eligible patients will be provided with study information on the study during their standard of care metabolic clinic visit.

Informed Consent

1. Informed consent will be obtained following the requirements set forth by 21 CFR 50.25.

2. Patients interested in the study will be provided the informed consent document. The document will be reviewed in a private quiet room and ample time for questions will be provided. The patient can keep a copy of the consent if they wish to discuss the study with friends and family. Consent will only be obtained once the patient has had time to ask questions and is aware that the study is completely voluntary.

Initial entry

1. Information regarding age, sex, MPS diagnosis (including genetic mutation and enzymatic levels, if possible) will be obtained

2. Height and weight will be obtained. If patient has had a recent (within 3 months) evaluation at CHOC Children's with height and weight, those parameters may be used

3. Medical records will be obtained specifically focusing upon

1. the genetic and/or enzymatic testing used to confirm the MPS diagnosis

2. the treatment status (treated or not) and duration of treatment (calculated by the difference between date of first carotid imaging and date of first treatment)

4. Carotid ultrasonography will be obtained

1. Study takes 10 - 15 minutes to complete

2. Subject will be asked to lay still and quietly during procedure

3. Blood pressure and heart rate will be obtained during the study

4. Results will be digitized and stored on CD

5. Echocardiography will be obtained

1. Study takes 15 - 20 minutes to complete

2. Subject will be asked to lay still and quietly during procedure

3. Results will be digitized and stored on CD

6. Venipuncture / phlebotomy

1. 10 mL of blood total will be drawn (5 mL in a blue top citrate tube, 5 mL in a purple top EDTA tube). Measurements of cytokines, clusterin, lipidomics, cathepsin S protease, and elastin (previously identified potential biomarker candidates) will be performed.

2. Blood will preferably be drawn via venipuncture, but if patient has a port-a-cath already implanted and is having blood drawn via port-a-cath for clinically required reasons, then study-related blood draw via port-a-cath can take place concurrently with clinically required blood draws.

Annual studies Procedures 2), 4), 5), and 6) will be repeated on an annual basis for a total of three years

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 30
• Est. completion date: March 31, 2025
• Est. primary completion date: October 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

1. Any patient with a molecularly confirmed diagnosis of mucopolysaccharidosis is eligible to enroll in this study

2. Parental / patient informed consent

Exclusion Criteria:

1. Any reason that the investigators would deem a patient unable to participate in this study

2. Inability to participate in the assessments required for this study

Related Conditions & MeSH terms

• Cardiac Disease
• Carotid Disease
• Heart Diseases
• Inflammation
• Mucopolysaccharidoses

Intervention

Diagnostic Test:
• Carotid ultrasonography
Study takes 10 - 15 minutes to complete Subject will be asked to lay still and quietly during procedure The ultrasound probe will be placed on one side of the neck to capture images of the carotid artery. When images from one side have been captured, the probe will be moved to the other side of the neck to capture images from the other carotid artery. Blood pressure and heart rate will be obtained during the study Results will be anonymized, digitized and stored on CD with unique identifier
• Echocardiography, transthoracic
Study takes 15 - 20 minutes to complete Subject will be asked to lay still and quietly during procedure The technician will apply an ultrasound probe to the chest. Images and movies will be acquired. Results will be digitized and stored on CD

Procedure:
• Venipuncture
10 mL of blood total will be drawn (5 mL in a blue top citrate tube, 5 mL in a purple top EDTA tube). Measurements of cytokines, clusterin, lipidomics, cathepsin S protease, and elastin (previously identified potential biomarker candidates) will be performed. Blood will preferably be drawn via venipuncture, but if patient has a port-a-cath already implanted and is having blood drawn via port-a-cath for clinically required reasons, then study-related blood draw via port-a-cath can take place concurrently with clinically required blood draws.

Locations

Country	Name	City	State
United States	Children's Hospital of Orange County	Orange	California

Sponsors (2)

Lead Sponsor	Collaborator
Children's Hospital of Orange County	Ultragenyx Pharmaceutical Inc

Country where clinical trial is conducted

United States, 

References & Publications (4)

Wang RY, Braunlin EA, Rudser KD, Dengel DR, Metzig AM, Covault KK, Polgreen LE, Shapiro E, Steinberger J, Kelly AS. Carotid intima-media thickness is increased in patients with treated mucopolysaccharidosis types I and II, and correlates with arterial stiffness. Mol Genet Metab. 2014 Feb;111(2):128-32. doi: 10.1016/j.ymgme.2013.11.001. Epub 2013 Nov 12. — View Citation

Wang RY, Covault KK, Halcrow EM, Gardner AJ, Cao X, Newcomb RL, Dauben RD, Chang AC. Carotid intima-media thickness is increased in patients with mucopolysaccharidoses. Mol Genet Metab. 2011 Dec;104(4):592-6. doi: 10.1016/j.ymgme.2011.09.004. Epub 2011 Sep 10. — View Citation

Wang RY, Rudser KD, Dengel DR, Braunlin EA, Steinberger J, Jacobs DR, Sinaiko AR, Kelly AS. The Carotid Intima-Media Thickness and Arterial Stiffness of Pediatric Mucopolysaccharidosis Patients Are Increased Compared to Both Pediatric and Adult Controls. Int J Mol Sci. 2017 Mar 15;18(3):637. doi: 10.3390/ijms18030637. — View Citation

Wang RY, Rudser KD, Dengel DR, Evanoff N, Steinberger J, Movsesyan N, Garrett R, Christensen K, Boylan D, Braddock SR, Shinawi M, Gan Q, Montano AM. Abnormally increased carotid intima media-thickness and elasticity in patients with Morquio A disease. Orphanet J Rare Dis. 2020 Mar 17;15(1):73. doi: 10.1186/s13023-020-1331-y. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Cardiovascular Event	A cardiovascular event is defined by new onset of clinically significant aortic or mitral valve disease, aortic root dilatation, cardiomyopathy, reduction in cardiac contractile function, myocardial ischemia, myocardial infarction, or cerebrovascular accident	3 years
Secondary	Age	Change of age of subject (unit: years)	3 years
Secondary	Height	Change of height of subject (unit: meters)	3 years
Secondary	Weight	Change of weight of subject (unit: kilograms)	3 years
Secondary	Blood pressure	Change in systolic and diastolic blood pressure over the duration of the study (unit: millimeters of mercury)	3 years
Secondary	Carotid structure	Change in carotid intima media thickness over the duration of the study (mm).	3 years
Secondary	Carotid stiffness	Change in carotid cross-sectional distensibility over the duration of the study (unit: %). This metric is acquired in the carotid ultrasound, and measures the stiffness of the carotid artery via quantitation of the difference between end-systolic and end-diastolic carotid diameter.	3 years
Secondary	Cardiac structure (left ventricle)	Change in left ventricular mass index over the duration of the study (unit: grams / m2 body surface area). This metric is acquired in the echocardiogram, and quantitates the amount of myocardium in the left ventricle.	3 years
Secondary	Cardiac structure (aortic root diameter)	Change in aortic root measurement over the duration of the study (unit: mm). This metric is acquired in the echocardiogram, and quantitates the width of the aortic root.	3 years
Secondary	Mitral valve function	Assessment of changes in mitral valve function over the duration of the study (unit: 4 point Likert scale from 0 [none] to 4 [severe]). This metric is acquired during the echocardiogram, and assess the degree of mitral valve insufficiency.	3 years
Secondary	Aortic valve function	Assessment of changes in aortic valve function over the duration of the study (unit: 4 point Likert scale from 0 [none] to 4 [severe]). This metric is acquired during the echocardiogram, and assess the degree of aortic valve insufficiency.	3 years
Secondary	Inflammatory biomarkers (Tumor Necrosis Factor - alpha)	Change in plasma TNFa over the duration of the study.	3 years
Secondary	Inflammatory biomarkers (Cathepsin S)	Change in plasma Cathepsin S over the duration of the study. (Unit: mcg/L)	3 years
Secondary	Inflammatory biomarkers (Elastin)	Change in plasma Elastin levels over the duration of the study. (Unit: ng/mL)	3 years
Secondary	Inflammatory biomarkers (Clusterin)	Change in plasma clusterin levels over the duration of the study. (Unit: mcg/mL)	3 years
Secondary	Inflammatory biomarkers (lipidomics)	Change in plasma lipid levels over the duration of the study. (Unit: mcmol/L)	3 years