Universal Rare Gene Study: A Registry and Natural History Study of Retinal Dystrophies Associated With Rare Disease-Causing Genetic Variants

Retinitis Pigmentosa Clinical Trial

— Uni-Rare  

Official title:

Universal Rare Gene Study: A Registry and Natural History Study of Retinal Dystrophies Associated With Rare Disease-Causing Genetic Variants

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05589714
• Other study ID #: Uni-Rare
• Status: Recruiting
• Start date: May 11, 2023
• Est. completion date: December 15, 2026

Study information

• Verified date: May 2024
• Source: Jaeb Center for Health Research
• Contact: Coordinating Center
• Phone: 813-975-8690
• Email: ffb[@]jaeb.org
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This is an international, multicenter study with two components:

Registry

• A standardized genetic screening and a prospective, standardized, cross-sectional clinical data collection

• Enrollment is open to all genes on the RD Rare Gene List

Natural History Study

• A prospective, standardized, longitudinal Natural History Study

• Enrollment opens gene-by-gene, based on funding and within-gene Registry enrollment The study objectives are as follows.

Registry Objectives

1. Genotype Characterization

2. Cross-Sectional Phenotype Characterization (within gene)

3. Establish a Link to My Retina Tracker Registry (MRTR)

4. Ancillary Exploratory Studies - Pooling of Genes

Natural History Study Objectives

1. Natural History (within gene)

2. Structure-Function Relationship (within gene)

3. Risk Factors for Progression (within gene)

4. Ancillary Exploratory Studies - Pooling of Genes

Description:

This study includes multiple phases.

1. Screening Phase

The patient's current genetic report will be reviewed. Genetic testing will not be performed in this study. A prior conclusive genetic test will be assessed for screening analysis. Having at least one gene on the RD Rare Gene List meets one of the eligible Genetic Screening Criteria and other eligibility criteria can be evaluated based on medical history.

2. Genetic Screening Phase:

Genetic reports for participants enrolled into the genetic screening phase will be uploaded to study website for review and confirmation by Central Genetics Auditor (CGA) as meeting Genetic Screening Criteria.Participants confirmed as meeting those criteria will be considered enrolled into the Registry.

3. Registry Phase:

The flow of participants who are enrolled into the Registry depends on whether their causal gene is designated as a Natural History Study (NHS) Target Gene. If they are not Designated as NHS Target Gene, they will receive annual phone calls up to 48 months from the Registry/Screening visit or until the gene is designated as NHS Target Gene. If they are Designated as NHS Target Gene participants will be considered pending enrollment into the NHS.

The Registry will establish genetically and clinically well-characterized cohorts of patients across hundreds of genetic variants associated with retinal dystrophy (RD). Characterization of these patients will accelerate eligibility screening for the Natural History Study, provide cross-sectional data on phenotype-genotype associations, and contribute to our knowledge of pathogenicity of these rare disease-causing variants.

4. Natural History Study (NHS) Phase

Participants pending enrollment will return to the clinic for the NHS Enrollment/Baseline Visit and return to the clinic for follow-up visits.

The Natural History Study will accelerate the identification and development of sensitive, reliable outcome measures for clinical trials, which will facilitate development of treatments for retinal dystrophies due to disease-causing genetic variants. The expected impact of the Natural History Study is as follows:

1. Describe the natural history of retinal degeneration in patients with rare disease-causing genetic variants

2. Identify sensitive structural and functional outcome

3. Identify well-defined subpopulations for future clinical trials of investigative treatments for rare inherited retinal degeneration

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 1500
• Est. completion date: December 15, 2026
• Est. primary completion date: December 15, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 4 Years and older

Eligibility

Inclusion Criteria: Participants must meet all the following inclusion criteria at the Registry/Screening Visit to be eligible to enroll into the genetic screening phase:

1. Willing to participate in the study and able to communicate consent during the consent process

2. Willing and able to complete all applicable Registry/Screening Visit assessments

3. Age = 4 years

4. Must have a single gene on the RD Rare Gene List which meets one of the Genetic Screening Criteria below based on a genetic report* from a clinically certified lab (or from a research lab which has been approved by the study Genetics Committee):

Inheritance Pattern is Recessive and has at least 2 disease-causing variants which are homozygous or heterozygous in trans

OR

Inheritance Pattern is Recessive and has 2 disease-causing variants with unknown phase and meets all the following additional informatic criteria that is consistent with likely segregation in trans:

1. Investigator confirms genotype and phenotype are consistent with autosomal recessive inheritance

2. The 2 disease-causing variants have not been reported in cis in variant databases

3. No additional potentially pathogenic variants were found on the gene (and the sequencing data for the gene were sufficiently robust to detect any additional potentially pathogenic variants)

4. No potentially pathogenic variants were found in other common, likely candidate genes for the proposed condition

OR

Inheritance Pattern is Dominant, X-linked, or Mitochondrial and has at least 1 disease-causing variant

Both eyes must meet the following criteria at the Registry/Screening Visit to enroll into the genetic screening phase:

1. Both eyes must have a clinical diagnosis of retinal dystrophy

2. Both eyes must permit good quality photographic imaging (e.g., but not limited to, clear ocular media, adequate pupil dilation, stable fixation)

Exclusion Criteria:

Participants must not meet any of the following exclusion criteria at the Registry/Screening Visit to be eligible to enroll into the genetic screening phase:

1. History of more than 1 year of cumulative treatment, at any time, with an agent associated with pigmentary retinopathy including amiodarone, chloroquine, deferoxamine, hydroxychloroquine, pentosan polysulfate, tamoxifen, and deferoxamine Note: Since this is an observational study, pregnant women will not be specifically excluded from participation. However, minors that are pregnant shall be precluded from participation until they become the age of majority.

Ocular Exclusion Criteria:

If either eye has any of the following ocular exclusion criteria at the Registry/Screening Visit, then the participant is not eligible to enroll into the genetic screening phase:

1. Current vitreous hemorrhage

2. Current complications of pathological myopia (for example, but not limited to, myopic maculopathy including atrophy, scar, choroidal neovascularization, schisis) that could inhibit ability to obtain good quality photographic imaging

3. History of intraocular surgery (for example, but not limited to, cataract surgery, vitrectomy, penetrating keratoplasty, or LASIK) within 3 months of Registry/Screening Visit

4. Current or any history of confirmed diagnosis of glaucoma (for example, but not limited to, glaucomatous VF changes or nerve changes, or history of glaucoma filtering surgery)

5. Current or any history of retinal vascular occlusion or proliferative diabetic retinopathy

6. History or current evidence of ocular disease that, in the opinion of the Investigator, may confound assessment of visual function (for example, but not limited to, tractional or rhegmatogenous retinal detachment, any vitreoretinal surgery, retinal vascular occlusion, proliferative diabetic retinopathy)

7. The following medications and treatments are prohibited as they can affect progression of retinitis pigmentosa (RP). The participant must not have received the following treatments:

Any use of ocular stem cell or gene therapy Any treatment with ocriplasmin Treatment with Ozurdex (dexamethasone), Iluvien, or Yutiq (fluocinolone acetonide) intravitreal implant

8. The following medications and treatments are excluded within the specified timeframe:

Treatment with an ophthalmic oligonucleotide within the last 9 months (last treatment date is less than 9 months prior to Registry/Screening Visit date)

Treatment with any other product within five times the expected half-life of the product (time from last treatment date to Registry/Screening Visit date is at least 5 times the half-life of the given product)

Related Conditions & MeSH terms

• Inherited Retinal Degeneration
• Rare Diseases
• Retinal Degeneration
• Retinal Dystrophies
• Retinitis
• Retinitis Pigmentosa

Locations

Country	Name	City	State
Australia	Centre for Eye Research Australia	East Melbourne	Victoria
Brazil	INRET Clínica e Centro de Pesquisa	Belo Horizonte	Minas Gerais
Brazil	Instituto de Genética Ocular	São Paulo	São Paulo Province
Canada	University of Alberta and Alberta Health Services	Edmonton	Alberta
Canada	University of Toronto, Hospital for Sick Children	Toronto	Ontario
Finland	Helsinki University Hospital	Helsinki
France	CHNO des Quinze-Vingts	Paris
Israel	Hadassah-Hebrew University Medical Center	Jerusalem
Mexico	Retina and Genomics Institute	Yucatan	Merida
Netherlands	Radboud University Medical Center	Nijmegen
Switzerland	University Hospital Basel	Basel	Basel-Stadt
United Kingdom	Moorfields Eye Hospital	London
United States	University of Michigan, Kellogg Eye Center	Ann Arbor	Michigan
United States	Emory University, Emory Eye Center	Atlanta	Georgia
United States	Johns Hopkins University, Wilmer Eye Institute	Baltimore	Maryland
United States	Harvard Univ., Massachusetts Eye and Ear Infirmary	Boston	Massachusetts
United States	Retina Foundation of the Southwest	Dallas	Texas
United States	Duke University, Duke Eye Center	Durham	North Carolina
United States	Baylor College of Medicine, Alkek Eye Center	Houston	Texas
United States	University of Florida Health Jacksonville	Jacksonville	Florida
United States	Univ. of California San Diego, Jacobs Retina Center	La Jolla	California
United States	University of Arkansas, Jones Eye Institute	Little Rock	Arkansas
United States	University of Wisconsin Madison	Madison	Wisconsin
United States	University of Miami, Bascom Palmer Eye Institute	Miami	Florida
United States	Medical College of Wisconsin Eye Institute	Milwaukee	Wisconsin
United States	Center for Advanced Retinal and Ocular Therapeutics	Philadelphia	Pennsylvania
United States	Associated Retina Consultants	Phoenix	Arizona
United States	UPMC Eye Center	Pittsburgh	Pennsylvania
United States	Oregon Health & Science Univ., Casey Eye Institute	Portland	Oregon
United States	Mayo Clinic	Rochester	Minnesota
United States	University of Utah, John Moran Eye Center	Salt Lake City	Utah
United States	University of California San Francisco	San Francisco	California

Sponsors (2)

Lead Sponsor	Collaborator
Jaeb Center for Health Research	Foundation Fighting Blindness

Countries where clinical trial is conducted

United States,  Australia,  Brazil,  Canada,  Finland,  France,  Israel,  Mexico,  Netherlands,  Switzerland,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Functional Outcome: Characterize change using Visual field sensitivity measured with quantitative topographic analysis (hill of vision [HOV])	Measured by Static Perimetry (SP) using Octopus 900 Pro	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change Using Early Treatment of Diabetic Retinopathy Study (ETDRS) / HOTV Best Corrected Visual Acuity (BCVA) letter score	Measured by Electronic Visual Acuity (EVA) system or ETDRS/HOTV charts	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change Using Low visual acuity test - for participants unable to see ETDRS letters	Measured by Berkeley Rudimentary Vision Test (BRVT) for Low Visual Acuity	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change Using ETDRS/HOTV best corrected low luminance visual acuity letter score	Measured by Electronic Visual Acuity (EVA) system or ETDRS/HOTV charts	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change in Mean retinal sensitivity	Measured by Fundus guided Microperimetry (MP) using MAIA	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change in Contrast sensitivity function	Measured by Contrast sensitivity CSV-1000E chart	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change in Retinal function using amplitudes and timing in response to rod- and cone-specific stimuli	Measured by Full-field Electroretinogram (ffERG) Diagnosys Espion	Baseline and at study completion (4 years)
Primary	Functional Outcome: Characterize Change in Full-field retinal sensitivity	Measured by Full-field stimulus threshold (FST) testing to blue, white, and red stimuli using Diagnosys Espion	Baseline and every year until study completion (4 years)
Primary	Functional Outcome: Characterize Change in Color vision function	Measured by Color vision testing using Lanthony D15	Baseline and every year until study completion (4 years)
Primary	Structural Outcome: Characterize Change in Ellipsoid zone (EZ) area; outer nuclear layer and ganglion cell layer thicknesses	Measured by Spectral Domain Optical Coherence Tomography (SD-OCT) using Heidelberg Spectralis	Baseline and every year until study completion (4 years)
Primary	Structural Outcome: Characterize Change Using Qualitative and quantitative assessments of autofluorescence pattern	Measured by Fundus Autofluorescence (FAF) using Optos	Baseline and every year until study completion (4 years)

External Links

•   Foundation Fighting Blindness Public Website
•   Uni-Rare Rare Gene List