Johns Hopkins Crohn's Disease and Ulcerative Colitis Study
Recruitment status was Recruiting
|First Received Date ICMJE||July 23, 2010|
|Last Updated Date||July 6, 2011|
|Start Date ICMJE||July 1996|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE||Not Provided|
|Original Primary Outcome Measures ICMJE||Not Provided|
|Change History||Complete list of historical versions of study NCT01169207 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE||Not Provided|
|Original Secondary Outcome Measures ICMJE||Not Provided|
|Current Other Outcome Measures ICMJE||Not Provided|
|Original Other Outcome Measures ICMJE||Not Provided|
|Brief Title ICMJE||Johns Hopkins Crohn's Disease and Ulcerative Colitis Study|
|Official Title ICMJE||Johns Hopkins Crohn's Disease and Ulcerative Colitis Study|
This research is being done to find out why Inflammatory Bowel Disease (IBD) (i.e., Crohn's disease and ulcerative colitis) occurs in individuals and in families. Recently the investigators and other researchers have found a gene (DNA) that when changed, gives people a higher risk for developing IBD or other inflammatory diseases like IBD. By doing this research, scientists and doctors will study the cells in the blood to see how the gene-change affects the way the blood cells' immune system works.
The inflammatory bowel diseases (IBD)—Crohn's disease (CD) and ulcerative colitis (UC) have an estimated combined prevalence of 0.2% to 0.3% in the United States, and are two to eight times more prevalent in Jewish Americans of Central or Eastern European descent (Ashkenazi Jews) as compared to non-Jewish Americans. CD may involve any part of the gastrointestinal tract, but most often the colon and terminal ileum. Bowel inflammation is discontinuous, transmural, and may contain granulomas. CD is also associated with bowel stenoses and intestinal and perianal fistulas. UC, by contrast, involves continuous, non-granulomatous inflammation of the colon and rectum, limited to the mucosal layers. Fistulas are not observed. Colonic disease that cannot be clearly identified as CD or UC is designated "indeterminate colitis".
There is strong evidence from twin studies and familial aggregation that CD and UC are in large part genetic, and follow a complex, non-Mendelian mode of inheritance. First-degree relatives of IBD patients have an 8 to 10 fold increased risk of developing IBD. Therefore, it was hypothesized that IBD is in part the result of mutations and disease polymorphisms in specific susceptibility genes. Furthermore, the complications, site of disease, onset and severity show increased familial concordance. Therefore, these and perhaps other factors in variability of disease expression and course appear to be in part under genetic control. The hypothesis is that familial disease aggregation is the result of IBD susceptibility genes disease risk polymorphisms and mutations. Loci containing these disease genes can be identified by linkage mapping and the disease gene polymorphisms can be determined by showing linkage disequilibrium (LD) with the disease variant greater in affected IBD cases as compared to within family (parental) or unrelated, matched controls. Power analyses show that to have 80% power to only identify IBD susceptibility loci with a relative sibling risk of 1.5 and an error of p = 0.01 and heterogeneity of 0.3 would require a genome screen on approximately 200 affected relative pair pedigrees. It would require several times this number of pedigrees to have power to establish these loci at genome wide levels of significance (Brant and Shugart, Inflamm Bowel Dis, 2004). To have power to establish (at p = 10-7) disease specific risk polymorphisms by LD association analyses—for genotypic relative risks of 2.0 with complex models of inheritance would require 350 to 700 cases and 350 to 700 controls or a similar number of parental/affected offspring "trio" pedigrees (i.e. up to 1400 parents with 700 affected offspring) (Knapp, AJHG, 1999). To establish lower relative risk polymorphisms would require about three times these numbers.
The current protocol was initiated in 1996 to initially collect multiplex pedigrees for linkage studies. The investigators performed the first IBD genome screen in North America in 1998 with DNAs from pedigrees collected from the study combined with those from the Univ. of Chicago and identified multiple loci, and confirmed the IBD1 locus on chromosome 16. In 2003, the investigators published a second genome wide screens that also included a large series
of patients recruited at Johns Hopkins under this protocol identifying and comfirming additional loci. The investigators (and others) have identified 8 confirmed IBD loci (IBD1-8), and there are several additional loci with strong evidence in one or more screens (Brant and Shugart, Inflamm Bowel Dis., 2004). The investigators have recently received funding for a new genome screen performed at the NIH funded Center for Inherited Disease Research (CIDR) genotyping facility, and samples are being submitted at this time. From these multiple loci, three proven disease genes for IBD have been established; the most provocative is the NOD2/CARD15 gene for the IBD1 locus. This gene is an intracellular sensor of bacterial cell wall components and a critical player in the innate immune system known to be important in IBD pathogenesis (Hugot et al and Ogura et al; Nature, 2001). The investigators participated in this discovery (Ogura et al., Nature, 2001).
There are three independent mutations in the NOD2 gene (G908R, R702W, and Cins1007fs) that are consistently increased in white CD patients as compared to healthy controls. These mutations interfere with the gene's ability to sense muramyl dipeptide, the critical bacterial cell wall residue. The investigators added to the protocol in 2001 permission to study isolated cells and biomarkers from larger blood withdrawals from study subjects and the investigators have found evidence for NOD2 gene expression variants. The two other established genetic factors are haplotype associations in the HLA region (IBD3) and the chromosome 5q cytokine cluster (IBD5, leading candidate are functional mutations in the OCTN1/2 genes). The investigators have also identified NFKB1 and MDR1 IBD predisposing polymorphisms.
Despite the exciting discoveries of multiple genes associated with IBD, altogether, these genes account of only a fraction of familial risk. Therefore, the investigators will continue to enroll participants to meet the present goal for recruitment of 2,500 samples composed of IBD pedigrees for linkage and familial LD studies, and singleton cases and controls for case-control LD association studies. The investigators will also work to discover if there is association of the genes with biomarkers from serum (the investigators have examined anti-Saccharomyces cerevisiae antibody and NOD2), and cells from blood and immortalized blood from IBD patients as compared to controls. In addition, the investigators will test biomarkers to evaluate their potential as predictors of disease course and therapeutic outcome.
|Study Type ICMJE||Observational|
|Study Design ICMJE||Observational Model: Case Control
Time Perspective: Prospective
|Target Follow-Up Duration||Not Provided|
|Biospecimen||Retention: Samples With DNA
whole blood, serum
|Sampling Method||Non-Probability Sample|
IBD patient's are primarily recruited at the Johns Hopkins inpatient and outpatient units. However, individuals contact us by phone, mail or email after hearing about our study
|Condition ICMJE||Inflammatory Bowel Disease|
|Intervention ICMJE||Not Provided|
|Study Group/Cohort (s)||
|Publications *||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Recruiting|
|Estimated Enrollment ICMJE||2500|
|Completion Date||Not Provided|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
|Ages||4 Years and older|
|Accepts Healthy Volunteers||Yes|
|Location Countries ICMJE||United States|
|NCT Number ICMJE||NCT01169207|
|Other Study ID Numbers ICMJE||96-01-31-06|
|Has Data Monitoring Committee||Yes|
|Responsible Party||Steven R. Brant, M.D., Johns Hopkins University-School of Medicine|
|Study Sponsor ICMJE||Johns Hopkins University|
|Collaborators ICMJE||Not Provided|
|Information Provided By||Johns Hopkins University|
|Verification Date||July 2011|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP