Natural History of Intestinal Inflammation in People With Primary Immune Dysregulations
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|ClinicalTrials.gov Identifier: NCT03278912|
Recruitment Status : Recruiting
First Posted : September 12, 2017
Last Update Posted : October 5, 2020
PIDD stands for primary immune dysregulation. It is a general term that includes many different inherited immune system disorders. The immune system is the part of the body that helps fight disease and infection. People with PIDDs can develop many kinds of health problems. One of these is inflammatory bowel disease (IBD), which causes diarrhea and cramping. Researchers want to learn more about these disorders to develop possible treatments.
To learn more about when and why IBD may develop in some people with PIDDs.
People ages 3 and older who have PIDD or IBD.
Healthy volunteers in this age group are also needed.
Visit 1: Participants will be screened with physical exam, medical history, and blood and urine tests.
Visit 2: Participants will:
- Have more physical exams and blood and urine tests.
- Answer questions about quality of life and food history.
- Provide a stool sample.
- Have nasal and rectal skin swabs.
- Have saliva collected.
Participants will have 1 follow-up visit per year. They will repeat visit 2 procedures.
Participants will be contacted by phone or email in between yearly visits. They will be asked about their health. They will complete a quality-of-life questionnaire and send a stool sample that is collected at home.
If participants experience a sudden change in symptoms or undergo a new treatment, they may be asked to complete visit 2 procedures.
If participants are not able to come to NIH, study data and samples can be collected without an in-person visit.
Participants will have a final study visit about 10 years after Visit 1. They will repeat visit 2 procedures.
|Condition or disease|
|Chronic Granulomatous Disease Inflammatory Bowel Disease|
Over 1 million people suffer from IBD in the United States. Although the exact pathogenesis is unclear, IBD results from an inappropriate inflammatory response to intestinal microbes which is influenced by the environment in a genetically susceptible host. IBDs can be classified as conventional (Crohn disease (CD) and ulcerative colitis (UC)) and unclassified (early onset, difficult to treat, associated with monogenic disorders and PIDDs). Among the 200 IBD susceptibility loci identified in genome-wide association studies (GWAS), overlap with aberrations identified in PIDDs has been observed, thereby supporting the study of PIDDs to better understand conventional IBD pathogenesis, while recognizing PIDD-associated IBDs as distinct disease entities requiring specialized management.
The prevalence of PIDDs worldwide is estimated at 1 in 2000 live births and encompasses a growing list of over 300 PIDDs. Despite the fact that GI disease is the second most common complication in patients with PIDDs (rates ranging from 5-50%), little is known about PIDDspecific
IBD pathogenesis and even less is understood about the role of the microbiota both as a consequence and modulator of immune response in these inherited disorders. Moreover, there may be a time-limited period ("immunological window of opportunity"), coinciding with the maturation of the host s microbiome, during which early immune education may have long-term effects on predisposition to aberrant immune responses and inflammatory dysregulation. The primary objective of this study is to determine if PIDDs result in intestinal dysbioses, which alter local and systemic immune responses. Our long-term goal is to comprehensively investigate the immunological window of opportunity as it relates to PIDD-associated IBDs to define time-sensitive immunoregulatory targets for therapeutic intervention. We will pursue this goal through a prospective, longitudinal study of pediatric and adult patients with PIDDs (with and without IBD) before and after treatment and/or diagnostic interventions, including but not limited to hematopoietic stem cell transplantation (HSCT). Findings from subjects with PIDDs will be compared to those from subjects with IBD as well as healthy volunteers. This multifaceted study will complement primary patient protocols while allowing for the direct interrogation of specific arms of innate and adaptive immunity in the context of host-microbiome interactions. Patients will be studied over time through the collection of clinical metadata, blood, stool, urine, saliva, skin swabs, and biopsies obtained from clinically-indicated endoscopies in age-appropriate patients. PIDDs of interest include but are not limited to: CGD, CTLA4 and LRBA protein deficiency, hypomorphic RAG deficiency, and IPEX syndrome.
|Study Type :||Observational|
|Estimated Enrollment :||339 participants|
|Official Title:||Natural History of Intestinal Inflammation in Patients With Primary Immune Dysregulations|
|Actual Study Start Date :||September 28, 2020|
|Estimated Primary Completion Date :||July 1, 2030|
|Estimated Study Completion Date :||July 1, 2030|
-Patients with IBD without a diagnosed PIDD.-First- or second-degree relatives of patients with a PIDD of interest who do not have a PIDD themselves, but have diagnosed or suspected IBD.
Non-PIDD/non-IBD (healthy volunteers)
CGD cohort; IPEX syndrome cohort; CTLA4 haploinsufficiency cohort; LRBA deficiency and hypomorphic RAG deficiency cohorts
- Disease-specific intestinal microbiome signatures, and related localized and systemic immune responses. [ Time Frame: Baseline and Annual follow-up visits spanning 10 years ]1. Microbiome, metabolomics, and transcriptomic signatures will be examined between comparison groups.
- Changes in microbiome signatures. Changes in metabolomic and transcriptomic signatures. [ Time Frame: Baseline and Annual follow up visits spanning 10 years. ]1. Microbiome, metabolomics, and transcriptomic signatures will be examined between comparison groups.
- Changes in systemic and tissue-specific markers of innate and adaptive immunity. [ Time Frame: Baseline and Annual follow up visits spanning 10 years ]2. For evaluation of markers of innate and adaptive immunity (local and systemic) most comparisons will be made using 2-tailed Student t tests with statistical significance set at a p less than or equal to 0.05.
- Disease-specific differences in relative quantity and function of peripheral blood and tissue immune cells (includes hematopoietic and stromal cells). [ Time Frame: Throughout length of study ]3. For evaluation of disease-specific differences in relative quantity and function of peripheral blood and tissue immune cells most comparisons will be made using 2-tailed Student t tests with statistical significance set at a p less than or equal to 0.05.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03278912
|Contact: LaQuita N Snow, C.R.N.P.||(240) firstname.lastname@example.org|
|United States, Maryland|
|National Institutes of Health Clinical Center||Recruiting|
|Bethesda, Maryland, United States, 20892|
|Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR) 800-411-1222 ext TTY8664111010 email@example.com|
|Principal Investigator:||Christa S Zerbe, M.D.||National Institute of Allergy and Infectious Diseases (NIAID)|