Study of the Sex Differences in Inflammatory Diseases in Children (SepsiX)

• ClinicalTrials.gov Identifier: NCT04815811
• Recruitment Status: Recruiting
• First Posted: March 25, 2021
• Last Update Posted: March 25, 2021
• Sponsor: Queen Fabiola Children's University Hospital
• Collaborator: Belgium Kid's Fund
• Information provided by (Responsible Party): Queen Fabiola Children's University Hospital

Study Description

Brief Summary:

Sexual differences in innate immune response have been demonstrated and were mainly attributed to the influence of the sex steroids (1-18). However, recent clinical data revealed significant differences in inflammatory markers between boys and girls suffering from acute and chronic inflammatory diseases (19-23). Sex hormone levels in prepubertal children are particularly low and insufficient to explain the gender differences observed in inflammatory conditions from neonates to the elderly, suggesting the contribution of another mechanism, such as the influence of genes situated on the sex chromosomes and involved in the inflammatory response.

The aim of this work is to evaluate the role of the X chromosome in the sex differences in inflammatory diseases in children. In order to discriminate more precisely the role of the X chromosome relatively to the sex steroids in the sex-specific inflammatory response, some innate immune functions related to X-linked genes will be evaluated in whole blood from prepubertal children of both sexes, suffering from acute inflammatory processes such as pyelonephritis caused by Escherichia coli, pneumonia with pleural effusion caused by Streptococcus pneumoniae or sepsis

Condition or disease	Intervention/treatment	Phase
Sex Differences in Immune Response; Acute Inflammatory Diseases in Children	Other: Blood collection; Other: Stool collection	Not Applicable

Detailed Description:

Many studies demonstrated immune differences between men and women suffering from acute and chronic inflammatory processes. In cases of acute inflammatory diseases, such as sepsis, females have better prognosis comparing to males (1,24-28).

On the contrary, worse prognosis for women is observed in chronic inflammatory diseases such as asthma or cystic fibrosis (8-10,12,13,29).

Sex-depended inflammatory response was attributed to the influence of sex hormones on the immune system. (2,15-18). However recent studies revealed differences in the clinical outcome but also in inflammatory markers between boys and girls suffering from acute and chronic inflammatory diseases (19-23). Sex hormone levels in prepubertal children are particularly low and insufficient to explain the gender differences observed in inflammatory conditions from neonates to the elderly, suggesting the contribution of another mechanism, such as the influence of genes situated on the sex chromosomes and involved in the inflammatory response.

The aim of this work is to identify the potential X-linked mechanisms responsible for some of the differences between boys and girls in the inflammatory response, making the girls more at risk of developing complications in chronic inflammatory diseases and the boys more at risk of lethal complications in severe acute inflammatory diseases like sepsis. Several genes coding for innate immunity components are linked to the X chromosome such as diapedesis molecule CD99 or TLR pathway proteins genes. (30-33). X chromosome is also highly enriched in genes encoding micro RNAs (miRNAs) involved in the post-transcriptional regulation of gene expression which play a critical role in immune inflammatory response (34-36).

Thus, in order to discriminate more precisely the role of the X chromosome relatively to the sex steroids in the sex-specific inflammatory response, some innate immune functions related to X-linked genes will be evaluated in whole blood from prepubertal children of both sexes, suffering from acute inflammatory processes such as pyelonephritis caused by Escherichia coli, pneumonia with pleural effusion caused by Streptococcus pneumoniae or sepsis. We will also study the correlations between inflammatory and clinical markers of the disease activity to identify prognosis indicators depending on the sex. Additionally, to delineate microbiome contribution, we will study the gut microbiota in stool samples obtained from the recruited patients.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 160 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Basic Science
• Official Title: Study of the Sex Differences in Inflammatory Diseases in Children
• Actual Study Start Date: August 17, 2019
• Estimated Primary Completion Date: December 31, 2023
• Estimated Study Completion Date: December 31, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: Children suffering from acute inflammatory processes.; The study population will consist of male and female children, aged from 6 months to 7 years old, admitted to the hospital for one of the three following types of acute inflammatory processes: Urinary tract infection caused by Escherichia coli; Pneumonia with pleural effusion caused by Streptococcus pneumoniae; Sepsis	Other: Blood collection; Blood samples collections to evaluation of the potential role of the sex chromosomes in the innate immune response by analyzing inflammatory cytokine production (IL-1β, IL-6, IL-8, IL-10, TNF-α and IFN-α), studying the cell diapedesis receptor CD99 on PMNs, monocytes, and lymphocytes, analyzing the contribution of X-linked genes of the TLR pathways and the influence of X-linked miRNAs.; Other: Stool collection; Fecal sample collection to delineate microbiome contribution, we will study the gut microbiota in faecal samples obtained from the recruited patients.
Control group; Male and female children, aged from 6 months to 7 years old, admitted to the hospital for a scheduled operation for a non-inflammatory pathology.	Other: Blood collection; Blood samples collections to evaluation of the potential role of the sex chromosomes in the innate immune response by analyzing inflammatory cytokine production (IL-1β, IL-6, IL-8, IL-10, TNF-α and IFN-α), studying the cell diapedesis receptor CD99 on PMNs, monocytes, and lymphocytes, analyzing the contribution of X-linked genes of the TLR pathways and the influence of X-linked miRNAs.

Outcome Measures

Primary Outcome Measures :

1. Whole blood production of cytokine IL-6 [ Time Frame: within 24 hours of hospital admission (Day 0) ]
   The production of IL6 is measured by multiplex techniques.

Secondary Outcome Measures :

1. Whole blood production of cytokine IL-1β [ Time Frame: within 24 hours of hospital admission (Day 0) ]
2. Whole blood production of cytokine IL-8 [ Time Frame: within 24 hours of hospital admission (Day 0) ]
3. Whole blood production of cytokine IL-10 [ Time Frame: within 24 hours of hospital admission (Day 0) ]
4. Whole blood production of cytokine TNF-α [ Time Frame: within 24 hours of hospital admission (Day 0) ]
5. Whole blood production of cytokine interferon-α [ Time Frame: within 24 hours of hospital admission (Day 0) ]
6. Intracellular quantity of the phosphorylated forms of NF-κB p65 in leukocyte population. [ Time Frame: within 24 hours of hospital admission (Day 0) ]
7. Intracellular quantity of the phosphorylated forms of ERK1/2 in leukocyte population. [ Time Frame: within 24 hours of hospital admission (Day 0) ]
8. Intracellular quantity of the phosphorylated forms of p38 MAPK in leukocyte population. [ Time Frame: within 24 hours of hospital admission (Day 0) ]
9. Expression of the cell diapedesis receptor CD99 on PMNs [ Time Frame: within 24 hours of hospital admission (Day 0) ]
   Measurements of cell diapedesis receptor CD99 on leukocytes will be performed by flow cytometry
10. Expression of the cell diapedesis receptor CD99 on monocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of cell diapedesis receptor CD99 on leukocytes will be performed by flow cytometry
11. Expression of the cell diapedesis receptor CD99 on lymphocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of cell diapedesis receptor CD99 on leukocytes will be performed by flow cytometry
12. Expression of TLR2 on PMNs [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of intracellular phosphorylated forms of TLR pathway proteins as well as the expression of TLR2 and TLR4 will be performed by flow cytometry
13. Expression of TLR2 on monocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of intracellular phosphorylated forms of TLR pathway proteins as well as the expression of TLR2 and TLR4 will be performed by flow cytometry
14. Expression of TLR2 on lymphocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of intracellular phosphorylated forms of TLR pathway proteins as well as the expression of TLR2 and TLR4 will be performed by flow cytometry
15. Expression of TLR4 on PMNs [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of intracellular phosphorylated forms of TLR pathway proteins as well as the expression of TLR2 and TLR4 will be performed by flow cytometry
16. Expression of TLR4 on monocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of intracellular phosphorylated forms of TLR pathway proteins as well as the expression of TLR2 and TLR4 will be performed by flow cytometry
17. Expression of TLR4 on lymphocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements of intracellular phosphorylated forms of TLR pathway proteins as well as the expression of TLR2 and TLR4 will be performed by flow cytometry
18. BTK gene expression [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements will be performed using the Quantitect Reverse Transcription Kit (Qiagen, Manchester, UK) for quantitative PCR (qPCR) on leucocytes.
19. IRAK1 gene expression [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements will be performed using the Quantitect Reverse Transcription Kit (Qiagen, Manchester, UK) for quantitative PCR (qPCR) on leucocytes.
20. NEMO gene expression [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Measurements will be performed using the Quantitect Reverse Transcription Kit (Qiagen, Manchester, UK) for quantitative PCR (qPCR) on leucocytes.
21. Expression of X-linked miRNAs in leucocytes [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Expression of X-linked miRNAs is measured by sequencing and qRT-PCR on leucocytes and/or plasma samples.
22. Expression of X-linked miRNAs in plasma [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Expression of X-linked miRNAs is measured by sequencing and qRT-PCR on leucocytes and/or plasma samples.
23. Leukocyte population [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    White blood cell count including neutrophils, monocytes, monocytes subtypes and lymphocytes.
24. Leukocyte population [ Time Frame: Day 1 ]
    White blood cell count including neutrophils, monocytes, monocytes subtypes and lymphocytes. Only applicable for the sepsis sub-group
25. Leukocyte population [ Time Frame: Day 2 ]
    White blood cell count including neutrophils, monocytes, monocytes subtypes and lymphocytes. Only applicable for the sepsis sub-group
26. Leukocyte population [ Time Frame: Day 3 ]
    White blood cell count including neutrophils, monocytes, monocytes subtypes and lymphocytes. Only applicable for the sepsis sub-group
27. CRP [ Time Frame: within 24 hours of hospital admission (Day 0) ]
28. CRP [ Time Frame: Day 1 ]
    Only applicable for the sepsis sub-group
29. CRP [ Time Frame: Day 2 ]
    Only applicable for the sepsis sub-group
30. CRP [ Time Frame: Day 3 ]
    Only applicable for the sepsis sub-group
31. Total 17β-estradiol [ Time Frame: within 24 hours of hospital admission (Day 0) ]
32. Testosterone [ Time Frame: within 24 hours of hospital admission (Day 0) ]
33. IGF1 [ Time Frame: within 24 hours of hospital admission (Day 0) ]
34. Microbiome analysis [ Time Frame: During subject hospitalisation ]
35. pSOFA score [ Time Frame: within 24 hours of hospital admission (Day 0) ]
    Only applicable for the sepsis sub-group. The pSOFA will be evaluated every 24 hours in order to compare laboratory and clinical data. The score will be based on the PaO2: FiO2 or SpO2: FiO2 ratio, the platelet count, the bilirubin level, the Mean Arterial Pressure (MAP), the Glasgow score and the creatinine level.
36. pSOFA score [ Time Frame: Day 1 ]
    Only applicable for the sepsis sub-group. The pSOFA will be evaluated every 24 hours in order to compare laboratory and clinical data. The score will be based on the PaO2: FiO2 or SpO2: FiO2 ratio, the platelet count, the bilirubin level, the Mean Arterial Pressure (MAP), the Glasgow score and the creatinine level.
37. pSOFA score [ Time Frame: Day 2 ]
    Only applicable for the sepsis sub-group. The pSOFA will be evaluated every 24 hours in order to compare laboratory and clinical data. The score will be based on the PaO2: FiO2 or SpO2: FiO2 ratio, the platelet count, the bilirubin level, the Mean Arterial Pressure (MAP), the Glasgow score and the creatinine level.
38. pSOFA score [ Time Frame: Day 3 ]
    Only applicable for the sepsis sub-group. The pSOFA will be evaluated every 24 hours in order to compare laboratory and clinical data. The score will be based on the PaO2: FiO2 or SpO2: FiO2 ratio, the platelet count, the bilirubin level, the Mean Arterial Pressure (MAP), the Glasgow score and the creatinine level.

Eligibility Criteria

• Ages Eligible for Study: 6 Months to 7 Years (Child)
• Sexes Eligible for Study: All
• Gender Based Eligibility: Yes
• Gender Eligibility Description: equity between male and female among the sample size
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria of Experimental group :

• Male (XY) and female (XX) aged from 6 months to 7 years old.

• Subject hospitalized either for:

  (1) Urinary tract infection caused by Escherichia Coli, with:

• Temperature ≥ to 38,5°C

• Urinalysis

  • Leukocyte esterase +
  • AND/OR Nitrites +
  • AND/OR pyuria (≥ 100WBC/mm³)
  • AND/OR bacteriuria.

• Urinalysis

  • Clean catch voided urine: > 10^4 Escherichia Coli colony form unit (CFU)/mm (urine collection method for children >3 years old or toilet trained children or by stimulation for children <3 years old)
  • Transurethral bladder catheterisation: > 10^4 Escherichia Coli colony form unit (CFU)/mm³ (urine collection method for children <3 years old).

  • Suprapubic aspiration: > 1 Escherichia Coli colony form unit (CFU)/mm³ (urine collection method for children <3 years old).

    (2) Pneumonia with pleural effusion with :

• Temperature ≥ 38,5°C
• Chest radiography/ultrasound: Pleural effusion

• Streptococcus pneumoniae identified on blood or pleural fluid culture or by PCR

  (3) Sepsis with:

• Documented or suspected infection
• Temperature < 36° or > 38.3°C

• Heart rhythm:

  • 2 SD above normal for age
  • 6-23 months: >180/min
  • 24-71 months: >140/min
  • 72-84 months: >130/min

• Respiratory Rate:

  • 6-23 months: >35/min
  • 24 - 71 months: >30/min
  • 72-84 months: >20/min

• WBC:

  • 6-23 months: >17500/µL or <5000/µL
  • 24-71 months: >15500/µL or <6000/µL
  • 72-84 months: >13500/µL or <4500/µL
  • and/or CRP (blood) > 2SD above normal

• And at least two of the following:

  • PaO2/FiO2 <300
  • Proven need for >50% FiO2 to maintain saturation ≥ 92%
  • Need for mechanical ventilation
  • Glasgow score < 11
  • Urine output < 0,5mL/kg/h for at least 2h

  • Creatinine:

    • 6-11 months: >0,4mg/dL
    • 12-23 months: >0,5mg/dL
    • 24-59 months: >0,8mg/dL
    • 60-84 months: >1mg/dL
    • Or creatinine increase more than 0,5 mg/dL
  • Platelet count <100000/mL
  • Bilirubin >2 mg/dL

  • Mean arterial pressure (MAP)

    • 6-11 months: <55 mmHg
    • 12 -23 months: <60 mmHg
    • 24-59 months: <62 mmHg
    • 60-84 months: <65 mmHg
  • SBP less than two SD below normal for age
  • Prolonged capillary refill: > 5 sec

Inclusion Criteria of Control group :

• Male (XY) and female (XX) aged from 6 months to 7 years old.
• Scheduled surgical intervention for a non-infectious pathology.

Exclusion Criteria:

• Use of antithrombotic drugs (acetylsalicylic acid, thienopyridines, dipyridamol, glycoprotein IIb / IIIa antagonists, vitamin K antagonists, heparins).
• Congenital or acquired immunodeficiency: immunosuppressive drugs, hematopoietic stem cells transplantation, immunoglobulin therapy, extracorporeal membrane oxygenation (ECMO).
• Hemodialysis.
• 48h following cardiac operation of any type.
• Malignant cancer.
• HIV.

Contacts and Locations

Contacts

Contact: Alexandros Popotas, MD; +32 2 477 24 24; alexandros.popotas@ulb.be

Contact: Nicolas Lefevre, MD, PhD; +32 2 477 23 41; nicolas.lefevre@huderf.be

Locations

Belgium

HUDERF; Recruiting

Brussels, Belgium, 1020

Contact: Alexandros Popotas, MD +32 2 477 24 24 alexandros.popotas@ulb.be

Contact: Georges Casimir, MD, PhD + 32 2 477 29 45 georges.casimir@huderf.be

Principal Investigator: Alexandros Popotas, MD

Sub-Investigator: Francis Corazza, MD, PhD

Sponsors and Collaborators

Queen Fabiola Children's University Hospital

Belgium Kid's Fund

Investigators

• Principal Investigator: Alexandros Popotals, MD; HUDERF

More Information

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• Responsible Party: Queen Fabiola Children's University Hospital
• ClinicalTrials.gov Identifier: NCT04815811
• Other Study ID Numbers: P2019/LABO/SepsiX
• First Posted: March 25, 2021
• Last Update Posted: March 25, 2021
• Last Verified: October 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Queen Fabiola Children's University Hospital:

Sex, immunology, inflammation, child, sepsis, UTI, pneumonia