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The NIH MINI Study: Metabolism, Infection, and Immunity in Inborn Errors of Metabolism

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01780168
Recruitment Status : Recruiting
First Posted : January 30, 2013
Last Update Posted : August 6, 2020
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Human Genome Research Institute (NHGRI) )

Brief Summary:

The Metabolism, Infection and Immunity (MINI) Study is a longitudinal natural history study at the National Institutes of Health (NIH) that aims to define the relationship between infection, immunity and clinical decline in individuals with mitochondrial disease. Mitochondrial diseases are a group of disorders caused by problems with the cell s ability to produce energy. Infection in individuals with mitochondrial disease can lead to worsening clinical symptoms, particularly neurologic symptoms.

Goals:

The main goal of our study is to understand the relationship between infection and clinical decline in patients with mitochondrial disease. Mitochondrial diseases can affect many different parts of the body, including the immune system and its ability to respond to infection. Therefore, we perform a comprehensive evaluation of participants including a detailed immunologic assessment.

We are not testing any new medicine or procedure to treat or cure IEM or mitochondrial diseases. However, by understanding the relationship between infection and mitochondrial disease, we hope to develop treatments in the future. At the NIH, we are interested in research. Although we do provide advice and care for people enrolled in our study, we are not able to take over the long-term care of participants. To enroll in our study, you (your child) must already have a confirmed diagnosis of a mitochondrial disease. We are not able to provide a "first time" diagnosis or regular metabolic care.

What is involved?

Once you contact our team members, you will be asked to provide medical records to determine eligibility. Our team will review the records and notify you if you (your child is) eligible to join the study.

-Onsite participation: You (your child) will be invited to visit the National Institutes of Health in Bethesda, Maryland. This first visit will typically last 3-5 days. Depending on the level of participation, additional visits may be requested. Our team members will work with you and your child to coordinate the supports needed during your stay at NIH. Study participants may be seen in the clinic, day hospital or inpatient setting.

When you (your child) arrive at the NIH we will have an informed consent discussion to confirm willingness to participate, answer questions and review the risks and benefits of the study. You (your child) will meet with a physician who will ask about medical and family history and do a physical exam (like in any doctor's office). We will ask all study participants to allow us to collect urine, draw blood, swab your (your child s) nose, and perform a detailed assessment. We may suggest additional evaluations or specialty consults for some participants based on clinical manifestations, age and level of independence. We will explain these studies to you (your child). They may include items such as- imaging studies, DEXA or MRI scan, energy expenditure or metabolic testing, developmental neuropsychological logical testing, physiatry, ophthalmology, or other consults. In some cases, we may request a skin biopsy (if one has not been done). You will receive the results of your (your child's) clinical testing and notes from any clinical consultations.

-Remote participation: If you (your child) are unable to travel, you (your child) may be enrolled remotely for records review, questionnaires, and telethealth exams. Blood or other samples collection may be requested in coordination with local providers or lab testing companies


Condition or disease
Oxidative Phosphorylation Deficiencies Electron Transport Chain Disorders, Mitochondrial Mitochondrial Disorders Leigh Disease

Detailed Description:

The biochemical perturbations in children with inborn errors of metabolism (IEM) may affect their immune response. As a result, this will not only increase risk for infection but also hamper their ability to develop protective immunity after vaccination. Characterizing perturbations in immunity and the ability of vaccines to provide protective immunity in IEM is critical. Immune deficiencies and the immunogenicity of vaccines have not been well characterized in IEM.

Viral infections play a significant role in precipitating life-threatening acute decompensations in various IEM. Seasonal variation of respiratory and gastrointestinal viruses places this vulnerable population at significant risk. The standard of care for these patients is routine childhood vaccination as well as vaccination for seasonal influenza viruses. However, nutritional deficiencies and their underlying IEM enzymopathies may affect the efficacy of vaccination.

In this protocol, we will clinically evaluate the immunologic states of patients with IEM. Routine inpatient and outpatient admissions will last 2-3 days and may involve blood drawing, radiological procedures, nutrition assessment and biometrics. Immune challenge may be performed using vaccinations for seasonal influenza and pneumococcus (PPV23). Follow-up appointments will be scheduled at the end of the study period.

The study objectives will be to describe the immune deficiencies seen, in this patient population, describe vaccine seroconversion in this patient population, and search for new genes in rare families that have evidence for an unknown class of IEM. The population will consist of patients previously evaluated at NIH, physician referrals, and families directed to the study from clinicaltrials.gov as well as the patient advocacy groups. All patients will be evaluated at the NIH Clinical Center.

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Study Type : Observational
Estimated Enrollment : 250 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: The NIH Mini Study: Metabolism, INfection and Immunity in Inborn Errors of Mitochondrial Metabolism
Actual Study Start Date : January 22, 2013
Estimated Primary Completion Date : December 31, 2022
Estimated Study Completion Date : December 31, 2022


Group/Cohort
Inborn errors of metabolism/mitochondrial disease
Patients with inborn errors of metabolism including those with mitochondrial disease



Primary Outcome Measures :
  1. To provide insight into the mechanisms involved in the interplay between the immune system and mitochondrial metabolism [ Time Frame: Initial visit and various timepoints thereafter dependent on protocol ]
    By developing an understanding of immune dysfunction, targets for rational therapies may be developed for this patient population.

  2. To document the development of adaptive immunity in cohorts of mitochondrial disease patients according to the standard of care for this vulnerable population. [ Time Frame: Initial visit and various timepoints thereafter dependent on protocol ]
    By developing an understanding of immune dysfunction, targets for rational therapies may be developed for this patient population.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   2 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients with inborn errors of metabolism including those with mitochondrial disease
Criteria
  • INCLUSION and EXCLUSION CRITERIA

Patients of any gender and ethnicity age 2 years and older are eligible to enroll in this protocol. Patients will be diagnosed based on a determination of several parameters that may include: plasma ammonia, acylcarnitine profile, amino acid and/or organic acid patterns. Some will have their DNA mutation or enzyme analysis known or pending. Participants need to be medically and/or nutritionally managed by a local metabolic provider. We will obtain written consent from the patient to review medical records from their home physician to confirm eligibility.

Healthy volunteers of any gender and ethnicity 2 years and older will also be eligible to enroll in the vaccination arm of the protocol. These individuals will be vaccinated and have blood collected in an outpatient setting on visits 1 and 2. Influenza vaccination is normally offered seasonally to the public. Volunteers will be compensated for their participation in the study. Healthy volunteers may be from the local community, or family members of patients with IEM.

Patient and healthy volunteer exclusion criteria include: less than 2 years of age, inability to travel to NIH because of their medical condition, and recent vaccination. The Principal Investigator may decline to enroll a patient for other reasons based on clinical judgment. Other criteria that may lead to exclusion include, for example, residing in a hospital, any patient who is being treated for an intercurrent infection with antibiotics or has evidence of an acute infection. Furthermore for IEM patients, any patient who does not have a regular/local metabolic, genetic or endocrine physician and/or a family physician, pediatrician, or internist will also be excluded. For IEM patients, Dr. McGuire will contact each potential patient s local metabolic physician to discuss the patient s past medical history, details of their last visit, and their current metabolic status to determine whether the patient is an appropriate candidate for this protocol. Closer to a scheduled visit, Dr. McGuire will confirm the details of the patient s formula recipe and medications.

Lastly, each family will be contacted by Dr. McGuire or a member of the study staff one week prior to a pending inpatient admission to confirm that the patient is metabolically stable and ready to visit the NIH in a state of relative health, with an adequate supply of special formulas, medications and supplements.


Information from the National Library of Medicine

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): NCT01780168


Contacts
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Contact: Shannon Kruk, R.N. (301) 496-0133 skruk@mail.nih.gov
Contact: Peter J McGuire, M.D. (301) 451-7716 mcguirepj@mail.nih.gov

Locations
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United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike 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    prpl@cc.nih.gov   
Sponsors and Collaborators
National Human Genome Research Institute (NHGRI)
Investigators
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Principal Investigator: Peter J McGuire, M.D. National Human Genome Research Institute (NHGRI)
Additional Information:
Publications:
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Responsible Party: National Human Genome Research Institute (NHGRI)
ClinicalTrials.gov Identifier: NCT01780168    
Other Study ID Numbers: 130053
13-HG-0053
First Posted: January 30, 2013    Key Record Dates
Last Update Posted: August 6, 2020
Last Verified: July 30, 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Human Genome Research Institute (NHGRI) ):
Mitochondrial Disorders
Leigh Disease
Subacute Necrotizing Encephalopathy
Disorders of Oxidative Phosphorylation (OXPHOS)
Additional relevant MeSH terms:
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Leigh Disease
Mitochondrial Diseases
Disease
Pathologic Processes
Metabolic Diseases
Brain Diseases, Metabolic, Inborn
Brain Diseases, Metabolic
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Metabolism, Inborn Errors
Genetic Diseases, Inborn
Pyruvate Metabolism, Inborn Errors
Carbohydrate Metabolism, Inborn Errors