An Exploratory Clinical Study to Investigate Biomarkers of Senescence in Patients With Osteoarthritis of the Knee
Primary Purpose
Osteoarthritis, Knee
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Arthroscopy
Arthrocentesis
MRI
Sponsored by
About this trial
This is an interventional basic science trial for Osteoarthritis, Knee focused on measuring Osteoarthritis, Senescence, Magnetic resonance imaging, Arthroscopy, Arthrocentesis, Biomarker
Eligibility Criteria
Inclusion Criteria:
- Patients must be diagnosed as having primary (idiopathic) femoro-tibial osteoarthritis (OA) of the knee as defined by a modified version of the American College of Rheumatology Criteria (modified clinical and laboratory criteria) for at least 6 months.
- Kellgren-Lawrence (KL) score of grade 1 to 4 inclusive based on a standardized, semi-fixed, weight-bearing radiograph of the knee.
- Adults of age ≥ 35 years
- Body Mass Index less than or equal to an upper limit of 35 kg/m2
- Patients who are able to commit the time required to attend all study visits
- Normal clinical laboratory results with no clinically significant organ dysfunction which, in the opinion of the investigator, would preclude patient from entering the study
Exclusion Criteria:
- Any condition, including laboratory findings and findings in the medical history or in the pre-study assessments, that, in the opinion of the Investigator constitutes a risk or contraindication for participation in the study or that could interfere with the study objectives, conduct or evaluation
- Prior open knee surgery to the target knee including but not limited to Anterior Cruciate Ligament Repair
- Patients who have had prior arthroscopy and intraarticular treatments for the management of osteoarthritis such as administration of hyaluronic acid or corticosteroids within the last 6 months
- Patients with traumatic knee injury who are scheduled for arthroscopic repair procedures to either target or non-target knee
- Patients who are deemed to be at risk of acute renal insufficiency of any severity due to hepato-renal syndrome or who are in the peri-operative liver transplant period.
- Patients with Diabetes Mellitus.
- Patients with renal dysfunction as defined by a Glomerular Filtration Rate <60 ml/min/1.73m2 by laboratory testing.
- Known allergic or hypersensitivity reaction to gadolinium-based contrast agents or patients who have other contraindications for MRI
- Patients requiring anticoagulation therapy other than low dose (81 mg or less) aspirin
- Treatment with an unapproved investigational therapeutic agent and/or experimental therapeutic procedure on the target knee within 24 weeks prior to screening
Any active known or suspected systemic autoimmune disease Permitted on Study
- vitiligo
- residual hypothyroidism due to autoimmune condition only requiring hormone replacement
- psoriasis not requiring systemic treatment for 2 years
- conditions not expected to recur in the absence of an external trigger Excluded on Study
- documented history of inflammatory bowel disease (including ulcerative colitis and Crohn's disease)
- symptomatic autoimmune conditions (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma])
- systemic lupus erythematosus
- autoimmune vasculitis (e.g. Wegener's Granulomatosis)
- patients with motor neuropathy considered of autoimmune origin (e.g. Guillain-Barré Syndrome)
- History of previous surgery (Total or Partial Knee Replacement) on the Target knee
- Lesions at the planned site of arthroscopy which would present a contraindication to the procedure such as open wounds or infection of the skin
- Any known active infection, including suspicion of intra-articular infection and/or infections that may compromise the immune system such as HIV, Hepatitis B or Hepatitis C infection
- History of sarcoma and/or history of other active malignancy within the last 5 years, except basal cell carcinoma, carcinoma in situ of the cervix and squamous cell carcinoma of the skin
Secondary osteoarthritis, including:
- Joint dysplasias
- Crystal-induced arthropathy (gout, calcium pyrophosphate deposition disease)
- Aseptic osteonecrosis
- Acromegaly
- Paget's disease
- Ehlers-Danlos Syndrome
- Gaucher's disease
- Stickler's syndrome
- Joint infection
- Hemophilia
- Hemochromatosis
- Neuropathic arthropathy of any cause
- Patients with risk factors for OA of the knee (e.g.: obesity, meniscectomy) are not considered as having secondary OA and can be included in this study
- Female patients who are pregnant. Female patients who are breast-feeding are eligible for enrollment providing the patient agrees not to breast-feed for 24 hours after receiving gadolinium for GE-MRI. Female patients of child-bearing potential must agree to utilize adequate contraceptive measures during the course of the study.
- Patients who do not have the legal capacity or medical competency to provide consent; consent via legally authorized representative is not accepted.
Sites / Locations
- The Arthritis Treatment Center
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
Patients with osteoarthritis of the knee
Arm Description
This is an exploratory non-drug, interventional biomarker study, however, there are study related procedures which are interventional such as arthroscopy, arthrocentesis and MRI assessment with infusion of a gadolinium-contrast agent.
Outcomes
Primary Outcome Measures
Degree of synovial senescence as defined by the percentage of cells staining positive for candidate molecular markers of senescence on IHC in patients with osteoarthritis
Percentage of cells staining positive for candidate molecular markers of senescence on IHC
Secondary Outcome Measures
Concentration of candidate biomarkers in serum, plasma, and urine and correlate with concentration in synovial fluid include but not limited to p16, p21, IL6
Correlation between candidate biomarkers in serum or plasma and urine with synovial fluid biomarkers
Correlation between senescence burden in synovial tissue (percentage of cells staining positive om IHC) and synovitis (semi-quantitative scoring of synovium by gadolinium-enhanced MRI)
Relationship between the synovial senescence, synovitis via biopsy samples and synovitis using gadolinium-enhanced MRI
Inter-interval variability of candidate biomarkers of senescence
Inter-interval variability of candidate biomarkers of senescence
Correlation between degree of synovitis (semi-quantitative scoring of synovium by gadolinium-enhanced MRI) with concentration of biomarkers in plasma or synovial fluid
To determine the relationship between GE-MRI-based assessment of synovium and plasma or synovial candidate biomarkers
Full Information
NCT ID
NCT03100799
First Posted
March 17, 2017
Last Updated
July 29, 2017
Sponsor
Unity Biotechnology, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT03100799
Brief Title
An Exploratory Clinical Study to Investigate Biomarkers of Senescence in Patients With Osteoarthritis of the Knee
Official Title
An Exploratory Clinical Study to Investigate Biomarkers of Senescence in Patients With Mild, Moderate and Severe Osteoarthritis of the Knee
Study Type
Interventional
2. Study Status
Record Verification Date
May 2017
Overall Recruitment Status
Completed
Study Start Date
March 2, 2017 (Actual)
Primary Completion Date
July 10, 2017 (Actual)
Study Completion Date
July 10, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Unity Biotechnology, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is an exploratory non-drug, interventional biomarker study in approximately 30 eligible patients with active osteoarthritis to investigate the degree of senescence-associated disease. Patients will provide blood and urine and undergo MRI imaging with and without gadolinium enhancement. Following imaging, arthrocentesis of both knees and an arthroscopy of the target knee will occur to obtain fluid, synovium and cartilage for analysis.
Detailed Description
This is an exploratory non-drug, interventional, hypothesis generating biomarker study. No Investigational Product will be administered in the study, however, there are study related procedures which are interventional such as arthroscopy, arthrocentesis and infusion of a gadolinium-containing contrast agent.
Consented patients who meet the selection criteria undergo MRI imaging with and without gadolinium contrast of both knees. Approximately seven days following the MRI imaging, patients undergo an arthrocentesis of both knees to obtain synovial fluid and then an arthroscopy of the target knee to obtain synovial and non-weight bearing cartilage tissues.
The patient will return to the clinic approximately seven days following the arthroscopy and arthrocentesis procedures for a routine safety follow-up.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Osteoarthritis, Knee
Keywords
Osteoarthritis, Senescence, Magnetic resonance imaging, Arthroscopy, Arthrocentesis, Biomarker
7. Study Design
Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Single arm, exploratory non-drug, interventional biomarker study in patients with active osteoarthritis to investigate the degree of senescence-associated disease
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Patients with osteoarthritis of the knee
Arm Type
Other
Arm Description
This is an exploratory non-drug, interventional biomarker study, however, there are study related procedures which are interventional such as arthroscopy, arthrocentesis and MRI assessment with infusion of a gadolinium-contrast agent.
Intervention Type
Procedure
Intervention Name(s)
Arthroscopy
Intervention Description
Arthroscopy of the target knee
Intervention Type
Procedure
Intervention Name(s)
Arthrocentesis
Intervention Description
Arthrocentesis of the target knee and contralateral knee (if patient consents)
Intervention Type
Diagnostic Test
Intervention Name(s)
MRI
Other Intervention Name(s)
Magnetic resonance imaging
Intervention Description
MRI with and without a gadolinium-based contrast agent
Primary Outcome Measure Information:
Title
Degree of synovial senescence as defined by the percentage of cells staining positive for candidate molecular markers of senescence on IHC in patients with osteoarthritis
Description
Percentage of cells staining positive for candidate molecular markers of senescence on IHC
Time Frame
Study Visit 3 (Day 14)
Secondary Outcome Measure Information:
Title
Concentration of candidate biomarkers in serum, plasma, and urine and correlate with concentration in synovial fluid include but not limited to p16, p21, IL6
Description
Correlation between candidate biomarkers in serum or plasma and urine with synovial fluid biomarkers
Time Frame
Screening (Day 1) and Visit 3 (Day 14)
Title
Correlation between senescence burden in synovial tissue (percentage of cells staining positive om IHC) and synovitis (semi-quantitative scoring of synovium by gadolinium-enhanced MRI)
Description
Relationship between the synovial senescence, synovitis via biopsy samples and synovitis using gadolinium-enhanced MRI
Time Frame
Visit 2 (Day 7) and Visit 3 (Day 14)
Title
Inter-interval variability of candidate biomarkers of senescence
Description
Inter-interval variability of candidate biomarkers of senescence
Time Frame
Screening (Day 1) and Visit 3 (Day 14)
Title
Correlation between degree of synovitis (semi-quantitative scoring of synovium by gadolinium-enhanced MRI) with concentration of biomarkers in plasma or synovial fluid
Description
To determine the relationship between GE-MRI-based assessment of synovium and plasma or synovial candidate biomarkers
Time Frame
Screening (Day 1), Visit 2 (Day 7) and Visit 3 (Day 14)
Other Pre-specified Outcome Measures:
Title
Correlation between senescence burden (percentage of cells staining positive on IHC) and phenotypic disease data (e.g., Kellgren Lawrence score) in patients with osteoarthritis
Description
To explore the possible relationships between the degree of synovial senescence and other biomarkers that are identified as potentially relevant in patients with osteoarthritis
Time Frame
Screening (Day 1), Visit 2 (Day 7) and Visit 3 (Day 14)
Title
Correlation between synovitis (semi-quantitative scoring of synovium by gadolinium-enhanced MRI) and pain (WOMAC-A as derived from KOOS Knee Survey)
Description
To explore the relationship of synovitis defined by either GE-MRI or by histologic assessment of synovial biopsy samples with WOMAC-A (as derived from the KOOS Knee Survey)
Time Frame
Screening (Day 1), Visit 2 (Day 7) and Visit 3 (Day 14)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients must be diagnosed as having primary (idiopathic) femoro-tibial osteoarthritis (OA) of the knee as defined by a modified version of the American College of Rheumatology Criteria (modified clinical and laboratory criteria) for at least 6 months.
Kellgren-Lawrence (KL) score of grade 1 to 4 inclusive based on a standardized, semi-fixed, weight-bearing radiograph of the knee.
Adults of age ≥ 35 years
Body Mass Index less than or equal to an upper limit of 35 kg/m2
Patients who are able to commit the time required to attend all study visits
Normal clinical laboratory results with no clinically significant organ dysfunction which, in the opinion of the investigator, would preclude patient from entering the study
Exclusion Criteria:
Any condition, including laboratory findings and findings in the medical history or in the pre-study assessments, that, in the opinion of the Investigator constitutes a risk or contraindication for participation in the study or that could interfere with the study objectives, conduct or evaluation
Prior open knee surgery to the target knee including but not limited to Anterior Cruciate Ligament Repair
Patients who have had prior arthroscopy and intraarticular treatments for the management of osteoarthritis such as administration of hyaluronic acid or corticosteroids within the last 6 months
Patients with traumatic knee injury who are scheduled for arthroscopic repair procedures to either target or non-target knee
Patients who are deemed to be at risk of acute renal insufficiency of any severity due to hepato-renal syndrome or who are in the peri-operative liver transplant period.
Patients with Diabetes Mellitus.
Patients with renal dysfunction as defined by a Glomerular Filtration Rate <60 ml/min/1.73m2 by laboratory testing.
Known allergic or hypersensitivity reaction to gadolinium-based contrast agents or patients who have other contraindications for MRI
Patients requiring anticoagulation therapy other than low dose (81 mg or less) aspirin
Treatment with an unapproved investigational therapeutic agent and/or experimental therapeutic procedure on the target knee within 24 weeks prior to screening
Any active known or suspected systemic autoimmune disease Permitted on Study
vitiligo
residual hypothyroidism due to autoimmune condition only requiring hormone replacement
psoriasis not requiring systemic treatment for 2 years
conditions not expected to recur in the absence of an external trigger Excluded on Study
documented history of inflammatory bowel disease (including ulcerative colitis and Crohn's disease)
symptomatic autoimmune conditions (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma])
systemic lupus erythematosus
autoimmune vasculitis (e.g. Wegener's Granulomatosis)
patients with motor neuropathy considered of autoimmune origin (e.g. Guillain-Barré Syndrome)
History of previous surgery (Total or Partial Knee Replacement) on the Target knee
Lesions at the planned site of arthroscopy which would present a contraindication to the procedure such as open wounds or infection of the skin
Any known active infection, including suspicion of intra-articular infection and/or infections that may compromise the immune system such as HIV, Hepatitis B or Hepatitis C infection
History of sarcoma and/or history of other active malignancy within the last 5 years, except basal cell carcinoma, carcinoma in situ of the cervix and squamous cell carcinoma of the skin
Secondary osteoarthritis, including:
Joint dysplasias
Crystal-induced arthropathy (gout, calcium pyrophosphate deposition disease)
Aseptic osteonecrosis
Acromegaly
Paget's disease
Ehlers-Danlos Syndrome
Gaucher's disease
Stickler's syndrome
Joint infection
Hemophilia
Hemochromatosis
Neuropathic arthropathy of any cause
Patients with risk factors for OA of the knee (e.g.: obesity, meniscectomy) are not considered as having secondary OA and can be included in this study
Female patients who are pregnant. Female patients who are breast-feeding are eligible for enrollment providing the patient agrees not to breast-feed for 24 hours after receiving gadolinium for GE-MRI. Female patients of child-bearing potential must agree to utilize adequate contraceptive measures during the course of the study.
Patients who do not have the legal capacity or medical competency to provide consent; consent via legally authorized representative is not accepted.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nathan Wei, MD
Organizational Affiliation
The Arthritis Treatment Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Arthritis Treatment Center
City
Frederick
State/Province
Maryland
ZIP/Postal Code
21702
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
21187293
Citation
Guermazi A, Roemer FW, Hayashi D, Crema MD, Niu J, Zhang Y, Marra MD, Katur A, Lynch JA, El-Khoury GY, Baker K, Hughes LB, Nevitt MC, Felson DT. Assessment of synovitis with contrast-enhanced MRI using a whole-joint semiquantitative scoring system in people with, or at high risk of, knee osteoarthritis: the MOST study. Ann Rheum Dis. 2011 May;70(5):805-11. doi: 10.1136/ard.2010.139618. Epub 2010 Dec 27.
Results Reference
background
PubMed Identifier
13498604
Citation
KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494-502. doi: 10.1136/ard.16.4.494. No abstract available.
Results Reference
background
PubMed Identifier
3741515
Citation
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039-49. doi: 10.1002/art.1780290816.
Results Reference
background
Citation
Benjamini Y, Hochberg Y. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B 1995;57(1):289-300.
Results Reference
background
PubMed Identifier
11840444
Citation
Kraus VB, Huebner JL, Fink C, King JB, Brown S, Vail TP, Guilak F. Urea as a passive transport marker for arthritis biomarker studies. Arthritis Rheum. 2002 Feb;46(2):420-7. doi: 10.1002/art.10124.
Results Reference
background
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An Exploratory Clinical Study to Investigate Biomarkers of Senescence in Patients With Osteoarthritis of the Knee
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