In Vitro Immunomodulation in Membranous Nephropathy Relapses (BIOGEM)
Primary Purpose
Extramembranous Glomerulopathy
Status
Recruiting
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Blood sample
Sponsored by
About this trial
This is an interventional other trial for Extramembranous Glomerulopathy focused on measuring membranous nephropathy, immunomodulation, relapse, Th17/Treg pathways
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 18 years
- Patient with MN proven on renal biopsy or by the presence of anti-PLA2R1 or anti-THDS71 antibodies
- Relapsed MN, defined as proteinuria > 3.5g/g after achieving remission (partial or complete, definitions according to KDIGO 2012 guidelines)
- At a distance from any immunosuppressive treatment (at least 6 months)
- Freely given informed consent signed by the patient after clear, fair and appropriate information
- Affiliated to a social security system
Exclusion Criteria:
- Pregnant or breastfeeding woman
- Patient under 18 years of age
- Persons of legal age
Sites / Locations
- Centre Hospitalier Universitaire de NiceRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
GEM patients
Arm Description
Outcomes
Primary Outcome Measures
Cytokine ELISA profiles of the Th17 pathway (IL-17 level), the Treg pathway (IL-10 level), the Th1 pathway (IL-12p70, IFN-γ) and the Th2 pathway (IL-4 and IL-5)
All cytokines (IL-17, IL-10, IL-12p70, IFN-γ, IL-4 and IL-5) measured by ELISA will be expressed in pg/ml.
Secondary Outcome Measures
Lymphocyte phenotyping (Treg and Th17) determined by flow cytometry
Percentage of cells expressing the fluorescent marker of interest
Full Information
NCT ID
NCT05428605
First Posted
June 10, 2022
Last Updated
June 20, 2022
Sponsor
Centre Hospitalier Universitaire de Nice
1. Study Identification
Unique Protocol Identification Number
NCT05428605
Brief Title
In Vitro Immunomodulation in Membranous Nephropathy Relapses
Acronym
BIOGEM
Official Title
In Vitro Study of the Efficacy of Different Immunomodulators on the Th17/Treg Balance in a Cohort of Relapsed Membranous Nephropathy
Study Type
Interventional
2. Study Status
Record Verification Date
June 2022
Overall Recruitment Status
Recruiting
Study Start Date
May 23, 2022 (Actual)
Primary Completion Date
November 23, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Hospitalier Universitaire de Nice
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
In order to propose the best therapeutic option to relapsed MN patients with strong activation of the Th17 pathway, the investigators propose to study in vitro the effect of different immunomodulators on the Th17/Treg balance, assessed by cytokine profile and lymphocyte phenotyping using flow cytometry.
Detailed Description
Membranous Nephropathy (MN) is a rare autoimmune renal disease and the first cause of nephrotic syndrome in adults. In one third of cases, it progresses to end-stage renal failure. Rituximab has shown very good efficacy (60-80%) and excellent safety in this indication. However, one third of MN patients relapse after a course of rituximab, raising the question of maintenance treatment or repeated courses of rituximab whose long-term impact is unknown.
The investigators studied the cytokine profile of MN patients and demonstrated, after non-specific stimulation of innate immunity cells and T cells, a Th17 profile (increased levels of interleukin-6 (Il-6) and interleukin-17A (Il-17A) compared to healthy subjects), and inhibition of the Th1 (decreased IL-12p70 and Interferon-γ (IFN-γ)) and T regulatory T reg pathways (decreased IL-10) (doi: 10. 3389/fimmu.2020.574997).
Th17 cells and Treg cells with interconnected development have opposite roles. Th17 cells induce inflammation to initiate a reaction against a pathogen, while Treg cells control an inflammatory reaction.
The investigators showed that high Il-17A levels were associated with a risk of thrombotic events (p = 0.03) and relapse (p = 0.0006). A patient with an IL-17A level > 73 pg/ml had a 10.5-fold increased risk of relapse.
Rituximab-induced remission leads to an increase in Treg and Th1 pathway cytokines but has no impact on IL-17A production, which remains important even in remission.
Thus, in this group of patients with high IL-17A levels, targeted action on B lymphocytes is probably not sufficient to avoid relapse and the addition of a treatment aimed at inhibiting the Th17 pathway and promoting Treg induction seems legitimate.
Various potential treatment exist: anti-Il-6 antibodies (tocilizumab), anti-Il-17 antibodies (secukinumab), low-dose Il-2 (a few studies have demonstrated its ability to induce Treg in various autoimmune diseases), hydroxychloroquine in low doses (used in lupus to limit relapses and having an anti-inflammatory effect), the plant extract Alphanosos (anti-Th1) or Levamizole (validated in nephrotic syndrome in children).
In order to propose the best therapeutic option to relapsed MN patients with a strong activation of the Th17 pathway, the investigators propose to study in vitro the effect of these different immunomodulators on the Th17/Treg balance evaluated by cytokine profile and lymphocyte phenotyping in flow cytometry.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Extramembranous Glomerulopathy
Keywords
membranous nephropathy, immunomodulation, relapse, Th17/Treg pathways
7. Study Design
Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
To compare in vitro the effect of different immunomodulators on Th17/Treg lymphocyte balance in a cohort of relapsed MN patients to determine the best therapeutic approach.
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
GEM patients
Arm Type
Experimental
Intervention Type
Other
Intervention Name(s)
Blood sample
Intervention Description
10 mL on lithium heparinate tubes, 10 mL on EDTA tubes.
Primary Outcome Measure Information:
Title
Cytokine ELISA profiles of the Th17 pathway (IL-17 level), the Treg pathway (IL-10 level), the Th1 pathway (IL-12p70, IFN-γ) and the Th2 pathway (IL-4 and IL-5)
Description
All cytokines (IL-17, IL-10, IL-12p70, IFN-γ, IL-4 and IL-5) measured by ELISA will be expressed in pg/ml.
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Lymphocyte phenotyping (Treg and Th17) determined by flow cytometry
Description
Percentage of cells expressing the fluorescent marker of interest
Time Frame
18 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age ≥ 18 years
Patient with MN proven on renal biopsy or by the presence of anti-PLA2R1 or anti-THDS71 antibodies
Relapsed MN, defined as proteinuria > 3.5g/g after achieving remission (partial or complete, definitions according to KDIGO 2012 guidelines)
At a distance from any immunosuppressive treatment (at least 6 months)
Freely given informed consent signed by the patient after clear, fair and appropriate information
Affiliated to a social security system
Exclusion Criteria:
Pregnant or breastfeeding woman
Patient under 18 years of age
Persons of legal age
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Barbara SEITZ-POLSKI, MD, PhD
Phone
+33492035990
Email
seitz-polski.b@chu-nice.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Céline FERNANDEZ
Phone
+33492038828
Email
fernandez.c3@chu-nice.fr
Facility Information:
Facility Name
Centre Hospitalier Universitaire de Nice
City
Nice
ZIP/Postal Code
06200
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
FERNANDEZ Céline
Phone
+33492038828
Email
fernandez.c3@chu-nice.fr
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
IPD is not planned to be shared with other researchers than the investigators
Learn more about this trial
In Vitro Immunomodulation in Membranous Nephropathy Relapses
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