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Exploration of the Activity of DNA Located Outside of Cellular Nucleus to Amplify Inflammation in Inflammatory Bowel Disease in Children Through Biological Pathway Cyclic GMP-AMP Synthase (cGAS) - Stimulator of Interferon Genes (STING) (ROXANE)

Primary Purpose

Inflammatory Bowel Diseases, Crohn Disease, Ulcerative Colitis

Status
Recruiting
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Blood and fecal samples
Coolonic biopsies
Sponsored by
Centre Hospitalier Régional d'Orléans
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Inflammatory Bowel Diseases focused on measuring Inflammatory Bowel disease, Crohn disease, Ulcerative colitis, cell-free DNA, cGAS, STING, Child, intestinal inflammation

Eligibility Criteria

6 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Participants aged from 6 years inclusive to 17 years inclusive Boys and girls Presenting an IBD or suspicion of IBD Requiring a colonoscopy for diagnosis or follow-up or other reason (abdominal pain, diarrhoea, rectal bleeding, weight loss) not confirming the diagnosis of Crohn's disease or Ulcerative Colitis Active IBD if: CD: PCDAI score >5 and CRP>20mg/L and faecal calprotectin> 400 µg/g UC: PUCAI score>10 and faecal calprotectin>250 µg/g IBD in remission if: CD: PCDAI score<5 and CRP<20mg/L and faecal calprotectin<400 µg/g UC: PUCAI score <10 and faecal calprotectin < 250 µg/g Patients and their parents who gave their consent to participate in the study Exclusion Criteria: Refusal of the participant and/or one of his two parents Body weight less than or equal to 20 kg Blood hemoglobin level less than or equal to 9 g/dl Refusal or contraindication to general anesthesia Co-existing severe chronic pathology and/or treatment that could interfere with the results of the study; example: trisomy 21, treatment with growth hormone etc. Protected person (under guardianship or curatorship) Person under legal protection Person not affiliated to a social security scheme Pregnant or breastfeeding woman

Sites / Locations

  • CHR OrléansRecruiting

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Patients with samples

Arm Description

Blood and fecal samples, and colonic biopsies will be analysed and compared between 3 groups of participants :1/ Active IBD; 2/Inactive IBD; 3/Controls "non-IBD".

Outcomes

Primary Outcome Measures

Amount of mRNA specific for colonic cGAS
the comparison, between the 3 groups of patients, of the quantity of specific mRNA of colonic cGAS expressed as the number of "reads" during RNA sequencing (RNAseq), by a Mann-Whitney U test. It is planned from the outset to compare the groups 2 by 2, regardless of the result of an overall test such as a Kruskal-Wallis test.

Secondary Outcome Measures

quantitative difference of amount of circulating mtDNA
to find quantitative differences between the 3 groups concerning the circulating mtDNA, the circulating total DNA, by the qPCR technique: by specific primer sequences to identify the origin of the DNA (mitochondrial or nuclear). Results will be expressed by the -2∆∆Ct method ("fold increase") compared to the control.
Cytokine response
to find quantitative differences between the 3 groups concerning the cytokine response by Luminex®: in pg/ml or in ng/ml depending on the cytokines
inflammatory / dysimmune response of cytokines
to find quantitative differences between the 3 groups concerning the inflammatory / dysimmune response of cytokines, components of the cGAS-STING pathways autophagy, NOD2, intestinal mucins, integrins, cadherins by RNAseq type transcriptomic analysis in Transcript Per Million (TPM). This outcome wil be mesured at the blood level abd the colonic level.
Difference of DNA methylation by Methyl-Seq between the 3 groups
to find quantitative differences between the 3 groups concerning the study of DNA methylation by Methyl-Seq. Results expessed in pourcentage of methylation. This outcome will be mesured at the bllod level and the colonic level.
Activation (phosphorylation) of the components of the cGAS-STING pathway
Activation (phosphorylation) of the components of the cGAS-STING pathway (proteins cGAS, p-CGAS, STING,p-STING,TBK1, p-TBK1,IRF-3, p-IRF-3) by Western-Blot
plasma DNase activity
plasma DNase activity in Kunitz unitz
differences in microbial distribution
search for quantitative differences in microbial distribution between the 3 groups by pyrosequencing RNA 16s of the microbiota at the fecal level
quantity (number of "reads") of colonic STING-specific mRNA
quantitative differences between the 3 groups concerning the quantity (number of "reads") of colonic STING-specific mRNA at the colonic level
extracellular DNA by qPCR
We will use specific primer sequences to identify the origin of the DNA (mitochondrial or nuclear). Results will be expressed by the -2∆∆Ct method ("fold increase") compared to the control. This outcome will be mesured at the colonic level.
Amount of STING in the cytoplasm
cytoplasmic presence of STING by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Amount of cGAS in the cytoplasm
cytoplasmic presence of cGAS by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Amount of nuclear DNA in teh cytoplasm
cytoplasmic presence of nuclear DNA by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Amount of mitochondrial DNA in the cytoplasm
cytoplasmic presence of mitochondrial DNA by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Amount of colonic DNase activity
Measurement of colonic DNase activity in Kunitz unitz

Full Information

First Posted
May 5, 2023
Last Updated
June 14, 2023
Sponsor
Centre Hospitalier Régional d'Orléans
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1. Study Identification

Unique Protocol Identification Number
NCT05916274
Brief Title
Exploration of the Activity of DNA Located Outside of Cellular Nucleus to Amplify Inflammation in Inflammatory Bowel Disease in Children Through Biological Pathway Cyclic GMP-AMP Synthase (cGAS) - Stimulator of Interferon Genes (STING)
Acronym
ROXANE
Official Title
Pro-inflammatory Role of Extracellular DNA in Inflammatory Bowel Disease in Children: Study of the cGAS-STING Pathway
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 31, 2023 (Actual)
Primary Completion Date
June 2026 (Anticipated)
Study Completion Date
June 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Hospitalier Régional d'Orléans

4. Oversight

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

5. Study Description

Brief Summary
Frequency of Inflammatory Bowel Diseases in children (IBD)-Crohn's disease (CD), Ulcerative colitis (UC) is constantly increasing. Pediatric-onset IBD represent a different nosological entity (from adult IBD) because of their major inflammatory activity, their significant anatomical extent and their stenotic and/or fistulizing character sometimes from diagnosis. Intestinal lesions are due to dysregulation of the intestinal immune system but the cause is unknown. The investigators hypothesize that extranuclear DNA participates in the amplification of the inflammatory response at the intestinal and blood levels during pediatric IBD through the cGAS-STING pathway. The investigators will analyse blood and fecal samples, and colonic biopsies issued from ill children and control participants on age of 6 to 17 years. The investigators think that this study will provide a better understanding of the mechanisms involved in pediatric IBD, assess the place of the cGAS-STING pathway, identify potential biomarkers of pediatric IBD and new potential therapeutic targets based in particular on the inhibition of the cGAS-STING pathway.
Detailed Description
Inflammatory Bowel Diseases in children (IBD)-Crohn's disease (CD), ulcerative colitis (UC) are severe pathology that can affect the entire digestive tract. Their annual incidence is however constantly increasing. IBD are complex multifactorial pathologies whose cause is still unknown today. IBD occurs on a predisposing genetic background in the presence of exogenous factors and alteration of the intestinal microbiota. Intestinal lesions are due to dysregulation of the intestinal immune system with increased secretion of pro-inflammatory cytokines at the expense of anti-inflammatory cytokines. Pediatric-onset IBD represent a different nosological entity (from adult IBD) because of their major inflammatory activity, their significant anatomical extent and their stenotic and/or fistulizing character sometimes from diagnosis. Their impact is not only individual (growth retardation, puberty delay, psychological disorders) but also family/parental, school and social. These particularities justify that biomedical research focuses on it in a more specific way. Extracellular and extranuclear DNA (enDNA) play a major role in innate immunity by stimulating pro-inflammatory responses and activating type I interferon production. The pro-inflammatory action of enDNA is mediated by enzyme cGAS, protein STING, toll-like receptor 9 (TLR9), and the inflammasome complex NLRP3. The investigators hypothesize that enDNA participates in the amplification of the inflammatory response at the intestinal and blood levels during pediatric IBD through the cGAS-STING pathway. They also hypothesize that there are links between the cGAS-STING pathway and other pathways involved in pediatric IBD such as NOD2 and Autophagy. The investigators will analyse blood and fecal samples, and colonic biopsies issued from ill children and controls on age of 6 to 17 years. The investigators think that this study will provide a better understanding of the mechanisms involved in pediatric IBD, assess the place of the cGAS-STING pathway, identify potential biomarkers of pediatric IBD and new potential therapeutic targets based in particular on the inhibition of the cGAS-STING pathway.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Inflammatory Bowel Diseases, Crohn Disease, Ulcerative Colitis
Keywords
Inflammatory Bowel disease, Crohn disease, Ulcerative colitis, cell-free DNA, cGAS, STING, Child, intestinal inflammation

7. Study Design

Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Patients with samples
Arm Type
Other
Arm Description
Blood and fecal samples, and colonic biopsies will be analysed and compared between 3 groups of participants :1/ Active IBD; 2/Inactive IBD; 3/Controls "non-IBD".
Intervention Type
Biological
Intervention Name(s)
Blood and fecal samples
Intervention Description
Blood and fecal samples will be performed
Intervention Type
Procedure
Intervention Name(s)
Coolonic biopsies
Intervention Description
colonic biopsies will be analysed
Primary Outcome Measure Information:
Title
Amount of mRNA specific for colonic cGAS
Description
the comparison, between the 3 groups of patients, of the quantity of specific mRNA of colonic cGAS expressed as the number of "reads" during RNA sequencing (RNAseq), by a Mann-Whitney U test. It is planned from the outset to compare the groups 2 by 2, regardless of the result of an overall test such as a Kruskal-Wallis test.
Time Frame
Baseline
Secondary Outcome Measure Information:
Title
quantitative difference of amount of circulating mtDNA
Description
to find quantitative differences between the 3 groups concerning the circulating mtDNA, the circulating total DNA, by the qPCR technique: by specific primer sequences to identify the origin of the DNA (mitochondrial or nuclear). Results will be expressed by the -2∆∆Ct method ("fold increase") compared to the control.
Time Frame
Baseline
Title
Cytokine response
Description
to find quantitative differences between the 3 groups concerning the cytokine response by Luminex®: in pg/ml or in ng/ml depending on the cytokines
Time Frame
Baseline
Title
inflammatory / dysimmune response of cytokines
Description
to find quantitative differences between the 3 groups concerning the inflammatory / dysimmune response of cytokines, components of the cGAS-STING pathways autophagy, NOD2, intestinal mucins, integrins, cadherins by RNAseq type transcriptomic analysis in Transcript Per Million (TPM). This outcome wil be mesured at the blood level abd the colonic level.
Time Frame
Baseline
Title
Difference of DNA methylation by Methyl-Seq between the 3 groups
Description
to find quantitative differences between the 3 groups concerning the study of DNA methylation by Methyl-Seq. Results expessed in pourcentage of methylation. This outcome will be mesured at the bllod level and the colonic level.
Time Frame
Baseline
Title
Activation (phosphorylation) of the components of the cGAS-STING pathway
Description
Activation (phosphorylation) of the components of the cGAS-STING pathway (proteins cGAS, p-CGAS, STING,p-STING,TBK1, p-TBK1,IRF-3, p-IRF-3) by Western-Blot
Time Frame
Baseline
Title
plasma DNase activity
Description
plasma DNase activity in Kunitz unitz
Time Frame
baseline
Title
differences in microbial distribution
Description
search for quantitative differences in microbial distribution between the 3 groups by pyrosequencing RNA 16s of the microbiota at the fecal level
Time Frame
Baseline
Title
quantity (number of "reads") of colonic STING-specific mRNA
Description
quantitative differences between the 3 groups concerning the quantity (number of "reads") of colonic STING-specific mRNA at the colonic level
Time Frame
Baseline
Title
extracellular DNA by qPCR
Description
We will use specific primer sequences to identify the origin of the DNA (mitochondrial or nuclear). Results will be expressed by the -2∆∆Ct method ("fold increase") compared to the control. This outcome will be mesured at the colonic level.
Time Frame
Baseline
Title
Amount of STING in the cytoplasm
Description
cytoplasmic presence of STING by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Time Frame
Baseline
Title
Amount of cGAS in the cytoplasm
Description
cytoplasmic presence of cGAS by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Time Frame
Baseline
Title
Amount of nuclear DNA in teh cytoplasm
Description
cytoplasmic presence of nuclear DNA by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Time Frame
Baseline
Title
Amount of mitochondrial DNA in the cytoplasm
Description
cytoplasmic presence of mitochondrial DNA by histology, immunohistochemical staining and optical microscopy analysis. Results will be qualitative (present/absent; localization) and quantitative based on optical density (pourcentage of positive cells)
Time Frame
Baseline
Title
Amount of colonic DNase activity
Description
Measurement of colonic DNase activity in Kunitz unitz
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants aged from 6 years inclusive to 17 years inclusive Boys and girls Presenting an IBD or suspicion of IBD Requiring a colonoscopy for diagnosis or follow-up or other reason (abdominal pain, diarrhoea, rectal bleeding, weight loss) not confirming the diagnosis of Crohn's disease or Ulcerative Colitis Active IBD if: CD: PCDAI score >5 and CRP>20mg/L and faecal calprotectin> 400 µg/g UC: PUCAI score>10 and faecal calprotectin>250 µg/g IBD in remission if: CD: PCDAI score<5 and CRP<20mg/L and faecal calprotectin<400 µg/g UC: PUCAI score <10 and faecal calprotectin < 250 µg/g Patients and their parents who gave their consent to participate in the study Exclusion Criteria: Refusal of the participant and/or one of his two parents Body weight less than or equal to 20 kg Blood hemoglobin level less than or equal to 9 g/dl Refusal or contraindication to general anesthesia Co-existing severe chronic pathology and/or treatment that could interfere with the results of the study; example: trisomy 21, treatment with growth hormone etc. Protected person (under guardianship or curatorship) Person under legal protection Person not affiliated to a social security scheme Pregnant or breastfeeding woman
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Georges DIMITROV, MD
Phone
+33238613390
Email
georges.dimitrov@chr-orleans.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Georges DIMITROV, MD
Organizational Affiliation
CHR d'Orleans
Official's Role
Principal Investigator
Facility Information:
Facility Name
CHR Orléans
City
Orléans
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Georges DIMITROV, MD
First Name & Middle Initial & Last Name & Degree
Georges DIMITROV

12. IPD Sharing Statement

Citations:
PubMed Identifier
29281834
Citation
Ahn J, Son S, Oliveira SC, Barber GN. STING-Dependent Signaling Underlies IL-10 Controlled Inflammatory Colitis. Cell Rep. 2017 Dec 26;21(13):3873-3884. doi: 10.1016/j.celrep.2017.11.101.
Results Reference
background
PubMed Identifier
29346345
Citation
Canesso MCC, Lemos L, Neves TC, Marim FM, Castro TBR, Veloso ES, Queiroz CP, Ahn J, Santiago HC, Martins FS, Alves-Silva J, Ferreira E, Cara DC, Vieira AT, Barber GN, Oliveira SC, Faria AMC. The cytosolic sensor STING is required for intestinal homeostasis and control of inflammation. Mucosal Immunol. 2018 May;11(3):820-834. doi: 10.1038/mi.2017.88. Epub 2017 Dec 20.
Results Reference
background
PubMed Identifier
31582793
Citation
Martin GR, Blomquist CM, Henare KL, Jirik FR. Stimulator of interferon genes (STING) activation exacerbates experimental colitis in mice. Sci Rep. 2019 Oct 3;9(1):14281. doi: 10.1038/s41598-019-50656-5.
Results Reference
background
PubMed Identifier
29718255
Citation
Boyapati RK, Dorward DA, Tamborska A, Kalla R, Ventham NT, Doherty MK, Whitfield PD, Gray M, Loane J, Rossi AG, Satsangi J, Ho GT. Mitochondrial DNA Is a Pro-Inflammatory Damage-Associated Molecular Pattern Released During Active IBD. Inflamm Bowel Dis. 2018 Sep 15;24(10):2113-2122. doi: 10.1093/ibd/izy095.
Results Reference
background
PubMed Identifier
33381513
Citation
Vrablicova Z, Tomova K, Tothova L, Babickova J, Gromova B, Konecna B, Liptak R, Hlavaty T, Gardlik R. Nuclear and Mitochondrial Circulating Cell-Free DNA Is Increased in Patients With Inflammatory Bowel Disease in Clinical Remission. Front Med (Lausanne). 2020 Dec 14;7:593316. doi: 10.3389/fmed.2020.593316. eCollection 2020.
Results Reference
background
PubMed Identifier
35344224
Citation
Khan S, Mentrup HL, Novak EA, Siow VS, Wang Q, Crawford EC, Schneider C, Comerford TE 4th, Firek B, Rogers MB, Loughran P, Morowitz MJ, Mollen KP. Cyclic GMP-AMP synthase contributes to epithelial homeostasis in intestinal inflammation via Beclin-1-mediated autophagy. FASEB J. 2022 May;36(5):e22282. doi: 10.1096/fj.202200138R.
Results Reference
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PubMed Identifier
34453041
Citation
Zhao F, Zheng T, Gong W, Wu J, Xie H, Li W, Zhang R, Liu P, Liu J, Wu X, Zhao Y, Ren J. Extracellular vesicles package dsDNA to aggravate Crohn's disease by activating the STING pathway. Cell Death Dis. 2021 Aug 27;12(9):815. doi: 10.1038/s41419-021-04101-z. Erratum In: Cell Death Dis. 2021 Oct 29;12(11):1022.
Results Reference
background
PubMed Identifier
35280696
Citation
Chen C, Zhang Y, Tao M, Zhao X, Feng Q, Fei X, Fu Y. Atrial Natriuretic Peptide Attenuates Colitis via Inhibition of the cGAS-STING Pathway in Colonic Epithelial Cells. Int J Biol Sci. 2022 Feb 7;18(4):1737-1754. doi: 10.7150/ijbs.67356. eCollection 2022.
Results Reference
background

Learn more about this trial

Exploration of the Activity of DNA Located Outside of Cellular Nucleus to Amplify Inflammation in Inflammatory Bowel Disease in Children Through Biological Pathway Cyclic GMP-AMP Synthase (cGAS) - Stimulator of Interferon Genes (STING)

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