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Exploring Biomarkers in Hereditary Transthyretin Amyloidosis (ELBA)

Primary Purpose

Hereditary Transthyretin Amyloidosis

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
Assessment of disease biomarkers
Sponsored by
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Hereditary Transthyretin Amyloidosis focused on measuring hereditary transthyretin amyloidosis, neurogenetics, neuromuscular disorders, biomarkers, mitochondrial dysfunction

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Molecularly defined patients with hereditary transthyretin amyloidosis, carrying TTR pathogenic variants Presymptomatic carriers of the pathogenic variants in TTR gene Subjects aged 18 years or older Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study Exclusion Criteria: Inability to understand or unwilling to follow the study requirements including attendance at the study center, completion of questionnaires and participation in laboratory testing as called for by the protocol Inability to sign an informed consent Severe psychiatric diseases

Sites / Locations

  • Fondazione Policlinico Universitario Agostino Gemelli IRCCSRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Assessment of disease biomarkers

Arm Description

Outcomes

Primary Outcome Measures

Circulating disease biomarkers in ATTRv amyloidosis
Validation of serum biomarkers of disease (DJ-1, cystatin C, calbindin, uromodulin, GDF-15 and NfL) in patients with ATTRv (baseline assessment). Change from baseline in serum levels of disease biomarkers (DJ-1, cystatin C, calbindin, uromodulin, GDF-15 and NfL) at different time points through week 96.
Neuropathological biomarkers in ATTRv amyloidosis
Baseline assessment of intraepidermal nerve fiber density (IENFD). Change from baseline in intraepidermal nerve fiber density (IENFD) at week 96.
Radiological biomarkers (muscle MRI) in ATTRv amyloidosis
Baseline assessment of total fatty infiltration score and STIR sequences. Change from baseline in total fatty infiltration score and STIR sequences at week 96.
Circulating disease biomarkers in presymptomatic individuals
Change from baseline in serum levels of disease biomarkers (DJ-1, cystatin C, calbindin, uromodulin, GDF-15 and NfL) at different time points through week 96.
Neuropathological biomarkers in presymptomatic individuals
Baseline assessment of intraepidermal nerve fiber density (IENFD). Change from baseline in intraepidermal nerve fiber density (IENFD) at week 96.
Radiological biomarkers (muscle MRI) in presymptomatic individuals
Baseline assessment of total fatty infiltration score and STIR sequences. Change from baseline in total fatty infiltration score and STIR sequences at week 96.

Secondary Outcome Measures

Inflammatory profile in ATTRv amyloidosis
To document the contribution of inflammation in the ATTRv pathogenesis by assessing serum cytokine levels.
Mitochondrial dysfunction in ATTRv amyloidosis
To document the contribution of mitochondrial dysfunction in the ATTRv pathogenesis by biochemical investigations on serum and muscle/skin.

Full Information

First Posted
June 7, 2023
Last Updated
June 26, 2023
Sponsor
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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1. Study Identification

Unique Protocol Identification Number
NCT05929209
Brief Title
Exploring Biomarkers in Hereditary Transthyretin Amyloidosis
Acronym
ELBA
Official Title
Exploring Biomarkers in Hereditary Transthyretin Amyloidosis: From Clinical Severity Assessment to New Disease Mechanisms
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 1, 2023 (Actual)
Primary Completion Date
December 31, 2025 (Anticipated)
Study Completion Date
April 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Fondazione Policlinico Universitario Agostino Gemelli IRCCS

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
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a severe and heterogeneous systemic condition due to mutations in the transthyretin (TTR) gene. The availability of disease-modifying therapies has led to an urgent need to have reliable biomarkers capable of assessing the clinical severity of the disease and of monitoring the efficacy of pharmacological treatment. At the same time, early markers for the clinical onset of ATTRv amyloidosis in presymptomatic subjects are needed to enable earlier initiation of anti-amyloid therapy. In this project the investigators seek to achieve three main goals: to identify and validate disease severity biomarkers in symptomatic patients; to establish disease onset biomarkers of ATTRv amyloidosis in presymptomatic subjects; to explore new pathogenetic mechanisms underlying this multisystem disorder, such as mitochondrial dysfunction and immune response.
Detailed Description
Hereditary transthyretin amyloidosis is a severe and heterogeneous systemic condition due to mutations in the transthyretin (TTR) gene. This autosomal-dominant neurogenetic disorder is characterized by an adult-onset with variable penetrance and an extracellular deposition of amyloid in different organs with a prevalent involvement of the somatic and autonomic peripheral nervous system (PNS). At the same time, the heart, the kidney, the gastro-intestinal system, and the eyes are frequently involved, leading to a lifethreatening multisystem disease with a huge clinical variability and course, and death within 10 years on average. The prevalence of the disease is highly variable between endemic and non-endemic countries and the global prevalence ranges from 5.526 to 38.468. However, the real numbers of ATTRv could even be higher, considering the missing diagnoses and pre-symptomatic carriers regularly followed in each centre. The last few years have been characterized by a significant change in disease management due to a deeper knowledge of the phenotype-genotype correlations and most importantly to the availability of disease-modifying therapies (DMTs). This raises the need for reliable disease biomarkers, in order to monitor the efficacy of the pharmacological treatment and the progression of the disease but also to identify the disease onset in the presymptomatic carriers of TTR gene pathogenic variants. While enormous progress has been made in diagnostics and treatment in ATTRv, advances in the identification of biomarkers useful for assessing the severity of the disease and the efficacy of pharmacological approaches have not been parallel to this so far. Once molecular diagnosis has been established, ATTRv patients are evaluated in clinical practice and in clinical trials through clinical scales such as the Familial Amyloid Polyneuropathy (FAP) staging system, the Polyneuropathy Disability (PND) score, the Neuropathy Impairment Score (NIS) and its subset, the NIS-lower limbs (NIS-LL) score, and the Norfolk Quality of Life-Diabetic Neuropathy (QoL-DN) questionnaire. However, these purely clinical scales detect a change only when patients have already progressed clinically. It would be desirable to have outcome measures in order to effectively treat presymptomatic patients with a high risk of future clinical worsening. Furthermore, investigating extraneurological involvement in ATTRv can help identifying disease severity biomarkers and shed light on new general and specific pathogenetic pathways besides those already known. In this context, neurofilament light chain (NfL), a neuronal cytoplasmic protein highly expressed in large calibre myelinated axons, has emerged as a good candidate as a disease biomarker in ATTRv, suggesting a key role in monitoring disease progression. Providing information about somatic and autonomic small fiber, skin biopsy appears to be a minimally invasive exam able to disclose pathological changes several years before the onset of symptoms. Skeletal muscle can be secondarily involved in ATTRv amyloidosis, as already described for other inherited neuropathies. In this context, muscle MRI can represent a useful tool to evaluate the progression of the pathology. The main purpose of our study is the definition and validation of disease severity biomarkers in symptomatic patients, able to describe the natural history of the disease and to monitor the efficacy of drug treatments currently available or to be evaluated in future clinical trials. At the same time, the investigators aim to identify measurable criteria capable of early identifying disease onset in presymptomatic subjects. Lastly, the investigators will explore new potentially pathogenetic mechanisms associated with ATTRv, such as mitochondrial dysfunction and the role of inflammation in order to identify a rationale for future innovative therapeutic strategies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hereditary Transthyretin Amyloidosis
Keywords
hereditary transthyretin amyloidosis, neurogenetics, neuromuscular disorders, biomarkers, mitochondrial dysfunction

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
80 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Assessment of disease biomarkers
Arm Type
Experimental
Intervention Type
Diagnostic Test
Intervention Name(s)
Assessment of disease biomarkers
Intervention Description
Assessment of serum, histological and radiological biomarkers
Primary Outcome Measure Information:
Title
Circulating disease biomarkers in ATTRv amyloidosis
Description
Validation of serum biomarkers of disease (DJ-1, cystatin C, calbindin, uromodulin, GDF-15 and NfL) in patients with ATTRv (baseline assessment). Change from baseline in serum levels of disease biomarkers (DJ-1, cystatin C, calbindin, uromodulin, GDF-15 and NfL) at different time points through week 96.
Time Frame
Baseline, weeks 24, 48, 72, 96
Title
Neuropathological biomarkers in ATTRv amyloidosis
Description
Baseline assessment of intraepidermal nerve fiber density (IENFD). Change from baseline in intraepidermal nerve fiber density (IENFD) at week 96.
Time Frame
Baseline, week 96
Title
Radiological biomarkers (muscle MRI) in ATTRv amyloidosis
Description
Baseline assessment of total fatty infiltration score and STIR sequences. Change from baseline in total fatty infiltration score and STIR sequences at week 96.
Time Frame
Baseline, week 96
Title
Circulating disease biomarkers in presymptomatic individuals
Description
Change from baseline in serum levels of disease biomarkers (DJ-1, cystatin C, calbindin, uromodulin, GDF-15 and NfL) at different time points through week 96.
Time Frame
Baseline, weeks 24, 48, 72, 96
Title
Neuropathological biomarkers in presymptomatic individuals
Description
Baseline assessment of intraepidermal nerve fiber density (IENFD). Change from baseline in intraepidermal nerve fiber density (IENFD) at week 96.
Time Frame
Baseline, week 96
Title
Radiological biomarkers (muscle MRI) in presymptomatic individuals
Description
Baseline assessment of total fatty infiltration score and STIR sequences. Change from baseline in total fatty infiltration score and STIR sequences at week 96.
Time Frame
Baseline, week 96
Secondary Outcome Measure Information:
Title
Inflammatory profile in ATTRv amyloidosis
Description
To document the contribution of inflammation in the ATTRv pathogenesis by assessing serum cytokine levels.
Time Frame
Baseline, week 96
Title
Mitochondrial dysfunction in ATTRv amyloidosis
Description
To document the contribution of mitochondrial dysfunction in the ATTRv pathogenesis by biochemical investigations on serum and muscle/skin.
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Molecularly defined patients with hereditary transthyretin amyloidosis, carrying TTR pathogenic variants Presymptomatic carriers of the pathogenic variants in TTR gene Subjects aged 18 years or older Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study Exclusion Criteria: Inability to understand or unwilling to follow the study requirements including attendance at the study center, completion of questionnaires and participation in laboratory testing as called for by the protocol Inability to sign an informed consent Severe psychiatric diseases
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Guido Alessandro Primiano
Phone
+39 0630154279
Email
guidoalessandro.primiano@policlinicogemelli.it
Facility Information:
Facility Name
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
City
Roma
State/Province
ID
ZIP/Postal Code
00168
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Guido Alessandro Primiano
Phone
+39 0630154279
Email
guidoalessandro.primiano@policlinicogemelli.it

12. IPD Sharing Statement

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Exploring Biomarkers in Hereditary Transthyretin Amyloidosis

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