Worms for Immune Regulation of Multiple Sclerosis (WIRMS)
Primary Purpose
Multiple Sclerosis, Relapsing-Remitting
Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Hookworm larvae
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Multiple Sclerosis, Relapsing-Remitting focused on measuring Multiple sclerosis, Hookworm larvae, Necator americanus, Treg cells
Eligibility Criteria
Inclusion Criteria:
- Relapsing remitting MS (RRMS) (McDonald criteria) and secondary MS with super imposing relapse on condition that they fulfil the next conditions, MRI scan consistent with MS by Barkhof or Fazekas criteria
- Patients with at least 1 relapse in the last 12 months or 2 in the last 24 months;
- Patients with Expanded disability status scale (EDSS) score in the range of 0 to 5.5 at the screening and week 0 visit
- Patients of both genders, age >18 years and < 65 years
- Women of child bearing potential, (who have a negative pregnancy test) must agree to use methods of medically acceptable forms of contraception during the study.
- Be able and willing to comply with study visits and procedures per protocol.
- Understand and sign consent form at the screening
Exclusion Criteria:
No populations at risk of severe illness or death will be included in this study
- Life expectancy < 6 months.
- Patient is < 5 years free of malignancy, except treated basal cell skin cancer or cervical carcinoma in situ.
- Patient with grade III/IV cardiac problems as defined by the New York Heart Association Criteria. (i.e., congestive heart failure, myocardial infarction within 6 months of study)
- Patients with severe and/or uncontrolled medical condition.
- Pregnancy, lactation or intention to become pregnant during the course of the study (please also see above under inclusion criterion 5)
- Patient has a known diagnosis of human immunodeficiency virus (HIV) infection.
- Anaemia (Hb <10 g/dL for females, <11 g/dL for males)
- Prior or present evidence of parasitic infection; prior treatment with anti-helminthic drugs in the last 6 years.
- Patient with serious medical or psychiatric illness that could potentially interfere with the completion of the study treatment according to this protocol
- History of poor compliance or history of drug/alcohol abuse, or excessive alcohol consumption that would interfere with the ability to comply with the study protocol,
- Severe asthma, allergy, other autoimmune disease or any condition that the physician judges could be detrimental to subjects participating in this study; including deviations deemed clinically important from normal clinical laboratory
Previous treatment
- Treatment with interferon or glatiramer acetate within 8 weeks prior to baseline or immunosuppressive drugs within 12 weeks prior to baseline
- Treatment with bone marrow transplantation, total lymphoid irradiation, monoclonal antibodies (other than natalizumab, umbilical cord stem cells, AIMSPRO at any time prior to baseline
- Treatment with corticosteroids or ACTH within 4 weeks prior to baseline
- Treatment with any investigational agent within 12 weeks prior to baseline
Sites / Locations
- University of Nottingham
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Hookworm larvae (Necator americanus)
Placebo
Arm Description
Participants will receive 25 live hookworm larvae
Participant will receive pharmacopoeial grade water
Outcomes
Primary Outcome Measures
The cumulative number of new or enlarging Gd+ lesions at month 9
Secondary Outcome Measures
Percentage of cells positive simultaneously for CD4, CD25, foxp3
Cumulative number of newly active lesions (new GD+ T1; new and enlarging T2) at month 9
Change in expanded disability status scale (EDSS) at month 9
Full Information
NCT ID
NCT01470521
First Posted
November 9, 2011
Last Updated
January 28, 2016
Sponsor
University of Nottingham
Collaborators
National Multiple Sclerosis Society
1. Study Identification
Unique Protocol Identification Number
NCT01470521
Brief Title
Worms for Immune Regulation of Multiple Sclerosis
Acronym
WIRMS
Official Title
Worms for Immune Regulation of Multiple Sclerosis (WIRMS)
Study Type
Interventional
2. Study Status
Record Verification Date
January 2016
Overall Recruitment Status
Completed
Study Start Date
December 2011 (undefined)
Primary Completion Date
January 2016 (Actual)
Study Completion Date
January 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Nottingham
Collaborators
National Multiple Sclerosis Society
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of this study is to determine whether people with MS who are exposed to a small number of hookworms will have less inflammation and less MS disease activity.
Detailed Description
There is evidence that certain parasitic infections may protect against autoimmune or inflammatory diseases, including multiple sclerosis (MS), asthma and type1 diabetes. The 'hygiene hypothesis' postulates exposure to infectious agents confers protection against these disorders. One putative mechanism depends on the activity of regulatory T cells (Treg), naturally occurring or induced cells that prevent excessive immune activation and autoimmunity. Reports in the last 5 years lend credence to the hygiene hypothesis in MS: epidemiological investigations show an inverse relationship to infections with the nematode Trichuris, and a study with serial clinical, immunological and MRI follow-up shows MS patients developing intestinal parasitoses have much milder disease course compared with uninfected matched MS controls followed over 5 years. A role for Treg and also a novel population of B regulatory (Breg) cells is suggested in this study. The University of Nottingham has extensive experience with human parasite research and have completed essential safety studies of controlled infection with hookworm in normal volunteers and people with atopy. Asthma and Crohn's disease studies are underway and show an immunological effect even with 10 larvae. This is the first controlled parasite exposure study in patients with relapsing MS with in 36 patients 25 hookworm larvae vs 36 patients with placebo. Patients will be followed clinically (relapse rate, disability scores), immunologically and radiologically (serial MRI scans with Gadolinium) for 1 year. The cumulative number of new and active lesions on T2 weighted MRI will be the primary outcome measure. Regulatory network induction (Treg induction, Breg/Tr1 and NK) will be the immunological secondary outcome measure. Relapse rate will be secondary clinical outcome measure. A number of clinical, MRI and immune parameters will be exploratory measures. Cytokine profiles, eosinophil and egg counts, IgE and IgG subsets and IgE/IgG4 ratios will be measured, to relate altered immune responses to disease modulation. Immune responses will be assessed to neuroantigen and to mitogen, and parasite antigens (excretory/secretory products). This study will be an essential early step in assessing the potential for therapeutic immunomodulation with parasites in MS.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis, Relapsing-Remitting
Keywords
Multiple sclerosis, Hookworm larvae, Necator americanus, Treg cells
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
72 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Hookworm larvae (Necator americanus)
Arm Type
Experimental
Arm Description
Participants will receive 25 live hookworm larvae
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participant will receive pharmacopoeial grade water
Intervention Type
Biological
Intervention Name(s)
Hookworm larvae
Other Intervention Name(s)
Necator americanus
Intervention Description
Hookworm larvae solution is pipetted onto a plaster dressing which is then placed on the upper forearm for 24 hours. This is administered only once.
Intervention Type
Biological
Intervention Name(s)
Placebo
Other Intervention Name(s)
Water
Intervention Description
Pharmacopoeial grade water is pipetted onto a plaster dressing which is then placed on the upper forearm for 24 hours. This is administered only once.
Primary Outcome Measure Information:
Title
The cumulative number of new or enlarging Gd+ lesions at month 9
Time Frame
Month 9
Secondary Outcome Measure Information:
Title
Percentage of cells positive simultaneously for CD4, CD25, foxp3
Time Frame
End of trial
Title
Cumulative number of newly active lesions (new GD+ T1; new and enlarging T2) at month 9
Time Frame
Month 9
Title
Change in expanded disability status scale (EDSS) at month 9
Time Frame
Month 9
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Relapsing remitting MS (RRMS) (McDonald criteria) and secondary MS with super imposing relapse on condition that they fulfil the next conditions, MRI scan consistent with MS by Barkhof or Fazekas criteria
Patients with at least 1 relapse in the last 12 months or 2 in the last 24 months;
Patients with Expanded disability status scale (EDSS) score in the range of 0 to 5.5 at the screening and week 0 visit
Patients of both genders, age >18 years and < 65 years
Women of child bearing potential, (who have a negative pregnancy test) must agree to use methods of medically acceptable forms of contraception during the study.
Be able and willing to comply with study visits and procedures per protocol.
Understand and sign consent form at the screening
Exclusion Criteria:
No populations at risk of severe illness or death will be included in this study
Life expectancy < 6 months.
Patient is < 5 years free of malignancy, except treated basal cell skin cancer or cervical carcinoma in situ.
Patient with grade III/IV cardiac problems as defined by the New York Heart Association Criteria. (i.e., congestive heart failure, myocardial infarction within 6 months of study)
Patients with severe and/or uncontrolled medical condition.
Pregnancy, lactation or intention to become pregnant during the course of the study (please also see above under inclusion criterion 5)
Patient has a known diagnosis of human immunodeficiency virus (HIV) infection.
Anaemia (Hb <10 g/dL for females, <11 g/dL for males)
Prior or present evidence of parasitic infection; prior treatment with anti-helminthic drugs in the last 6 years.
Patient with serious medical or psychiatric illness that could potentially interfere with the completion of the study treatment according to this protocol
History of poor compliance or history of drug/alcohol abuse, or excessive alcohol consumption that would interfere with the ability to comply with the study protocol,
Severe asthma, allergy, other autoimmune disease or any condition that the physician judges could be detrimental to subjects participating in this study; including deviations deemed clinically important from normal clinical laboratory
Previous treatment
Treatment with interferon or glatiramer acetate within 8 weeks prior to baseline or immunosuppressive drugs within 12 weeks prior to baseline
Treatment with bone marrow transplantation, total lymphoid irradiation, monoclonal antibodies (other than natalizumab, umbilical cord stem cells, AIMSPRO at any time prior to baseline
Treatment with corticosteroids or ACTH within 4 weeks prior to baseline
Treatment with any investigational agent within 12 weeks prior to baseline
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cris Constantinescu, MD phD
Organizational Affiliation
University of Nottingham
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Nottingham
City
Nottingham
State/Province
Nottinghamshire
ZIP/Postal Code
NG7 2UH
Country
United Kingdom
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
32539079
Citation
Tanasescu R, Tench CR, Constantinescu CS, Telford G, Singh S, Frakich N, Onion D, Auer DP, Gran B, Evangelou N, Falah Y, Ranshaw C, Cantacessi C, Jenkins TP, Pritchard DI. Hookworm Treatment for Relapsing Multiple Sclerosis: A Randomized Double-Blinded Placebo-Controlled Trial. JAMA Neurol. 2020 Sep 1;77(9):1089-1098. doi: 10.1001/jamaneurol.2020.1118.
Results Reference
derived
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Worms for Immune Regulation of Multiple Sclerosis
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