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Cystic FibrosisNCT04242420

Connexin Genotypes in Cystic Fibrosis

A study testing Genotyping, Lung function and Microbiology in people with Cystic Fibrosis and Inflammation, run by University Childrens' Hospital (Zentrum für Kinderheilkunde des Universitätsklinikum Bonn) at 3 sites in 2 countries.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Background: There is wide variety in lung disease phenotype for the delta F508 (homozygous) genotype. A leukocyte driven inflammation is most important for the pathogenesis of pulmonary disease in CF. Blood cytokines correlate negatively with pulmonary function in delta F508 homozygous patients. Read more about this study

Who is it for?
Ages 6 years and older
Conditions the study is for
Cystic Fibrosis, Inflammation
What is being tested?
Genotyping, Lung function and Microbiology
Could I receive a placebo?
No, everyone receives an active treatment
How many people
300 participants
Where
3 sitesin 2 countries
Study dates
Apr 2002to 31 Dec 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Homozygosity for delta F 508

Who cannot join

  • treatment with systemic steroids 14 days preceding this trial, participation in another study within the past 30 days, treatment with Orkambi or status after lung transplantation (for assessment of all parameters except survival).

Trial locations and contacts

3 sites in 2 countries.

Sabina Schmitt-Grohe, MD contact

004915254568942

s.schmitt-grohe@ukbonn.de

3 sites in 2 countries

Germany2 sites, 2 recruiting
  • University Hospital

    Bonn, Nordrhine-Westphalia, 53113

    Sabina Schmitt-Grohe, MD, 004915254568942, s.schmitt-grohe@ukbonn.de

    Recruiting
  • University Hospital

    Frankfurt, Hessia, 60590

    Christina Smaczny, MD, 0049-69-6301 ext. 4232, smaczny@em.uni-frankfurt.de

    Recruiting

Other trials in Germany

Netherlands1 site, 1 recruiting
  • University Hospital

    Amsterdam

    Anne Neerinx-vanStuvyenberg, PhD, a.vanstuyvenbergneerincx@amc.uva.nl

    Recruiting

Other trials in Netherlands

About this study

Official title: Impact of Connexin 37, Connexin 43 on Clinical Disease Phenotype in Delta F508 Homozygous Patients With Cystic Fibrosis (CF) (CF-Modifier)

Background: There is wide variety in lung disease phenotype for the delta F508 (homozygous) genotype. A leukocyte driven inflammation is most important for the pathogenesis of pulmonary disease in CF. Blood cytokines correlate negatively with pulmonary function in delta F508 homozygous patients. Gap junction proteins might be of importance for the influx of blood cells into the lung and may influence the course of pulmonary inflammation. A primary analysis (Horn et al. 2020) has shown that GJA4 variants (rs41266431) are linked to more severe disease in CF. This is very similar to variants of MBL.

Aims: To assess the relationship between gap junction proteins alpha 1 (GJA1/Connexin 43) and alpha 4 (GJA4/connexin 37) genotypes and clinical disease phenotype. Moreover are GJA4 variants in terms of clinical phenotype independent of MBL variants.

Methods:Patients homozygous for delta F508 get recruited from the CF centres of Bonn, Frankfurt and Amsterdam. Sequence analysis is performed for connexin 43 and 37 and MBL genotypes. Clinical disease is assessed longitudinally over 3 years by pulmonary function tests (FEV1 (forced expiratory volume in one second), FVC (=(forced vital capacity), FEF75 % (Forced expiratory flow at 75% of the pulmonary volume) pred), BMI (percentiles), P. aeruginosa colonization, diabetes mellitus and survival to end-stage CF lung disease (death or lung transplantation).

Read the detailed description

Progressive pulmonary destruction is the major cause of morbidity and mortality in human subjects with cystic fibrosis. Many studies could not find an association between delta F 508 and severity of pulmonary disease . The most important factor in CF lung disease is an inflammation driven by leukocytes and cytokines. The investigators have provided evidence in former studies that cytokines (Interleukin-8 (IL-8), tumour necrosis factor (TNF) alpha, Lipopolysaccahride binding protein (LBP), transforming growth factor (TGF) ß)measured in blood correlate negatively with lung function in delta 508 homozygous patients.

The question arises, what other factors influence recruitment of proinflammatory leukocytes from blood capillaries into the lung .

Connexins are a family of transmembrane proteins, which oligomerize into hexameric structures to form a hemichannel (connexon) and ultimately pair with a partner hemichannel in an adjacent cell to form gap junction intercellular communication channels (GJIC) . There is evidence of expression of connexin 37 (=gap junction protein A4 (GJA4)) on macrophages in humans. Moreover there is evidence of expression of connexin 37 on vascular endothelia in humans . Connexin 37 is expressed on human neutrophils . Pulmonary disease in CF is dominated by a leukocyte driven inflammation. GAP junction proteins might be of importance for the influx of blood cells into the lung. In this regard, the hypothesis was that Cx37 or Cx43 genotypes have an impact on clinical disease phenotype in CF patients homozygous for delta F508. The first analysis (Horn et al 2020) has shown a clinical phenotype linked to the GJA4 genotype is very similar to MBL variants. In this regard the question arises whether there is a link between the MBL variant alleles and the GJA4 variants. Moreover some TGFbeta genotypes are linked to certain pulmonary phenotypes. So we are looking for interactions between Cx37 and TGFbeta genotypes and their impact on the clinical phenotype as well.

Being tested
Genotyping, Lung function, Microbiology, Blood sample, Induced Sputum
Keywords
connexin 37+43, MBL, TGF beta, Lung function, Interleukin 8
Medical subject headings
Cystic Fibrosis, Inflammation, Camurati-Engelmann Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • GenotypingDiagnostic test

    Genotyping for single nucleotide polymorphisms for Connexin 37\&43, Mannose binding lectin (MBL) and transforming growth factor beta (TGF beta) genotypes

  • Lung functionDiagnostic test

    Spirometry,

  • MicrobiologyDiagnostic test

    Bacterial culture from Sputum or swab

  • Blood sampleDiagnostic test

    Interleukin-8 assay (via chemiluminescence) blood cell count

  • Induced SputumDiagnostic test

    Interleukin-8 assay (via chemiluminescence) blood cell count

Study groups in NCT04242420
Study groupRoleWhat they receive
Connexin genotypeOtherGenotyping
Receives: Diagnostic Test: Genotyping; Diagnostic Test: Lung function; Diagnostic Test: Microbiology; Diagnostic Test: Blood sample; Diagnostic Test: Induced Sputum

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Survival to end stage lung disease

    End stage lung disease: Death or lung transplantation

    Measured: through study completion, on average 27 years

  2. Lung function parameter: FEV1

    Best FEV1 value in % predicted of the year according to German registry according to Global lung initiative (GLI)

    Measured: 3 years

  3. Lung function parameters: FVC

    Best FVC value in % predicted of the year according to German registry according to Global lung initiative (GLI)

    Measured: 3 years

  4. Lung function parameters: FEF75

    Best FEF75 value in % predicted of the year according to German registry according to Global lung initiative (GLI)

    Measured: 3 years

Secondary outcomes (4)
  1. Interleukin-8 in blood

    single spot value (cross-sectional)

    Measured: through study completion, an average of 3 year

  2. Interleukin-8 in sputum

    single spot value (cross-sectional)

    Measured: through study completion, an average of 3 year

  3. White blood cell count

    Leukocytes (single spot value (cross-sectional))

    Measured: through study completion, an average of 3 year

  4. Inflammatory markers in sputum

    Leukocyte count in sputum (single spot value (cross-sectional))

    Measured: through study completion, an average of 3 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Jan 2020
  2. Study startApr 2002
  3. Primary completion31 Dec 2023 (estimated)
  4. Study completion31 Dec 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Model description
Evaluation of clinical parameters by genotype
Masking
None (open label)
Enrolment
300 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04242420
Sponsor's protocol ID
BN 178/01
Status last verified
Aug 2021
First submitted
20 Dec 2019
Last updated
16 Aug 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Drumm ML, Konstan MW, Schluchter MD, Handler A, Pace R, Zou F, Zariwala M, Fargo D, Xu A, Dunn JM, Darrah RJ, Dorfman R, Sandford AJ, Corey M, Zielenski J, Durie P, Goddard K, Yankaskas JR, Wright FA, Knowles MR; Gene Modifier Study Group. Genetic modifiers of lung disease in cystic fibrosis. N Engl J Med. 2005 Oct 6;353(14):1443-53. doi: 10.1056/NEJMoa051469.

    PubMed 16207846
  • Cystic Fibrosis Genotype-Phenotype Consortium. Correlation between genotype and phenotype in patients with cystic fibrosis. N Engl J Med. 1993 Oct 28;329(18):1308-13. doi: 10.1056/NEJM199310283291804.

    PubMed 8166795
  • McKone EF, Goss CH, Aitken ML. CFTR genotype as a predictor of prognosis in cystic fibrosis. Chest. 2006 Nov;130(5):1441-7. doi: 10.1378/chest.130.5.1441.

    PubMed 17099022
  • Schmitt-Grohe S, Naujoks C, Bargon J, Wagner TO, Schubert R, Hippe V, Zielen S. Interleukin-8 in whole blood and clinical status in cystic fibrosis. Cytokine. 2005 Jan 7;29(1):18-23. doi: 10.1016/j.cyto.2004.09.004.

    PubMed 15579374
  • Schmitt-Grohe S, Hippe V, Igel M, von Bergmann K, Posselt HG, Krahl A, Smaczny C, Wagner TO, Nikolazik W, Schubert R, Lentze MJ, Zielen S. Lipopolysaccharide binding protein, cytokine production in whole blood, and lipoproteins in cystic fibrosis. Pediatr Res. 2005 Nov;58(5):903-7. doi: 10.1203/01.PDR.0000182598.98167.24. Epub 2005 Sep 23.

    PubMed 16183806
  • Schmitt-Grohe S, Stuber F, Book M, Bargon J, Wagner TO, Naujoks C, Schubert R, Lentze MJ, Zielen S. TNF-alpha promoter polymorphism in relation to TNF-alpha production and clinical status in cystic fibrosis. Lung. 2006 Mar-Apr;184(2):99-104. doi: 10.1007/s00408-005-2568-x.

    PubMed 16622779
  • Eickmeier O, Boom Lv, Schreiner F, Lentze MJ, NGampolo D, Schubert R, Zielen S, Schmitt-Grohe S. Transforming growth factor beta1 genotypes in relation to TGFbeta1, interleukin-8, and tumor necrosis factor alpha in induced sputum and blood in cystic fibrosis. Mediators Inflamm. 2013;2013:913135. doi: 10.1155/2013/913135. Epub 2013 Aug 26.

    PubMed 24062613
  • Dempsie Y, Martin P, Upton PD. Connexin-mediated regulation of the pulmonary vasculature. Biochem Soc Trans. 2015 Jun;43(3):524-9. doi: 10.1042/BST20150030.

    PubMed 26009202
  • Chanson M, Derouette JP, Roth I, Foglia B, Scerri I, Dudez T, Kwak BR. Gap junctional communication in tissue inflammation and repair. Biochim Biophys Acta. 2005 Jun 10;1711(2):197-207. doi: 10.1016/j.bbamem.2004.10.005. Epub 2004 Oct 30.

    PubMed 15955304
  • Kwak BR, Mulhaupt F, Veillard N, Gros DB, Mach F. Altered pattern of vascular connexin expression in atherosclerotic plaques. Arterioscler Thromb Vasc Biol. 2002 Feb 1;22(2):225-30. doi: 10.1161/hq0102.104125.

    PubMed 11834520
  • Zahler S, Hoffmann A, Gloe T, Pohl U. Gap-junctional coupling between neutrophils and endothelial cells: a novel modulator of transendothelial migration. J Leukoc Biol. 2003 Jan;73(1):118-26. doi: 10.1189/jlb.0402184.

    PubMed 12525569
  • Saez PJ, Shoji KF, Aguirre A, Saez JC. Regulation of hemichannels and gap junction channels by cytokines in antigen-presenting cells. Mediators Inflamm. 2014;2014:742734. doi: 10.1155/2014/742734. Epub 2014 Sep 9.

    PubMed 25301274
  • Horn T, Ludwig M, Eickmeier O, Neerinex AH, Maitland-van der Zee AH, Smaczny C, Wagner TOF, Schubert R, Zielen S, Majoor C, Bos LD, Schmitt-Grohe S. Impact of a Gap Junction Protein Alpha 4 Variant on Clinical Disease Phenotype in F508del Homozygous Patients With Cystic Fibrosis. Front Genet. 2020 Oct 28;11:570403. doi: 10.3389/fgene.2020.570403. eCollection 2020.

    PubMed 33193670
  • Laubach JP, Ludwig M, Horn T, Eickmeier O, Smaczny C, Schubert R, Zielen S, Majoor C, Aydin M, Schnell A, Schmitt-Grohe S. Transforming Growth Factor ss1 and Gap Junction Protein Alpha 4 Gene Heterogeneity in Relation to the Severity of Clinical Disease in Cystic Fibrosis. Front Biosci (Landmark Ed). 2023 Jul 19;28(7):138. doi: 10.31083/j.fbl2807138.

    PubMed 37525914

Questions about this trial

What is this clinical trial studying?

A study testing Genotyping, Lung function and Microbiology in people with Cystic Fibrosis and Inflammation, run by University Childrens' Hospital (Zentrum für Kinderheilkunde des Universitätsklinikum Bonn) at 3 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 16 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Germany, Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Sabina Schmitt-Grohe, MD (004915254568942, s.schmitt-grohe@ukbonn.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Survival to end stage lung disease (time frame: through study completion, on average 27 years). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04242420, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Aug 2021.

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