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AzTrials

Single Cell Sequencing TechnologyNCT06846645

Host Response to Infection by Direct Analysis of Leukocyte Single Cell-type Gene Expression/transcript Abundance, Direct LS-TA. a Prospective Study Will Evaluate the Performance of Direct LS-TA in Triage Febrile Patients Into Major Categories of Infections: Viral, Bacterial or Active Tuberculosis.

An observational study of Single Cell Sequencing Technology and Gene Expression Profiling, run by Chinese University of Hong Kong at 1 site in Hong Kong.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Febrile illness is a common condition and it is crucial to have an early triage of patients according to various aetiologies to enable appropriate treatment. Currently, most screening/diagnostic tests target the detection of pathogens, while only a few assays aim to understand the host response, and they are mostly… Read more about this study

Who is it for?
Ages 18 to 80 years
How many people
200 participants
Where
1 siteHong Kong
Study dates
Feb 2025to Dec 2028
Phase
Observational
Are there results?
Not yet: the study is under way

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 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with fever due to infections which are later clinically diagnosed as viral infection, bacterial infection or active tuberculosis.

Who may be able to join

  • Adult patients with fever of acute onset which is defined by a raised body temperature.
  • Patient should understand Chinese word to give informed consent.

Who cannot join

  • Patients with a history of any immunodeficiency or immunocompromised condition. Patients received steriod or other immunotherapy.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Hong Kong1 site
  • Dept of Chemical Pathology, Chinese University of Hong Kong

    Hong Kong

    Tang, 852 35053330, nelsontang@cuhk.edu.hk

Other trials in Hong Kong

About this study

Official title: Peripheral Blood Single Cell-type Expression Profile of Interferon-stimulated and Other Biomarker Genes for Triage of Febrile Patients

Febrile illness is a common condition and it is crucial to have an early triage of patients according to various aetiologies to enable appropriate treatment. Currently, most screening/diagnostic tests target the detection of pathogens, while only a few assays aim to understand the host response, and they are mostly based on a measurement of serum proteins (e.g. CRP or procalcitonin).

Recently, blood transcriptome has been explored to differentiate bacterial and viral infections. However, gene expression in blood represents a composite score of gene expression of all the component cell-types present in the sample. Here, we propose to develop a rapid test that can determine gene expressions of a specified single cell type in peripheral blood (e.g., monocytes or granulocytes) as a host response biomarker to differentiate three major categories of infections that are bacterial, viral, and tuberculosis The assay is called Direct Leukocyte Single cell-type transcript abundance (TA) assay (DIRECT LS-TA) as it can directly determine the gene expression of a specified single cell-type among various other leukocyte populations directly in a peripheral blood sample. Such results signify the nature of host response according to 3 or more axes (Type I or Type II interferon signaling response or pro-inflammatory cytokine signaling) And it can be used to indicate the type of underlying infection (viral, bacterial, or active tuberculosis).

Read the detailed description

DIRECT LS-TA is a ratio-based biomarker (RBB) for blood gene expression analysis which can be performed in commonly available equipments (e.g. qPCR or digital PCR machines). Using the ratio of TA of prior defined numerator gene and denominator gene, this RBB can quantify gene expression of the specified constitutional single cell-type (e.g. monocytes and granulocytes) inside a cell-mixture sample of Whole blood. DIRECT LS-TA was a method pioneered by the PI [Tang 2017, https://patents.google.com/patent/US9589099B2/]. And it has been developed for quantification of early B cell response after vaccination [DOI: 10.3390/genes12070971]. Recently, the method is used to develop host response biomarkers after infection to differentiate the type of pathogens (such as viral, bacterial or active tuberculosis). Numerator and denominator genes have been identified by using public gene expression datasets for monocytes and granulocytes. Diagnostic performance was good using these public data. Therefore, these RBBs will be applied in the prospective study to evaluate and compare their diagnostic (triage) performance of febrile patients into different pathogen etiologies.

Comparing to other methods to obtain single cell-type gene expression data, DIRECT LS-TA has many advantages The conventional (gold standard) approach is to quantify gene expression in a sample of purified single cell-type from peripheral blood but it is very labour intensive procedure. Recent single-cell RNA sequencing can also provide gene expression data for every individual cell in a sample, but it is slow and very costly. DIRECT LS-TA provides the unique technique to quantify single cell-type gene expression in blood samples without the need to isolate the targeted cell-type. It has been used to differentiate the type of host response in fever patients into 3 major axes (Type I or Type II interferon signaling response or pro-inflammatory cytokine signaling) which correspond to the nature of underlying infection aetiologies (viral infection, active tuberculosis and bacterial infection).

See preprint DOI: 10.1101/2025.01.27.634977. and patents in B cells : https://patents.google.com/patent/WO2022089426A1/ Monocytes: https://patents.google.com/patent/WO2023109365A1/ Granulocytes : https://patents.google.com/patent/GB202400180D0/

Being tested
No intervention
Keywords
host response, transcriptome, single cell-type gene expression, single cell RNA, triage, fever, febrile patient, Direct LS-TA
Medical subject headings
Infections, Virus Diseases, Bacterial Infections, Latent Tuberculosis, Fever

What participants receive

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

  • No interventionOther

    Patients will receive clinical treatment with no special intervention in this observational study. There is no difference in term of treatment of patients. It only involves one additional blood sampling early after admission.

Study groups in NCT06846645
Study groupRoleWhat they receive
Bacterial infection groupA prospective sample of adult patients who later confirmed to have fever due to bacterial infection by positive culture results.
Receives: Other: No intervention
Viral infection groupA prospective sample of adult patients who later confirmed to have fever due to viral infection by positive pathogen diagnostic results.
Receives: Other: No intervention
Active tuberculosis groupA prospective sample of adult patients who later confirmed to have fever due to active tuberculosis by clinical diagnosis and/or positive pathogen results.
Receives: Other: No intervention

What is being measured

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

  1. Viral host response Direct LS-TA in monocytes (Type I interferon response)

    Direct LS-TA is a kind of RBB that can be readily quantified by qPCR or dPCR of a pair of genes, the RBB numerator gene and the RBB denominator gene. The biomarker is the ratio of the 2 genes. Single cell-type: Monocyte. RBB numerator gene: IFI27 or IFI44L. RBB denominator gene: PSAP, CTSS or CPVL.

    The various RBB (e.g. IFI27/PSAP and IFI44L/PSAP ratios) will be compared in terms of their sensitivity/specificity of diagnostic performance in the samples from infection groups. AUC of ROC analysis will be performed where appropriate.

    Measured: first collected sample within the first week after admission

  2. Viral host response Direct LS-TA in granulocytes (Type I interferon response)

    Direct LS-TA is a kind of RBB that can be readily quantified by qPCR or dPCR of a pair of genes, the RBB numerator gene and the RBB denominator gene. The biomarker is the ratio of the 2 genes. Single cell-type: Granulocyte. RBB numerator gene: RSAD2 or IFIT1.

    RBB denominator gene: SAT1 or SRGN. The various RBB will be compared in terms of their sensitivity/specificity of diagnostic performance in the infection groups. AUC of ROC analysis will be performed where appropriate.

    Measured: first collected sample within the first week after admission

  3. Bacterial infection host response Direct LS-TA in monocytes (pro-inflammatory response)

    Direct LS-TA is a kind of RBB that can be readily quantified by qPCR or digital PCR (dPCR) of a pair of genes, the RBB numerator gene and the RBB denominator gene. The biomarker is the ratio of the 2 genes. Single cell-type: Monocyte. RBB numerator gene: VNN1 or NLRC4. RBB denominator gene: PSAP, CTSS or CPVL. The various RBBs will be compared in terms of their sensitivity/specificity of diagnostic performance in the infection groups. AUC of ROC analysis will be performed where appropriate.

    Measured: first collected sample within the first week after admission

  4. Bacterial infection host response Direct LS-TA in granulocytes (pro-inflammatory response)

    Direct LS-TA is a kind of RBB that can be readily quantified by qPCR or dPCR of a pair of genes, the RBB numerator gene and the RBB denominator gene. The biomarker is the ratio of the 2 genes. Single cell-type: Granulocyte. RBB numerator gene: ALPL, ANXA3 or ARG1.

    RBB denominator gene: SAT1 or SRGN. The various RBB will be compared in terms of their sensitivity/specificity of diagnostic performance in the infection groups. AUC of ROC analysis will be performed where appropriate.

    Measured: first collected sample within the first week after admission

  5. Active TB host response Direct LS-TA in monocytes (Type II interferon response)

    Direct LS-TA is a kind of RBB that can be readily quantified by qPCR or dPCR of a pair of genes, the RBB numerator gene and the RBB denominator gene. The biomarker is the ratio of the 2 genes. Single cell-type: Monocyte.

    RBB numerator gene: WARS1, ATF3 or CALHM6. RBB denominator gene: PSAP, CTSS or CPVL. The various RBB will be compared in terms of their sensitivity/specificity of diagnostic performance in infection groups. AUC of ROC analysis will be performed where appropriate.

    Measured: first collected sample within the first week after admission

  6. Active TB host response Direct LS-TA in granulocytes (Type II interferon response)

    Direct LS-TA is a kind of RBB that can be readily quantified by qPCR or dPCR of a pair of genes, the RBB numerator gene and the RBB denominator gene. The biomarker is the ratio of the 2 genes. Single cell-type: granulocyte. RBB numerator gene: ANKRD22, BATF2, CD274, FCGR1A or ETV7.

    RBB denominator gene: SAT1 or SRGN. The various RBB will be compared in terms of their sensitivity/specificity of diagnostic performance in infection groups. AUC of ROC analysis will be performed where appropriate.

    Measured: first collected sample within the first week after admission

Secondary outcomes (2)
  1. DIRECT LS-TA results distribution and median of these DIRECT LS-TA RBB in infection groups

    The statistical distribution of the biomarker and statistical comparison to the control range or comparison to control group median. The outcomes will be reported as p-values of the statistical tests.

    Measured: first collected sample within the first week after admission

  2. Method evaluation to compare the performance of quantitative PCR and digital PCR

    Evaluate the assay performance and precision of both TA quantification methods: quantitative PCR and digital PCR.

    Quantitative PCR results will be reported as delta-delta CT values. Digital PCR results will be reported as ratios of 2 counts. And then converted to multiple of mean/median in the control control (MoM) for comparison with delta-delta CT values.

    Measured: first collected sample within the first week after admission

Timeline

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

  1. First posted26 Feb 2025
  2. Study startFeb 2025 (estimated)
  3. Primary completionSep 2028 (estimated)
  4. Study completionDec 2028 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Case only
Time perspective
Prospective
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06846645
Sponsor's protocol ID
Direct LS-TA prospective study
Status last verified
Feb 2025
First submitted
18 Feb 2025
Last updated
3 Mar 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Descriptive statistics of results will be provided on a reasonable request.

Publications

  • Huang D, Liu AYN, Leung KS, Tang NLS. Direct Measurement of B Lymphocyte Gene Expression Biomarkers in Peripheral Blood Transcriptomics Enables Early Prediction of Vaccine Seroconversion. Genes (Basel). 2021 Jun 25;12(7):971. doi: 10.3390/genes12070971.

    PubMed 34202032
  • Huang B, Huang J, Chiang NH, Chen Z, Lui G, Ling L, Kwan MYW, Wong JSC, Mak PQ, Ling JWH, Lam ICS, Ng RWY, Wang X, Gao R, Hui DS, Ma SL, Chan PKS, Tang NLS. Interferon response and profiling of interferon response genes in peripheral blood of vaccine-naive COVID-19 patients. Front Immunol. 2024 Jan 10;14:1315602. doi: 10.3389/fimmu.2023.1315602. eCollection 2023.

    PubMed 38268924

Questions about this trial

What is this clinical trial studying?

An observational study of Single Cell Sequencing Technology and Gene Expression Profiling, run by Chinese University of Hong Kong at 1 site in Hong Kong.

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 2 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: opening soon, as of the sponsor's last update on 3 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Hong Kong. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Tang (852 35053330, nelsontang@cuhk.edu.hk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Viral host response Direct LS-TA in monocytes (Type I interferon response) (time frame: first collected sample within the first week after admission). The study lists 6 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 NCT06846645, which also lists 2 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 3 Mar 2025.

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