Identification of Genetic, Immunologic and Microbial Markers of Hirschsprung Associated Enterocolitis in Children With Hirschsprung Disease (HAEC)
To identify demographic, clinical, genetic, immunologic and/or microbial (i.e., fecal stream characterization) risk factors that influence the likelihood of development of the HAEC phenotype in children who carry the diagnosis of HD. The newly formed HAEC Collaborative Research Group (HCRG) will utilize the 4 participating centers in the current consortia and recruit additional centers to enroll children diagnosed with Hirschsprung disease.
1a: To recruit 200 patients with Hirschsprung disease without HAEC.
1b: To recruit 200 patients with Hirschsprung disease and HAEC using standardized diagnostic criteria by collaborating with participating members of the HAEC Collaborative Research Group.
1c: To collect clinical and demographic information from well-characterized HD patients both with and without HAEC.
1d: To collect samples blood for DNA for genome wide association study (GWAS) by high throughput SNP technology and mutational analysis of known HSCR genes.
1e: To collect serum samples at the time of recruitment in a subset cohort (n=50 HD only, n=50 HD + HAEC) for serological immune markers known for inflammatory bowel disease (IBD) including ANCA, ASCA, OMPC, I2, and CBir1 and any newly identified markers.
1f: To collect and store fresh fecal specimens for future evaluation by molecular methodologies to determine relative proportions of enteric microflora in a subset cohort (n=50 HD only, n=50 HD + HAEC) of children (<18 years).
1g: To establish a Centralized Data Coordinating Center for data collection, data quality and detailed data analyses (CSMC) and tissue bank (CSMC) to facilitate specimen analysis for this study.
The HAEC risk factor identification will be completed by multivariate logistic regression analysis. Genetic association will be studied for each SNP in the GWAS together with all other potential risk factors. Further analysis will be carried out to evaluate multiple SNPs/genes simultaneously.
Hirschsprung Associated Enterocolitis
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||Identification of Genetic, Immunologic and Microbial Markers of Hirschsprung Associated Enterocolitis in Children With Hirschsprung Disease|
- To identify genetic associations in HD patients who display HAEC phenotype [ Time Frame: 7 years ] [ Designated as safety issue: No ]
Rationale & hypothesis:
Currently there is no generally accepted pathogenic hypothesis for Hirschsprung Associated Enterocolitis. A number of hypotheses propose the role of host genetics, host immune responses, and environmental factors such as microbial triggers, including in particular, enteric flora, resulting in disease susceptibility and development. These factors (host immune/inflammatory cells, intestinal epithelia and microbial flora) and their interactions may also be important determinants of disease phenotype and disease progression. Therefore we hypothesize that there are identifiable immunologic, genetic, enteric flora profiles along with clinical risk factors that influence development of HAEC phenotype.
- To identify immunological markers in HD patients who display HAEC phenotype [ Time Frame: 8 years ] [ Designated as safety issue: No ]There is recent evidence that some HD patients who were thought to have refractory HAEC, actually developed IBD. Levin, DN et al. JPGN 2012. This aim is to explore the possibility that there may be similarities between the immune mechanisms involved in HAEC and IBD.
- To identify microbial markers in HD patients who display HAEC phenotype [ Time Frame: 8-10 years ] [ Designated as safety issue: No ]Data suggest that altered gut microbial populations may be partially responsible for the development of HAEC in susceptible HD patients. Most studies have focused on Clostridium difficile, because two groups reported increased frequency of C. diff. toxin positive stools in HD patients with HAEC compared with those without HAEC .[10, 11] Other groups subsequently reported very low frequencies of C. diff. toxin positivity in their patients with HAEC, thereby calling into question the role C. diff. plays in the pathogenesis of HAEC. Other investigators have found E. coli, C. diff. and Cryptosporidium adherent to enterocytes on histological examinations of colon biopsies of patients with HAEC. These findings indicate a breech in the protective mucus gel layer covering the luminal surface of the colon, leading to invasion of the epithelial barrier. Taken together, these studies suggest that the intestine-microbial interaction may be important in the pathogenesis of HAEC.
Biospecimen Retention: Samples With DNA
Procedures include prospective data collection from medical records venipuncture and stool collection. 4 cc of blood will be drawn at the screening visit for genetic and immune testing. Additional 8.5 cc of blood will be drawn for CSMC patients for establishment of cell lines.
1. Stool sample will be collected at screening or at follow-up if patient unable to provide at screening.
DNA will be prepared from blood for Genome Wide Association Study and mutational analysis 2. serological immune markers known for inflammatory bowel disease (IBD) including ANCA, ASCA, OMPC, I2, and CBir1 and any newly identified markers. These tests will only be performed on patients who consent to the immune response sub-study. This will not require the collection of an additional blood sample. 3. Collect and store fresh fecal specimens for future evaluation by molecular methodologies to determine relative proportions of enteric microflora.
|Study Start Date:||February 2010|
|Estimated Study Completion Date:||December 2025|
|Estimated Primary Completion Date:||December 2022 (Final data collection date for primary outcome measure)|
Subjects with HAEC
There is no intervention involvement. The clinical data and biologic specimens collected during the study will serve as an invaluable resource for a wide spectrum of clinical and translational ancillary studies directly related to the aims and goals of the study.
|Subjects without HAEC|
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT02193685
|Contact: Philip K Frykman, MD, PhD, MBA||310-423-7779 ext firstname.lastname@example.org|
|Contact: Denice M Dubuclet, DC||310-423-6996 ext email@example.com|
|United States, California|
|Cedars-Sinai Medical Center 8723 Alden Drive, Suite 240||Recruiting|
|Los Angeles, California, United States, 90048|
|Contact: Philip K Frykman, MD, PhD, MBA 310-423-7779 firstname.lastname@example.org|
|Contact: Denice M Dubuclet, DC 310-423-6996 ext 36996 email@example.com|
|Principal Investigator: Philip K Frykman, MD, PhD, MBA|
|Principal Investigator:||Philip K Frykman, MD, PhD, MBA||Associate Professor, Surgery and Biomedical Sciences Associate Director, Pediactic Surgery for Cedars-Sinai Medical Center|