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Correlation of CXCR4 Expression in Premature Infants With a Diagnosis of Autism at 24 Months (ASD-CXCR4)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01686685
Recruitment Status : Completed
First Posted : September 18, 2012
Last Update Posted : April 12, 2018
Information provided by (Responsible Party):
Hadassah Medical Organization

Brief Summary:

Preterm children are at increased risk for autism spectrum disorders, with an estimated rate of 10%. In the US, about 1 in 8 pregnancies ends with a premature birth. Therefore, individuals with ASD who were born prematurely form a substantial body of children diagnosed with ASD.

Premature birth confers an insult to the newborn at a neurologically vulnerable stage. Prematurity associated changes in oxygen tension can be detrimental to developing organs, the brain being one of the most rapidly developing organs in the second half of the pregnancy. Changes in oxygen tension mediate activation of proteins that change the course of cell development.

In this study, we plan to measure changes in the expression of 3 proteins that may be affected by changes in oxygen level at birth. We will study the interaction between the proteins' levels in the first few days after premature birth with a diagnosis of ASD at 2 years of age. The proteins are:

  1. VEGF (Vascular Endothelial Growth Factor), a protein that takes part in creating new blood vessels during embryonic development.
  2. Hypoxia-inducible factor -1(HIF-1), a key protein that coordinates expression of different genes, many with developmentally critical functions.
  3. CXCR4, a cell surface protein that is activated by SDF-1. SDF- 1 is a molecule that regulates migration of cells to their target destination during embryonic life. CXCR4 is expressed in areas of the brain and on cells that are known to be associated with ASD.

We hypothesis that changes in oxygen tension in premature babies initiates a cascade of events that lead to changes in cell mobility via abnormal CXCR4 expression. This change leads to abnormal neurodevelopment.

The investigators' primary aim is to find if there is a correlation between postnatal levels of expression of HIF-1, CXCR4 and VEGF and a diagnosis of autism at age 24 months. The investigators' secondary aim is to find if there is a correlation between postnatal levels of expression of HIF-1, CXCR4 and VEGF and a language or neurocognitive delay.


  1. Premature babies will be recruited in the first day post delivery.
  2. Blood samples will be collected at 3 time points during their hospitalization, and the expression of HIF-1, CXCR4 and VEGF will be determined.
  3. Infants will undergo a complete developmental evaluation at 18-24 months of age .
  4. Postnatal levels of HIF, CXCR4 and VEGF will be plotted against the results of the developmental evaluation.

Condition or disease
Autism Spectrum Disorder Complication of Prematurity

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Study Type : Observational
Estimated Enrollment : 400 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Study of Correlation Between Expression of Proteins That Are Essential for Embryonic Brain Development and Neurodevelopmental Outcomes at 2 Years of Age in Premature Infants.
Study Start Date : September 2013
Actual Primary Completion Date : April 2018
Actual Study Completion Date : April 1, 2018

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Diagnosis of ASD at 24 months corrected age [ Time Frame: 30 months ]
    Participants will be screened at 18 and 24 months for autism using the MCHAT questionnaire all positive screens will be referred for a complete developmental evaluation by child psychologist and developmental pediatrician: History, assessment (ADOS) and clinical judgement based on DSM criteria

Secondary Outcome Measures :
  1. Language or cognitive delay at 24 months corrected age [ Time Frame: 30 months ]
    Participants will be screened by questionnaires at 18 and 24 months. all positive screens will be referred for a full developmental evaluation using the Mullen Scales of Early learning

Biospecimen Retention:   Samples Without DNA
blood samples. expression of proteins or RNA will be determined from the blood.

Information from the National Library of Medicine

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Ages Eligible for Study:   up to 1 Day   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
neonatal intensive care units newborn ward

Inclusion Criteria:

  • Parents gave informed consent approved by the Institutional Review Board
  • Gestational week 28-34 as determined by an ultrasound during the first trimester
  • Singleton or twin pregnancy

Exclusion Criteria:

  • Major anatomical abnormalities as detected on prenatal US
  • Genetic syndrome as detected by prenatal US, MRI or chorioamniocentesis
  • Obvious anatomical abnormalities or dysmorphic features detected on physical examination immediately following birth
  • Triplet pregnancy
  • Mother known or suspected to consume alcohol or illegal drugs during pregnancy
  • Mother took medications during pregnancy that are known to have adverse affects on development (e.g. anti-epileptics)
  • Family history of genetic syndrome related to developmental delays, that was not ruled out during current pregnancy (e.g. sibling with Tuberous Sclerosis or fragile X)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01686685

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Hadassah Medical Center
Jerusalem, Israel
Sponsors and Collaborators
Hadassah Medical Organization
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Study Director: Michal Begin, MD Hadassah HMO
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Responsible Party: Hadassah Medical Organization Identifier: NCT01686685    
Other Study ID Numbers: begin1HMO-CTIL
First Posted: September 18, 2012    Key Record Dates
Last Update Posted: April 12, 2018
Last Verified: September 2012
Keywords provided by Hadassah Medical Organization:
oxygen-dependant gene activation
Language delay
Cognitive delay
Additional relevant MeSH terms:
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Premature Birth
Autistic Disorder
Autism Spectrum Disorder
Child Development Disorders, Pervasive
Neurodevelopmental Disorders
Mental Disorders
Obstetric Labor, Premature
Obstetric Labor Complications
Pregnancy Complications