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AtherosclerosisNCT01063309

Non-Invasive Assessment of Atherosclerosis in Patients With CGD and Other Disorders of the Immune System

An observational study of Atherosclerosis and Chronic Granulomatous Disease (CGD), run by National Institute of Allergy and Infectious Diseases (NIAID) at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Background: Atherosclerosis, the arterial plaques or blockages that cause heart disease, develops in many people by the time they are in their mid-20s. The rate of atherosclerosis in patients with immune system disorders has not been well studied, but it may be very different from the general population. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
How many people
156 participants
Where
1 siteUnited States
Study dates
5 Jan 2010to 26 Aug 2020
Phase
Observational
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 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Patients will be identified for this protocol who are enrolled on existing protocols studying patients with disorders of the immune system who volunteer for participation and who do not have any of the listed exclusion criteria. Normal volunteers will be enrolled as controls on this protocol. They will be recruited through the normal volunteer office, which will provide a list of volunteers including their age to allow for inclusion of controls that approximate the study population.All participants enrolled on this protocol will be over the age of 18 and may be male or female and will be accrued without regard to religion, race or sexual orientation.

Who may be able to join

  • Patients will be identified for this protocol who are enrolled on existing protocols studying patients with disorders of the immune system who volunteer for participation and who do not have any of the listed exclusion criteria. Patients will remain enrolled on their existing protocol. Normal volunteers will be enrolled as controls on this protocol. They will be recruited through the normal volunteer office which will provide a list of volunteers including their age to allow for inclusion of controls that approximate the study population.
  • All patients enrolled on this protocol will be over the age of 18 and may be male or female and will be accrued without regard to religion, race or sexual orientation. They must be able to understand and sign informed consent documents and comply with study procedures that include undergoing a CT scan and an MRI scan. Patients who are unable or unwilling to complete one or more of the studies will not be excluded. The available data will be included in the appropriate analysis.

Who cannot join

  • For Participation in MRI-Based Studies Only:
  • Subjects with contraindication to MRI scanning. These contraindications include but are not limited to the following devices or conditions:
  • Implanted cardiac pacemaker or defibrillator
  • Cochlear Implants
  • Ocular foreign body (i.e., metal shavings)
  • Embedded shrapnel fragments
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  • Central nervous system aneurysm clips
  • Implanted neural stimulator
  • Medical infusion pumps
  • Any implanted device that is incompatible with MRI
  • Patients whose medical condition is such that in the referring physicians estimation, they could not tolerate an MRI scan. Examples of medical conditions that would not be accepted would include unstable angina and dyspnea at rest.
  • Subjects with a condition precluding entry into the scanner (e.g. morbid obesity, claustrophobia, etc.) or who require more than oral sedation (i.e. IV sedation) for anxiety associate with MRI studies.
  • Pregnant or lactating women are excluded from this study because excessive exposure of the developing human fetus and child to radiation and/or intravenous contrast agents can be detrimental.
  • Subjects with severe back-pain or motion disorders who will be unable to tolerate supine positioning within the MRI scanner and hold still for the duration of the examination.
  • For Gadolinium-Based MRI Studies Only:
  • History of severe allergic reaction to gadolinium contrast agents despite the use of premedication with an anti-histaminic and/or corticosteroid.
  • eGFR less than 60mL/min
  • Serum creatinine greater than 3.0 mg/dl
  • For Iodine-Based Contrast CT Studies Only:
  • Contraindication to the use of iodine based CT contrast agents:
  • Serum creatinine greater than 1.4 mg/dl
  • History of multiple myeloma
  • Use of metformin-containing products less than 24 hours prior to contrast administration
  • History of significant allergic reaction to CT contrast agents despite the use of premedication with an anti-histaminic and cortisone.
  • For Coronary CT Angiography Only:
  • Contraindication to the use of CT contrast agents:
  • Creatinine value greater than1.4 mg/dl
  • History of multiple myeloma
  • Use of metformin-containing products less than 24 hours prior to contrast administration
  • History of significant allergic reaction to CT contrast agents despite the use of premedication with an anti-histaminic and cortisone.
  • Subjects with contraindication precluding the use of beta blockers necessary to perform the coronary CT angiography. These include:
  • Severe, uncontrolled asthma
  • Active bronchospasm
  • Moderate or severe COPD
  • 2nd or 3rd degree AV block
  • Decompensated cardiac failure
  • Allergy to beta blockers
  • Systolic blood pressure less than100 mm Hg
  • Pregnancy or nursing
  • For FDG-PET:
  • Participants who are unable or unwilling to comply with the dietary modifications or physical activity restrictions prior to FDG-PET scanning will be excluded. Due to the need for dietary manipulation and maintenance of strict glycemic control we will exclude diabetic patients from our initial study sample. Blood glucose measurements before injection must be within normal limits, less than 200 mg/dl (11mmol/L).
  • Participation of Minors: Atherosclerosis is a disease that does not generally affect young children. This protocol involves exposure to a low dose of radiation. As radiation exposure may increase the risk of malignancy, it is prudent to avoid this in children. Therefore, patients under the age of 18 will not be considered for enrollment under this protocol.
  • Participation of Women: Excessive radiation exposure of the developing human fetus can be detrimental. For this reason, women of childbearing-age will have a pregnancy test prior to undergoing study procedures. Should a woman become pregnant or suspect that she is pregnant while participating in this study, she should immediately inform study staff and her primary care physician.
  • Pregnancy: Pregnant women are excluded from this study because excessive exposure of the developing human fetus to radiation can be detrimental.
  • Co-enrollment Guidelines: Co-enrollment in other trials is not restricted.
  • Medical Exclusions: Patients with current atrial fibrillation will not be considered for enrollment under this protocol. Patients who are medically unstable (e.g. severe sepsis, acute myocardial infarction) and/or would require active, acute medical management in order to be medically stable enough to participate in this protocol will not be enrolled.
  • X-linked CGD Cohort: Patients in this cohort must have X-linked CGD as demonstrated by DHR or genetic screening. Patients who have undergone bone marrow transplant may not be enrolled in this cohort for analysis. Carriers of X-linked CGD must be evaluated by DHR to determine the extent of X-inactivation (lyonization) in their neutrophils.
  • AutosomalRecessive CGD Cohort: Patients in this cohort must have autosomal recessive CGD (p47phox, p67phox, or p22phox deficiency) as demonstrated by DHR or genetic screening. Patients who have undergone bone marrow transplant may not be enrolled in this cohort for analysis.
  • Inflammatory Bowel Disease Cohort: Patients enrolled into this cohort may not have been diagnosed with CGD.
  • Normal Volunteer Cohort: Patients in this cohort may not have been diagnosed with CGD, Inflammatory Bowel Disease, or another primary disease of the immune system.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • National Institutes of Health Clinical Center, 9000 Rockville Pike

    Bethesda, Maryland, 20892

Other trials in United States

About this study

Background:

  • Atherosclerosis, the arterial plaques or blockages that cause heart disease, develops in many people by the time they are in their mid-20s. The rate of atherosclerosis in patients with immune system disorders has not been well studied, but it may be very different from the general population.
  • Patients with chronic granulomatous disease (CGD) produce less of a group of molecules known as free radicals, which help to fight infection and may play a role in the development of atherosclerosis. Patients with CGD may develop atherosclerosis much more slowly than people without CGD. On the other hand, carrier mothers of children with genetically-linked CGD often have problems with autoimmune problems in addition to a problem with making free radicals. Patients with other immune system disorders also have very different responses to infection, and many of them also have autoimmune-like problems that may change the risk of developing atherosclerosis.
Read more

Objectives:

  • To study the prevalence of atherosclerosis in patients with immune system disorders, compared with healthy individuals.

Eligibility:

  • Individuals at least 18 years of age who either have been diagnosed with an immune system disorder or are healthy volunteers.

Design:

  • The active part of the study involves one or two visits to the National Institutes of Health Clinical Center for a series of imaging tests and scans.
  • Participants will have the following tests during the active part of the study:
  • (1) CAT scan to obtain images of the chest arteries and measure the amount of calcium in the artery walls.
  • (2) Magnetic resonance imaging scan to obtain images of the coronary and carotid arteries in the chest and neck.
  • (3) Electrocardiogram to provide data on current heart function.
  • (4) Blood samples to provide data on heart, kidney, and immune system function.
  • Participants will be contacted every 2 years in the future for up to 30 years to determine whether they have developed heart disease. Researchers will ask participants to provide contact information for two other people who may likely know how to get in touch with the participant in the future.
Read the detailed description

Heart disease kills more than half a million people in the U.S. each year. Atherosclerosis, the major cause of heart disease, is thought to relate to dysregulated inflammation in the cardiovascular system and possibly results from over production of reactive oxygen species (ROS). The rate of atherosclerosis in patients with disorders of the immune system has not been well characterized but is likely to be dramatically different than that seen in the general population. Specifically, patients with Chronic Granulomatous Disease (CGD) may be protected from developing atherosclerosis due to reduced superoxide and other ROS production by phagocytic cells. We hypothesize that patients with CGD are at decreased risk of developing atherosclerosis. The primary objective of this study is to determine the prevalence of atherosclerosis and it s inflammatory characteristics in these and other patients with in-born disorders of immune function. The primary objective will be assessed using carotid studies and other imaging techniques to measure coronary artery calcium scores and the presence or absence of soft plaque. Secondary endpoints include physiologic characteristics such as blood pressure as well as circulating biomarkers associated with heart disease such as C-reactive protein and lipid profile. This study may lead to improved understanding of the pathophysiology of atherosclerosis, specifically the role of free radical stress, and could lead to novel therapies for atherosclerosis that may benefit patients with immune disorders and the general population.

Keywords
CAT SCAN, Heart Disease, Magnetic Resonance Imaging, Electrocardiogram, Superoxide
Medical subject headings
Atherosclerosis, Granulomatous Disease, Chronic, Heart Diseases

What participants receive

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

Study groups in NCT01063309
Study groupRoleWhat they receive
Autosomal recessive CGDParticipants must have autosomal recessive CGD (p47phox, p67phox, or p22phox deficiency) as demonstrated by DHR or genetic screening.
CGD carrierParticipants with confirmed as X-linked CGD carriers as demonstrated by DHR or genetic screening.
Healthy VolunteerHealthy volunteers over the age of 18, both male and female. That have not been diagnosed with CGD, Inflammatory Bowel Disease, or another primary disease of the immune system.
IFN-gamma treated CGDParticipants with CGD the have been treated with Interferon gamma.
Inflammatory bowel diseaseParticipants with Inflammatory Bowel Disease with a well-recognized granulomatous inflammation, but normal phagocyte function and ROS production. They have not been diagnosed with CGD.
Other immune system disordersParticipants with other disorders such as Chediak-Higashi Syndrome, Leukocyte Adhesion Deficiency, myeloperoxidase deficiency, Hyper- IgE (Job's) Syndrome, IRAK4-deficiency, and NEMO-deficiency
X-linked Chronic Granulomatous Disease (CGD)Participants diagnosed with X-linked CGD confirmed by DHR.

What is being measured

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

  1. Coronary CT angiography

    presence or absence of soft plaque

    Measured: September 2009- December 2024

  2. Coronary Artery Calcium score

    numerical value ranging from 0 to >1000

    Measured: September 2009- December 2024

  3. Coronary MRI angiography

    presence of absence of soft plaque

    Measured: September 2009- December 2024

  4. Carotid Artery Intimal Medial Thickness

    numerical value (in millimeters) representing the thickness of the artery and vessel wall volume

    Measured: September 2009- December 2024

  5. Carotid arterial FDG uptake

    target to background ratio of FDG activity measured by PET imaging.

    Measured: September 2009- December 2024

Secondary outcomes (5)
  1. Circulating Markers of Cardiac Disease

    Lipid Profile, CRP,Myeloperoxidase analyzed for coronary artery disease risk.

    Measured: September 2009- December 2024

  2. Demographic Characteristics and Questionnaire Results

    Standard questionnaires will be used to collect information about demographics, socioeconomic and psychosocial status, medical and family history, medication use, dietary and alcohol intakes, smoking, and physical activity. Data will be analyzed using a multivariate analysis.

    Measured: September 2009- December 2024

  3. Physiologic Characteristics

    Physiologic data including blood pressure, heart rate, and pulse pressure will also be obtained. EKG will be assessed for electrocardiographic evidence of prior ischemic injury.

    Measured: September 2009- December 2024

  4. Circulating Markers of Inflammation or Immune Dysregulation

    IL-8, TNF, ESR,IFN, DHR

    Measured: September 2009- December 2024

  5. Cardiac MRI

    used to determine left ventricular wall motion and cardiac size and to determine the presence of granulomas in the ventricular wall. Results will be reported as an overall cardiac volume, left ventricular ejection fraction, the presence or absence of wall motion abnormalities, and the presence or absence of granulomas

    Measured: September 2009- December 2024

Timeline

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

  1. First posted5 Feb 2010 (estimated)
  2. Study start5 Jan 2010
  3. Primary completion31 Dec 2018
  4. Study completion26 Aug 2020

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
Cohort
Time perspective
Cross-sectional
Enrolment
156 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01063309
Sponsor's protocol ID
100029
Other IDs
10-I-0029
Status last verified
Jul 2021
First submitted
4 Feb 2010
Last updated
28 Jul 2021
Results posted
No

Publications

  • Winkelstein JA, Marino MC, Johnston RB Jr, Boyle J, Curnutte J, Gallin JI, Malech HL, Holland SM, Ochs H, Quie P, Buckley RH, Foster CB, Chanock SJ, Dickler H. Chronic granulomatous disease. Report on a national registry of 368 patients. Medicine (Baltimore). 2000 May;79(3):155-69. doi: 10.1097/00005792-200005000-00003.

    PubMed 10844935
  • Lassegue B, Sorescu D, Szocs K, Yin Q, Akers M, Zhang Y, Grant SL, Lambeth JD, Griendling KK. Novel gp91(phox) homologues in vascular smooth muscle cells : nox1 mediates angiotensin II-induced superoxide formation and redox-sensitive signaling pathways. Circ Res. 2001 May 11;88(9):888-94. doi: 10.1161/hh0901.090299.

    PubMed 11348997
  • Sorescu D, Weiss D, Lassegue B, Clempus RE, Szocs K, Sorescu GP, Valppu L, Quinn MT, Lambeth JD, Vega JD, Taylor WR, Griendling KK. Superoxide production and expression of nox family proteins in human atherosclerosis. Circulation. 2002 Mar 26;105(12):1429-35. doi: 10.1161/01.cir.0000012917.74432.66.

    PubMed 11914250
  • Sibley CT, Estwick T, Zavodni A, Huang CY, Kwan AC, Soule BP, Long Priel DA, Remaley AT, Rudman Spergel AK, Turkbey EB, Kuhns DB, Holland SM, Malech HL, Zarember KA, Bluemke DA, Gallin JI. Assessment of atherosclerosis in chronic granulomatous disease. Circulation. 2014 Dec 2;130(23):2031-9. doi: 10.1161/CIRCULATIONAHA.113.006824. Epub 2014 Sep 19.

    PubMed 25239440

Questions about this trial

What is this clinical trial studying?

An observational study of Atherosclerosis and Chronic Granulomatous Disease (CGD), run by National Institute of Allergy and Infectious Diseases (NIAID) at 1 site in United States.

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 50 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: finished, as of the sponsor's last update on 28 Jul 2021. 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 United States. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Coronary CT angiography (time frame: September 2009- December 2024). The study lists 5 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 NCT01063309, which also lists 4 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 28 Jul 2021.

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