A Longitudinal Study of Familial Hypereosinophilia (FE): Natural History and Markers of Disease Progression

Eosinophils are a type of white blood cell. Elevated eosinophil levels can damage the heart, nerves, and other organs, in the syndrome known as hypereosinophilic syndrome (HES). Some individuals have a hereditary form of HES known as familial eosinophilia (FE). More research on the causation and mechanisms of HES is needed in order to design more effective and less toxic therapies.

This study will investigate FE and its genetic causes, damage mechanisms, and disease markers (such as blood test abnormalities). It will enroll approximately 50 individuals (both adults and children) from a previously studied family with FE. This is a long-term study of indefinite duration.

Participants will undergo yearly clinical examinations including medical history, physical examination, bloodwork, EKG, echocardiogram, and pulmonary function tests, with additional or more frequent examinations and tests as required. In addition, participants will donate blood and tissue for research purposes. Both adult and child participants will donate blood. At the initial evaluation, adult participants will donate bone marrow. During the study, some adult participants will also undergo a limited number of leukaopheresis sessions, in which blood is donated from one arm, the blood is separated into red blood cells and other components, and the red blood cells are returned into the donor's other arm.

Study Overview

• Status: Recruiting
• Conditions: Eosinophilia; Hypereosinophilic Syndrome

Detailed Description

Study Description:

Affected and unaffected members of families with familial hypereosinophilia (FE) will be admitted on this protocol. For affected family members, a thorough clinical evaluation will be performed every 2 years with emphasis on potential sequelae of eosinophil-mediated tissue damage. Blood cells, bone marrow and/or serum will also be collected to provide reagents (such as DNA, RNA, and specific antibodies) for use in the laboratory to address issues related to the genetic and immunologic basis of FE as well as its pathogenesis. It is anticipated that affected family members will undergo a more extensive evaluation than is generally available and that the specimens collected from them will prove to be valuable reagents for laboratory studies related to eosinophilia, eosinophil activation and function. While the study is not designed to address the question of therapy for FE, in patients for whom medical therapy is indicated (for either the hypereosinophilia itself or its sequelae), appropriate treatment will be instituted by our clinical service or the patients local physicians. No experimental chemotherapy is involved in this protocol. Unaffected family members will provide research specimens on this protocol to help determine the underlying genetic causes of FE.

Objectives:

Primary Objective: To study the natural history of familial hypereosinophilia (FE)

Secondary Objectives:

1. To determine the immunologic and molecular mechanisms responsible for eosinophilia, eosinophil activation, and pathogenesis in FE
2. To identify early clinical or laboratory markers of disease progression

Endpoints: Primary Endpoint: Development of eosinophilic end organ manifestations

Secondary Endpoints:

1a. Description of immunologic features of FE.

1b. Identification of genetic driver(s) of FE

2. Identification of clinical or laboratory markers that become abnormal prior to disease progression in FE

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Thomas W Brown, R.N.; Phone Number: (301) 402-7823; Email: browntw@mail.nih.gov
• Study Contact Backup: Name: Amy D Klion, M.D.; Phone Number: (301) 435-8903; Email: aklion@niaid.nih.gov

Study Locations

• United States
  • Maryland
    • Bethesda, Maryland, United States, 20892
      • Recruiting
      • National Institutes of Health Clinical Center
      • Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR); Phone Number: TTY dial 711 800-411-1222; Email: ccopr@nih.gov

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 100 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Affected family members from the previously identified family with FE, as well as affected member of newly identified families with FE and unaffected family members from known families with FE, may enroll.

Description

• INCLUSION CRITERIA:

In order to be eligible to participate in this study, an individual must meet all of the following criteria:

• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, aged 1-100 years of age
• Genetically related member of a previously identified family with FE
• Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

An individual who meets any of the following criteria will be excluded from participation in this study:

• Any condition that the investigator feels put the subject at unacceptable risk for participation in the study
• Pregnancy (in family members who do not have eosinophilia)

Study Plan

How is the study designed?

Design Details

• Observational Models: Family-Based
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Affected family members; Family members with peripheral blood eosinophilia
Unaffected family members; Family members without peripheral blood eosinophilia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To study the natural history of familial hypereosinophilia (FE)	Development of eosinophilic end organ manifestations	30 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To determine the immunologic and molecular mechanisms responsible for eosinophilia, eosinophil activation, and pathogenesis of FE	Description of immunologic features of FE; identification of genetic driver(s) of FE	30 years
To identify early clinical or laboratory markers of disease progression	Identification of clinical or laboratory markers that become abnormal prior to disease progression in FE	30 year

Collaborators and Investigators

• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
• Investigators: Principal Investigator: Amy D Klion, M.D., National Institute of Allergy and Infectious Diseases (NIAID)

Publications and helpful links

General Publications

• Rioux JD, Stone VA, Daly MJ, Cargill M, Green T, Nguyen H, Nutman T, Zimmerman PA, Tucker MA, Hudson T, Goldstein AM, Lander E, Lin AY. Familial eosinophilia maps to the cytokine gene cluster on human chromosomal region 5q31-q33. Am J Hum Genet. 1998 Oct;63(4):1086-94. doi: 10.1086/302053.
• Prakash Babu S, Chen YK, Bonne-Annee S, Yang J, Maric I, Myers TG, Nutman TB, Klion AD. Dysregulation of interleukin 5 expression in familial eosinophilia. Allergy. 2017 Sep;72(9):1338-1345. doi: 10.1111/all.13146. Epub 2017 Apr 18.
• Klion AD, Law MA, Riemenschneider W, McMaster ML, Brown MR, Horne M, Karp B, Robinson M, Sachdev V, Tucker E, Turner M, Nutman TB. Familial eosinophilia: a benign disorder? Blood. 2004 Jun 1;103(11):4050-5. doi: 10.1182/blood-2003-11-3850. Epub 2004 Feb 26.

Helpful Links

• NIH Clinical Center Detailed Web Page

Study record dates

Study Major Dates

• Study Start (Actual): June 8, 2005
• Primary Completion: December 7, 2022
• Study Completion: December 7, 2022

Study Registration Dates

• First Submitted: September 17, 2004
• First Submitted That Met QC Criteria: September 17, 2004
• First Posted (Estimated): September 20, 2004

Study Record Updates

• Last Update Posted (Actual): March 8, 2024
• Last Update Submitted That Met QC Criteria: March 7, 2024
• Last Verified: July 26, 2023

More Information

Terms related to this study

• Keywords: Natural History; Eosinophil; Hypereosinophilia; Familial; Interleukin 5; Familial Hypereosinophilia; FE
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Hematologic Diseases; Leukocyte Disorders; Disease Progression; Eosinophilia; Hypereosinophilic Syndrome
• Other Study ID Numbers: 040286; 04-I-0286

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: .This is a longitudinal observational study in a rare inherited disease. At this point in time, there is no plan to share individual participant data as the main outcomes of the study are based on group data (incidence of end organ manifestations in the group) and identification of genetic and immunologic drivers of familial eosinophilia.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No