Biomarkers of aHSCT (BIO-MS)

Identifying Immune Biomarkers of Disease and Disease Control in Autoimmune Neurological Disease Using Autologous Haematopoietic Stem Cell Transplantation

The underlying disease mechanisms which occur in patients with immune mediation neurological diseases, such as Multiple Sclerosis (MS), are incompletely understood. For such patients, autologous haematopoietic stem cell transplantation (aHSCT) has been increasingly used as a highly successful one-off treatment for some patients. This treatment aims to delete the faulty immune system with a course of chemotherapy and then 'reboot' the immune system using a patients' own stem cells (a cell with the unique ability of being a building block to create many different cells in the body) to stop further damage. Over the last 20 years more than 1800 patients with MS have been treated in Europe with high levels of success. It may be more successful than disease modifying treatment but unfortunately, a small portion of people do not respond to this treatment optimally and continue to accumulate disability. There is a risk of side effects, restricted largely to the time of treatment, which necessitates the need to ensure appropriate patients are treated. Whilst aHSCT is a very effective therapy, it is still in its early phase of development, is not in widespread use, and there is incomplete knowledge regarding how it works and importantly, why it does not work in some patients, and how to monitor response to treatment.

Unfortunately, there is no way of detecting which patients will, and will not, benefit from the different treatments available or a way of monitoring the immune system to ensure further treatment is provided before irreversible damage occurs.

This study will investigate the immune system which is found in the fluid surrounding the brain and spinal cord, blood and stool of patients undergoing aHSCT and compare it to those receiving disease modifying treatment. This study will therefore further the understanding of biomarkers of aHSCT to develop an awareness of how it can be refined, may improve monitoring of patients following treatment and permit the development of markers which can predict potential treatment success or failure before patients are exposed to the risks.

Study Overview

• Status: Recruiting
• Conditions: Multiple Sclerosis, Relapsing-Remitting

• Study Type: Observational
• Enrollment (Estimated): 15

Contacts and Locations

• Study Contact: Name: Gavin Brittain, MBBS, MRCP; Phone Number: +44114 271 1900; Email: gavin.brittain@sheffield.ac.uk

Study Locations

• United Kingdom
  • England
    • Sheffield, England, United Kingdom, S10 2JF
      • Recruiting
      • Sheffield Teaching Hospitals NHS Foundation Trust
      • Contact: Gavin Brittain, MBBS, MRCP; Phone Number: 07845519027; Email: gavin.brittain@sheffield.ac.uk
      • Principal Investigator: Gavin Brittain, MBBS, MRCP

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Outpatients who are attending the Sheffield (UK) transplant clinic for neurological disease.

Description

Inclusion Criteria:

1. Diagnosis of a immune mediated neurological disease according to disease specific criteria (active treatment arm) or diagnosis of relapsing remitting multiple sclerosis (control arm).
2. Treatment with autologous haematopoetic stem cell transplantation (active treatment arm) or high efficacy disease modifying treatment (control arm).
3. Willing to provide biological samples for analysis and undergo clinical assessments for the duration of follow up.
4. Able to understand English and provide informed consent.

Exclusion Criteria:

1. Inability to provide informed consent.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Patients treated with aHSCT; Patients with aggressive disease treated with autologous haematopoetic stem cell transplantation.
Patients treated with disease modifying treatment; Patients with aggressive disease treated with high efficacy disease modifying treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quantitatively and qualitatively characterise the immune profile of the stem cells, blood, cerebrospinal fluid (CSF) and the microbiome pre and post treatment.	Phenotype profiling of stem cells, cells in blood and CSF using multi-parameter flow cytometry. Profile the gut microbiome using 16S rRNA sequencing and flow cytometric analysis.	24 months
Perform single cell RNA sequencing (scRNA-Seq) on paired CSF and blood pre and post treatment.	Profiling of T cell receptor and B cell receptor repertoire diversity and clonality	24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Characterisation of the regeneration of mucosal cell immunity and the reconstitution of pathogen specific immunity following aHSCT by scRNA-Seq on nasopharyngeal swabs and mucosal strips.	Assess immune response in treated patients post vaccination.	24 months
Evaluate immunological disease response and the duration of response to aHSCT according to expanded disability status scale score (EDSS)	EDSS to be observed longitudinally following treatment.	24 months
Evaluate immunological disease response and the duration of response to aHSCT according to low contrast visual acuity (LCLA)	LCLA to be observed longitudinally following treatment.	24 months
Evaluate immunological disease response and the duration of response to aHSCT according to multiple sclerosis functional composite score (MSFC)	MSFC to be observed longitudinally following treatment.	24 months
Evaluate immunological disease response and the duration of response to aHSCT according to short form 36 (SF-36)	SF-36 to be observed longitudinally following treatment.	24 months
Evaluate immunological disease response and the duration of response to aHSCT according to symbol digit modality test (SDMT)	SDMT to be observed longitudinally following treatment.	24 months
Evaluate immunological disease response and the duration of response to aHSCT according to Karnofsky performance status	Karnofsky performance status to be observed longitudinally following treatment.	24 months

Collaborators and Investigators

• Sponsor: Sheffield Teaching Hospitals NHS Foundation Trust
• Collaborators: University of Sheffield; Nottingham Trent University; Sheffield Hospitals Charity
• Investigators: Principal Investigator: Gavin Brittain, MBBS, MRCP, Sheffield Teaching Hospitals NHS Foundation Trust and The University of Sheffield

Study record dates

Study Major Dates

• Study Start (Actual): August 9, 2023
• Primary Completion (Estimated): August 9, 2026
• Study Completion (Estimated): August 9, 2026

Study Registration Dates

• First Submitted: October 13, 2023
• First Submitted That Met QC Criteria: January 4, 2024
• First Posted (Estimated): January 8, 2024

Study Record Updates

• Last Update Posted (Estimated): January 8, 2024
• Last Update Submitted That Met QC Criteria: January 4, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: multiple sclerosis; aHSCT; Autologous haematopoetic stem cell transplantation
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis; Multiple Sclerosis, Relapsing-Remitting
• Other Study ID Numbers: STH22343

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No