The Epigenomic Signature of Eosinophilic Granulomatosis With Polyangiitis (EPI-EGPA)

Disease Susceptibility and Response to IL5 Blockade in Patients With Eosinophilic Granulomatosis With Polyangiitis (EGPA): an Epigenome-wide Association Study Integrated With Transcriptomic and Proteomic Analyses

This is a case-control observational study on blood samples. The primary goal of this study is to identify the epigenetic marks that can distinguish patients suffering from Eosinophilic Granulomatosis with Polyangiitis (EGPA) from healthy individuals. The secondary goal is to identify epigenetic or transcriptional marks that can predict if a patient with EGPA will benefit from therapy with Mepolizumab. This study is observational, meaning there will be no alterations of patients' routine clinical care. A blood sample will be drawn for each patient. If the patient will undergo treatment with Mepolizumab (based on routine clinical care), then the blood sample will be drawn before Mepolizumab initiation. The blood samples will be used for genome-wide DNA methylation profiling and for transcriptomic profiling. Healthy individuals as controls for the association study will not be recruited. In fact, the epigenetic and transcriptomic data obtained from EGPA patient blood will be compared against already available genome-wide DNA methylation and transcriptomic profiles of the blood of healthy individuals from previous studies. A total of 300 patients with EGPA will be recruited for the study. The first part of the study, corresponding to the primary goal, will involve all of the 300 patients. The second part of the study, corresponding to the secondary goal, will involve a study population subset consisting of 50 patients.

Study Overview

• Status: Not yet recruiting
• Conditions: Eosinophilic Granulomatosis With Polyangiitis

Detailed Description

Background and Rationale. Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare multisystem immune-mediated disease classified both among Anti Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis and among hypereosinophilic disorders. Current scientific knowledge describes EGPA as a complex or multifactorial nature of the disease, i.e. the disease is triggered by a combination of inherited genetic variants and environmental factors. The term "epigenetics" refers to heritable alterations in gene expression which do not correspond to a variation in the underlying DNA sequence. In the context of various autoimmune diseases similar to EGPA and in the context of asthma (a condition that almost all EGPA patients suffer from), several studies have highlighted that epigenetics plays a fundamental role in the pathogenesis/pathophysiology and that in particular it can potentially represent the mechanism by which environmental exposures interact with genetics to cause the disease. Therefore, studying epigenetics (and namely DNA methylation as the most studied epigenetic mechanism) in EGPA could lead to an in-depth knowledge of the pathology and in particular to the identification of epigenetic markers, useful in diagnosis, or in monitoring disease activity, or in predicting response to pharmacological treatment.

Objectives. The primary objective is the identification of loci whose methylation level is associated with the pathology (i.e. epigenetic markers of the disease). The secondary objectives are: identification of loci whose methylation level correlates with the response to treatment with the drug Mepolizumab in patients affected by the disease (i.e. epigenetic markers predictive of response to Mepolizumab); identification of genes whose transcription level is related to the disease and of proteins whose plasma concentration is related to the disease (in this way, we expect to evaluate the effects of epigenetic variation on gene/protein expression and to identify the corresponding biological pathways); identification of epigenetic predictors of disease outcomes, e.g. remission, relapse, survival; identification of epigenetic markers of the main disease subphenotypes, i.e. the ANCA+ and ANCA- subsets.

Study Design. Observational case-control study on biological samples. The study is divided into two different parts: The first part is a genome-wide DNA methylation case-control association study. The genome-wide methylation profile derived from blood samples from 300 patients will be compared to the methylation profile in the blood of healthy individuals. The second part is a predictive study, aiming at assessing whether epigenetics can be used to predict the response to Mepolizumab. This part of the study will cover a study population subset, consisting of 50 patients who will undergo treatment with Mepolizumab (as part of their clinical routine) and whose blood sample will be drawn before starting Mepolizumab therapy. Not only the genome-wide methylation profile will be obtained from the blood (like all the other patients included in the study), but also the transcriptomic profile. These profiles will be analyzed to search for loci whose level of methylation and/or expression correlate with the response to treatment with Mepolizumab.

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

• Study Contact: Name: Augusto Vaglio, MD, PhD; Phone Number: +39 0555662905; Email: augusto.vaglio@meyer.it

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Probability Sample

Study Population

The study will include 300 adult (>18yo) patients with Eosinophilic Granulomatosis with Polyangiitis (EGPA). All patients will be recruited at Meyer Children's Hospital and Careggi University Hospital, which are referral centres for EGPA and have a large cohort of prevalent cases under long-term follow-up. They will represent the cases for the case-control epigenome-wide association study. Patients are expected to be untreated or under glucocorticoids at the time of sampling. A blood sample will be drawn for each participant. Among this cohort, 50 patients will be identified that will undergo treatment with Mepolizumab, and they will form the sub-cohort in which epigenetic predictors of the response to Mepolizumab treatment (predictive epigenomic study) will be searched for.

Description

Inclusion Criteria:

• Patients over 18 years of age who meet the 1990 American College of Rheumatology classification criteria for EGPA or the criteria proposed in the MIRRA trial, or the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria;
• Written informed consent from all the study participants.

Exclusion Criteria:

• Patients with inadequate or unavailable data regarding response to treatment at months 6 and 12 after Mepolizumab initiation will be included in the case-control Epigenome-Wide Association Study (EWAS) but not in the predictive epigenomic study;
• Patients with childhood-onset EGPA;
• Patients who are pregnant or breast-feeding.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Overall Cohort; The study will include 300 adult (>18yo) patients with Eosinophilic Granulomatosis with Polyangiitis (EGPA). All patients will be recruited at Meyer Children's Hospital and Careggi University Hospital, which are referral centers for EGPA and have a large cohort of prevalent cases under long-term follow-up. They will represent the cases for the case-control epigenome-wide association study. Patients are expected to be untreated or under glucocorticoids at the time of sampling. A blood sample will be drawn for each participant. Among this cohort, 50 patients will be identified that will undergo treatment with Mepolizumab, and they will form the sub-cohort in which we will search for epigenetic predictors of the response to Mepolizumab treatment (predictive epigenomic study). These 50 patients will also be analyzed with regard to the transcriptomic and proteomic profile. Written informed consent from all participants and approval from the local ethical committees will be obtained.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Epigenome-Wide Association Study	The primary objective of the study is the identification of loci whose methylation level is associated with the pathology (i.e. epigenetic markers of the disease). This means that there is not any outcome that will be measured with regard to the primary objective.	Through study completion, an average of 1 year
Mepolizumab Therapy Response	The main secondary objective of the study is the identification of loci whose methylation level correlates with the response to treatment with the Mepolizumab in patients with EGPA (i.e. epigenetic predictors of response to Mepolizumab). To this end, the response to treatment with Mepolizumab is the outcome that will be measured. Complete response to treatment will be defined as no disease activity (Birmingham Vasculitis Activity Score = 0) and a prednisolone or prednisone dose (or equivalent) of ≤4.0 mg/day, as defined by the MIRRA trial. Partial response to treatment will be defined as no disease activity and a prednisone dose (or equivalent) of >4.0 mg/day.	6 months and 12 months after Mepolizumab therapy initiation

Collaborators and Investigators

• Sponsor: Meyer Children's Hospital IRCCS
• Collaborators: Careggi Hospital; University of Florence
• Investigators: Principal Investigator: Augusto Vaglio, MD, PhD, Meyer Children's Hospital IRCCS

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2024
• Primary Completion (Estimated): September 1, 2025
• Study Completion (Estimated): December 1, 2025

Study Registration Dates

• First Submitted: November 14, 2023
• First Submitted That Met QC Criteria: January 29, 2024
• First Posted (Actual): January 30, 2024

Study Record Updates

• Last Update Posted (Actual): February 23, 2024
• Last Update Submitted That Met QC Criteria: February 21, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: DNA Methylation; Eosinophilic Granulomatosis with Polyangiitis; EGPA; Epigenome
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Skin Diseases; Respiratory Tract Diseases; Immune System Diseases; Lymphoproliferative Disorders; Lymphatic Diseases; Autoimmune Diseases; Lung Diseases; Vasculitis; Skin Diseases, Vascular; Lung Diseases, Interstitial; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Granuloma; Granulomatosis with Polyangiitis; Churg-Strauss Syndrome; Systemic Vasculitis
• Other Study ID Numbers: EPI-EGPA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared with researchers other than the study investigators

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