Liver Immune Tolerance Marker Utilization Study (LITMUS)
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
Previous pre-clinical work in the Levy Lab identified a novel biomarker gene set for the identification of tolerance in murine models of rapamycin-induced cardiac tolerance and spontaneous hepatic tolerance. Validation of this gene expression tolerance biomarker in operationally tolerant patients is now required for its implementation in the clinical setting. This proposal intends to validate and test our pre-clinically established tolerance gene expression biomarker in the clinical setting in order to translate our findings into improving the length and quality of life of transplant patients in the clinic.
The investigators hypothesize that a distinct gene expression profile expressed in the peripheral blood will identify operationally tolerant liver transplant recipients, allowing for the successful withdrawal of immunosuppression in these patients. Our study aims are: (I) To validate the pre-clinical gene expression profile for the identification of operationally tolerant liver recipients in plasma peripheral blood mononuclear cells (PBMCs) (2) To determine that the gene expression profile in the PBMCs is the same as the intra-graft gene expression profile (3) To demonstrate that liver transplant recipients with the tolerant gene expression profile can be safely weaned off of immunosuppression.
This proof of principle study will be conducted in two phases at the Toronto General Hospital (TGH) Phase 1 will address study aims 1 and 2, and phase 2 will address study aim 3. Potential participants will be screened and selected following predefined eligibility criteria. Eligible participants will undergo an informed consent process. The primary goal of this study is to validate the pre-clinical tolerant gene expression profile that will allow for the identification of tolerant liver recipients and for the monitored weaning off immunosuppression in these tolerant patients.
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Ontario
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Toronto, Ontario, Canadá, M5G 2C4
- Toronto General Hospital
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
To be eligible to participate in this study, patients must:
- Be between 18 and 65 years of age.
- Be recipients of a hepatic allograft.
- Be less than 3 months post-transplant and be experiencing rejection, or be a minimum of 3 months post-transplant with or without presently experiencing rejection.
- Be healthy live liver donors
Exclusion Criteria:
Patients with the following conditions may not participate in the study:
- Patients under the age of 18 and over the age of 65.
- Patients who are positive for Human Immunodeficiency Virus (HIV),
- Patients who have detectable levels of HCV RNA, and HBV DNA, at the time of enrollment.
- Patients who have a combined transplant and/or have been re-transplanted.
- Patients taking immunosuppression for other diseases besides their liver transplant.
- Patients unable to give written informed consent in accordance with research ethics board guidelines.
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Diagnóstico
- Alocação: N / D
- Modelo Intervencional: Atribuição de grupo único
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Controlled weaning of immunosuppression
Participants who are found to have the tolerance gene expression profile during phase 1 of the study will undergo closely monitored immunosuppression weaning during phase 2.
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At week 0 patients have liver biopsy and liver functional tests (LFTs).
Week 1-4 medication reduction to 1.5mg Tacrolimus (Tac) daily or 150mg Cyclosporine A (CsA).
At week 4 LFTs.
Week 5-8 medication reduction to 1mg Tac / 100mg CsA.
Week 8 LFTs.
Week 9-12 reduction to 0.5mg Tac/ 50mg CsA.
Week 12 LFTs.
Week 13-16 reduction to 0mg.
Week 16 liver biopsy & LFTs.
Weekly LFTs performed Week 17-20.
Monthly LFTs for the next 3 months.
LFTs every 3 months for monitoring.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
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Validation of Tolerance Gene Expression Profile
Prazo: Enrollment to one year post cessation of immunosuppression
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The primary endpoint of this study is the identification and validation of a unique tolerance gene expression profile, consisting of a 6 gene profile, in 3-6 operationally tolerant patients compared to 25 rejecting and 25 healthy controls.
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Enrollment to one year post cessation of immunosuppression
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Tolerance gene expression profile in graft versus peripheral blood mononuclear cells (PBMCs)
Prazo: Enrollment to one year post cessation of immunosuppression
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This endpoint will be defined as the ratio of patients (n=55) that will express the tolerance gene expression profile in the liver graft versus in the peripheral blood mononuclear cells.
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Enrollment to one year post cessation of immunosuppression
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Test of tolerance gene expression profile
Prazo: Enrollment to one year post cessation of immunosuppression
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This endpoint will assess whether the tolerance gene expression profile can be successfully used to select immunosuppressed patients for the successful weaning off immunosuppression.
This endpoint will be evaluated using the number of successful immunosuppression-weaned patients from a 7-10 patient cohort.
Successful immunosuppression-weaned patients are defined as patients who achieve an immunosuppression free state without any histological or clinical evidence of rejection for a minimum of 1 year.
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Enrollment to one year post cessation of immunosuppression
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Gary Levy, M.D., University Health Network, University of Toronto
- Cadeira de estudo: Leslie Lilly, M.D., University Health Network, Toronto
- Cadeira de estudo: Nazia Selzner, M.D. PhD., University Health Network, Toronto
- Diretor de estudo: Meaghan MacArthur, M.Ed, University Health Network, Toronto
Publicações e links úteis
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Estimativa)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Outros números de identificação do estudo
- Tol002
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