Protocol Details

Assessment of the Biochemical Response to Interferon-Gamma in Subjects with Specific Gene Mutation in Chronic Granulomatous Disease

This study is currently recruiting participants.

Summary | Eligibility | Citations | Contacts

Summary

Number	10-I-0123
Sponsoring Institute	National Institute of Allergy and Infectious Diseases (NIAID)
Recruitment Detail	Type: Participants currently recruited/enrolled Gender: Male & Female Min Age: 0 Max Age: 999
Referral Letter Required	No
Population Exclusion(s)	None
Special Instructions	Currently Not Provided
Keywords	NADPH Oxidase; CGD; Gene Mutation; Superoxide by Phagocytes; IFN-Gamma
Recruitment Keyword(s)	Chronic Granulomatous Disease; CGD
Condition(s)	IFN-Gamma Therapy; CGD Gene Mutation; CGD Response to IFNg; Chronic Granulomatous Disease; Immunodeficiency Disease
Investigational Drug(s)	None
Investigational Device(s)	None
Intervention(s)	Drug: IFN-gamma
Supporting Site	National Institute of Allergy and Infectious Diseases

Background:

- Chronic granulomatous disease (CGD) is an immunodeficiency disease in which white blood cells are unable to kill certain bacteria and fungi. People with CGD are more likely to develop recurrent life-threatening infections. Certain changes or mutations in genes contribute to the severity of CGD, and also appear to affect the success of treatment with interferon-gamma, a substance that is used to improve the immune system's ability to fight infection. Researchers are interested in studying changes in the immune system caused by interferon-gamma treatment of CGD in individuals with different mutations that cause CGD.

Objectives:

- To compare changes in the immune system caused by interferon-gamma treatment for CGD in individuals with different mutations that cause CGD.

Eligibility:

- Individuals of any age who have been diagnosed with CGD and have specific types of mutations that cause CGD (to be determined after testing).

Design:

- Participants will be screened with a medical history, physical examination, and blood and urine tests. Participants must weigh more than 11 kilograms (~24 pounds) to participate in the study.

- Participants will receive injections of interferon-gamma once weekly for 4 weeks, twice weekly for 4 weeks, and then three times weekly for 4 weeks (a total of 24 injections).

- Blood will be drawn periodically during treatment and for 8 weeks after the treatment, for a total of 21 weeks on the study. Participants will regularly provide information on their symptoms and responses to treatment to the study researchers.

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Eligibility

INCLUSION CRITERIA:

Subjects may be enrolled if they are:

1. Already are enrolled on an existing CGD protocol at the Clinical Center (and will remain enrolled on their existing protocol);

2. Are included in one of the study cohorts listed below;

3. Male or female;

4. Able to comply with self-administration of a subcutaneous injection; and

5. Willing to have their blood samples stored for the duration of this study and for future research.

Study Groups/Cohorts:

X-linked CGD Nonsense/Frameshift/RNA Processing/Deletion Mutations Cohort: Subjects in this cohort must have X-linked CGD resulting from a documented nonsense, frameshift, RNA processing, or deletion gene mutation. Subjects with other gene defects or for whom the specific genetic defect has not been determined are not eligible for inclusion in this cohort.

X-linked CGD Missense Mutation with Low Baseline Superoxide Production (less than or equal to 2.5 nmol/10(6) cells/hr) Cohort: Subjects in this cohort must have X-linked CGD resulting from a documented missense gene and superoxide production by cytochrome c reduction assay at baseline of less than or equal to 2.5 nmol/10(6) cells/hr. Subjects with other gene defects or for whom the specific genetic defect has not been determined are not eligible for inclusion in this cohort.

X-linked CGD Missense Mutation with Higher Baseline Superoxide Production (greater than 2.5 nmol/10(6) cells/hr) Cohort: Subjects in this cohort must have X-linked CGD resulting from a documented missense gene and superoxide production by cytochrome c reduction assay at baseline of greater than 2.5 nmol/10(6) cells/hr. Subjects with other gene defects or for whom the specific genetic defect has not been determined are not eligible for inclusion in this cohort.

Autosomal Recessive p47phox CGD Cohort: Subjects in this cohort must have autosomal recessive CGD resulting from a documented p47phox gene mutation. Subjects with other gene defects or for whom the specific genetic defect has not been determined are not eligible for inclusion in this cohort.

Autosomal Recessive p67phox CGD Cohort: Subjects in this cohort must have autosomal recessive CGD resulting from a documented p67phox gene mutation. Subjects with other gene defects or for whom the specific genetic defect has not been determined are not eligible for inclusion in this cohort.

EXCLUSION CRITERIA:

Subjects are excluded from the study who:

1. Have undergone successful bone marrow transplantation;

2. Had a serious adverse reaction to IFN gamma in the past;

3. Are pregnant or breast feeding;

4. Weigh less than 11 kg;

5. Are currently on therapy with INF gamma;

6. Have any of the following medical conditions:

-Coronary artery disease;

-Hepatic disease and/or liver enzymes elevated above 3 times normal;

-Seizure disorder, or

-Severe myelosuppression (absolute neutrophil count less than1000 cells/mm(3)).

Participation of Minors: During the treatment phase of the study, up to 290 mL blood will be required during one 8-week period. As such, participation by individuals under 11 kg is not allowed and certain testing will be limited based on the subject's weight at the time of enrollment. Subjects will be assigned to 1 of 4 blood collection schedules based on their weight at time of enrollment. These categories will be as follows: adults (over 30kg), participants 20-30 kg, participants 15-20 kg, and participants 11-15 kg.

Participation of Women: Exposure to IFN gamma by the developing human fetus may 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 and Lactation: The effects of IFN gamma therapy on the developing fetus and newborn infant have not been studied. Therefore, it is not recommended that subjects who are pregnant or breast-feeding receive IFN gamma and they will be excluded from this study.

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Citations:

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.

Nathan CF, Murray HW, Wiebe ME, Rubin BY. Identification of interferon-gamma as the lymphokine that activates human macrophage oxidative metabolism and antimicrobial activity. J Exp Med. 1983 Sep 1;158(3):670-89.

Berton G, Zeni L, Cassatella MA, Rossi F. Gamma interferon is able to enhance the oxidative metabolism of human neutrophils. Biochem Biophys Res Commun. 1986 Aug 14;138(3):1276-82.

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Contacts:

Principal Investigator	Referral Contact	For more information:
John I. Gallin, M.D. National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health BG 10-CRC RM 6-2551 10 CENTER DR BETHESDA MD 20814 (301) 496-4114 jgallin@cc.nih.gov	Patricia L. Littel, R.N. National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health Building 10 Room 5-5140 10 Center Drive Bethesda, Maryland 20892 (301) 402-5964 plittel@cc.nih.gov	Patient Recruitment and Public Liaison Office Building 61 10 Cloister Court Bethesda, Maryland 20892-4754 Toll Free: 1-800-411-1222 TTY: 301-594-9774 (local),1-866-411-1010 (toll free) Fax: 301-480-9793 prpl@mail.cc.nih.gov

Clinical Trials Number:

NCT01147042

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