Studying Skeletal Muscle, Heart, and Diaphragm Imaging in Boys With Duchenne Muscular Dystrophy
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 5 - 17 |
| Updated: | 2/23/2019 |
| Start Date: | September 15, 2011 |
Evaluation of Skeletal Muscle, Cardiac, and Diaphragm Imaging Biomarkers for GSK2402968 Effects in Ambulatory Boys With Duchenne Muscular Dystrophy
Background:
- Duchenne muscular dystrophy (DMD) is a disease in which the muscles are unable to make the
protein dystrophin. Without this protein, the muscles become gradually weaker. A new medicine
called GSK2402968 is being tested to see if it can help prevent or slow down this loss of
muscle strength. In this study, boys with DMD and healthy volunteers will have different
types of imaging studies to see which ones provide the best images of the muscles. This
information will help researchers use these imaging techniques to test the safety and
effectiveness of GSK2402968 and other agents.
Objectives:
- To test magnetic resonance imaging and ultrasound techniques that can detect changes in
muscles of boys with DMD.
Eligibility:
- Boys who have DMD and are in the GSK2402968 drug test study.
- Healthy boys of the same age as the above study participants.
Design:
- Participants will be screened with a medical history and physical exam.
- Healthy volunteers will have one 2-hour visit with three tests. Magnetic resonance
imaging (MRI) scans of the skeletal muscles and heart and diaphragm muscles will be
carried out. Muscle ultrasound imaging of leg and arm muscles will also be done.
Participants should not perform heavy physical activity like school sports or long walks
during the week before the visit.
- Participants in the GSK2402968 study will have the same series of tests as the healthy
volunteers. The tests will be given during the study screening phase. They will be
repeated after 3 months and 6 months of receiving the study agent (GSK2402968 or
placebo) and at 6 months after stopping the GSK study.
- Duchenne muscular dystrophy (DMD) is a disease in which the muscles are unable to make the
protein dystrophin. Without this protein, the muscles become gradually weaker. A new medicine
called GSK2402968 is being tested to see if it can help prevent or slow down this loss of
muscle strength. In this study, boys with DMD and healthy volunteers will have different
types of imaging studies to see which ones provide the best images of the muscles. This
information will help researchers use these imaging techniques to test the safety and
effectiveness of GSK2402968 and other agents.
Objectives:
- To test magnetic resonance imaging and ultrasound techniques that can detect changes in
muscles of boys with DMD.
Eligibility:
- Boys who have DMD and are in the GSK2402968 drug test study.
- Healthy boys of the same age as the above study participants.
Design:
- Participants will be screened with a medical history and physical exam.
- Healthy volunteers will have one 2-hour visit with three tests. Magnetic resonance
imaging (MRI) scans of the skeletal muscles and heart and diaphragm muscles will be
carried out. Muscle ultrasound imaging of leg and arm muscles will also be done.
Participants should not perform heavy physical activity like school sports or long walks
during the week before the visit.
- Participants in the GSK2402968 study will have the same series of tests as the healthy
volunteers. The tests will be given during the study screening phase. They will be
repeated after 3 months and 6 months of receiving the study agent (GSK2402968 or
placebo) and at 6 months after stopping the GSK study.
Objective:
Duchenne muscular dystrophy (DMD) is the most frequent inherited fatal childhood disease.
Antisense oligonucleotide (AON)-induced exon skipping is a promising therapeutic strategy for
DMD that is currently being explored in clinical trials. Magnetic resonance imaging (MRI) and
ultrasound imaging methods are sensitive to key processes in dystrophic muscle such as edema
and fat infiltration and therefore could serve as a biomarker of disease progression and
therapeutic response. Our objective is to explore the potential of these imaging biomarkers
for GSK2402968 (AON) effects in ambulatory boys with DMD. The primary objective is to assess
longitudinal changes in skeletal muscle structural MRI measures reflecting fat and edema in
the lower extremities in ambulatory boys with DMD receiving GSK2402968 or placebo
Study Population:
We aim to enroll up to 65 ambulatory boys with DMD. Healthy volunteer/control boys (up to 25)
matched for the age-range will be recruited to obtain pilot data for imaging studies.
Design:
This prospective study of skeletal muscle, cardiac, and diaphragm imaging at the NIH will be
offered to all subjects participating in a phase 2, double blind, exploratory parallel-group,
placebo-controlled clinical study in ambulatory subjects with DMD resulting from a mutation
that can be corrected by exon 51 skipping induced by GSK2402968 (parent study; DMD114876).
Subjects will travel with a family member to the NIH for MRI and ultrasound assessments
during the screening phase of the parent study or up to 3 weeks after randomization and
additionally at the following time points in the parent study: at 12 weeks ( 3 weeks), and 24
weeks ( 3 weeks) during the blinded treatment period; and finally, after completion of 24
week post-treatment phase (at 48 weeks 4 weeks). If not randomized, the subjects will have a
one-time evaluation during the screening phase of the parent study. Pilot data also will be
obtained from healthy boys (matched for the age-range) for comparisons to allow exploration
of MRI and ultrasound measures specific to pathology in the ambulatory boys with DMD.
Subjects will not be treated with GSK2402968 or any other experimental drug at the NIH. There
are no follow-up or termination procedures for this study.
Outcome Measures:
Primary Outcome Measure: MRI changes in skeletal muscle percent fat in the lower extremities
using T1w GRE Dixon method at 24 weeks from baseline in the parent study in ambulatory boys
with DMD receiving GSK2402968 or placebo. Secondary outcome measures: Differences in the
following outcome measures between healthy boys and ambulatory boys with DMD at baseline; and
changes in these measures over time in the parent study at 12 weeks, 24 weeks, and 48 weeks
from baseline in ambulatory boys with DMD receiving GSK2402968 or placebo: 1. Skeletal muscle
MRI: relative muscle fat/water quantified by T1w GRE Dixon imaging method in skeletal
muscles; Muscle edema assessed by T2 imaging; Muscle fat/water content and edema additionally
quantified by IDEAL-CPMG method; and 2. Cardiac MRI: Cardiac function (ejection fraction/ LV
function) assessed by SSFP Cine MRI and manual planimetry of LV volumes and mass at end
systole and end diastole; Myocardial fat content assessed by Multiecho Dixon Fat /Water
Separation method; Myocardial edema assessed by T2 quantification; Myocardial T1 assessed by
MOLLI (modified Look-Locker Inversion recovery).
Exploratory Outcome Measures: MRI changes in muscle architecture and water diffusivity will
be assessed by Diffusion EPI MRI. If well tolerated, then we will use a portable device
(Ankle IntelliStretch device, RehabTek) to study the effects of exercise on selected MRI
measures in leg muscles. Muscle ultrasound will be used to monitor changes in skeletal muscle
volume, echogenicity and stiffness. Dynamic breathing MRI will be performed to measure
diaphragm motion during free breathing and voluntary maximal inspiration and exhalation.
Duchenne muscular dystrophy (DMD) is the most frequent inherited fatal childhood disease.
Antisense oligonucleotide (AON)-induced exon skipping is a promising therapeutic strategy for
DMD that is currently being explored in clinical trials. Magnetic resonance imaging (MRI) and
ultrasound imaging methods are sensitive to key processes in dystrophic muscle such as edema
and fat infiltration and therefore could serve as a biomarker of disease progression and
therapeutic response. Our objective is to explore the potential of these imaging biomarkers
for GSK2402968 (AON) effects in ambulatory boys with DMD. The primary objective is to assess
longitudinal changes in skeletal muscle structural MRI measures reflecting fat and edema in
the lower extremities in ambulatory boys with DMD receiving GSK2402968 or placebo
Study Population:
We aim to enroll up to 65 ambulatory boys with DMD. Healthy volunteer/control boys (up to 25)
matched for the age-range will be recruited to obtain pilot data for imaging studies.
Design:
This prospective study of skeletal muscle, cardiac, and diaphragm imaging at the NIH will be
offered to all subjects participating in a phase 2, double blind, exploratory parallel-group,
placebo-controlled clinical study in ambulatory subjects with DMD resulting from a mutation
that can be corrected by exon 51 skipping induced by GSK2402968 (parent study; DMD114876).
Subjects will travel with a family member to the NIH for MRI and ultrasound assessments
during the screening phase of the parent study or up to 3 weeks after randomization and
additionally at the following time points in the parent study: at 12 weeks ( 3 weeks), and 24
weeks ( 3 weeks) during the blinded treatment period; and finally, after completion of 24
week post-treatment phase (at 48 weeks 4 weeks). If not randomized, the subjects will have a
one-time evaluation during the screening phase of the parent study. Pilot data also will be
obtained from healthy boys (matched for the age-range) for comparisons to allow exploration
of MRI and ultrasound measures specific to pathology in the ambulatory boys with DMD.
Subjects will not be treated with GSK2402968 or any other experimental drug at the NIH. There
are no follow-up or termination procedures for this study.
Outcome Measures:
Primary Outcome Measure: MRI changes in skeletal muscle percent fat in the lower extremities
using T1w GRE Dixon method at 24 weeks from baseline in the parent study in ambulatory boys
with DMD receiving GSK2402968 or placebo. Secondary outcome measures: Differences in the
following outcome measures between healthy boys and ambulatory boys with DMD at baseline; and
changes in these measures over time in the parent study at 12 weeks, 24 weeks, and 48 weeks
from baseline in ambulatory boys with DMD receiving GSK2402968 or placebo: 1. Skeletal muscle
MRI: relative muscle fat/water quantified by T1w GRE Dixon imaging method in skeletal
muscles; Muscle edema assessed by T2 imaging; Muscle fat/water content and edema additionally
quantified by IDEAL-CPMG method; and 2. Cardiac MRI: Cardiac function (ejection fraction/ LV
function) assessed by SSFP Cine MRI and manual planimetry of LV volumes and mass at end
systole and end diastole; Myocardial fat content assessed by Multiecho Dixon Fat /Water
Separation method; Myocardial edema assessed by T2 quantification; Myocardial T1 assessed by
MOLLI (modified Look-Locker Inversion recovery).
Exploratory Outcome Measures: MRI changes in muscle architecture and water diffusivity will
be assessed by Diffusion EPI MRI. If well tolerated, then we will use a portable device
(Ankle IntelliStretch device, RehabTek) to study the effects of exercise on selected MRI
measures in leg muscles. Muscle ultrasound will be used to monitor changes in skeletal muscle
volume, echogenicity and stiffness. Dynamic breathing MRI will be performed to measure
diaphragm motion during free breathing and voluntary maximal inspiration and exhalation.
- INCLUSION CRITERIA:
DMD Subjects
- Eligible for the parent study
- Willing and able to comply with all protocol requirements and procedures, including
MRI without sedation
- Able to give informed assent and parent(s)/legal guardian to give informed consent in
writing signed by the subject and/or parent(s)/legal guardian
Healthy Volunteers
- Must be unaffected by a neuromuscular condition
- Willing and able to comply with all protocol requirements and procedures, including
MRI without sedation.
- Able to give informed assent and parent(s)/legal guardian to give informed consent in
writing signed by the subject and/or parent(s)/legal guardian.
EXCLUSION CRITERIA:
DMD Subjects and Healthy Volunteers
- Having metal objects in his body that are not MRI-safe. These include the following
objects: 1) pacemakers or other implanted electrical devices; 2) brain stimulators; 3)
some types of dental implants; 4) aneurysm clips (metal clips on the wall of a large
artery); 5) metallic prostheses (including metal pins and rods, heart valves, and
cochlear implants; 6) implanted delivery pump; 7) permanent eye liner; or 8) shrapnel
fragments.
- Having a fear of closed spaces
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
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