Relating Genetic and Environmental Risk Scores to Multiple Sclerosis Susceptibility
| Status: | Recruiting |
|---|---|
| Conditions: | Other Indications, Neurology, Multiple Sclerosis |
| Therapuetic Areas: | Neurology, Other |
| Healthy: | No |
| Age Range: | 18 - 50 |
| Updated: | 2/23/2019 |
| Start Date: | May 30, 2012 |
| Contact: | Jenifer E Dwyer |
| Email: | jdwyer@cc.nih.gov |
| Phone: | (301) 496-0586 |
Integrating Genetic and Environmental Risk Scores Into an Algorithm to Predict Multiple Sclerosis Susceptibility
Background:
- Research shows that both genes and the environment influence a person s risk for getting
multiple sclerosis (MS). However, it is not possible to accurately predict who will develop
MS. Researchers want to study people with MS and their family members. They have developed a
Genetic and Environmental Risk Score for MS. This score combines information from a person's
medical history and genes. It also includes environmental factors that may be related to
developing MS. This study will test this risk score to see if it can help predict who will
develop MS.
Objectives:
- To evaluate a score for genetic and environmental risk factors that may help predict
whether a person will develop MS.
Eligibility:
- Individuals at least 18 years of age who have MS.
- Individuals between 18 to 50 years of age who are the parent, brother, sister, or child
of a person with MS.
Design:
- People with MS will allow researchers to look at their personal and medical data. These
data will have been collected in other MS-related studies.
- Relatives of people with MS will fill out a questionnaire and give blood and saliva
samples. They will fill out the questionnaire again one year later.
- Some relatives will have additional optional testing. These tests will include a
physical exam and imaging studies. There may also be other tests. These tests may be
repeated every 1 to 5 years for 20 years.
- Research shows that both genes and the environment influence a person s risk for getting
multiple sclerosis (MS). However, it is not possible to accurately predict who will develop
MS. Researchers want to study people with MS and their family members. They have developed a
Genetic and Environmental Risk Score for MS. This score combines information from a person's
medical history and genes. It also includes environmental factors that may be related to
developing MS. This study will test this risk score to see if it can help predict who will
develop MS.
Objectives:
- To evaluate a score for genetic and environmental risk factors that may help predict
whether a person will develop MS.
Eligibility:
- Individuals at least 18 years of age who have MS.
- Individuals between 18 to 50 years of age who are the parent, brother, sister, or child
of a person with MS.
Design:
- People with MS will allow researchers to look at their personal and medical data. These
data will have been collected in other MS-related studies.
- Relatives of people with MS will fill out a questionnaire and give blood and saliva
samples. They will fill out the questionnaire again one year later.
- Some relatives will have additional optional testing. These tests will include a
physical exam and imaging studies. There may also be other tests. These tests may be
repeated every 1 to 5 years for 20 years.
Objective. The overall objective of this study is to investigate the genetic, immune, and
neuroimaging profiles that may increase a person s risk of developing multiple sclerosis (MS)
in order to identify and validate predictive biomarkers in populations at risk for this
disorder.
Study population. There will be three study populations:
1. Individuals at risk for developing MS As part of the Genes and Environment in Multiple
Sclerosis (GEMS) study, we plan to recruit up to 1000 first-degree relatives of MS
patients. GEMS is a study aiming to recruit 5000 individuals that is being led by our
collaborators at Columbia University Medical Center. For the purposes of this study, a
first-degree relative may be a parent, sibling, or child between 18 and 50 years of age
but must not carry a diagnosis of MS. The first-degree relative must have the ability to
provide consent and be willing to participate in the study. Two potentially overlapping
subsets of these individuals will undergo detailed testing at the NIH:
1. The cross-sectional subcohort will consist of up to 150 participants with combined
genetic and environmental risk scores (GERS), defined in the protocol, in the
highest and lowest 20 percent of the entire study population. Selected participants
may be invited for follow-up studies based on data obtained at baseline if symptoms
develop.
2. The NINDS longitudinal subcohort will consist of up to 10 participants, ages 18 to
40,who express willingness to be followed for 20 years at the NIH, whose GERS falls
in the top 20 percent of the entire study population, and who have a first-degree
relative with MS who is participatipate
2. MS patients - We plan to recruit up to 1000 MS patients whose first-degree relatives are
enrolled this study. These participants either: (A) will be evaluated under other
Neuroimmunology Branch Clinic protocols and will not undergo separate evaluation under
this protocol; or (B) will send us medical records confirming their MS diagnosis via
mail/fax/secure email, without the requirement to participate in another NIH protocol.
The purpose of including this cohort in the current study is to allow access to their
clinical, biological, and imaging data for comparison with first-degree relatives, if
available, and to confirm that existing GEMS participants have a first-degree relative
diagnosed with MS.
3. Healthy volunteers - We plan to recruit up to 80 healthy volunteers, ages 18-50, who do
not have a known first-degree relative with MS. The purpose of including this cohort in
the current study is to allow quantification of the degree and extent of abnormalities,
including abnormalities of the blood-brain barrier, in individuals at risk for
developing MS. Without imaging data obtained from healthy volunteers, there is no way to
determine whether subtle clinical and neuroimaging findings in the at-risk cohort are
truly abnormal, or to correctly threshold and quantify the observed abnormalities.
Design. This is a prospective cohort natural-history study. All GEMS participants will
complete the following study procedures, which can be performed offsite: informed consent;
study questionnaire; saliva sample; and blood draw. The questionnaire will be repeated 1 year
after enrollment.
There will two additional substudies conducted at NIH: a cross-sectional substudy and a
longitudinal substudy. Participants in these substudies will be evaluated with clinical,
radiological, and laboratory procedures. Participants in the cross-sectional cohort will
undergo evaluation at the NIH at a single time point (with optional longitudinal follow up),
whereas participants in the longitudinal cohort will undergo evaluation at the NIH for 20
years. There will be an interim analysis 5 years after the 50th participant is recruited to
the longitudinal cohort, and the study of this cohort may be terminated if we have not
observed the development of MS-related radiological or laboratory abnormalities in any of the
participants. Participants with MS will provide informed consent to allow access to their own
research data, but the data themselves will be (or will have already been) collected under
other Neuroimmunology Clinic clinical protocols.
NIH is a unique site within the overall GEMS study, for the following reasons: (1) It is the
only site at which imaging is being performed, as part of the cross-sectional and
longitudinal substudies; (2) GEMS participants seen at NIH may undergo additional procedures
that are not part of the overall GEMS study; (3) Data from participants in the NIH substudy
will be directly linked to data from their own relatives with MS.
Outcome measures. For participants in the overall GEMS study, the primary outcome measure is
the GERS itself, as most participants in this cohort will not undergo further testing. For
participants in the cross-sectional cohort, which consists of individuals at highest and
lowest risk for MS, the primary outcome measure is the presence or absence of lesions on
T2-weighted brain MRI that meet the 2010 MRI criteria for dissemination in space - a finding
that, in this population, may well be related to MS. For participants in the longitudinal
cohort, the study endpoint is a clinical diagnosis of MS according to the same 2010 criteria.
Secondary outcome measures include: (1) The age at which participants develop MS-related
abnormalities on brain imaging studies, abnormalities on laboratory testing, and clinical
symptoms and signs; (2) The time lag between defined exposures (for example, infectious
mononucleosis) and the appearance of MS-related radiological, laboratory, and clinical
abnormalities; (3) The time lag between the appearance of asymptomatic radiological and
laboratory abnormalities and the onset of clinical symptoms; and (4) Additional exploratory
clinical, imaging, and biological data in the crosssectional that may suggest subclinical MS
disease activity.
neuroimaging profiles that may increase a person s risk of developing multiple sclerosis (MS)
in order to identify and validate predictive biomarkers in populations at risk for this
disorder.
Study population. There will be three study populations:
1. Individuals at risk for developing MS As part of the Genes and Environment in Multiple
Sclerosis (GEMS) study, we plan to recruit up to 1000 first-degree relatives of MS
patients. GEMS is a study aiming to recruit 5000 individuals that is being led by our
collaborators at Columbia University Medical Center. For the purposes of this study, a
first-degree relative may be a parent, sibling, or child between 18 and 50 years of age
but must not carry a diagnosis of MS. The first-degree relative must have the ability to
provide consent and be willing to participate in the study. Two potentially overlapping
subsets of these individuals will undergo detailed testing at the NIH:
1. The cross-sectional subcohort will consist of up to 150 participants with combined
genetic and environmental risk scores (GERS), defined in the protocol, in the
highest and lowest 20 percent of the entire study population. Selected participants
may be invited for follow-up studies based on data obtained at baseline if symptoms
develop.
2. The NINDS longitudinal subcohort will consist of up to 10 participants, ages 18 to
40,who express willingness to be followed for 20 years at the NIH, whose GERS falls
in the top 20 percent of the entire study population, and who have a first-degree
relative with MS who is participatipate
2. MS patients - We plan to recruit up to 1000 MS patients whose first-degree relatives are
enrolled this study. These participants either: (A) will be evaluated under other
Neuroimmunology Branch Clinic protocols and will not undergo separate evaluation under
this protocol; or (B) will send us medical records confirming their MS diagnosis via
mail/fax/secure email, without the requirement to participate in another NIH protocol.
The purpose of including this cohort in the current study is to allow access to their
clinical, biological, and imaging data for comparison with first-degree relatives, if
available, and to confirm that existing GEMS participants have a first-degree relative
diagnosed with MS.
3. Healthy volunteers - We plan to recruit up to 80 healthy volunteers, ages 18-50, who do
not have a known first-degree relative with MS. The purpose of including this cohort in
the current study is to allow quantification of the degree and extent of abnormalities,
including abnormalities of the blood-brain barrier, in individuals at risk for
developing MS. Without imaging data obtained from healthy volunteers, there is no way to
determine whether subtle clinical and neuroimaging findings in the at-risk cohort are
truly abnormal, or to correctly threshold and quantify the observed abnormalities.
Design. This is a prospective cohort natural-history study. All GEMS participants will
complete the following study procedures, which can be performed offsite: informed consent;
study questionnaire; saliva sample; and blood draw. The questionnaire will be repeated 1 year
after enrollment.
There will two additional substudies conducted at NIH: a cross-sectional substudy and a
longitudinal substudy. Participants in these substudies will be evaluated with clinical,
radiological, and laboratory procedures. Participants in the cross-sectional cohort will
undergo evaluation at the NIH at a single time point (with optional longitudinal follow up),
whereas participants in the longitudinal cohort will undergo evaluation at the NIH for 20
years. There will be an interim analysis 5 years after the 50th participant is recruited to
the longitudinal cohort, and the study of this cohort may be terminated if we have not
observed the development of MS-related radiological or laboratory abnormalities in any of the
participants. Participants with MS will provide informed consent to allow access to their own
research data, but the data themselves will be (or will have already been) collected under
other Neuroimmunology Clinic clinical protocols.
NIH is a unique site within the overall GEMS study, for the following reasons: (1) It is the
only site at which imaging is being performed, as part of the cross-sectional and
longitudinal substudies; (2) GEMS participants seen at NIH may undergo additional procedures
that are not part of the overall GEMS study; (3) Data from participants in the NIH substudy
will be directly linked to data from their own relatives with MS.
Outcome measures. For participants in the overall GEMS study, the primary outcome measure is
the GERS itself, as most participants in this cohort will not undergo further testing. For
participants in the cross-sectional cohort, which consists of individuals at highest and
lowest risk for MS, the primary outcome measure is the presence or absence of lesions on
T2-weighted brain MRI that meet the 2010 MRI criteria for dissemination in space - a finding
that, in this population, may well be related to MS. For participants in the longitudinal
cohort, the study endpoint is a clinical diagnosis of MS according to the same 2010 criteria.
Secondary outcome measures include: (1) The age at which participants develop MS-related
abnormalities on brain imaging studies, abnormalities on laboratory testing, and clinical
symptoms and signs; (2) The time lag between defined exposures (for example, infectious
mononucleosis) and the appearance of MS-related radiological, laboratory, and clinical
abnormalities; (3) The time lag between the appearance of asymptomatic radiological and
laboratory abnormalities and the onset of clinical symptoms; and (4) Additional exploratory
clinical, imaging, and biological data in the crosssectional that may suggest subclinical MS
disease activity.
- INCLUSION CRITERIA:
GEMS cohort (target n equals 1000)
- First-degree relative (parent, sibling, or child) of a self-reported MS patient.
- Age 18-50, inclusive, at the time of enrollment into the overall GEMS study.
- Willingness to be contacted regarding additional follow-up procedures.
- Cross-sectional subcohort (target n equal 150):
- Referred by Columbia University Medical Center as having a genetic and
environmental risk score (GERS), defined in Section 4.1.1, in the top or bottom
20% of the overall GEMS study.
- NINDS Longitudinal subcohort (target n equal 100):
- Ages 18-40, inclusive.
- Referred by Columbia University Medical Center as having a GERS in the top 20% of
the overall GEMS study.
- Willing to undergo additional study procedures at the NIH for up to 20 years,
with planned follow-up every year for participants between ages 18 and 25, every
2 years for participants between ages 26 and 30, and every 5 years for
participants between ages 31 and 40.
- Relative enrolled in NIH study with confirmation of MS diagnosis.
MS patient cohort (target n=1000):
- MS patients (NIH)
- Co-enrolled in another Neuroimmunology Clinic natural history protocol.
- Diagnosis confirmed at NIH.
- Age 18 or older.
- MS patient (non-NIH)
- First-degree relative (parent, sibling, or child) of an existing GEMS
participant.
- Able and willing to send medical records associated with their MS diagnosis to
NIH.
- Healthy volunteer cohort (target n=80)
- Age 18-50, inclusive.
- No known first-degree relative (parent, sibling, or child) with MS.
- All cohorts
- Able to give informed consent.
EXCLUSION CRITERIA:
GEMS cohort
-Diagnosis of MS.
Cross-sectional and NINDS longitudinal subcohorts
- Contraindications to MRI scanning.
- Diagnosis of another central nervous system disease disease (CNS neoplasm, known
cerebrovascular disease, known CNS degenerative diseases, or known CNS inflammatory
diseases) at the time enrollment into the study.
- MS cohort (both)
- Healthy volunteer cohort
- Diagnosis of MS or another central nervous system (CNS neoplasm, cerebrovascular
disease CNS degenerative diseases, or CNS inflammatory diseases) or a systemic
disease that would interfere with the aims of this study.
- Contraindications to MRI scanning.
Eligible NIH employees and staff may participate.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
Phone: 800-411-1222
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