New Biomarker-based Strategy to Screen and Monitor for Activated Phosphoinositide 3-kinase Δ Syndrome

Not yet recruiting

• Conditions: Activated PI3K Delta Syndrome
• Interventions: Biological: Blood samples; Biological: Urine samples; Biological: Stool samples

• Registration Number: NCT06694363
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

The study would like to compare patient samples at different time points using state-of the art-phenotyping tools.

Collection of blood samples of APDS patients undergoing PI3K inhibitor treatment will be collected when feasible according to the standard of care planning (a blood test is supposed to be performed for these patients at M0-M3-M6-M12 then each 6 months for a total period of 2 years from the beginning of the PI3K inhibitor treatment).

The whole blood will be processed in order to isolate the peripheral blood mononuclear cells (PBMC) and the plasma. Serum, RNA and DNA extraction will be performed on a separate sample.

Detailed Description

Activated PI3K delta syndromes (PI3Kδ) (APDS type 1 and type 2) are combined immunodeficiencies with variable clinical manifestations caused by heterozygous gain-of-function mutations of the PIK3CD gene. APDS is a very young onset disease, most clinical manifestations appear in pediatric age. Patients may experience severe, disabling, and life-threatening clinical manifestations. Additionally, they may exhibit autoimmunity in addition to immune deficiency. APDS patients present a high risk of developing tumors especially B lymphomas. Hematopoietic stem cell transplantation (HSCT) is the only curative option and, given the risks, may be considered for patients with severe APDS (including those who have developed lymphoma). HSCT is curative, but carries a 10 to 20% mortality risk and cannot guarantee reversibility of organ damage. Positive data from the phase II/III study of the PI3Kδ selective inhibitor leniolisib met the co-primary criteria of reduced lymph node size and increased percentage of B naïve cells in patients with APDS. In addition, safety data from the study showed that leniolisib was well tolerated by participants. The drug is also under review by the European Medicines Agency and a marketing authorization for APDS patients older than 12 years old will be soon available. In the meantime the access to this drug is available by compassionate use for patients older than 12 years old.

In this context, it will be interesting to evaluate the clinical and biological profile of these patients before and after leniolisib treatment in order to identify useful biomarkers for the follow up of the disease. In addition, carful long-term monitoring of patients under PI3Kδ inhibitors is mandatory to detect adverse effects of iatrogenic overinhibition of the PI3K pathway.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Status Verified: 2024-11
• Study First Submitted: 2024-11-15
• Study First Submitted QC: 2024-11-15
• Last Update Submitted: 2024-11-15
• Study First Posted: 2024-11-19
• Last Update Posted: 2024-11-19
• Study Start: 2024-12
• Primary Completion: 2028-09
• Study Completion: 2029-05

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 14

Inclusion Criteria

Group 1:

• Patients with genetic diagnosis of APDS type 1 or type 2 and planned to be treated by PI3Kδ selective inhibitor leniolisib
• Primary immunodeficient patients with new disease-causing variants in the PIK3CD gene or PIK3R1 gene
• Minimum age 12 years old
• Patients or holders of parental authority do not oppose participation in this research.
• Patients affiliated to a Health Insurance scheme or beneficiaries

Group 2 :

• Patients with genetic diagnosis of APDS type 1 or type 2 already treated by PI3Kδ selective inhibitor leniolisib in the last 2 years
• Patients whose pre-treatment samples are available/analyzable
• Minimum age 12 years old
• Patients or holders of parental authority do not oppose participation in this research.
• patients affiliated to a Health Insurance scheme or beneficiaries

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Exclusion Criteria

• Bone marrow transplantation
• Refusal to participate to the study.

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
1 - initiating treatment	Blood samples	10 patients with a genetic diagnosis of APDS type 1 or type 2 who are to be treated with a selective PI3Kδ inhibitor, Lenolisib.
1 - initiating treatment	Urine samples	10 patients with a genetic diagnosis of APDS type 1 or type 2 who are to be treated with a selective PI3Kδ inhibitor, Lenolisib.
1 - initiating treatment	Stool samples	10 patients with a genetic diagnosis of APDS type 1 or type 2 who are to be treated with a selective PI3Kδ inhibitor, Lenolisib.
2 - already on treatment	Blood samples	4 patients with a genetic diagnosis of APDS type 1 or type 2 already treated with a selective PI3Kδ inhibitor, Lenolisib.
2 - already on treatment	Urine samples	4 patients with a genetic diagnosis of APDS type 1 or type 2 already treated with a selective PI3Kδ inhibitor, Lenolisib.
2 - already on treatment	Stool samples	4 patients with a genetic diagnosis of APDS type 1 or type 2 already treated with a selective PI3Kδ inhibitor, Lenolisib.

Primary Outcome Measures

Name	Time	Method
Biomarker	At 0 day, 3 months, 6 months, 12 months, 18 months and 24 months of treatment	Identify new biomarker marker for increased PI3K signaling to monitor the disease severity by mass cytometry, single cell RNA-sequencing, single cell ATAC-sequencing and screening for auto-antibodies

Secondary Outcome Measures

Name	Time	Method
Correlation between biological data with the clinical data	At 0 day, 3 months, 6 months, 12 months, 18 months and 24 months of treatment	the analyses results will be correlated with the clinical data collected for the patients enrolled in the trial and receiving PIK3CD inhibitor treatment (early access program) in order to explore a possible correlation between biological data and clinical characteristics.
activation-induced cytidine deaminase (AID) off-target activity	At 0 day, 3 months, 6 months, 12 months, 18 months and 24 months of treatment	Investigate the possibility of activation-induced cytidine deaminase (AID) off-target activity in memory B cells due to PI3Kdelta inhibitor treatment by NGS panel sequencing
Enteric virus infection research	At 0 day, 3 months, 6 months, 12 months, 18 months and 24 months of treatment	Presence of Chronic enteric virus infection will be investigated by multiplex PCR and if negative by NGS in stools, plasma, urins

Trial Locations

Locations (7)

Hôpital Haut Levêque - BORDEAUX; 🇫🇷 Bordeaux, France

Hôpital Pellerin Enfants - BORDEAUX; 🇫🇷 Bordeaux, France

Hôpital Jeanne de Flandres - LILLE; 🇫🇷 Lille, France

Hôpital La Timone adulte - MARSEILLE; 🇫🇷 Marseille, France

Hôpital Necker Enfants Malades - PARIS; 🇫🇷 Paris, France

CHU IUCT Oncopole - TOULOUSE; 🇫🇷 Toulouse, France

Hôpital des enfants - TOULOUSE; 🇫🇷 Toulouse, France