OSTEOMICS: Identifying Regulators of Bone Homeostasis

Recruiting

• Conditions: Bone Diseases; Bone Marrow Disease; Bone Fracture; Osteoporosis; Osteoarthritis
• Interventions: Procedure: Relevant orthopaedic surgery

• Registration Number: NCT05732870
• Lead Sponsor: Relation Therapeutics

Brief Summary

Diseases of bone associated with ageing, including osteoporosis (OP) and osteoarthritis (OA), reduce bone mass, bone strength and joint integrity. Current non-surgical approaches are limited to pharmaceutical agents that are not disease modifying and have poor patient tolerability due to side effect profiles. Developing a fundamental understanding of cellular bone homeostasis, including how key cell types affect tissue health, and offering novel therapeutic targets for prevention of bone disease is therefore essential. This is the focus of OSTEOMICS.

A number of factors have been linked to increased risk of bone disease, including genetic predisposition, diet, smoking, ageing, autoimmune disorders and endocrine disorders. In our study, we will recruit patients undergoing elective and non-elective orthopaedic surgery and obtain surgical bone waste for analysis. This will capture a cohort of patients with bone disorders like OP and OA, in addition to patients without overt clinical bone disease. We will study the relationship between the molecular biology of bone cells, bone structure, genetics (DNA) and environmental factors with the aim of identifying and validating novel therapeutic targets.

We will leverage modern single cell technologies to understand the diversity of cell types found in bone. These technologies have now led to the characterisation of virtually every tissue in the body, however bone and bone-adjacent tissues are massively underrepresented due to the anatomical location and underlying technical challenges. Early protocols to demineralise bone and perform single cell profiling have now been developed. We will systematically scale up these efforts to observe how genetic variation at the population level leads to alterations in bone structure and quality.

Over the next 10 years, we will generate data to comprehensively characterise bone across health and disease, use machine learning to drive analysis, and experimentally validate hypotheses - which will ultimately contribute to developing the next generation of therapeutic agents.

Detailed Description

Not available

Study Timeline

• Study Start: 2023-01-12
• Study First Submitted: 2023-01-30
• Study First Submitted QC: 2023-02-08
• Study First Posted: 2023-02-17
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-20
• Last Update Posted: 2024-02-23
• Primary Completion: 2027-12
• Study Completion: 2032-12

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 2000

Inclusion Criteria

1. Patients with osteoarthritis undergoing total joint arthroplasty, osteotomy or arthrodesis of any joint (including hip, knee, shoulder, wrist, elbow, ankle).
2. Patient with fractured neck of femurs undergoing hemiarthroplasty or total hip arthroplasty, or other internal fixation procedure.
3. Patients undergoing acute low-velocity or fragility fracture fixation surgery.
4. Patients aged between 18-110 years old with capacity to consent.

Since deteriorating bone health including diseases like osteoporosis are primarily conditions of older age there is no practical upper age-limit. However, study involvement is limited by suitability for surgery which encompasses multiple factors considered on an individual case basis including age, frailty, comorbidities, baseline mobility, renal function and ability to consent (for instance due to dementia or delirium).

We note that our inclusion criteria is purposefully broad as we aim to deduce trends across a wide range of conditions and backgrounds.

Exclusion Criteria

1. Patients unable to provide informed consent.
2. Patients with suspected/established underlying malignancy.
3. Patients with suspected/established osteomyelitis.
4. Patients with suspected/established bloodborne disease
5. Patients who are currently a subject of a clinical trial involving an investigational medicinal product.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Participant undergoing orthopaedic surgery	Relevant orthopaedic surgery	* Patients with osteoarthritis undergoing total joint arthroplasty, osteotomy or arthrodesis of any joint (including hip, knee, shoulder, elbow, ankle). * Patients with fractured neck of femurs undergoing hemiarthroplasty or total hip arthroplasty, or other internal fixation procedure. * Patients undergoing acute low-velocity or fragility fracture fixation surgery.

Primary Outcome Measures

Name	Time	Method
Acquisition of bone waste	Within 4 hours of resection.	Discarded bone waste to be used for the study of RNA.

Secondary Outcome Measures

Name	Time	Method
Acquisition of 10ml of blood.	Within 4 hours of resection.	Discarded blood to be used for genetic sequencing, and/or other downstream omics/assays
Completion of participant questionnaire	EDC entry within 1 week of surgery.	Patient metadata to be used to understand cohort and identify confounding factors.

Trial Locations

Locations (8)

Barts Health NHS Trust; 🇬🇧 London, United Kingdom

Luton & Dunstable University Hospital; 🇬🇧 London, United Kingdom

West Middlesex University Hospital; 🇬🇧 London, United Kingdom

Chase Farm Hospital; 🇬🇧 London, United Kingdom

Fitzrovia Hospital/QASMC; 🇬🇧 London, United Kingdom

Harley Street Specialist Hospital; 🇬🇧 London, Greater London, United Kingdom

Royal National Orthopaedic Hospital NHS Trust; 🇬🇧 London, United Kingdom

King's College Hospital; 🇬🇧 London, United Kingdom