The Potential Pharmacological Role of the TNF-Like Ligand 1A (TL1A) Inhibition in Modulating Systemic Sclerosis (SSc)-Related Skin Fibrosis and Immunological Alterations: A Proof-of-Concept, In Vitro, Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 20
- 试验地点
- 1
研究概览
简要总结
Systemic Sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by microvascular injury, immune activation, and progressive fibrosis of the skin and internal organs. Diffuse cutaneous SSc (dcSSc), particularly in its early phase, is associated with aggressive fibrotic evolution and high morbidity. Despite advances in immunomodulatory therapy, no treatment has proven capable of consistently halting or reversing fibrosis, highlighting the need for new mechanistic targets.
TL1A (TNF-like ligand 1A) is a cytokine of the TNF superfamily expressed by endothelial and immune cells, which interacts with death receptor 3 (DR3) to regulate immune activation, endothelial dysfunction, and tissue remodeling. Elevated TL1A levels have been observed in SSc patients and correlate with disease activity. TL1A has also been shown to promote lung fibrosis in preclinical models.
The FIBROSTOP study is a proof-of-concept, in vitro, interventional study on biological samples aimed at elucidating the immunological and fibrotic mechanisms regulated by TL1A, and at assessing whether TL1A inhibition can reverse pathogenic processes in SSc.
Ten (n=10) patients with early diffuse cutaneous SSc and ten (n=10) age- and sex-matched healthy controls will be enrolled at a single center (Fondazione Policlinico Universitario Campus Bio-Medico, Rome). Each participant will undergo a single visit (T0) involving peripheral blood sampling and skin biopsy. No follow-up visits are planned.
The study pursues three co-primary objectives: (1) evaluating the role of TL1A and its inhibition in modulating T lymphocyte activity; (2) assessing the effects of TL1A and its inhibition on endothelial cell activation and function; (3) investigating the impact of TL1A and its inhibition on fibrotic remodeling in ex vivo SSc skin cultures using single-cell RNA sequencing.
The findings may inform future targeted antifibrotic interventions in SSc and other fibrotic diseases.
详细描述
BACKGROUND AND RATIONALE
Systemic sclerosis (SSc) is an immune-mediated connective tissue disease characterized by fibrosis and vasculopathy. SSc is a heterogeneous orphan disease with a broad spectrum of organ involvement and life-threatening manifestations. The hallmark feature is the presence of thickened and hardened skin (scleroderma). The disease is divided into limited cutaneous and diffuse cutaneous SSc subsets based on the extent of skin involvement. Diffuse cutaneous SSc (dcSSc) is associated with a higher risk of interstitial lung disease, renal crisis, and cardiac involvement.
The pathophysiology of SSc involves a progressive self-amplifying process starting with microvascular/endothelial damage, followed by autoimmune response, inflammation, and fibrosis. T lymphocytes, particularly CD4+ T cells with a predominant Th2 cytokine profile, play an essential role in SSc pathogenesis. Regulatory T cells (Tregs) show decreased functional ability to suppress effector T cells.
TL1A (TNF-like cytokine 1A) is a member of the TNF superfamily constitutively expressed in endothelial cells and upregulated in response to TNF-α stimulation. TL1A binds to its receptor death receptor 3 (DR3), activating downstream signaling involved in innate and adaptive immune homeostasis. Elevated TL1A levels have been detected in serum of SSc patients compared to healthy subjects and correlate with disease activity. TL1A has been demonstrated to promote lung fibrosis in bleomycin-induced mouse models. The ATHENA-SSc-ILD study is currently evaluating Tulisokibart, a TL1A inhibitor, for SSc-associated interstitial lung disease.
STUDY DESIGN
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •For both SSc and healthy control populations:
- •Signed written informed consent
- •Age ≥18 years at the time of consent
- •For SSc population only:
- •Diagnosis of SSc according to ACR/EULAR 2013 classification criteria
- •Diffuse cutaneous SSc subtype (LeRoy et al., 1988)
- •Disease onset (defined as the first non-Raynaud symptom) within 5 years prior to recruitment
- •No new initiation of immunosuppressive therapy (including methotrexate, mycophenolate mofetil, cyclophosphamide, rituximab, tocilizumab, or prednisone >20 mg/day) within the 2 months preceding recruitment
- •Ongoing immunosuppressive therapy must be at a stable dose for at least 1 month prior to enrollment
排除标准
- •Coexisting active or treated skin diseases (e.g., atopic dermatitis), except for SSc
- •Diagnosis of other systemic autoimmune rheumatic diseases, including overlap syndromes (e.g., SSc + dermatomyositis)
- •History or current signs/symptoms of severe or uncontrolled non-rheumatic diseases
- •Active malignancy or history of malignancy within the previous 5 years (except adequately treated non-melanoma skin cancer or in situ cervical carcinoma)
- •Chronic or recurrent infections, including viral hepatitis B/C, HIV, or untreated tuberculosis
- •Severe active infection or major surgery within 8 weeks before enrollment
- •Non-serious skin infections within 8 weeks before enrollment
- •Limited cutaneous SSc or SSc sine scleroderma
- •SSc patients unable to undergo therapeutic stabilization due to severe organ complications
- •Pregnancy or lactation
- •Inability to provide informed consent
研究者
Luca Navarini
Professor
Fondazione Policlinico Universitario Campus Bio-Medico