Tonsillar Cytokine Expression After Allergen and/or Virus Intervention
NCT ID: NCT01924208
Last Updated: 2016-04-21
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
PHASE3
180 participants
INTERVENTIONAL
2013-10-31
2016-09-30
Brief Summary
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1. Immunotherapy induces tolerogenic effects to allergens in T cell regulation in tonsils.
2. Influenza vaccination induces a strong interferon response and decreases Th2 response in tonsils.
3. Influenza vaccination as an adjuvant on immunotherapy induces a better response to immunotherapy.
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Detailed Description
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Patients: Human tonsil samples will be obtained from less than 30-year-old routine tonsillectomy patients after sublingual grass immunotherapy (n=30), nasal live attenuated influenza vaccine (n=30 for atopic; and n=30 for non-atopic) and immunotherapy+influenza vaccine intervention (n=30). Controls without age limit or intervention (n=580) will also be recruited. Of these, age and atopy-matched controls will be selected as comparator groups for each intervention trial (n=30 for atopic; and n=30 for non-atopic). Control group will also be used for investigation of role of tissues in immune tolerance and chronicity in allergic diseases, immunomodulatory effects of respiratory viruses main focus being on human bocavirus and human rhinovirus infections, and in the search of new respiratory viruses.
Design: Study intervention products will be administered openly but the immunology outcomes will be analysed blindly.
Main outcomes: Gene expressions of IFN and T cell related genes will be the main outcomes and compared between intervention groups and correlated with the number of allergen extract doses or time from nasal influenza vaccination. Systemic immunologic outcomes (in peripheral blood mononuclear cells, blood RNA expression profiles, antibodies and cytokines in serum) will also be studied. The analyses include immunogenetics, virology, bacteriology and sensitization status. Clinical symptom scores will be recorded during the next 12 months from the screening visit.
Anticipated results: We expect that our tonsil approach will offer a new in vivo model for the understanding immune tolerance induction and will give new insights to the immunologic mechanisms in lymphoid tissue level. We hope to demonstrate that the immunologic effects of sublingual pollen immunotherapy can be modified with a nasal live attenuated influenza vaccine and thereby it should give basis for other add-on treatments aiming for more effective immunotherapy. The influenza virus vaccine is expected to promote Th1 cell expression over Th2 cell expression. Since the immunologic outcomes will be correlated to clinical efficacy during next influenza and pollen seasons, we hope to understand the clinical significance of the immunologic outcomes.
Innovation and impact: The unique strength of the project is to answer essential questions on development of allergen tolerance and a protective vaccine response in a human in vivo situation that cannot be answered in other settings. The proposed investigations may substantially enlarge our knowledge on the pathogenesis of organ directed allergic and non-allergic inflammation in humans, because the experiments will be performed directly with disease associated human cells and tissues. We expect that novel genes and pathways of immune regulation can be identified in tonsils by a detailed investigation of human immune response development to sublingual immunotherapy and influenza vaccine. The transcriptome and epigenome of these groups and further analyses of the role of T cells, B cells and innate lymphoid cells will provide essential information particularly on differences between atopic and non-atopic individuals, and anti-vaccine responses, natural viral infection, chronic viral infection, mechanisms of hypertrophic tonsillitis versus recurrent tonsillitis. The identification of new immune tolerance and immune activation pathways involved in the regulation of tissue cells is expected to provide novel knowledge for many other diseases in addition to asthma, because dysregulated immune system activation occurs in various human disorders such as cancer, autoimmunity, transplantation rejection and chronic infections.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
BASIC_SCIENCE
NONE
Study Groups
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Timothy
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) (n=30) .
Live attenuated influenza virus
Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=60, 50:50 atopic:non-atopic).
Timothy + attenuated influenza virus
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) + Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=30).
Live attenuated influenza virus
Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=60, 50:50 atopic:non-atopic).
Timothy, Phleum pretense
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) (n=30) .
Timothy + attenuated influenza virus
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) + Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=30).
Timothy + attenuated influenza virus
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) + Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=30).
Timothy, Phleum pretense
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) (n=30) .
Live attenuated influenza virus
Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=60, 50:50 atopic:non-atopic).
No intervention
No intervention (n=60, 50:50 atopic:non-atopic).
No interventions assigned to this group
Interventions
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Timothy, Phleum pretense
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) (n=30) .
Live attenuated influenza virus
Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=60, 50:50 atopic:non-atopic).
Timothy + attenuated influenza virus
Allergen. Grazax® sublingual 75.000 SQ-T tablet (extracted from timothy, Phleum pretense), once daily until operation (ALK-Abelló, Hørsholm, Denmark) + Virus. Fluenz®, nasal live attenuated influenza vaccine, one 0.2 mL dose (MedImmune, Gaithersburg, USA) (n=30).
Eligibility Criteria
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Inclusion Criteria
* age \>4 and \<30 years
* written informed consent from the study subject or his/her guardian
* Fluenz® will be used for ages \>4 and \<30 years, i.e. off-label use of ages \>18 and \<30 years
Exclusion Criteria
* systemic diseases affecting the immune system e.g. autoimmune diseases, immune complex diseases or immune deficiency diseases other than allergy, asthma or atopic dermatitis
* malignancy, depression, psychiatric illness or medication; planned vaccination during the study period (vaccinations should not be given during study period)
* forced expiratory volume in 1 second (FEV1) is under 80% of normal value or asthma is in a bad balance for those patients who would participate in the immunotherapy
* sublingual grass pollen will not be given for children under the age of 5
4 Years
30 Years
ALL
Yes
Sponsors
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Academy of Finland
OTHER
Juselius Foundation, Helsinki, Finland
UNKNOWN
Foundation for Paediatric Research, Finland
OTHER
EVO special government transfers, Turku, Finland
UNKNOWN
Turku University Hospital
OTHER_GOV
Responsible Party
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Tuomas Jartti
Dr
Principal Investigators
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Tuomas Jartti, M.D.
Role: PRINCIPAL_INVESTIGATOR
Dept of Pediatrics, Turku University Hospital, Turku, Finland.
Cezmi Akdis, M.D., prof
Role: PRINCIPAL_INVESTIGATOR
Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
Locations
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Department of Otorhinolaryngology, Satakunta Central Hospital
Pori, , Finland
Department of Otorhinolaryngology, Salo Regional Hospital
Salo, , Finland
Department of Otorhinolaryngology, Turku University Hospital
Turku, , Finland
Department of Pediatrics, Turku University Hospital
Turku, , Finland
Countries
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Central Contacts
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Facility Contacts
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References
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Kucuksezer UC, Palomares O, Ruckert B, Jartti T, Puhakka T, Nandy A, Gemicioglu B, Fahrner HB, Jung A, Deniz G, Akdis CA, Akdis M. Triggering of specific Toll-like receptors and proinflammatory cytokines breaks allergen-specific T-cell tolerance in human tonsils and peripheral blood. J Allergy Clin Immunol. 2013 Mar;131(3):875-85. doi: 10.1016/j.jaci.2012.10.051. Epub 2012 Dec 23.
Palomares O, Ruckert B, Jartti T, Kucuksezer UC, Puhakka T, Gomez E, Fahrner HB, Speiser A, Jung A, Kwok WW, Kalogjera L, Akdis M, Akdis CA. Induction and maintenance of allergen-specific FOXP3+ Treg cells in human tonsils as potential first-line organs of oral tolerance. J Allergy Clin Immunol. 2012 Feb;129(2):510-20, 520.e1-9. doi: 10.1016/j.jaci.2011.09.031. Epub 2011 Nov 3.
Other Identifiers
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Tons2
Identifier Type: -
Identifier Source: org_study_id
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