Diagnostic Tools for Human African Trypanosomiasis Elimination and Clinical Trials: Early Test-of-cure

NCT ID: NCT03112655

Last Updated: 2021-02-21

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 88 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-02-24
• Study Completion Date: 2021-01-31

Brief Summary

The study validates the diagnostic performance of cerebrospinal fluid neopterin quantification and of blood and cerebrospinal fluid trypanosomal spliced leader RNA detection for assessing outcome after treatment of human African trypanosomiasis.

Detailed Description

In the last decade, the prevalence of Trypanosoma brucei gambiense human African trypanosomiasis (HAT) has fallen and HAT has been targeted for elimination. Development of safe and efficacious drugs for HAT, applicable in an elimination context, is considered as a high priority. The drug developmental process is however slowed down by the need to follow-up treated patients for 18 months to decide on cure. For timely diagnosis of treatment failure in clinical trials, patients should have control visits with follow-up examinations at 6, 12 and 18 months after treatment. Furthermore, due to repeated lumbar punctures, treated patients refrain to present for control visits spontaneously, and tend not to comply with follow-up. Clinical trials on new drugs for HAT would therefore be accelerated by availability of an early test of cure. Trypanosomal spliced leader (SL)-RNA, neopterin & 5-hydroxytryptophan are good candidates for accurate and shortened treatment follow-up. In particular SL-RNA detection in blood offers an opportunity for non-invasive post-treatment follow-up.

The objective of the DiTECT-HAT-WP4 study is to validate the diagnostic performance of cerebrospinal fluid neopterin & 5-hydroxytryptophan quantification and of blood and cerebrospinal fluid trypanosomal spliced leader RNA detection for assessing treatment outcome. The DiTECT-HAT-WP4 study is embedded into an ongoing therapeutic phase II/III study (DNDi-OXA-02-HAT) testing a new oral single dose drug against HAT. Within the Framework of the therapeutical trial, patients will have post-treatment examinations, including blood and cerebrospinal fluid examination at day 11, and during follow-up at month 6, month 12 and month 18. Combination of DiTECT-HAT-WP4 with this ongoing clinical trial allows evaluation of new treatment outcome assessment markers during follow-up without the need for additional lumbar or venipunctures. The volumes of venous blood and cerebrospinal fluid taken will be increased by 2.5 mls for the DiTECT-HAT-WP4 study.

Reverse transcriptase real time PCR for spliced leader RNA detection in blood and cerebrospinal fluid and neopterin detection will be carried out in the reference laboratory in Kinshasa, (index tests). The reference laboratory will be blinded to the results of the reference standard. For evaluation of diagnostic performance of the index tests, the reference standard will consist of classification of treatment outcome according to international standards applied for the clinical trial. Receiver operator curves, sensitivity and specificity of the different index tests for treatment outcome assessment will be determined at each follow-up time point. If sufficiently accurate, trypanosomal spliced leader RNA detection in blood would allow post-treatment follow-up without the need for lumbar punctures. Improved treatment outcome assessment will not only facilitate follow-up by avoiding the feared lumbar puncture but also speed up the development and implementation of new drugs. In addition, it will also improve management of patients in routine. The proposed research will impact on clinical decision and treatment outcomes, and contribute to successful HAT elimination.

Conditions

African Trypanosomiasis; African; Trypanosomiasis, West; Sleeping Sickness; West African; Trypanosoma Brucei Gambiense; Infection

Study Design

• Allocation Method: NA
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: NONE

Study Groups

Human african trypanosomiasis patient

RNA, neopterin and 5-hydroxytryptophan detection

Group Type: EXPERIMENTAL

RNA and neopterin detection

Intervention Type: DIAGNOSTIC_TEST

Detection of spliced leader RNA will be performed on blood and cerebrospinal fluid taken before treatment, 11 days after treatment, 6, 12 and 18 months after treatment. Neopterin and 5-hydroxytryptophan will be quantified in cerebrospinal fluid taken at the same time points.

Interventions

RNA and neopterin detection

Detection of spliced leader RNA will be performed on blood and cerebrospinal fluid taken before treatment, 11 days after treatment, 6, 12 and 18 months after treatment. Neopterin and 5-hydroxytryptophan will be quantified in cerebrospinal fluid taken at the same time points.

Intervention Type: DIAGNOSTIC_TEST

Other Intervention Names

Reverse transcriptase real-time PCR Trypanozoon SL-RNA; Neopterin & 5-hydroxytryptophan EIA, Mybiosource

Eligibility Criteria

Inclusion Criteria

• Eligible for participation in DNDi-OXA-02-HAT clinical trial

Exclusion Criteria

• Excluded for DNDi-OXA-02-HAT clinical trial; No informed consent for participation in the DiTECT-HAT-WP4 study

• Minimum Eligible Age: 15 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Institute of Tropical Medicine, Belgium

OTHER

Sponsor Role: collaborator

Institut National de Recherche Biomédicale. Kinshasa, République Démocratique du Congo

OTHER

Sponsor Role: collaborator

Ministry of Public Health, Democratic Republic of the Congo

OTHER_GOV

Sponsor Role: collaborator

Institut de Recherche pour le Developpement

OTHER_GOV

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Veerle Lejon, PhD

Role: PRINCIPAL_INVESTIGATOR

Institut de Recherche pour le Developpement

Locations

Programme Nationale de Lutte contre la trypanosomiase humaine Africaine

Kinshasa, , Democratic Republic of the Congo

Countries

Democratic Republic of the Congo

References

Gonzalez-Andrade P, Camara M, Ilboudo H, Bucheton B, Jamonneau V, Deborggraeve S. Diagnosis of trypanosomatid infections: targeting the spliced leader RNA. J Mol Diagn. 2014 Jul;16(4):400-4. doi: 10.1016/j.jmoldx.2014.02.006. Epub 2014 May 9.

Reference Type: BACKGROUND

PMID: 24814957 (View on PubMed)

Ilboudo H, Camara O, Ravel S, Bucheton B, Lejon V, Camara M, Kabore J, Jamonneau V, Deborggraeve S. Trypanosoma brucei gambiense Spliced Leader RNA Is a More Specific Marker for Cure of Human African Trypanosomiasis Than T. b. gambiense DNA. J Infect Dis. 2015 Dec 15;212(12):1996-8. doi: 10.1093/infdis/jiv337. Epub 2015 Jun 16.

Reference Type: BACKGROUND

PMID: 26080371 (View on PubMed)

Tiberti N, Lejon V, Hainard A, Courtioux B, Robin X, Turck N, Kristensson K, Matovu E, Enyaru JC, Mumba Ngoyi D, Krishna S, Bisser S, Ndung'u JM, Buscher P, Sanchez JC. Neopterin is a cerebrospinal fluid marker for treatment outcome evaluation in patients affected by Trypanosoma brucei gambiense sleeping sickness. PLoS Negl Trop Dis. 2013;7(2):e2088. doi: 10.1371/journal.pntd.0002088. Epub 2013 Feb 28.

Reference Type: BACKGROUND

PMID: 23469311 (View on PubMed)

Vincent IM, Daly R, Courtioux B, Cattanach AM, Bieler S, Ndung'u JM, Bisser S, Barrett MP. Metabolomics Identifies Multiple Candidate Biomarkers to Diagnose and Stage Human African Trypanosomiasis. PLoS Negl Trop Dis. 2016 Dec 12;10(12):e0005140. doi: 10.1371/journal.pntd.0005140. eCollection 2016 Dec.

Reference Type: BACKGROUND

PMID: 27941966 (View on PubMed)

Ngay Lukusa I, Van Reet N, Mumba Ngoyi D, Mwamba Miaka E, Masumu J, Patient Pyana P, Mutombo W, Ngolo D, Kobo V, Akwaso F, Ilunga M, Kaninda L, Mutanda S, Mpoyi Muamba D, Valverde Mordt O, Tarral A, Rembry S, Buscher P, Lejon V. Trypanosome spliced leader RNA for diagnosis of acoziborole treatment outcome in gambiense human African trypanosomiasis: A longitudinal follow-up study. EBioMedicine. 2022 Dec;86:104376. doi: 10.1016/j.ebiom.2022.104376. Epub 2022 Nov 24.

Reference Type: DERIVED

PMID: 36436279 (View on PubMed)

Ngay Lukusa I, Van Reet N, Mumba Ngoyi D, Miaka EM, Masumu J, Patient Pyana P, Mutombo W, Ngolo D, Kobo V, Akwaso F, Ilunga M, Kaninda L, Mutanda S, Muamba DM, Valverde Mordt O, Tarral A, Rembry S, Buscher P, Lejon V. Trypanosome SL-RNA detection in blood and cerebrospinal fluid to demonstrate active gambiense human African trypanosomiasis infection. PLoS Negl Trop Dis. 2021 Sep 17;15(9):e0009739. doi: 10.1371/journal.pntd.0009739. eCollection 2021 Sep.

Reference Type: DERIVED

PMID: 34534223 (View on PubMed)

Related Links

http://apps.who.int/iris/bitstream/10665/173583/1/9789241508834_eng.pdf?ua=1

Human African trypanosomiasis: update of the methodological framework for clinical trials

https://clinicaltrials.gov/ct2/show/NCT01533961

phase 1 study of drug now in phase 2/3

Other Identifiers

DiTECT-HAT-WP4

Identifier Type: -

Identifier Source: org_study_id