Sema 4A as a Marker for Inflammatory Disease in Multiple Sclerosis

Study Overview
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Brief Summary
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Measure serum and cerebrospinal fluid Sema4A levels in female subjects with newly diagnosed and untreated relapsing multiple sclerosis, clinically stable relapsing multiple sclerosis receiving disease modifying therapy, relapsing multiple sclerosis receiving disease modifying therapy with breakthrough disease, or non-multiple sclerosis controls (patients without inflammatory central nervous system disease).

Detailed Description
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This pilot study proposal will further investigate whether Semaphorin 4A (Sema4A) elevation in cerebrospinal fluid (CSF) and serum is a potential disease activity biomarker in patients with multiple sclerosis (MS). A total of 40 female subjects between the ages of 18-55 who meet the criteria of one of the following four groups will be enrolled to measure serum and CSF Sema4A levels: Group 1: Newly diagnosed/untreated Relapsing MS patients (RMS) Group 2: Clinically stable RMS patients receiving disease modifying therapy (DMT) Group 3: RMS patients receiving DMT with breakthrough disease Group 4: Non-MS controls (patients without inflammatory CNS disease) Participants will provide blood and CSF samples at baseline for Sema4A analysis. Follow up blood samples will be collected at 6 months and 12 months as part of lymphocyte subset analysis. Participation will end after 12 months of follow up. The expected risks are related to blood draws and lumbar puncture. Lumbar puncture will be performed under fluoroscopy to decrease risks of pain from repeated needle punctures, injury from incorrect placement of the needle, and post puncture CSF leakage.

Official Title
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Sema 4A as a Marker for Inflammatory Disease in Multiple Sclerosis

Conditions
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Relapsing Multiple Sclerosis, Multiple Sclerosis

Intervention / Treatment
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* Diagnostic Test: Cerebrospinal and Blood Serum Semaphorin 4A Levels


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female aged 18-55, inclusive at the time of consent Not pregnant at the time of the screening/baseline visit Able to understand the purpose, benefits, and risks of the study; willing and able to adhere to the study requirements; able and provide informed consent in English Meet the criteria of one of the four groups at the time of consent: Group 1: subjects who have recently been diagnosed with MS, have had a clinical attack within the last 6 months, have not received steroids in the last 30 days, and have not started on a disease modifying therapy Group 2: subjects with clinically stable relapsing MS, with no evidence of clinical relapse for at least the past 12 weeks, and have no gadolinium enhancing lesions on MRI in the prior 4 weeks, who are receiving a FDA-approved MS DMT Group 3: subjects with relapsing MS on a FDA-approved DMT but with evidence of breakthrough disease, with a documented clinical relapse and/or gadolinium-enhancing lesion(s) on brain or spinal cord MRI taken within the 4 weeks Group 4: subjects without evidence of inflammatory systemic or CNS disease, who require CSF removal for some other cause, such as for idiopathic intracranial hypertension or communicating hydrocephalus Exclusion Criteria: There are no exclusion criteria for this study.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Recently Diagnosed Multiple Sclerosis<br>Recently diagnosed MS, who have had a clinical attack within the last 6 months, have not received steroids in the last 30 days, and have not started on a disease modifying therapy (DMT). | Diagnostic Test: Cerebrospinal and Blood Serum Semaphorin 4A Levels<br>* Cerebrospinal fluid and serum will be collected at baseline to measure the level of semaphorin 4A.<br>|
| Clinically Stable Relapsing Multiple Sclerosis<br>Clinically stable relapsing MS, who are receiving a FDA-approved MS DMT and have had no evidence of a clinical relapse for at least the past 12 weeks or gadolinium enhancing lesions on MRI in the prior 4 weeks. | Diagnostic Test: Cerebrospinal and Blood Serum Semaphorin 4A Levels<br>* Cerebrospinal fluid and serum will be collected at baseline to measure the level of semaphorin 4A.<br>|
| Relapsing Multiple Sclerosis on Disease Modifying Therapy<br>Relapsing MS on a FDA-approved DMT with evidence of recent breakthrough disease, with a documented clinical relapse and/or gadolinium-enhancing lesion(s) on brain or spinal cord MRI taken within the 4 weeks. | Diagnostic Test: Cerebrospinal and Blood Serum Semaphorin 4A Levels<br>* Cerebrospinal fluid and serum will be collected at baseline to measure the level of semaphorin 4A.<br>|
| Healthy Volunteers<br>Patients without evidence of inflammatory systemic or CNS disease, who require CSF removal for some other cause, such as for idiopathic intracranial hypertension or communicating hydrocephalus. | Diagnostic Test: Cerebrospinal and Blood Serum Semaphorin 4A Levels<br>* Cerebrospinal fluid and serum will be collected at baseline to measure the level of semaphorin 4A.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood Serum Semaphorin 4A Levels | Measure blood serum semaphorin 4A levels at baseline | Baseline | 
| Cerebrospinal Fluid Semaphorin 4A Levels | Measure cerebrospinal fluid semaphorin 4A levels at baseline | Baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation between Semaphorin 4A levels and Demyelination and Axonal Degeneration | MRI will be performed at 6 months and 12 months to evaluate if there is a correlation between baseline semaphorin 4 A levels and demyelination and axonal degeneration. | 12 Months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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multiple sclerosis, relapsing multiple sclerosis, semaphorin 4A, sema4a, disease modifying therapy, biomarker