N-PhenoGENICS: Neurocognitive-Phenome, Genome, Epigenome and Nutriome In Childhood Leukemia Survivors

Study Overview
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Brief Summary
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To find possible therapeutic targets to help prevent long-term brain and behavioural side effects in survivors of childhood leukemia that may have been caused by chemotherapy (Treatment-Related late Adverse Neuro-Cognitive Effects: TRANCE). The study hypothesis is that genetic variations of the elements in the folate-related cycles and methotrexate disposition networks are associated with the deficit phenotype (TRANCE) of childhood leukemia survivors.

Detailed Description
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Hypothesis Genetic variants of the elements in the folate-related cycles and methotrexate disposition networks are associated with the TRANCE phenotype of childhood leukemia survivors. Objectives To identify TRANCE phenotypes of the childhood leukemia survivors. To characterize the folate and vitamin B12 levels of these children To identify DNA methylation patterns associated with TRANCE trait in the leukemia survivors To identify SNPs associated with the TRANCE trait in the leukemia survivors. To identify the deficit genotype associated only with the TRANCE leukemia survivors, but not with general population children who show developmental phenotypes similar to TRANCE: TRANCE-unique deficit variant To replicate the association between the TRANCE-unique deficit variants and the TRANCE trait in a population of childhood leukemia survivors. To evaluate the importance of rare genetic variants in the TRANCE trait in the leukemia survivors. Study design: A case-control study of leukemia survivors Analyses Leukemia survivors will be characterized by their status of neurocognitive function, and categorized into the Deficit case and the non-deficit Control case. They will be also characterized by the following attributes Pathway-based genetic variant status (folate and PK-related genes) Folate and vitamin B12 status Epigenetic markers Comparative analyses between neuro-cognitiive deficit phenotype (TRANCE) and Control on those parameters

Official Title
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N-PhenoGENICS: Neurocognitive-Phenome, Genome, Epigenome and Nutriome In Childhood Leukemia Survivors

Conditions
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Childhood Leukemia Survivors

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Past diagnosis of acute lymphoblastic leukemia 8 years : 0 months - 20 years : 11 months old at the time of their study visit At least 2 years : 0 months from the last treatment for acute lymphoblastic leukemia at the time of their study visit Continuous complete remission and undergone no bone marrow transplantation or cranial radiation therapy Fluent in English (a subject and one parent) for test completion Signed informed consent Exclusion Criteria: Inability to complete the phenotyping tests Down Syndrome diagnosis

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Leukemia survivors with neurocognitive deficit<br>Leukemia survivors with neuro-cognitive deficit phenotype. Based on DIVERGET and other phenotyping tools, we will identify those with the deficit phenotype. This will be treated as case. | |
| Leukemia survivors without neurocognitive deficit<br>Leukemia survivors who did not show impaired neurocognitive function, compared to the Control group defined above. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| DIVERGET | This is a short battery of tests that has been shown to be predictive of both global and academic impairment in survivors of childhood cancer. All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| Stop Signal Task (SST) | Response inhibition, disturbed by behavioral inattention, will be characterized using our task-based computer program, the Stop Signal Task (SST). All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| CONNERS 3 | To characterize behavioural aspects, we will administer the standard measure based on parent report. All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| Pathway-based gene variant status | In the hypothesis-driven genome-wide approach, we will focus on the candidate pathways/regions including (but not limited to): a) Folate/methionine cycle genes and transporters; b) drug metabolizing enzymes and transporters (including families of CYP, SLC and ABC transporters); c) epigenetic modifying factors; and d) neuro-regeneration and tissue repair. | Within 3 months from the end of enrolment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| WISC-IV | In order to confirm validity of DIVERGT in our sample, and provide the data source for future studies, we will include tests of general cognitive function (WISC-IV). All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| WIAT-III numerical operations and math fluency composite score | In order to confirm validity of DIVERGT in our sample, and provide the data source for future studies, we will include tests of general cognitive function: WIAT-III numerical operations and math fluency composite score. All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| Brief Rating Inventory of Executive Function (BRIEF) | In order to confirm validity of DIVERGT in our sample, and provide the data source for future studies, we will administer Brief Rating Inventory of Executive Function (BRIEF), which is designed to assess executive functioning in the home environment. All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| N-Back Task | In order to confirm validity of DIVERGT in our sample, and provide the data source for future studies, we will administer N-Back Task, which is a continuous performance computerized task used to measure aspects of working memory. All neuro-cognitive tests are done on a same day. | Within 6 months from the enrolment | 
| Folate, vitamin B12 and iron intake | Folate and other vitamin intakes vary among individuals. Folic acid fortification in Canadian food product has changed the Canadian population norm of folate status, virtually eliminating folate deficiency status. However, a large inter-individual variation still remains. We will use a Supplement Questionnaire to capture information on all and any supplements that participants may be currently taking. | Within 6 months from the enrolment | 
| Folate status | In order to complement the Supplement Questionnaire (above), we will measure the folate concentration in plasma and red blood cells. | Within 6 months from the enrolment | 
| Serum vitamin B12 | Vitamin B12 and folate pathways interact to maintain biochemical homeostasis. To complement the intake assessment (above), we will measure serum vitamin B12. | Within 6 months from the enrolment | 
| Iron status | Iron status affects cognitive function of children. In addition to the intake assessment (above), we will estimate iron status by measuring hemoglobin and soluble transferrin receptor. | Within 6 months from the enrolment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Childhood leukemia survivors, Acute lymphoblastic leukemia, Leukemia, Late effects, Folate, Blood folate, Neurotoxicity, Methotrexate, Pharmacogenetics, Cognitive, Cognitive late effects, N-PhenoGENICS