Genotype-phenotype Association in Hereditary Hemorrhagic Telangiectasia

Study Overview
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Brief Summary
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The present project aims to study the inflammatory and endothelial responses involved in the differences in clinical events related to both genotypes (ENG vs. ACVRL1) in HHT. Accordingly, a cross-sectional study is proposed to evaluate the differences in circulating inflammatory and endothelial biomarkers, including interleukines, adhesion molecules, chemokines and immune regulatory molecules between both HHT groups.

Detailed Description
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Background and rationale: Hereditary Hemorrhagic Telangiectasia (HHT) is a rare disease characterized by a multisystemic vascular dysplasia with autosomal dominant inheritance, mainly caused by mutations in ENG and ACVRL1 genes. Even though those mutations have been related to different clinical manifestations, the molecular mechanisms involved in each genetic variant have not been clarified. Methods: A cohort study will be carried out to compare the incidence of clinical events after a 12-months follow-up. The ability of these biomarkers to predict the clinical events will be assessed in a multivariate analysis.

Official Title
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Genotype-phenotype Association Study of ENG and ACVRL1 Genes in the Inflammatory and Endothelial Response in Hereditary Hemorrhagic Telangiectasia (HHT)

Conditions
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Hereditary Hemorrhagic Telangiectasia, HHT, Rendu Osler Weber Disease

Intervention / Treatment
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* Other: Registry


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age between 18 and 75 years. Confirmed diagnosis of HHT, according to the Curaçao criteria or genetic diagnosis. Clinically stable condition at the time of inclusion, defined as score < 7 points on the Epistaxis Severity Score (ESS). Having signed the informed consent, after having received all the information concerning the study. Exclusion Criteria: Major coronary or cerebrovascular event in the 3 months prior to inclusion. Serious intercurrent illnesses, such as acute infections, outbreaks of autoimmune or inflammatory pathology, active cancer, or other pathologies that, at the investigator's discretion, could interfere with the conduct of the study. Major surgery during the 2 months prior to inclusion. Pharmacological treatment maintained during the 3 months prior to inclusion with NSAIDs, corticosteroids or chemotherapy. Toxic habits, including severe smoking, alcohol or drug abuse, which in the opinion of the investigator could interfere with the conduct of the study. Pregnancy or puerperium. Any other condition that limits compliance with the visits or procedures established in the protocol.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| HHT1<br>Mutations in the ENG (endoglin) gene | Other: Registry<br>* Non-interventional registry<br>|
| HHT2<br>Mutations in the ALK-1 (activin receptor-like kinase) gene | Other: Registry<br>* Non-interventional registry<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemorrhagic clinical events | Presence of significant bleeding of any location, recurrent and/or massive, or performance of therapeutic procedures to control them. | 12-month follow-up period after inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Other significant clinical events | Significant clinical events other than hemorrhagic episodes (e.g., infections, neoplasms or other severe diseases) | 12-month follow-up period after inclusion | 
| Changes in quality of life | Significant changes in quality of life as measured by the EuroQol 5-level EQ-5D version (EQ-5D-5L) and the EuroQol visual analogue scale (EQ VAS). EQ-5D-5L comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The index ranges from 1 (best state of health) to 0 (death). The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' (100 points) and 'The worst health you can imagine' (0 points). | 12-month follow-up period after inclusion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HHT, ENG, Hereditary Hemorrhagic Telangiectasia, Rendu Osler Weber Disease, Genotype-phenotype association, ALK-1