Clinical trial NCT06868979: Optical Imaging in X-linked Disorders.
Official title: Optical Imaging as a Diagnostic Tool for Monitoring Brain Function in X-linked Rare Disorders
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: Fragile X Syndrome (FXS)
Creatine Transporter Deficiency
Keywords: Fragile X syndrome
Optical imaging
brain function
Creatine transporter
cognitive function
reasoning tasks
Lead sponsor: Hospices Civils de Lyon
Sponsor class: OTHER
First posted: 2025-03-11
Enrollment: 88
Sex: MALE
Minimum age (years): 5
Maximum age (years): 35
Standard ages: CHILD
ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This is a multicentric prospective, cross-sectional case control study to determine biomarkers to be used in future clinical trials in CTD and FXS patients.
Primary purpose: OTHER

Brief summary: Fragile X syndrome (FXS, OMIM #300624) and Creatine Transporter Deficiency (CTD, #300352) are the two most common causes of X-linked intellectual disability. FXS and CTD affect hemizygous males and with highly variable severity heterozygous females. Both these neurodevelopmental disorders (NDDs) have a dramatic impact on the family quality of life and the health-care system. These disorders share common clinical traits, including intellectual disability, autistic-like features, behavioural and mood alterations and seizures. Brain anatomy appears largely normal, suggesting that functional deficits result from subtle changes in synaptic connectivity. Moreover, common physiological mechanisms related to brain energetics might concur to the pathophysiology of FXS and CTD. Indeed, FMR1 and SLC6A8 are directly involved in the regulation of metabolism and the loss-of-function of both genes leads to a disruption of the mitochondrial network.

There is no cure for these disorders and the efficacy study of potential treatments is hindered by the scarcity of unbiased, quantitative, non-invasive biomarkers for monitoring brain function.

This is a critical problem, since the often-used phenotypic observation of behavioural endpoints to score NDDs such as FXS and CTD is highly prone to subjective bias. For successful clinical trials, the availability of objective readouts is crucial to evaluate the therapeutic response to new drugs. There are multiple techniques to visualize neural circuit activity in the living brain. Interestingly, FXS and CTD are the only two NDDs that at preclinical level show an abnormally large hemodynamic response to sensory stimulation in functional imaging studies of intrinsic optical signals.

The objective of this project is to exploit optical imaging techniques to devise a measurable and non-invasive biomarker of brain function in FXS and CTD. Since a disruption of brain energy metabolism is a major disease mechanism linking these disorders, we hypothesized that the assessment of the cerebral blood flow and oxygen consumption represents a sensitive readout for quantifying functional alterations of neural circuits.

Functional near-infrared spectroscopy (fNIRS), allows quantifying changes of hemoglobin species and local blood flow in the cerebral cortex of humans, providing an indirect measure of neuronal activity. In the clinical framework, this blood-oxygen-level-dependent signal is similar to that detected with functional MRI (fMRI). However, fNIRS has the advantage of being completely non-invasive, low-cost, portable, noiseless, endowed with high experimental flexibility and easy to implement in both laboratory and clinical settings. Moreover, fNIRS is more tolerant to motion artifacts than fMRI, and robust methods for motion detection/correction allow to image very young children without sedation. These methodological strengths make fNIRS as an outstanding choice for investigating neural circuits in clinically relevant populations at the very-low cost. Although introduced into the clinical care almost 40 years ago, fNIRS gained much popularity in the study of brain development and NDDs only recently. To date, however, fNIRS has been used primarily to investigate the typical maturation of speech perception and language, sensory and motor functions, social communication and interaction, object and action processing in toddlers and children.

In this proposal, the investigators hypothesize that by combining the above-mentioned strengths of fNIRS to the clinical study of several cognitive and motor parameters, the investigators can define unique "fNIRS signatures" for FXS and CTD as brain biomarkers for the diagnosis and the assessment of treatment outcomes. Since the measurement of visual responses has been introduced as a quantitative method to assess brain function in NDDs, the investigators will test the value of visually-evoked fNIRS signals in classifying patients and predicting symptom severity in the FXS and CTD clinical population. Preliminary data in the mouse models of CTD and FXS strongly suggest that visual hemodynamic responses (vHDR) are markedly altered in the occipital cortex of mutant animals. Morever, the investigators will use a standardized procedure with high entertaining value to measure vHDR in the occipital cortex of children.


Eligibility criteria: Inclusion Criteria :

CTD patients :

* male
* having a confirmed mutation in the SLC6A8 gene
* ≥ 5 to ≤ 35 years old
* whose maternal language is French,
* having signed the informed consent and/or for whom parents (for children)/legal guardian (for protected adults) have signed the informed consent.
* affiliated to national Health Insurance system (sécurité sociale) or parents/legal guardian affiliated to national health insurance system

FXS patients :

* male
* having a confirmed full mutation in the FMR1 gene (\>200 GCC repeats)
* ≥ 5 to ≤ 35 years old
* whose maternal language is French,
* having signed the informed consent and/or for whom parents (for children)/legal guardian (for protected adults) have signed the informed consent.
* affiliated to national Health Insurance system (sécurité sociale) or parents/legal guardian affiliated to national health insurance system

Chronological age-matched controls :

* male
* ≥ 5 to ≤ 35 years old
* whose maternal language is French,
* having signed the informed consent and/or for whom parents have signed the informed consent.
* affiliated to national Health Insurance system (sécurité sociale) or parents/legal guardian affiliated to national health insurance system

Exclusion Criteria:

CTD patients :

* Refusal of the subject and/or the subject's parents/legal guardian to sign the informed consent
* Refusal of the subject and/or the subject's parents/legal guardian to be informed of possible abnormalities detected during the neuropsychological assessment.

FXS patients :

* Refusal of the subject and/or the subject's parents/legal guardian to sign the informed consent
* Refusal of the subject and/or the subject's parents/legal guardian to be informed of possible abnormalities detected during the neuropsychological assessment.

Chronological age-matched controls :

* Refusal of the subject and/or the subject's parents/legal guardian to sign the informed consent
* Refusal of the subject and/or the subject's parents/legal guardian to be informed of possible abnormalities detected during the neuropsychological assessment.
* History of neurological or psychiatric disorder,
* Repetition of a grade,
* Learning disability requiring rehabilitation (speech therapy, psychomotor or oculomotor therapy).

Primary outcomes:
measure: Amplitude of the visual hemodynamic response
timeFrame: Inclusion visit
measure: Latency of the visual hemodynamic response
timeFrame: Inclusion visit
Secondary outcomes:
measure: Clinical Endpoints_Presence of epilepsy
timeFrame: Inclusion visit
measure: Clinical Endpoints_Type of epilepsy
timeFrame: Inclusion visit
measure: Clinical Endpoints_Treatment of epilepsy
timeFrame: Inclusion visit
measure: Clinical endpoints_Developmental trajectory
timeFrame: Inclusion visit
measure: Clinical endpoints_Autism spectrum disorder (ASD)
timeFrame: Inclusion visit
measure: Cognitive assessment with Leiter 3 scale
timeFrame: Inclusion visit
measure: Cognitive assessment with Bayley 4 scale
timeFrame: Inclusion visit
measure: Language assessment with the PPVT-5 test
timeFrame: Inclusion visit
measure: Language assessment with the EVT-3 test
timeFrame: Inclusion visit
measure: Reasoning tasks
timeFrame: Inclusion visit
measure: Parental questionnaires to assess adaptive abilities (Vineland 2)
timeFrame: Inclusion visit
measure: Parental questionnaires to assess behavioral disorder (ABC 2)
timeFrame: Inclusion visit
measure: Parental questionnaires to assess behavioral disorder (CBCL)
timeFrame: Inclusion visit
measure: Parental questionnaires to assess autistic features (PDD-MRS)
timeFrame: Inclusion visit
measure: Parental questionnaires to assess autistic features (SRS2)
timeFrame: Inclusion visit
measure: Parental questionnaires to assess executive functions (BRIEF)
timeFrame: Inclusion visit
Other outcomes:
Locations:
city: Bron
country: France
facility: Woman, mother and child hospital, Hospices Civils de Lyon
Study officials:
References: