Clinical trial NCT05746845: Implication of 5-HT7 Receptor in Inflammatory Mechanisms in Multiple Sclerosis
Official title: RESEPTOR 5-HT7 : Interest of the 5-HT7 Serotonin Receptor as a Biomarker in Multiple Sclerosis
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Healthy
Multiple Sclerosis
Keywords: Multiple sclerosis
Serotonin
5-HT7 receptor
Inflammation
Lymphocytes
Monocytes
Cytokines
Lead sponsor: Centre Hospitalier Régional d'Orléans
Sponsor class: OTHER
First posted: 2023-02-28
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Group 1: Healthy individuals, so-called "control" donors whose blood samples will be collected from the EFS (French Blood Establishment) Group 2: Stable MS patients without inflammatory activity of the disease under high efficacy treatment (Natalizumab or Ocrelizumab) Group 3: Stable MS patients without inflammatory disease activity under moderately effective treatment (Teriflunomide or Fumarate)

Brief summary: Multiple Sclerosis is a chronic autoimmune disease associated with inflammatory response harmful for the Central Nervous System. Immunological imbalance is involved with Th1 and Th17 cells in correlation with a disturbance of regulators mechanisms as Treg cells. Despite years of research, the mechanisms involved remain unclear.

Serotonin (5-HT) seems to be play an essential role in developing CNS inflammatory diseases and in particular in MS. Indeed, several studies have shown the anti-inflammatory potential of this neurotransmitter and also its vulnerability in inflammatory context. Moreover, a recent study has shown that 5-HT can reduced CD4 T cells proliferation and pro-inflammatory cytokines released in vitro. Interestingly, treatment, treatment with SSRIs (selective serotonin reuptake inhibitor) in an animal model of MS, on Experimental Autoimmune Encephalomyelitis, was shown to improve the clinical score and promote remission of the disease.

Among serotonin receptors, the 5-HT7 receptor, can be considered as an interesting target to treat neurological disorders associated with inflammatory context. Present in humans and mice, this receptor is expressed on the surface of a large number of cells, such as T-lymphocytes, macrophages, dendritic cells as well as on cells of CNS such as neurons, astrocytes and microglia.

Given the importance of the positive cells for 5-HT7 receptor, in the inflammatory context observed in multiple sclerosis, the investigators propose to study the receptor expression in blood samples from multiple sclerosis patient.

Detailed description: In a previous translational study (5-HT SEP), the expression modulation of 5-HT7 receptor in function of immunological context was investigated, in different group of MS patients:

* Group 1: MS patients with an acute relapse
* Group 2: MS stable patients treated with Natalizumab
* Group 3: Healthy people (from Etablissement Français du Sang) From blood cells of different groups of individuals, the investigators determined the percentage and intensity of expression of the receptor on circulating lymphocytes by flow cytometry.

The investigators demonstrated in this first study that the 5-HT7 receptor is mainly expressed on the surface of B lymphocytes compared to T lymphocytes.

Interestingly, while the percentage of T lymphocytes (CD4+, CD8+) remained unchanged between the 3 groups, the investigators observed that the expression of R5-HT7 on the surface of the T lymphocyte subpopulations (Th1, Th2, Th17 and Treg), is significantly increased in the blood of MS patients treated with Natalizumab compared to healthy individuals and MS patients in relapse.

Considering litterature data and our preliminary results showing the therapeutic potential of 5-HT7R ligand in animal models of MS as well as the upregulation of 5-HT7 expression in NTZ-treated patients (5-HTSEP study), the investigators wish to go further with these investigations. The main objective of this new translational study is to demonstrate the interest of the 5-HT7 serotonin receptor as a biomarker in the therapeutic monitoring of patients suffering from Multiple Sclerosis.

The investigators first want to know if the increase in the expression of R5-HT7 on the surface of lymphocyte populations in stable MS patients is due specifically to Natalizumab treatment or if other treatments would also induce a similar effect. To answer this question, the investigators will study the expression of the receptor not only on the surface of lymphocyte cells but also on the surface of monocytes, NK cells and polymorphonuclear cells (cells not investigated in the first 5-HTSEP study) in three groups of individuals:

* Group 1: Healthy individuals, so-called "control" donors whose blood samples will be collected from the EFS (French Blood Establishment)
* Group 2: Stable MS patients without inflammatory activity of the disease treated with high efficacy treatment (Natalizumab or Ocrelizumab)
* Group 3: Stable MS patients without inflammatory disease activity treated with moderately effective treatment (Teriflunomide or Fumarate)

Group 1 (healthy volunteers) is a control group necessary for the smooth running of the study and the interpretation of the results.

For group 2, the Natalizumab treatment has already been investigated during the previous 5-HTSEP study. This new study will make it possible to 1) compare the expression/activity of the receptor in the three groups 2) check the reproducibility of the results compared to the previous study 3) evaluate any variations linked to the temporality of the treatment with 2 blood samples, a first before injection of Natalizumab, a second 14 days later. Indeed, unlike the 5-HTSEP study, where a single sample 1 month after injection of Natalizumab was analysed, the investigators wish to take these two samples, in order to carry out a longitudinal study making it possible to observe the evolution of the expression of the 5-HT7 receptor as a function of the temporality of the treatment.

Group 3 will assess whether other treatments (teriflunomide or fumarate) can induce an effect similar to that observed after Natalizumab treatment which is associated with an increase of R5-HT7 expression on the surface of lymphocyte populations in stable MS patients.

Eligibility criteria: Inclusion Criteria:

* Men and women
* Aged between 18 and 50 years old,
* With multiple sclerosis already diagnosed and fulfilling the modified Mc Donald criteria
* Stable (no relapse in the last 6 months and MRI less than a year old, with no new lesions) and with at least 1 year of treatment with Natalizumab, Ocrelizumab, Teriflunomide or Fumarate
* Subject medically fit to give a maximum of 50 ml of extra whole blood
* Patient having given their consent to participate in the study

Exclusion Criteria:

* HIV serology known or discovered during the present episode
* Demented patient
* Patient treated with corticosteroids in the last month
* Non-affiliated person or non-beneficiary of a social security scheme
* Uncooperative patient
* Patient under legal protection, guardianship or curatorship
* Pregnant or breastfeeding women

Primary outcomes:
measure: 5-HT7 receptor expression on circulating cells
timeFrame: Day 1
Secondary outcomes:
measure: Expression of the 5-HT7 receptor after positive selection of different cell populations from PBMC
timeFrame: Day 15
measure: Expression of the different isoforms of the 5-HT7 receptor on PBMC
timeFrame: Day 15
measure: Functional activity of the 5-HT7 receptor on PBMC: protein studies
timeFrame: Day 15
measure: Functional activity of the 5-HT7 receptor on PBMC: mRNA expression studies
timeFrame: Day 15
measure: Relationship between Multiple sclerosis treatment on inflammation and serotonin production in serum
timeFrame: Day 15
Other outcomes:
Locations:
city: Orléans
country: France
facility: CHR Orléans
Study officials:
affiliation: CHR d'Orleans
name: Maud PALLIX-GUYOT, Dr
role: PRINCIPAL_INVESTIGATOR
References:
citation: Sacramento PM, Monteiro C, Dias ASO, Kasahara TM, Ferreira TB, Hygino J, Wing AC, Andrade RM, Rueda F, Sales MC, Vasconcelos CC, Bento CAM. Serotonin decreases the production of Th1/Th17 cytokines and elevates the frequency of regulatory CD4+ T-cell subsets in multiple sclerosis patients. Eur J Immunol. 2018 Aug;48(8):1376-1388. doi: 10.1002/eji.201847525. Epub 2018 Jun 6.
citation: Yuan XQ, Qiu G, Liu XJ, Liu S, Wu Y, Wang X, Lu T. Fluoxetine promotes remission in acute experimental autoimmune encephalomyelitis in rats. Neuroimmunomodulation. 2012;19(4):201-8. doi: 10.1159/000334095. Epub 2012 Mar 21.