Evaluating the Genetics and Immunology of Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) Syndrome and Other Tonsil Disorders

• ClinicalTrials.gov Identifier: NCT05656365
• Recruitment Status: Recruiting
• First Posted: December 19, 2022
• Last Update Posted: March 25, 2024
• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
• Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) )

Study Description

Brief Summary:

Background:

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is the most common periodic fever syndrome of childhood. Symptoms can include swelling of the glands in the throat, mouth ulcers, and tonsillitis. Removal of the tonsils can stop the periodic flareups. But researchers do not know how PFAPA develops. In this natural history study, researchers will collect specimens and data from people with PFAPA to see what they might have in common.

Objective:

To collect blood and other specimens from people with PFAPA to learn more about the illness.

Eligibility:

People aged 1 month or older with symptoms of PFAPA or another tonsil disorder.

Design:

Participants will be screened. Their medical records will be reviewed. Researchers will ask about a family history of PFAPA.

The following specimens may be collected:

Blood. Blood will be drawn either from a needle inserted into a vein or from a prick in the finger or heel.

Mucus and cells. A stick with soft padding on the tip may be rubbed inside the nostrils or mouth.

Stool.

Saliva.

Tissue samples may be taken if participants are having surgery to remove the tonsils or adenoids. Participants having surgery may also have a nasopharyngeal wash; salt water will be squirted into the back of the throat and then sucked back out with a syringe.

Most participants will provide specimens only once. They can do this in person at the clinic; they can also have their local health providers send specimens to the researchers. Some participants may have optional follow-up visits over 10 years.

Condition or disease
Periodic Fever, Aphthous Stomatitis, Pharyngitis, And Cervical Adenitis (Pfapa); Obstructive Sleep Apnea; Tonsillitis; Tonsil Disorder; Sleep Disordered Breathing

Detailed Description:

Study Description:

The purpose of this multisite study is to collect specimens and data from patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome and other tonsil disorders for genetic, immunologic, cellular, molecular, and microbial research into the pathogenesis of these conditions. Specimens include blood, saliva, buccal swabs, oropharyngeal swabs, nasopharyngeal swabs, nasopharyngeal wash, and/or stool. If a participant is scheduled to undergo a clinically indicated tonsillectomy and/or adenoidectomy, then leftover clinical specimens will also be collected for research. Participants may either be seen in person at the study sites or may be seen remotely via telehealth and provide send-in samples collected locally.

Primary Objective:

To collect samples to understand the immunologic mechanisms and genetic and microbial risk factors for PFAPA and other tonsil disorders.

Primary Endpoints:

1. Identify genetic risk variants for PFAPA and other tonsil disorders.
2. Characterize immune cell populations, gene expression (including at the single-cell level), epigenetic features, and protein expression ex vivo in blood, tissue, washes, or swabs from people with PFAPA and other tonsil disorders.
3. Characterize the tonsillar/adenoid, oral, nasal and/or stool microbiota in people with PFAPA and other tonsil disorders.
4. Characterize clinical outcomes following tonsillectomy and other clinically indicated treatments.

Secondary Objective: To understand the characteristics and function of unique cell populations in the pharyngeal lymphoid tissues (tonsils and adenoids) and how immune responses to antigens are generated in these tissues.

Secondary Endpoints:

1. Study responses to antigens and infection in the mucosal lymphoid tissue and peripheral blood.
2. Characterize unique immune cell populations present in the mucosal tissue.
3. Characterize immunologic and molecular pathways in the tissue cells.

Study Design

• Study Type: Observational
• Estimated Enrollment: 1500 participants
• Observational Model: Cohort
• Time Perspective: Prospective
• Official Title: Evaluating the Genetics and Immunology of Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) Syndrome and Other Tonsil Disorders
• Actual Study Start Date: May 23, 2023
• Estimated Primary Completion Date: June 30, 2037
• Estimated Study Completion Date: December 31, 2038

Groups and Cohorts

Group/Cohort
Patients; Patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome and other tonsil disorders.

Outcome Measures

Primary Outcome Measures :

1. Identify genetic risk variants for PFAPA and other tonsil disorders [ Time Frame: Throughout study ]
   To collect samples to understand the immunologic mechanisms and genetic and microbial risk factors for PFAPA and other tonsil disorders
2. Characterize clinical outcomes following tonsillectomy and other clinically indicated treatments. [ Time Frame: Throughout study ]
   To collect samples to understand the immunologic mechanisms and genetic and microbial risk factors for PFAPA and other tonsil disorders
3. Characterize the tonsillar/adenoid, oral, nasal and/or stool microbiota in people with PFAPA and other tonsil disorders [ Time Frame: Throughout study ]
   To collect samples to understand the immunologic mechanisms and genetic and microbial risk factors for PFAPA and other tonsil disorders
4. Characterize immune cell populations, gene expression including at the single cell level, epigenetic features, and protein expression ex vivo in blood, tissue, washes, or swabs from people with PFAPA and other tonsil disorders [ Time Frame: Throughout study ]
   To collect samples to understand the immunologic mechanisms and genetic and microbial risk factors for PFAPA and other tonsil disorders

Secondary Outcome Measures :

1. Characterize immunologic and molecular pathways in the tissue cells. [ Time Frame: Throughout study ]
   To understand the characteristics and function of unique cell populations in the pharyngeal lymphoid tissues (tonsils and adenoids) and how immune responses to antigens are generated in these tissues
2. Study responses to antigens and infection in the mucosal lymphoid tissue and peripheral blood. [ Time Frame: Throughout study ]
   To understand the characteristics and function of unique cell populations in the pharyngeal lymphoid tissues(tonsils and adenoids) and how immune responses to antigens are generated in these tissues
3. Characterize unique cell populations and the immunologic and molecular pathways in the tissue cells [ Time Frame: Throughout study ]
   To understand the characteristics and function of unique cell populations in the pharyngeal lymphoid tissues (tonsils and adenoids) and how immune responses to antigens are generated in these tissues

Eligibility Criteria

• Ages Eligible for Study: 1 Month to 99 Years (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with PFAPA and other tonsil disorders.

Criteria

• INCLUSION CRITERIA:

Participants must meet all the following inclusion criteria to be eligible for this study:

1. Aged >=1 month. To be seen at the NIH CC, participants must be >=3 years of age.
2. Diagnosed with PFAPA or another tonsil disorder, or has symptoms consistent with these conditions, as determined by the investigator.
3. Able to provide informed consent (for ages >=18 years) or has a parent or guardian who can provide informed consent on their behalf (for ages <18 years).
4. Willing to allow specimens and data to be stored for future research.
5. Willing to allow genetic testing on their biospecimens.

EXCLUSION CRITERIA:

An individual who has any condition that, in the judgment of the investigator, may put them at undue risk or make them unsuitable for participation in the study will be excluded.

Contacts and Locations

Contacts

Contact: Mary T Bowes; (240) 408-0970; mbowes@cc.nih.gov

Contact: Kalpana Manthiram, M.D.; (301) 529-4787; kalpana.manthiram@nih.gov

Locations

United States, District of Columbia

Children's National Medical Center; Not yet recruiting

Washington, District of Columbia, United States, 20010

Contact: Srinivasalu Hemalatha 202-476-2800 HSriniva@childrensnational.org

United States, Indiana

Indiana University School of Medicine; Recruiting

Indianapolis, Indiana, United States, 46290

Contact: Rachel Lemont 317-944-7260 rlemont@iu.edu

Contact: Annette Childress (317) 944-7260 afoti@iu.edu

United States, Maryland

National Institutes of Health Clinical Center; Recruiting

Bethesda, Maryland, United States, 20892

Contact: For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR) 800-411-1222 ext TTY dial 711 ccopr@nih.gov

Contact: Mary Bowes (240) 408-0970 mbowes@cc.nih.gov

Sponsors and Collaborators

National Institute of Allergy and Infectious Diseases (NIAID)

Investigators

• Principal Investigator: Kalpana Manthiram, M.D.; National Institute of Allergy and Infectious Diseases (NIAID)

More Information

Additional Information:

NIH Clinical Center Detailed Web Page 

Publications:

Xu Q, Milanez-Almeida P, Martins AJ, Radtke AJ, Hoehn KB, Oguz C, Chen J, Liu C, Tang J, Grubbs G, Stein S, Ramelli S, Kabat J, Behzadpour H, Karkanitsa M, Spathies J, Kalish H, Kardava L, Kirby M, Cheung F, Preite S, Duncker PC, Kitakule MM, Romero N, Preciado D, Gitman L, Koroleva G, Smith G, Shaffer A, McBain IT, McGuire PJ, Pittaluga S, Germain RN, Apps R, Schwartz DM, Sadtler K, Moir S, Chertow DS, Kleinstein SH, Khurana S, Tsang JS, Mudd P, Schwartzberg PL, Manthiram K. Adaptive immune responses to SARS-CoV-2 persist in the pharyngeal lymphoid tissue of children. Nat Immunol. 2023 Jan;24(1):186-199. doi: 10.1038/s41590-022-01367-z. Epub 2022 Dec 19.

Manthiram K, Preite S, Dedeoglu F, Demir S, Ozen S, Edwards KM, Lapidus S, Katz AE; Genomic Ascertainment Cohort; Feder HM Jr, Lawton M, Licameli GR, Wright PF, Le J, Barron KS, Ombrello AK, Barham B, Romeo T, Jones A, Srinivasalu H, Mudd PA, DeBiasi RL, Gul A, Marshall GS, Jones OY, Chandrasekharappa SC, Stepanovskiy Y, Ferguson PJ, Schwartzberg PL, Remmers EF, Kastner DL. Common genetic susceptibility loci link PFAPA syndrome, Behcet's disease, and recurrent aphthous stomatitis. Proc Natl Acad Sci U S A. 2020 Jun 23;117(25):14405-14411. doi: 10.1073/pnas.2002051117. Epub 2020 Jun 9.

Stojanov S, Lapidus S, Chitkara P, Feder H, Salazar JC, Fleisher TA, Brown MR, Edwards KM, Ward MM, Colbert RA, Sun HW, Wood GM, Barham BK, Jones A, Aksentijevich I, Goldbach-Mansky R, Athreya B, Barron KS, Kastner DL. Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) is a disorder of innate immunity and Th1 activation responsive to IL-1 blockade. Proc Natl Acad Sci U S A. 2011 Apr 26;108(17):7148-53. doi: 10.1073/pnas.1103681108. Epub 2011 Apr 8.

• Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
• ClinicalTrials.gov Identifier: NCT05656365
• Other Study ID Numbers: 10001043; 001043-I
• First Posted: December 19, 2022
• Last Update Posted: March 25, 2024
• Last Verified: March 21, 2024

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: .Deidentified IPD that underlie results in a publication or associated with genomic data deposited in a data base will be shared.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Clinical Study Report (CSR); Analytic Code
• Time Frame: Will be shared at the time of publication or data deposition into data base.
• Access Criteria: Individual level data in dbGaP is controlled access as investigators must place a request and be approved by dbGaP. Aggregated data will be open access.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) ):

Genome-Wide Association Study (Gwas); Immunology; Autoinflammation; Tonsillitis; Obstructive Sleep Apnea; Sleep Disordered Breathing; Natural History

Additional relevant MeSH terms:

Hereditary Autoinflammatory Diseases; Pharyngitis; Tonsillitis; Stomatitis; Stomatitis, Aphthous; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Respiratory Aspiration; Lymphadenitis; Familial Mediterranean Fever; Amyloidosis; Fever; Apnea; Respiration Disorders; Respiratory Tract Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Nervous System Diseases; Pathologic Processes; Body Temperature Changes; Mouth Diseases; Stomatognathic Diseases; Respiratory Tract Infections; Infections; Pharyngeal Diseases; Otorhinolaryngologic Diseases; Genetic Diseases, Inborn; Proteostasis Deficiencies; Metabolic Diseases