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NCT Number: NCT07456358

Autoimmune Neurological Diseases and Those Secondary to Immunotherapy: Study of Immunological Mechanisms and Research Into Targets of Immune Attack

The pathophysiology of neurological toxicities secondary to immune checkpoint inhibitors (ICIs) is unknown. Various mechanisms have been proposed: activation of cytotoxic CD8 T cells, autoantibodies via activation of B cells and CD4 cells, non-specific inflammation through the production of pro-inflammatory cytokines, and complement activation.

The aim of this research is to characterise the pathophysiological mechanisms of neurotoxicities in cancer patients treated with ICIs.

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Key information

Conditions

Neurological Diseases Auto Immune Disease

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, France

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Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adult patient (aged ≥ 18 years)
  • Affiliated with a social security scheme
  • Express consent to participate in the study
  • Indication for lumbar puncture And
  • Patients with cancer, undergoing treatment with ICIs, presenting neurological symptoms after starting treatment with ICIs. These symptoms must have appeared no more than 3 months after the last administration of ICIs.

Or

  • Patients with an autoimmune disease of the central nervous system (diagnosis made by teams 1, 2 and 3) according to internationally recognised criteria, with no history of active cancer in the last 3 years and no other autoimmune disease Or
  • Patients with normal pressure hydrocephalus (NPH) or idiopathic intracranial hypertension (diagnosed based on imaging (brain MRI) and clinical findings), with no history of active cancer in the last 3 years and no active autoimmune disease

Exclusion criteria

  • Contraindication or refusal to perform a lumbar puncture
  • Sample not suitable for research (volume of CSF collected for treatment >5 mL)
  • Corticosteroid therapy or other immunomodulatory treatment in progress (discontinued less than 15 days prior to inclusion)
  • Pregnant or breastfeeding women
  • Not affiliated with the social security system, patients under French State Medical Aid for undocumented migrants
  • Patients under guardianship or curatorship, under judicial protection measures, or deprived of their liberty by judicial or administrative decision

Treatment and study plan

Lumbar puncture and blood sampling

Other

For all patients in the study, lumbar puncture will be performed as part of their care, according to the clinical indication given by the referring physician. If the patient gives their consent, an additional volume of CSF will be collected for this study, so that the total volume collected (care plus research) does not exceed 5 mL. No lumbar puncture will be performed specifically for the study.

Blood samples will also be collected: these are additional blood tubes collected during a blood sample taken as part of the treatment (as described in the section 'Minimal risks and constraints added by the research').

Primary outcomes

  1. Presence of nervous system-specific TCRs in CSF of patients with ICI-related neurotoxicity

    Time frame: At day 1

    Specific TCR repertoires of ICI-related neurotoxicity will be identified by TCR sequencing of CSF and blood lymphocytes of patients at the time of diagnosis of neurotoxicity of ICIs in comparison to those found in the control cohort 1.2.

    The target of these lymphocytes specifically found in cohort 1.1 will be assessed by EliSpot with known neuronal antigens as well as a search for serum and CSF onconeuronal autoantibodies. In silico methods as well as public TCR database will also be used to find the neurological targets.

Secondary outcomes

  1. Proportions of lymphocytes

    Time frame: At day 1

    Absolute number and percentage of different cells subsets in CSF (CD3, CD20, CD4, CD8, C56) and of their phenotype (naif, effector memory, central memory, Treg) and expression profile will be assessed in study cohort and control cohorts by single cell RNA sequencing and flow cytometry.

  2. Concentration of pro and anti-inflammatory cytokines in CSF of patients with ICI-related neurotoxicity and control cohorts

    Time frame: At day 1

    Measurement of CSF cytokines concentration by Single-Molecule Array and comparison of their levels in the four cohorts. The comparaison of cohort 1.1 with control cohort 3 will allow us to determine the normal level of each cytokine, the comparaison with the other cohorts will lead to the identification of the specific cytokine profile of ICI-related neurotoixicity.

  3. Presence and strength of correlation between TCR repertoires and phenotype/ expression profile of CSF lymphocytes and clinical presentation of ICI-related neurotoxicity

    Time frame: At day 1

    Comparison of the proportions of TCR repertoire, phenotypic and expression profiles of the lymphocytes present in the CSF between the subgroups of patients with different neurological presentations (encephalitis, myelitis, meningitis, polyraduculonevritis, neuropathy) within the cohort 1.1 by using Spearman correlation.

Study contacts

Contact information is provided by the study sponsor or research team.

Jérôme Lambert, MD PhD

CONTACT

[email protected]

0142499742 ext. +33

Stefania Cuzzubbo, MD

CONTACT

[email protected]

0171207467 ext. +33

Sponsors and collaborators

Lead sponsor

Assistance Publique - Hôpitaux de Paris

Other

Registry information

Official study title

Maladies Neurologiques Auto-immunes et Secondaires à l'immunothérapie : étude Des mécanismes Immunologiques et Recherche Des Cibles de l'Attaque Immune

Acronym: DINAMIC

Important dates

Study start
2026
Primary completion
2030
Study completion
2030
First posted
Mar 6, 2026
Registry last updated
Jul 7, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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