Muscle Connective Tissue in Limb Development and Disease

King's College London

Status: Enrolling

Conditions: Radial Dysplasia

Treatments: Procedure: Tissue biopsy

Study type: Observational

Funder types: Other

Identifiers

NCT02611089

15/LO/2085 (Other Identifier)

14SG01

Details and patient eligibility

About

The objective of this work is to understand how the disruption of the muscle connective tissue contributes to the limb soft-tissue defects in radial dysplasia. In parallel, the researchers will investigate the role of muscle connective tissue in normal limb development.

Full description

The objective of this work is to understand the origins of the soft tissue defects in a disabling, disfiguring limb anomaly called radial dysplasia, and what mechanisms of normal limb development have been disrupted in these patients to produce their phenotype. The investigators aim to use this knowledge to improve their treatment. Currently, despite sophisticated surgical treatment, the limb malformation the child is born with typically recurs as they grow: it is thus an 'unsolved problem'.

The investigators have previously shown, in an experimental mouse model of radial dysplasia, the underlying soft tissue problem is a change in the muscle connective tissue and its derivatives, causing abnormal soft-tissue patterning. The investigators wish to expand this work into the investigators' patient population by comparing samples of post-natal muscle connective tissue derivatives from radial dysplasia patients with control samples.

The investigators will ask patients undergoing corrective hand surgery to let the investigators take small tissue samples during their planned operations. The investigators will also ask patients having other forms of hand surgery, such as surgery for hand injuries, to let the investigators take similar samples for comparison. In either case, their scar and peri-operative treatment will be unchanged. The investigators will examine the tissue samples in the investigators' laboratory to look for changes in tissue architecture, cellular composition, cell signalling, and how they behave when grown in culture. The investigators will also make attempts to derive cell lines from biopsy samples to use in further studies, exploring cellular phenotype and functional capacity.

Simultaneously, the investigators will look at the long-term surgical outcomes and the range of genetic changes in the investigators' patient population. Eligible patients will be referred for consideration in the (separate) 100,000 genome project; this should further expand the investigators' knowledge of the genetic changes underlying limb anomalies. The ability to combine data on genotype, long-term phenotype and soft tissue changes will give a comprehensive overview of the condition. The investigators expect this to lead to a better understanding of patient subgroups, and to provide a rational basis for improved treatment approaches.

Enrollment: 45 estimated patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Cases

Inclusion Criteria:

• Patients with a clinical diagnosis of radial dysplasia, requiring reconstructive surgery
• Either sex
• Informed (parental) consent to participate

Exclusion Criteria:

• Patients with a clinical diagnosis of radial dysplasia, but not requiring reconstructive surgery
• Patients with a diagnosis other than radial dysplasia
• Patients with extensive previous scarring to their forearm and hand.
• Patients with a significant pathological skin or soft tissue lesion at the donor site.

Controls

Inclusion Criteria:

• Patients with an injury requiring reconstructive surgery
• Either sex
• Informed (parental) consent to participate

Exclusion Criteria:

• Patients with extensive previous scarring to their forearm and hand.
• Patients with a significant pathological skin or soft tissue lesion at the donor site.

Trial design

45 participants in 2 patient groups

Radial dysplasia patients

Description:

Recruited participants will have 2-3 small tissue biopsy samples taken during 1-2 of their planned reconstructive surgical procedures for radial dysplasia, whilst under general anaesthesia in the operating theatre. Samples will be taken by scalpel or scissors, by the operating surgeon, from within the surgical site in the forearm and hand. The skin incision and deep dissection will have to be made as part of the normal course of reconstructive surgery, regardless of participation in this study.

Treatment:

Procedure: Tissue biopsy

Control patients

Description:

Recruited participants will have 2-3 small tissue biopsy samples taken during their planned reconstructive surgery for hand trauma, whilst under general anaesthesia in the operating theatre. Samples will be taken by scalpel or scissors, by the operating surgeon, from within the surgical site in the forearm and hand. The skin incision and deep dissection will have to be made as part of the normal course of reconstructive surgery, regardless of participation in this study.

Treatment:

Procedure: Tissue biopsy