Fecal Microbiota Transplantation (FMT) in Nonalcoholic Steatohepatitis(NASH). A Pilot Study

October 30, 2017 updated by: Kittichai Promrat, M.D., Lifespan
Nonalcoholic steatohepatitis (NASH) is common, may progress to cirrhosis and is predicted to become a leading indication for liver transplantation in the near future. Though often associated with obesity and the metabolic syndrome, our current understanding of disease development is limited and there are few therapeutic options. Imbalance of gut bacteria is suspected to play a key role driving the progression of fatty liver disease and there is hope manipulation of these bacteria may be beneficial. This study will determine if fecal microbiota transplantation, using stool from lean donors, is an effective and safe treatment for NASH.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Unknown

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Nonalcoholic Steatohepatitis (NASH), a severe form of fatty liver disease, is highly prevalent and can lead to cirrhosis, liver failure and hepatocellular carcinoma. It is strongly associated with obesity and the metabolic syndrome. The impact of the gut microbiota on obesity and the metabolic syndrome is potentially large and increasing evidence suggests that dysbiosis might contribute to the development of NASH. There is a fundamental gap in understanding how alterations in the intestinal microbiota lead to a wide range of metabolic syndrome associated conditions including fatty liver disease in humans. The long-term goal of this project is to better understand the mechanisms linking intestinal dysbiosis and extra-intestinal clinical phenotypes, in particular obesity and NAFLD. Compositional shifts in gut bacteria from antibiotic use can perpetuate diseases such as Clostridum difficile infection, and manipulation of the microbiota through stool transplant from healthy donors can be used to cure disease. The objective of this application is to determine whether restoration of beneficial gut microbiota via fecal microbiota transplantation using stool from lean donors (FMT-L) improves NASH. The central hypothesis for this project is that transfer of gut microbiota from lean donors will result in reduced hepatic steatosis, and improved histological and biochemical features of NASH, all of which will correlate with observed changes in the small bowel and distal gut microbiome. This hypothesis will be tested by pursuing 3 specific aims: 1) determine the effect of FMT-L in patients with NASH on hepatic steatosis and markers of NASH; 2) perform microbiome analyses on pre- and post-FMT-L small bowel & stool samples; and 3) investigate mechanistic correlates linking dysbiosis with histologic changes in NASH after FMT-L. The study will be a pilot open labeled trial examining the effect of FMT-L in patients with biopsy proven NASH. The primary outcome measure will be a change in MRI-determined hepatic fat fraction,12 weeks after transplantation. Differences in the microbiota after FMT-L in the small bowel and distal gut, including the durability of microbiota changes, will be examined using advanced metagenomic techniques. Clinical and laboratory features of the metabolic syndrome and obesity as well as hepatic and systemic inflammatory markers will be examined for mechanistic correlates linking dysbiosis with histologic changes in the liver. In addition to understanding how the gut microbiota affects fatty liver disease progression, study findings will provide a framework for future microbiome research on metabolic syndrome related diseases such as diabetes, obesity, and other inflammatory disorders. An increased understanding of how the human gut microbiota is altered in metabolic disease may open a new avenue of therapeutics based on manipulation of gut bacteria.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Anticipated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
5

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • United States
    • Rhode Island
      • Providence, Rhode Island, United States, 02903
        • Recruiting
        • Rhode Island Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

14 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

1) >18 years of age 2) histologic evidence of definite or probable NASH based upon a liver biopsy obtained <90 days prior to enrollment and a NAFLD activity score (NAS) ≥4 with ≥1 in each component of the NAS score (steatosis, scored 0-3, ballooning degeneration, 0-2, and lobular inflammation, 0-3).

-

Exclusion Criteria:

  1. current or history of significant alcohol consumption for a period of more than 3 consecutive months within 1 year prior to screening (significant alcohol consumption is defined as more than 20 g/day in females and more than 30 g/day in males, on average)
  2. Another form of liver disease
  3. Recent antibiotic use within 3 months or need for chronic antibiotic therapy
  4. Use of drugs historically associated with NAFLD or drugs known to improve NASH histology such as vitamin E> 400 IU/day or pioglitazone
  5. Prior or planned (during the study period) bariatric surgery
  6. Uncontrolled diabetes defined as HbA1c 9.5% or higher within 60 days prior to enrollment
  7. Presence of cirrhosis on liver biopsy
  8. Clinical evidence of hepatic decompensation
  9. Inability to safely obtain a liver biopsy or perform an upper endoscopy
  10. Human Immunodeficiency Virus (HIV) infection
  11. Active, serious medical disease with likely life expectancy less than 5 years
  12. Active substance abuse including inhaled or injection drugs in the year prior to screening
  13. pregnancy, planned pregnancy, potential for pregnancy and unwillingness to use effective birth control during the trial, breast feeding
  14. Participation in an IND trial in the 30 days before randomization
  15. Any other condition which, in the opinion of the investigator, would impede compliance or hinder completion of the study
  16. History of severe (anaphylactic) food allergy
  17. History of inflammatory bowel disease
  18. History of gastroparesis or altered gastric motility -

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Fecal Microbiota Transplantation
Intervention: standardized preparation of frozen fecal material from lean healthy donors Route: infused into the duodenum through the working channel of the instrument at upper endoscopy Dosing: 1 dose
Drug: Fecal Microbiota Transplantation
Administration of frozen fecal materials into gastrointestinal tract
Other Names:
  • FMT

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Time Frame
degree of hepatic steatosis as determined by MRI
Time Frame: 12 weeks
12 weeks

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Time Frame
Liver Function Tests
Time Frame: 12 weeks
12 weeks
Markers of insulin sensitivity
Time Frame: 12 weeks
12 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Lifespan

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Kittichai Promrat, M.D., Lifespan
  • Principal Investigator: Colleen Kelly, M.D., Lifespan

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
May 1, 2015

Primary Completion (Anticipated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
June 1, 2018

Study Completion (Anticipated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
June 1, 2018

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 9, 2015

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 9, 2015

First Posted (Estimate)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 11, 2015

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 1, 2017

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 30, 2017

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2017

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • Committee # 2014-15

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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