Modification of the COVID-19 Vaccine Response by an Intervention on the Intestinal Flora (PIRATES-COV)

January 14, 2025 updated by: Université de Sherbrooke

Modulation of Immune Responses to COVID-19 Vaccination by an Intervention on the Gut Microbiota: a Randomized Controlled Trial

The elderly, who are often in poorer health, have been particularly affected by the COVID-19 pandemic. Recent study results show that while vaccines have been very effective in the short term, protection for the elderly may not be sufficient 6 months after the 2nd dose. Some countries have started to offer a 3rd dose. We are considering acting on the intestinal flora of the elderly (which is often unbalanced) in order to increase the effectiveness of the vaccination. Indeed, it has been demonstrated that probiotics (which can rebalance the intestinal flora) significantly increase the production of antibodies after vaccination against the flu virus. Our hypothesis is that taking probiotics one month before and one month after the 4th dose of COVID vaccine would result in longer lasting vaccine protection in seniors. This study will include 688 seniors, aged 65-89 years, who have not had COVID-19, who have received 3 doses of an mRNA vaccine and who will accept a another booster dose . All participants will take 1 capsule/day (probiotics or placebo) for 1 month and in the middle of this period will receive a booster dose. On 3 occasions (inclusion, 3 months and 6 months post-vaccination), they will prick their fingertip and express the drop of blood on a blotting paper. They will mail this dried blood sample in an envelope for antibody testing in Quebec Research center. A subgroup of 100 participants willing to travel at CHUS' Clinical Research Center for 2 times (inclusion visit and final visit) will be invited to do a blood test. The investigators expect to reduce the number of seniors who are poorly protected by a booster dose 6 months after the injection. If successful, this approach could quickly be implemented worldwide as probiotics have few side effects and are affordable.

Study Overview

Status

Status

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

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

The elderly are at high risk of morbidity and mortality from COVID-19. They are particularly targeted by recent data: i) faster decline of the immune response in the elderly and ii) increase of COVID infection 6 months after the 2nd dose of vaccine. In addition, they often have an imbalance of the microbiota that plays a key role in the activation of the immune system. Taking probiotics, which improve the microbiota, could increase the vaccine response of the elderly. Indeed, it has been shown in 2 meta-analyses that probiotics improve immune response after influenza vaccination. The investigators believe that probiotics taken at the time of 4th dose (booster dose) of vaccine could improve immune memory: i) humoral (cellular Receptor-Binding Domain antibody) and ii) (B lymphocytes, CD4+ T and CD8+ T), in the medium term and would then allow a greater spacing of the booster doses in the future OBJECTIVE: To reduce by 33% the percentage of elders without RBD antibodies, 6 months after the booster dose of vaccine, by taking 2 strains of probiotics compared to placebo. Secondary objectives: To improve the evolution of RBD Ac by longitudinal analysis at 5 different time points (inclusion, vaccination, 1 month, 3 months, and 6 months post-vaccination).- To compare the evolution of neutralizing Ac and memory B, CD4+ T, and CD8+ T cells, at inclusion and 6 months post-vaccination. METHODOLOGYDesign. A randomized, intention-to-treat, blinded, placebo-controlled trial.Investigation products are: for the intervention group, a capsule with 2 strains of probiotics and for control group or a placebo capsule. Participants will take one capsule per day for 30 days (15 d and 15 d after the booster dose of vaccine). Both vaccines (Pfizer-BioNTech, Moderna) may be used depending on availability and state of knowledge . With 1:1 allocation, via the REDCap application, using permuted blocks and stratified according to randomization.gender, age (65-79 and 80-89 years) and vaccine type for the booster dose. Inclusion criteria: (Pfizer-BioNTech or Moderna) for more than 6 months, volunteers for booster dose of vaccine, telephone or internet access, informed consent, and living <75 km from CRC (only for participants for blood test visits). Exclusion criteria: patients with allergies (soy...), COVID-19 disease, possibly affected cognitive functions, chronically weakened immune system (AIDS...) or undergoing anti-cancer treatment. Five finger-prick dried blood samples (DBS) are planned (inclusion, vaccination, 1, 3 and 6 months post-vaccination).The DBS will be mailed to Quebec City . A telephone or mail follow up will be realised for each participant. A subgroup of 100 participants willing to travel will be invited to visit us at the inclusion and final visit to do a blood test. Fecal self-sampling (inclusion) for microbiota study will be sent to I Laforest-Lapointe's laboratory. The levels of RBD Ac and N Ac will be determined by a validated Elisa test (3 time points). From the venous blood samples (inclusion and 6 months post-vaccination),we will be studied: i) the pseudotyped viral neutralization and ii) the cellular immune memory in flow cytometry (B, T CD4+ and T CD8+ lymphocytes). With 30% undetectable RBD Ac in the placebo group (6 months post-vaccine) and 20% in the intervention group, are required (15% attrition, 80% power, 5% two-sided test). The 688 subjects primary analysis on the dichotomous criterion (Ac RBD) will use a GMM logistic regression model for longitudinal data with covariate variant/time.PROJECT OUTCOMEImproving vaccination and spacing vaccine doses among the elderly are major public health issues. If successful, probiotics could be used worldwide very quickly. They have few side effects, are available over the counter and are affordable.

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 (Actual)

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.
592

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.
  • Not Applicable

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 Contact Backup

Study Locations

  • Canada
    • Quebec
      • Sherbrooke, Quebec, Canada, J1H 5N4
        • Centre de recherche clinique du CHUS

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

65 years to 89 years (Older Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Men and women
  • aged 65-89 years
  • who have received 3 doses of a mRNA vaccine (Pfizer-BioNTech or Moderna) for more than 6 months;
  • volunteered for a booster dose
  • had telephone or internet access
  • were able to provide informed consent
  • lived <75 km from the CRC (subgroup of 100 participants only)

Exclusion Criteria:

  • Patients with COVID-19 disease (clinical and serological data at post);
  • with possibly affected cognitive functions (score < 12 on the Functional Activities Questionnaire (FAQ))
  • with allergies (soy, lactose, yeast, maltodextrin)
  • with a chronically weakened immune system (AIDS...)
  • undergoing anti-cancer treatment (chemotherapy or radiotherapy)
  • who do not speak French or English.

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: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

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: Probiotics
taking a capsule containing the probiotics 15 d before and 15 d after booster shot.
Dietary supplement: Taking capsule containing probiotics or placebo
The probiotics capsule containing two strains of probiotics.
Placebo Comparator: Control
taking a capsule containing a placebo 15 d before and 15 d after booster shot.
Dietary supplement: Taking capsule containing probiotics or placebo
The probiotics capsule containing two strains of probiotics.

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
Measure Description
Time Frame
Receptor-Binding Domain (RBD) antibodies, 6 months after the vaccine booster shot
Time Frame: inclusion, 3 and 6 months
The RBD antibody level will be determined by a validated ELISA test (95% sensitivity and 100% specificity). The primary outcome measure is a dichotomous measure of RBD antibodies (detectable or undetectable). The positivity threshold was defined based on the mean optical density (colorimetric reaction on blotting paper) of negative sera +3 SD. Possibly, a quantitative variable will be available.
inclusion, 3 and 6 months

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
Measure Description
Time Frame
Anti-N Antibodies
Time Frame: inclusion, 3 and 6 months
The Anti-N antibodies will be determined by the same procedure than for the dichotomous RBD antibody level (90% sensitivity and 95% specificity).
inclusion, 3 and 6 months

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.
Université de Sherbrooke

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
CHU de Quebec-Universite Laval

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.
  • Study Director: Jean-Charles Pasquier, Dr, Université de Sherbrooke

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 (Actual)

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.
November 10, 2022

Primary Completion (Actual)

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.
July 17, 2024

Study Completion (Actual)

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.
July 17, 2024

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).
January 13, 2022

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.
January 13, 2022

First Posted (Actual)

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.
January 18, 2022

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.
March 25, 2025

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.
January 14, 2025

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.
January 1, 2025

More Information

Terms related to this study

Keywords

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.
  • EG9-179473

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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