- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01787305
Pilot Study of Gut Commensals in Antiphospholipid Syndrome
Longitudinal Study of the Fecal Microbiome in Persistently Anti-β2 Glycoprotein-I Positive Individuals and Patients With Antiphospholipid Syndrome
Study Overview
Status
Conditions
Detailed Description
Antiphospholipid syndrome (APS) is an autoimmune disorder in which people are at risk to form blood clots. Having a positive antiphospholipid antibody (aPL) test does not mean the person has APS; but a small number of people do develop APS. These antibodies can also occur in otherwise healthy people. We believe certain bacteria in the gut may cause these antibodies to be produced.
Current treatments in APS target the blood clotting system and the goal is to prevent future blood clots. Many patients require this therapy for their entire life. If an persistent trigger can be found within the gut microbiota, it may help in developing other treatments. This study is being conducted at two centers, Yale University School of Medicine in New Haven, CT, and The Hospital for Special Surgery in Manhattan, New York. We expect to enroll a total of 40 subjects in this study at these study sites.
Visits will be as follows:
Visit 1: Initial screening visit: Review of medical records and questionnaire completion.
Visit 2 (one month after initial visit) & Visit 3 (2 months after initial visit): Questionnaire relating to any changes that may have taken place since recruitment. Brief physical examination by the study doctor.
Overall participation: Over a period of 8 weeks.
Sample Collection:
At each study visit, a sample of blood will be obtained (approximately 6.5 tablespoons of whole blood) via one needle stick.
A take-home stool sample collection kit will be provided. Stool samples will be obtained within 24 hours before or after blood collection and delivered (or mailed) to a study site. 2 kits will be provided at the initial visit, 1 kit will be provided at the follow up visit at month 1.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Locations
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Connecticut
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New Haven, Connecticut, United States, 06511
- Yale University School of Medicine; Yale-New Haven Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- 18-70 years of age
- One of the following groups below:
Group 1a: Persistently positive anti-β2GPI on Coumadin (n: 10) Group 1b: Persistently positive anti-β2GPI not on Coumadin (n: 10) Group 2a: Negative aPL on Coumadin (n: 10) Group 2b: Negative aPL not on Coumadin (n: 10) Persistently positive aβ2GPI will be defined as anti-β2GPI immunoglobulin G (IgG)/IgM/IgA ≥ 40 SGU/SMU at two separate time points at least 12 weeks apart.
Negative aPL will be defined as negative Lupus anticoagulant test, aCL IgG/IgM/IgA, and anti-β2GPI IgG/IgM/IgA within 12 months of the study entry.
Exclusion Criteria:
- Any autoimmune diseases including Rheumatoid Arthritis, Spondylarthropathy, Inflammatory Muscle Disease, and Sarcoidosis
- Steroid use greater than 10 mg/d prednisone or equivalent 30 days prior to enrollment
- Any immunosuppressive drug use within 3 months prior to screening (mycophenolate mofetil, azathioprine, methotrexate, leflunomide, rituximab, cyclophosphamide, intravenous immunoglobulin, plasmapheresis).
- Ongoing chronic infection (viral, bacterial or fungal) including known HIV, Hepatitis B/C
- Acute infection receiving any antibiotics within 30 days prior to screening
- Acute thrombosis within 2 days prior to screening
- Major gastrointestinal surgery less than 5 years prior to enrollment (with the exception of appendectomy)
- Any Gastrointestinal bleeding history
- Inflammatory Bowel Disease diagnosed by biopsy
- Celiac Disease diagnosed by biopsy
- Bulimia or anorexia nervosa
- Probiotics (greater than estimated 10^9 cfu or organisms per day) within 30 days prior to enrollment (with the exception of fermented beverages, milks or yogurts).
- Morbid obesity (BMI ≥ 40)
- Diabetes Mellitus Type I or II on medical therapy
- Malignancy within one year prior to screening (with the exception of non-metastatic squamous or basal cell skin carcinomas and cervical carcinoma if received curative surgical treatment)
- Known alcohol abuse
- Pregnancy
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Other
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in autoantibody levels
Time Frame: Baseline
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Certain gut bacteria will correlate with anti-β2GPI autoantibody titers in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects
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Baseline
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Change in autoantibody levels
Time Frame: 4 weeks
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Certain gut bacteria will correlate with anti-β2GPI autoantibody titers in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects
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4 weeks
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Change in autoantibody levels
Time Frame: 8 weeks
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Certain gut bacteria will correlate with anti-β2GPI autoantibody titers in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects
|
8 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in autoreactive T cell frequencies
Time Frame: Baseline
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Certain gut bacteria will correlate with β2GPI-reactive CD4+ T-cells in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects.
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Baseline
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Change in autoreactive T cell frequencies
Time Frame: 4 weeks
|
Certain gut bacteria will correlate with β2GPI-reactive CD4+ T-cells in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects.
|
4 weeks
|
Change in autoreactive T cell frequencies
Time Frame: 8 weeks
|
Certain gut bacteria will correlate with β2GPI-reactive CD4+ T-cells in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects.
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8 weeks
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Martin A Kriegel, MD PhD, Yale University
Publications and helpful links
General Publications
- Ruff WE, Dehner C, Kim WJ, Pagovich O, Aguiar CL, Yu AT, Roth AS, Vieira SM, Kriegel C, Adeniyi O, Mulla MJ, Abrahams VM, Kwok WW, Nussinov R, Erkan D, Goodman AL, Kriegel MA. Pathogenic Autoreactive T and B Cells Cross-React with Mimotopes Expressed by a Common Human Gut Commensal to Trigger Autoimmunity. Cell Host Microbe. 2019 Jul 10;26(1):100-113.e8. doi: 10.1016/j.chom.2019.05.003. Epub 2019 Jun 18.
- Ruff WE, Greiling TM, Kriegel MA. Host-microbiota interactions in immune-mediated diseases. Nat Rev Microbiol. 2020 Sep;18(9):521-538. doi: 10.1038/s41579-020-0367-2. Epub 2020 May 26.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1210010962
- U01AI101990 (U.S. NIH Grant/Contract)
- R01AI118855-01 (U.S. NIH Grant/Contract)
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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