- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03434483
The Microbiome as a Target for Precision Medicine in Atherosclerosis (MIGATER)
Microbiome, Inflammation and Genetics as a Target for Precision Medicine in AThERosclerosis
Study Overview
Status
Conditions
Detailed Description
The study will prospectively study two groups of patients : 1) patients with acute coronary syndrome and 2) age and sex matched patients with chronic stable documented atherosclerosis.
Immune cell populations and immune-related metabolites will be characterized, the genetic profile of the main known functional variants will be determined, and the oral, gastrointestinal, and blood microbiota will be compared in both groups in a transversal observational design.
In addition, 1-year clinical follow-up will be performed and correlation with the evolution of the microbiota and immune response in a longitudinal design will be conducted.
Besides, an angiographic substudy, for those patients included in the study but that require revascularization of culprit artery according to clinical indication, will be 1 year follow-up and functional assessment and intravascular imaging and the degree of remodelling of the atherosclerotic plaque will be correlated with the evolution of the microbiota and immune response in a longitudinal design.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Madrid, Spain, 28007
- Hospital General Universitario Gregorio Marañón
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Acute coronary syndrome candidates for the study will be all patients with an episode of acute coronary syndrome wwho enter the Gregorio Marañón General University Hospital who meet all of the inclusion criteria and none of the exclusion criteria.
Chronic atherosclerosis candidates for the study will be all patients with chronic atherosclerosis under follow-up in the General University Hospital Gregorio Marañón that meet all the following inclusion criteria and none of the exclusion criteria.
Description
Inclusion Criteria Acute coronary syndrome group:
- Diagnosis of acute coronary syndrome
- Signature of informed consent for the study (Annex I).
Exclusion Criteria Acute coronary syndrome group:
- Previous Ejection fraction of VI less than 30%.
- History of heart failure
- Systemic inflammatory diseases
- In treatment with corticosteroids or immunomodulators
- In treatment with antibiotics during the last month
Aditional Inclusion Criteria for angiographic substudy group:
- Clinical indication of coronary angiography in the acute phase (in the first 72 hours after its hospital diagnosis).
- At least one non-causal coronary lesion in a coronary segment with reference diameter> 2 mm, stenosis between 40-80%, and TIMI 3 flow in this vessel (angiographic criteria, only confirmed after performing coronary angiography)
- Signature of informed consent for the substudy (Annex II).
Aditional Exclusion Criteria for angiographic substudy group:
- Renal insufficiency with creatinine clearance less than 30 ml / h
- Hepatic insufficiency: patients with cirrhosis in Child B or C stages will be excluded.
Inclusion Criteria Chronic atherosclerosis group:
- Angiographic diagnosis, using catheterization or computed tomography of coronary atherosclerotic disease.
- Clinical situation of stable chronic ischemic heart disease.
- Signature of informed consent for the study (Annex III).
Exclusion Criteria Chronic atherosclerosis group:
- Previous Ejection fraction of VI less than 30%.
- History of heart failure
- Systemic inflammatory diseases
- In treatment with corticosteroids or immunomodulators
- In treatment with antibiotics during the last month
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Acute Coronary Syndrome
Patients with an episode of acute coronary syndrome.
Clinical evaluation 1 year.
Gene variants in atherosclerosis.
Microbiota analysis.
Immunological analysis.
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From the blood samples of the patients, the total DNA will be extracted and the main functional variants identified in the literature will be genotyped
From the samples of blood, feces, oral cavity and blood, the DNA of the microbiota will be extracted using specific extraction kits and the microbiome will be analyzed through the study of 16S ribosomal RNA amplicons.
A study of immunological cell populations and cytokines will be carried out from fresh blood samples using antibody panels and flow cytometry
Clinical evaluation including hemostasis and biochemical studies and questionaries for diet and exercice registration
|
ACS-Angiographic substudy
Patients included in the Acute Coronary Syndrome group with clinical indication for revascularization. Clinical evaluation. Assessment of the atherosclerotic plaque in a moderate lession at baseline and 1-year . Gene variants in atherosclerosis. Microbiota analysis. Immunological analysis |
From the blood samples of the patients, the total DNA will be extracted and the main functional variants identified in the literature will be genotyped
From the samples of blood, feces, oral cavity and blood, the DNA of the microbiota will be extracted using specific extraction kits and the microbiome will be analyzed through the study of 16S ribosomal RNA amplicons.
A study of immunological cell populations and cytokines will be carried out from fresh blood samples using antibody panels and flow cytometry
Clinical evaluation including hemostasis and biochemical studies and questionaries for diet and exercice registration
In patients who have been successfully revascularized the artery responsible for AMI and also present an intermediate lesion (40-80%) in another coronary territory, the clinical care protocol of the Cardiology Service stipulates the need for a physiological assessment with guidance of pressure (FFR). The thickness of the fibrous cap shall be measured using optical coherence tomography. In addition to the FFR measurement, a complete physiological assessment with a Doppler-pressure guide. This will allow the procedure to be performed without additional risk to the patient. The physiological study will include the analysis of endothelium-dependent vascular function and endothelium-independent vascular function.
Other Names:
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Chronic coronary atherosclerosis
Patients with chronic atherosclerosis.
Gene variants in atherosclerosis.
Microbiota analysis.
Immunological analysis.
|
From the blood samples of the patients, the total DNA will be extracted and the main functional variants identified in the literature will be genotyped
From the samples of blood, feces, oral cavity and blood, the DNA of the microbiota will be extracted using specific extraction kits and the microbiome will be analyzed through the study of 16S ribosomal RNA amplicons.
A study of immunological cell populations and cytokines will be carried out from fresh blood samples using antibody panels and flow cytometry
Clinical evaluation including hemostasis and biochemical studies and questionaries for diet and exercice registration
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline in clinical evaluation at 12 months
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Cardiac events register including hemostasis and biochemical determinations
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Change from baseline in fibrous cap thickness at 12 months
Time Frame: Inclusion and 12 months
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Angiographic substudy-Change from baseline in the thickness of the fibrous cap (μm) of an atherosclerotic plaque in the nonculprit vessel as measured using optical coherence tomography
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Inclusion and 12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Endothelial dysfunction
Time Frame: Inclusion and 12 months
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Angiographic substudy-Micro and macrovascular endothelial function measured using a Doppler pressure guidewire
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Inclusion and 12 months
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Intestinal microbiota composition changes 16S
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline in intestinal microbiota will be analysed using the 16S rRNA target gene sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Intestinal microbiota composition changes metagenome
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline in intestinal microbiota will be analysed using the metagenome sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Blood microbiota composition changes 16S
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline in blood microbiota will be analysed using the 16S rRNA target gene sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Blood microbiota composition changes metagenome
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline in blood microbiota will be analysed using the metagenome sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Oral microbiota composition changes 16S
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline in oral microbiota will be analysed using the 16S rRNA target gene sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Oral microbiota composition changes metagenome
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline in oral microbiota will be analysed using the genome sequencing approach at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Adaptive immune system status changes
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline of adaptive immune cell lineages will be assessed dynamically using high performance cytometry at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Innate immune system status changes
Time Frame: Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Changes from baseline of innate immune cell lineages will be assessed dynamically using high performance cytometry at 1 week, 1 month, 3 months, 6 months and 12 months
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Inclusion, 1 week, 1 month, 3 months, 6 months and 12 months
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Collaborators and Investigators
Investigators
- Study Director: Francisco Fernández-Aviles, Prof, MD, Hospital General Universitario Gregorio Marañón
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- FIBHGM-MIGATER
- PIE 16/00055 (OTHER_GRANT: Instituto de Salud Carlos III)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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