Vaginal Microbiota Transplant (MOTIF)

Vaginal Microbiota Transplant to Promote Lactobacillus-dominant Cervicovaginal Communities

This is a randomized trial of vaginal microbiome transplant vs. saline placebo to restore a Lactobacillus dominant vaginal microbial community in women with recurrent bacterial vaginosis.

Study Overview

• Status: Recruiting
• Conditions: Recurrent Bacterial Vaginosis
• Intervention / Treatment: Biological: Vaginal microbiome transplant; Drug: Oral Metronidazole; Other: Sterile saline

Detailed Description

The investigators propose a randomized, double-blind, placebo-controlled trial to evaluate the safety of vaginal microbiota transplant (VMT) in women with recurrent bacterial vaginosis (BV), and to assess the ability of antibiotic treatment plus vaginal microbiota transplant to establish a Lactobacillus-dominant vaginal community as compared to antibiotic treatment alone. The underlying hypothesis is that the VMT will lead to less inflammation and higher prevalence of vaginal Lactobacillus compared to antibiotics alone. The transplant material will be vaginal fluid collected from healthy donors using a disposable menstrual cup. Donors undergo extensive testing for possible infections to ensure the safety of the donated material.

Study Visits and Procedures: In addition to the pre-screening eligibility phone call and screening visit, there will be two treatment study visits and six post-VMT follow up visits at weeks 3, 5, 7, 11, 15, and 27. The baseline visit will occur within 45 days of the screening visit.

Phone Screen: A brief phone discussion to explain approach and alternatives (see details below in "Technical Methods"). A set of short screening questions will be asked to identify women with clear exclusion criteria for participation.

Visit 1, Screening Visit: At the screening visit, after written informed consent is obtained, the information from the pre-screening questionnaire will be reviewed with the subject and updated as necessary. Blood and vaginal specimens will be collected. The VMT process will be explained in detail and subjects will have the opportunity to inspect an example applicator if interested. Subjects will be counseled not to have vaginal intercourse or insert anything into their vagina from the 72 hours prior to the first transplant dose until 72 hours after the second transplant dose.

• Review eligibility and understand/see applicator
• Obtain informed consent
• Height, weight measurements
• Subjects will be given information about how to perform vaginal swab collections (see vaginal swab collection document)
• Physical exam
• Pelvic exam
• Screening labs: Complete blood cell count w/ differential, comprehensive metabolic panel, Pap/HPV (human papillomavirus) testing, gonorrhea, chlamydia, trichomonas testing. HIV, Hepatitis B&C, Herpes.
• Urine pregnancy test
• Behavior and sexual assessment

Visit 2: Baseline, Week 1 (occurs immediately prior to menses)

• Self-Administered Vaginal Swab and soft cup collection
• Blood draw
• Pelvic Exam: cervical swabs, cytobrush
• Symptom and Sexual Behavior Assessment
• Assignment into study groups using block randomization
• Subjects will be given 7-day course of: Metronidazole 500mg PO every 12 hours

Visit 3: First Transplant Administration, Week 2

• Self-collected Vaginal Swab and soft cup collection
• Pelvic Exam: VMT/placebo Administration
• Symptom and Sexual Behavior Assessment

Visit 4: Second Transplant Administration, Week 2

• Self-Administered Vaginal Swab
• Pelvic Exam: VMT/Placebo Administration
• Symptom and Sexual Behavior Assessment

Visits 5-10: Post-transplant follow ups, Weeks 3, 5, 7, 11, 15, 27

• Blood draw (visit 7 only)
• Self-Administered Vaginal Swab
• Self-Administered soft cup collection (visit 5, 7 & 9)
• Symptom and Sexual Behavior Assessment
• Pelvic Exam: cervical swabs, cytobrush (visits 7 & 9)

• Study Type: Interventional
• Enrollment (Estimated): 134
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Doug Kwon, MD, PhD; Phone Number: 857-268-7009; Email: dkwon@mgh.harvard.edu

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Recruiting
      • Massachusetts General Hospital
      • Contact: Caroline Mitchell, MD, MPH; Phone Number: 617-724-2182; Email: caroline.mitchell@mgh.harvard.edu
      • Principal Investigator: Caroline Mitchell, MD, MPH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Premenopausal women, 18- 50 years old
• Abnormal Nugent score: > 3
• History of recurrent bacterial vaginosis (BV) (3 or more documented episodes in past 12 months)

• If participating in sexual activity that could lead to pregnancy, study participants must agree to use an effective contraceptive while actively participating in the protocol. At least one of the following methods MUST be used:

  • Condoms (male or female), with or without a spermicidal agent
  • Intrauterine device (IUD)
  • Hormonal contraceptive (including oral pills, vaginal ring, implant, injection)

Exclusion Criteria:

• History of clinically significant vaginal, cervical, or uterine disease including but not limited to: cancer of the female reproductive tract, prior hysterectomy, high grade cervical dysplasia (CIN III), or diagnosed with cervicovaginal infection (with the exception of bacterial vaginosis) within the 30 days prior to the procedure.

  • Allergy to metronidazole
  • Use of investigational therapies or investigational vaccines within 90 days prior to study entry
  • Use of any immunomodulatory agents within 30 days prior to study enrollment. Subject taking any of the following medications: systemic steroids (inhaled or nasal steroid therapy is permitted), interleukins, systemic interferons (e.g. local injection of interferon alpha for treatment of HPV is permitted) or systemic chemotherapy.
  • History of coronary artery disease, myocardial infarction, COPD, chronic renal failure, decompensated cirrhosis, or any other condition that in the opinion of the investigator will compromise ability to participate in the study.
  • History of abnormal pap smear within 12 months
  • Insertion of levonorgestrel-containing IUD within 3 months prior to study entry
  • Either breastfeeding or pregnant within 24 weeks prior to study entry
  • Use of probiotics and prebiotics (supplements and products, oral or vaginal) within 30 days of the study. (NOTE: Oral yogurt with live cultures is allowed.)
  • Routine use of oral antibiotics i.e. daily use for acne, Hidradenitis suppurativa, or regular use for post-coital urinary tract infection prophylaxis within the past 30 days.
  • Taken non-metronidazole antibiotics in last 30 days
  • BMI > 40

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Vaginal microbiome transplant; Women in this group will be randomized to receive two doses of vaginal fluid from a healthy donor	Biological: Vaginal microbiome transplant; Vaginal fluid from healthy donors; Drug: Oral Metronidazole; 500mg oral metronidazole twice daily for 7 days
Placebo Comparator: Saline placebo; Women in this group will be randomized to receive two doses of sterile saline	Drug: Oral Metronidazole; 500mg oral metronidazole twice daily for 7 days; Other: Sterile saline; 700 uL of sterile saline placed in the vagina as a placebo intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence of Lactobacillus-dominant microbiome	Lactobacillus dominant = relative abundance of Lactobacillus in the vaginal microbial community > 50%	5 weeks after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence of Lactobacillus-dominant microbiome	Characterization of the vaginal microbial community using 16S rRNA sequencing	1, 3, 7 weeks, 4 and 6 months after intervention
Number of women reporting adverse events	Report of adverse events	1, 3, 5, 7 weeks, 4 and 6 months after intervention

Collaborators and Investigators

• Sponsor: Douglas Kwon
• Investigators: Principal Investigator: Doug Kwon, MD, PhD, Massachusetts General Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 22, 2021
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): June 1, 2025

Study Registration Dates

• First Submitted: July 31, 2019
• First Submitted That Met QC Criteria: August 3, 2019
• First Posted (Actual): August 6, 2019

Study Record Updates

• Last Update Posted (Actual): June 26, 2023
• Last Update Submitted That Met QC Criteria: June 23, 2023
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Infections; Bacterial Infections; Bacterial Infections and Mycoses; Vaginal Diseases; Vaginitis; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Genital Diseases, Female; Vaginosis, Bacterial; Anti-Infective Agents; Anti-Bacterial Agents; Antiprotozoal Agents; Antiparasitic Agents; Metronidazole
• Other Study ID Numbers: 2019P001543

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: Yes
• Studies a U.S. FDA-regulated device product: No