Establishment of the Human Intestinal and Salivary Microbiota Biobank - Kidney Diseases (BIOMIS-Nefro)

Costituzione Della Biobanca Del Microbiota Intestinale e Salivare Umano: Dalla Disbiosi Alla Simbiosi

This is a prospective, clinical, multicentre study aimed to collect biological samples and study microbiota from subjects suffering from chronic kidney disease and from healthy volunteers. Microbiota is a complex consortium of microorganisms, located at the mucosal level (in particular intestinal, oral and vaginal) having a key role in human health and in the onset of several diseases. Microbiota alterations have been found in several diseases (gastrointestinal, metabolic, renal, oncological, gynaecological).

The study will allow to:

• Provide biological samples (faeces, saliva, blood, urine) from healthy volunteers and patients suffering from chronic renal diseases to the first Italian microbiota biobank;
• Study microorganisms using different in vitro and in vivo techniques;
• Study the link between the microbiota and the disease. This study is part of the BIOMIS project (Project Code: ARS01_01220), presented as part of the "Avviso per la presentazione di progetti di ricerca industriale e sviluppo sperimentale nelle 12 aree di specializzazione individuate dal PNR 2015-2020" and admitted to funding under the National Operational Program "Ricerca e Innovazione" 2014-2020 by directorial decree of MIUR - Department for Higher Education and Research - n. 2298 of 12 September 2018. BIOMIS includes several clinical studies that enrol patients with different pathologies to collect and store biological samples and study microbiota.

Study Overview

• Status: Completed
• Conditions: Autosomal Dominant Polycystic Kidney Disease (ADPKD); IgA Nephropathy (IgAN); Diabetic Kidney Disease (DKD); Advanced-Chronic Kidney Disease (CKD)
• Intervention / Treatment: Other: Questionnaire; Other: Medical examination; Other: Biological sample collection

Detailed Description

The primary aim of this multicentric study is to populate the first national microbioma biobank with biological samples (fecal, salivary, urinary and blood samples) subjects suffering from chronic kidney disease (IgAN, ADPKD, advanced CKD and DKD), and healthy volunteers.

The secondary aim is the characterization of microorganisms of the biobank and study of the microbiota-pathology relationship using meta-omics, in vitro and in vivo approaches, The study plans to enrol 150 subjects at Policlinic of Bari and University of Perugia, according to the inclusion/exclusion criteria. The study participation is voluntary, and the subjects have the right to withdraw from the study at any time and for any reason.

During the study, 3 visits are planned:

• Visit 0 (V0), including description of the objectives and procedures study, signature written informed consent, inclusion/exclusion criteria evaluation, medical examination (blood pressure measurement, abdominal and thoracic physical examination), filling in of the anamnestic questionnaire, delivery of kits for the collection of fecal, salivary and urinary material to be reported at Visit 1 and delivery of a 3-day food diary, to be completed autonomously in the days preceding the Visit 1.
• Visit 1 (V1) - at least 4 days after V0, including delivery of the of the collected biological material (feces, saliva, urine), and of a 3-day food diary, filling in of the new signs and symptoms anamnestic questionnaire and blood sampling by medical staff.
• Telephone evaluation: administration of a "Food Frequency Questionnaire" to assess the subjects' alimentary habits.

Standard Operative Procedures (SOP) for samples storing, transport and processing will be adopted to ensure samples stability and grant results validity and quality.

Following collections, samples will be processed in different aliquots that will be used for:

• routine screening;
• storage in the first Italian human microbiote biobank (I.R.C.C.S. - Istituto Tumori "Giovanni Paolo II", Bari);
• evaluation of the proteomic, metascriptomic, metabolomic, metagenomic, and metagenetic profile.

Furthermore, molecular characterization of pathogenic microorganisms and pathogenic biotypes (pathovars) of commensal species of subjects with selected pathologies will be conducted.

Part of the biological material will be used for animal studies on the physiopathological role of the human intestinal microbiota transplanted into mouse models of pathology and Germ-free mouse models (specific animal study protocol developed).

The study foresees no more than minimal risk associated with blood sampling procedures. All the necessary measures to avoid any risks / inconveniences resulting from participation of the subject under study will be taken.

The study is compliant with Good Clinical Practice. Study protocol and all related documents have been approved by approved by the Independent Ethics Committees (IEC) of the involved clinical sites.

To ensure the protection and confidentiality of the participants' data, all study activities will be carried out in accordance with the European General Data Protection Regulation, Regulation (EU) 2016/679, which repeals Directive 95/46/EC.

• Study Type: Observational
• Enrollment (Actual): 150

Contacts and Locations

Study Locations

• Italy
  • Bari, Italy
    • Nefrologia, Dialisi e Trapianto di Rene - Dipartimento dell'emergenza e dei trapianti d'organo (DETO) - Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari
  • Perugia, Italy
    • Sezione Medicina Interna e Scienze Endocrine e Metaboliche - (MISEM) - Università degli Studi di Perugia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients with a diagnosis of ADKD, advanced CDK, DKD and IgAN attending one of the clinical centres involved in the study.

Healthy volunteers will be recruited by invitation. Enrolled subjects must not have any family relationship and hierarchical subordination with the hospitals in which biological samples will be collected.

Description

Inclusion Criteria:

HEALTHY VOLUNTEERS

Inclusion criteria:

• healthy subjects aged between 18 and 60 years
• BMI between 18.5-30
• omnivorous diet
• signature of the informed consent

PATIENTS WITH ADPKD

Inclusion criteria:

• subjects with ADPKD aged between 18 and 60 years
• creatinine clearance between 30mL / min and 60mL / min
• creatinine clearance > 60 mL / min
• BMI between 18.5-30
• omnivorous diet
• signature of the informed consent

PATIENTS WITH ADVANCED CKD

Inclusion criteria:

• subjects with advanced CDK (creatinine clearance <30 mL / min)
• age between 18 and 60 years
• BMI between 18.5-30
• omnivorous diet
• signature of the informed consent

PATIENTS WITH IgAN

Inclusion criteria:

• subjects with IgAN, "progressor" (who have an increase in proteinuria or creatininemia or reduction in eGFR within the previous three years)
• subjects with IgAN, "non progressor"
• creatinine clearance> 30 mL / min
• BMI between 18.5-30
• omnivorous diet
• signature of the informed consent

PATIENTS WITH DKD

Inclusion criteria:

• subjects with DKD
• subjects with A1, G1-3a staging
• subjects with A2, G1-3a staging
• subjects with staging A3, G1-3a
• creatinine clearance> 45 mL / min
• age between 18 and 60 years
• BMI between 18.5-30
• omnivorous diet
• signature of the informed consent.

Exclusion Criteria:

HEALTHY VOLUNTEERS

• Current or previous infectious diseases (HAV, HBV, HCV, HIV, Cytomegalovirus, Epstein-Barr virus)
• Chronic liver disease
• History of Clostridium difficile infections
• Recent (<3 months) therapy with antibiotics, immunosuppressive drugs, chemotherapy
• Chronic therapy with proton pump inhibitors
• Recent (<3 months) use of probiotics, laxatives or other aids (drugs / supplements) for the regulation of gastrointestinal activity
• Previous history of organ / tissue transplantation
• Recent onset of diarrhea
• Chronic diarrhea
• Chronic constipation
• Previous gastrointestinal surgery (eg gastric bypass)
• Recurring urinary tract infections (3 cases per year)
• Previous major acute cardiovascular diseases (myocardial infarction, stroke)
• Type 2 diabetes mellitus
• Hypertension
• eGFR (estimated glomerular filtration rate) lower than 60ml / minute and / or diagnosis of nephropathy
• Chronic gastrointestinal disorders
• Systemic inflammatory diseases
• Suspicion, clinical diagnosis or previous history of cancer (<5 years)
• Autoimmune disorders or history of chronic and systemic autoimmune disorders
• Neurodegenerative disorders
• Pregnancy and breastfeeding
• Healthcare workers
• Operators work with animals
• Psychiatric conditions that reduce protocol compliance.

PATIENTS WITH ADPKD; PATIENTS WITH ADVANCED CKD; PATIENTS WITH IgAN; PATIENTS WITH DKD

• Current or previous infectious diseases (HAV, HBV, HCV, HIV, Cytomegalovirus, Epstein-Barr virus)
• Chronic liver disease
• History of Clostridium difficile infections
• Recent (<3 months) therapy with antibiotics, immunosuppressive drugs, chemotherapy
• Chronic therapy with proton pump inhibitors
• Recent (<3 months) use of probiotics, laxatives or other aids (drugs / supplements) for the regulation of gastrointestinal activity
• Previous history of organ / tissue transplantation
• Recent emergence of diarrhea
• Chronic diarrhea
• Chronic constipation
• Previous gastrointestinal surgery (eg gastric bypass)
• Recurring urinary tract infections (3 cases per year)
• Previous major acute cardiovascular diseases (myocardial infarction, stroke) occurred in the last 3 years
• Chronic gastrointestinal disorders
• Systemic inflammatory diseases
• Suspicion, clinical diagnosis or previous history of cancer (<5 years)
• Autoimmune disorders or history of chronic and systemic autoimmune disorders
• Neurodegenerative disorders
• Type 2 diabetes mellitus
• Pregnancy and breastfeeding
• Psychiatric conditions that reduce protocol compliance.

Study Plan

How is the study designed?

Number of groups / cohorts

5

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Healthy volunteers	Other: Questionnaire; Anamnestic questionnaire, 3-day food questionnaire, Food Frequency Questionnaire; Other: Medical examination; Blood pressure measurement, abdominal and thoracic physical examination; Other: Biological sample collection; Collection of faeces, urine, saliva, PBMC and blood for biobanking, to evaluate the proteomic, metascriptomic, metabolomic, metagenomic, and metagenetic profile, and to perform routine screening
ADPKD; Patients with ADPKD	Other: Questionnaire; Anamnestic questionnaire, 3-day food questionnaire, Food Frequency Questionnaire; Other: Medical examination; Blood pressure measurement, abdominal and thoracic physical examination; Other: Biological sample collection; Collection of faeces, urine, saliva, PBMC and blood for biobanking, to evaluate the proteomic, metascriptomic, metabolomic, metagenomic, and metagenetic profile, and to perform routine screening
advanced CKD; Patients with advanced CKD	Other: Questionnaire; Anamnestic questionnaire, 3-day food questionnaire, Food Frequency Questionnaire; Other: Medical examination; Blood pressure measurement, abdominal and thoracic physical examination; Other: Biological sample collection; Collection of faeces, urine, saliva, PBMC and blood for biobanking, to evaluate the proteomic, metascriptomic, metabolomic, metagenomic, and metagenetic profile, and to perform routine screening
DKD; Patients with DKD	Other: Questionnaire; Anamnestic questionnaire, 3-day food questionnaire, Food Frequency Questionnaire; Other: Medical examination; Blood pressure measurement, abdominal and thoracic physical examination; Other: Biological sample collection; Collection of faeces, urine, saliva, PBMC and blood for biobanking, to evaluate the proteomic, metascriptomic, metabolomic, metagenomic, and metagenetic profile, and to perform routine screening
IgAN; Patients with IgAN	Other: Questionnaire; Anamnestic questionnaire, 3-day food questionnaire, Food Frequency Questionnaire; Other: Medical examination; Blood pressure measurement, abdominal and thoracic physical examination; Other: Biological sample collection; Collection of faeces, urine, saliva, PBMC and blood for biobanking, to evaluate the proteomic, metascriptomic, metabolomic, metagenomic, and metagenetic profile, and to perform routine screening

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biological samples collection for establishment of the first National Microbiome Biobank	Recruitment of 150 subjects (ADPKD, advanced CDK, DKD, IgAN patients and healthy volunteers) to collect biological samples for establishment of the first National Microbiome Biobank	through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
• Collaborators: Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies; Istituti Tumori Giovanni Paolo II; University of Bari Aldo Moro; University of Salento; Università degli Studi di Perugia
• Investigators: Principal Investigator: Loreto Gesualdo, MD, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari

Publications and helpful links

General Publications

• Zhou Y, Xu H, Huang H, Li Y, Chen H, He J, Du Y, Chen Y, Zhou Y, Nie Y. Are There Potential Applications of Fecal Microbiota Transplantation beyond Intestinal Disorders? Biomed Res Int. 2019 Jul 29;2019:3469754. doi: 10.1155/2019/3469754. eCollection 2019.
• Cosola C, Rocchetti MT, Sabatino A, Fiaccadori E, Di Iorio BR, Gesualdo L. Microbiota issue in CKD: how promising are gut-targeted approaches? J Nephrol. 2019 Feb;32(1):27-37. doi: 10.1007/s40620-018-0516-0. Epub 2018 Aug 1.
• Castillo-Rodriguez E, Fernandez-Prado R, Esteras R, Perez-Gomez MV, Gracia-Iguacel C, Fernandez-Fernandez B, Kanbay M, Tejedor A, Lazaro A, Ruiz-Ortega M, Gonzalez-Parra E, Sanz AB, Ortiz A, Sanchez-Nino MD. Impact of Altered Intestinal Microbiota on Chronic Kidney Disease Progression. Toxins (Basel). 2018 Jul 19;10(7):300. doi: 10.3390/toxins10070300.
• Kanbay M, Onal EM, Afsar B, Dagel T, Yerlikaya A, Covic A, Vaziri ND. The crosstalk of gut microbiota and chronic kidney disease: role of inflammation, proteinuria, hypertension, and diabetes mellitus. Int Urol Nephrol. 2018 Aug;50(8):1453-1466. doi: 10.1007/s11255-018-1873-2. Epub 2018 May 4.
• Ramezani A, Massy ZA, Meijers B, Evenepoel P, Vanholder R, Raj DS. Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target. Am J Kidney Dis. 2016 Mar;67(3):483-98. doi: 10.1053/j.ajkd.2015.09.027. Epub 2015 Nov 15.

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 3, 2021
• Primary Completion (ACTUAL): May 10, 2022
• Study Completion (ACTUAL): May 10, 2022

Study Registration Dates

• First Submitted: December 16, 2020
• First Submitted That Met QC Criteria: December 28, 2020
• First Posted (ACTUAL): December 30, 2020

Study Record Updates

• Last Update Posted (ACTUAL): August 1, 2022
• Last Update Submitted That Met QC Criteria: July 29, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: Microbioma biobank; Biological human samples; Meta-omics approaches; Microbiota-pathology relationship; Chronic kidney diseases
• Additional Relevant MeSH Terms: Immune System Diseases; Autoimmune Diseases; Urologic Diseases; Endocrine System Diseases; Congenital Abnormalities; Diabetes Complications; Diabetes Mellitus; Renal Insufficiency; Genetic Diseases, Inborn; Nephritis; Abnormalities, Multiple; Glomerulonephritis; Kidney Diseases, Cystic; Ciliopathies; Kidney Diseases; Renal Insufficiency, Chronic; Diabetic Nephropathies; Glomerulonephritis, IGA; Polycystic Kidney Diseases; Polycystic Kidney, Autosomal Dominant
• Other Study ID Numbers: BIOMIS-Nefro

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