Supplementation With B. Infantis for Mitigation of Type 1 Diabetes Autoimmunity (SINT1A)

"SINT1A" - Supplementation With B. Infantis for Mitigation of Type 1 Diabetes Autoimmunity - A Study of the Global Platform for the Prevention of Autoimmune Diabetes ("GPPAD")

Investigator initiated, randomised, placebo-controlled, double-blind, multi-centre primary intervention study to assess whether daily administration of B. infantis EVC001 from age 7 days to 6 weeks (+14 days) until age 12 months (+ 14 days) to children with elevated genetic risk for type 1 diabetes reduces the cumulative incidence of beta-cell autoantibodies in childhood.

Study Overview

• Status: Active, not recruiting
• Conditions: Diabetes Mellitus, Type 1
• Intervention / Treatment: Dietary supplement: B. infantis; Dietary supplement: Placebo

Detailed Description

The GPPAD-04 SINT1A study will evaluate whether early, regular supplementation with a daily dose of a probiotic can reduce the risk of developing beta-cell autoimmunity in children identified by GPPAD-02 as being genetically predisposed to developing type 1 diabetes. Children will be enrolled at age 7 days to 6 weeks (+14 days) and the study product (B. infantis EVC001 or Placebo) will be administered orally once per day from enrollment until age 12 months (+14 days).

The hypotheses is that administration of B. infantis may have a positive influence on the intestinal flora and thus have a regulating effect on the immune system. The study is designed to investigate whether pathogenic immune reactions as in type 1 diabetes but also in other diseases, such as celiac disease, can be reduced and if the disease can be prevented.

Children will be followed until age 3.5 - 6.5 years (2.5 - 5.5 years after end of treatment).

Throughout the study data will be collected by regular study visits, phone calls with the families and electronic questionaires.

Blood samples will be collected to investigate glucose, HbA1c, beta-cell autoantibodies, transglutaminase antibodies, vaccine responses, genetic susceptibility and mechanistic markers. Stool samples will be collected for further assessments such as colonization,microbiome, pH and calprotectin.

Exploratory outcomes (allergy, vaccine responses, stool microbiome, blood metabolomics, stool pH and calprotectin or site specific ancillary measurements) may be assessed or in part assessed on a portion of the participants after unblinding the study. They may not necessarily be included in the primary outcome analysis and publication.

GPPAD is committed to sharing of data in compliance with all applicable European and GPPAD Consortium Member State, Data Protection and Privacy Protection laws, rules and regulations.

Pseudonymized data of the GPPAD-04 SINT1A study will be available to the scientific community after the publication of the trial analysis, which is anticipated in 2028. The SINT1A data will be available upon request.

• Study Type: Interventional
• Enrollment (Actual): 1149
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Belgium
  • Leuven, Belgium
    • University Hospitals Leuven Faculty of Medicine, Catholic University of Leuven
• Germany
  • Dresden, Germany
    • Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
  • Hannover, Germany
    • AUF DER BULT, Kinder- und Jugendkrankenhaus
  • Munich, Germany
    • Institute of Diabetes Research, Helmholtz Zentrum Munich, Germany, and Forschergruppe Diabetes, Technical University Munich (TUM), School of Medicine, Klinikum rechts der Isar
• Poland
  • Warsaw, Poland
    • Department of Paediatrics Medical University of Warsaw
• Sweden
  • Malmö, Sweden
    • Lund University, Skane University Hospital SUS
• United Kingdom
  • Cambridge, United Kingdom
    • University Department of Paediatrics, Cambridge Biomedical Campus
  • Newcastle, United Kingdom
    • Royal Victoria Infirmary, Newcastle upon Tyne

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 week to 1 month (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Infants between the ages of 7 days and 6 weeks (+14 days in case of illness or COVID-19 related issues or unexpected delay in result reporting) at the time of randomisation.

2. A 10% or higher genetic risk to develop multiple beta-cell autoantibodies by age 6 years:

   1. For infants without a first-degree family history of type 1 diabetes, high genetic risk is defined as a DR3/DR4-DQ8 or DR4-DQ8/DR4-DQ8 genotype and a genetic risk score that is in the upper 25th centile (>14.4) or a DR3/DR4-DQ8 genotype with a GRS between the upper 50th (14.0) and 25th centile and a GG genotype at the rs3763305 SNP. These represent around 1% of all newborns.
   2. For infants with a first-degree family history of type 1 diabetes, high genetic risk is defined as having HLA DR4 and DQ8, and none of the following protective alleles: DRB1*1501, DQB1*0503, DRB1*1303. These represent around 30% of infants with a first-degree family history of T1D.
3. Written informed consent signed by the custodial parent(s).-

Exclusion Criteria:

1. Any medical condition, concomitant disease or treatment that may interfere with the assessments or may jeopardize the participant's safe participation in the study, as judged by the Investigators.
2. Preterm delivery < 36 weeks of gestation.
3. Proven immunodeficiency.
4. Any condition that could be associated with poor compliance.5. Diagnosis of diabetes at the time of recruitment

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: B. infantis; Activated B. infantis EVC001; Bifidobacterium longum subsp. infantis; 8 x 109 colony forming units (CFU) per day	Dietary supplement: B. infantis; Activated B. infantis EVC001; Bifidobacterium longum subsp. infantis; 8 x 109 colony forming units (CFU) per day
Placebo Comparator: Placebo; Lactose identical in appearance and taste to the active supplement	Dietary supplement: Placebo; Lactose identical in appearance and taste to the active supplement

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Persistent confirmed multiple beta-cell autoantibodies	Persistent confirmed multiple beta-cell autoantibodies is defined as confirmed IAA, confirmed GADA, confirmed IA-2A, or confirmed ZnT8A in two consecutive samples, AND a confirmed second antibody from these four antibodies in one sample. The primary outcome is the elapsed time from the random treatment assignment to the first confirmed autoantibody positive sample used in defining the persistent confirmed multiple beta-cell autoantibody positive status. Diabetes in the absence of multiple beta-cell autoantibodies is also considered as a primary outcome endpoint, and in this case, the date of diagnosis is the time of the end point.	Through study completion, up to 6.5 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Persistent confirmed beta-cell autoantibodies	Any persistent confirmed beta-cell autoantibody, defined as at least one confirmed autoantibody in two consecutive samples, including IAA, GADA, IA-2A or ZnT8A	Through study completion, up to 6.5 years
Diabetes	Criteria for T1D onset are, as defined by the American Diabetes Association (ADA), based on glucose testing, or the presence of unequivocal hyperglycaemia with acute metabolic decompensation (diabetic ketoacidosis).	Through study completion, up to 6.5 years
Transglutaminase antibodies	Transglutaminase antibodies defined as persistent in two consecutive samples	Through study completion, up to 6.5 years
Respiratory infection rate	Respiratory infection rate in first year of life during supplementation	1 year
Measurement of Safety parameters	Adverse Events and Serious Adverse Events will be captured until 30 days after the last administration of the food product. Local and systemic adverse effects will be elicited by direct questioning of the participant or parent. Systemic effects will be sought by questioning about any untoward symptoms or signs, and graded as mild, moderate, severe, life-threatening or death according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 5.0.	from Baseline until 30 days after end of supplementation

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Allergy	Participant's parents will be asked to complete questionnaires to obtain information about allergies every 12 months. Analyses will compare the B. infantis supplementation and placebo groups for the frequency of allergy and allergy sub-groups as defined form the yearly questionnaires.	Through study completion, up to 6.5 years
Antibody response (IgG titres) to vaccines	Information about rotavirus and MMR vaccination will be collected from parents and antibody response (IgG titers) will be measured centrally.	at age 6 months (rotavirus) and at age 2 years (MMR)
Alterations of the gut microbiome or blood metabolome	Exploratory analyses will examine the associations between B. infantis supplementation and mouth and stool organisms (microbiome), and blood markers such as the metabolome.	from baseline to age 12 months
Stool pH	Stool pH levels will be compared between B. infantis supplementation and placebo groups in a subset of children	at age 6 months
Stool calprotectin	Stool calprotectin levels will be compared between B. infantis supplementation and placebo groups in a subset of children	at age 6 months

Collaborators and Investigators

• Sponsor: Helmholtz Zentrum München
• Collaborators: Universitaire Ziekenhuizen KU Leuven; Technical University of Munich; Medical University of Warsaw; Skane University Hospital; Kinderkrankenhaus auf der Bult; University Hospital Carl Gustav Carus; Cambridge Biomedical Campus, Cambridge, UK; Royal Victoria Infirmary, Newcastle upon Tyne, UK

Publications and helpful links

General Publications

• Ziegler AG, Arnolds S, Kolln A, Achenbach P, Berner R, Bonifacio E, Casteels K, Elding Larsson H, Gundert M, Hasford J, Kordonouri O, Lundgren M, Oltarzewski M, Pekalski ML, Pfirrmann M, Snape MD, Szypowska A, Todd JA; GPPAD STUDY GROUP. Supplementation with Bifidobacterium longum subspecies infantis EVC001 for mitigation of type 1 diabetes autoimmunity: the GPPAD-SINT1A randomised controlled trial protocol. BMJ Open. 2021 Nov 9;11(11):e052449. doi: 10.1136/bmjopen-2021-052449.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start (Actual): April 22, 2021
• Primary Completion (Estimated): October 1, 2027
• Study Completion (Estimated): October 1, 2027

Study Registration Dates

• First Submitted: February 19, 2021
• First Submitted That Met QC Criteria: February 23, 2021
• First Posted (Actual): February 24, 2021

Study Record Updates

• Last Update Posted (Estimated): December 13, 2024
• Last Update Submitted That Met QC Criteria: December 12, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: probiotic; prevention; allergy; respiratory infections; Type 1 diabetes autoimmunity; celiac autoimmunity; B. infantis
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Immune System Diseases; Glucose Metabolism Disorders; Diabetes Mellitus; Diabetes Mellitus, Type 1; Autoimmune Diseases
• Other Study ID Numbers: GPPAD-04

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

GPPAD is committed to sharing of data in compliance with all applicable European and GPPAD Consortium Member State, Data Protection and Privacy Protection laws, rules and regulations.

Pseudonymized data of the GPPAD-04 SINT1A study will be available to the scientific community after the publication of the trial analysis, which is anticipated in 2028. The SINT1A data will be available upon request.

Drug and device information, study documents

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