The Gut and Oral Bacteria, Atherosclerosis and Ischemic Stroke Study

April 25, 2022 updated by: Mona Skjelland, Oslo University Hospital

The main aim of this project is to demonstrate an association between gut and oral microbiota and their metabolites to carotid atherosclerosis and risk of ischemic stroke.

The investigators aim to show that these metabolite levels are diet-dependent (mainly egg yalk and red meat) and associated with specific types of microbiota.

The investigators to assess serum microbiota metabolite levels as a predictor of stroke and plaque progression for patients with carotid atherosclerosis.

Study Overview

Status

Active, not recruiting

Intervention / Treatment

Detailed Description

The Project will include four studies:

Study 1: (Comparative cross-sectional study) The main objective in this study is to assess if patients with carotid atherosclerosis have increased serum levels gut microbiota dependent metabolites compared to healthy controls.

This study will be done on prospectively collected information already available in our existing database. Approximately 215 patients will be included in this study where collected samples will be analyzed and levels of metabolites quantified. These metabolite levels will be compared to a control group of 70 healthy controls without carotid atherosclerosis (verified by ultrasound), cardiovascular outcome defined as stroke/TIA or vascular death, as well as traditional risk factors for ischemic stroke (diabetes, hypertension, smoking and coronary artery disease).

Study 2: (Comparative cross-sectional study) The aim of this study is to asses if microbiota and microbiota metabolite Levels are Associated With certain types of diet, in particular Rich in red meat and egg yalk.

In this study, 215 patients with ultrasound verified carotid atherosclerosis with or without symptoms of TIA/stroke will be compared to 70 controls. Dietary intake and food habits will be recorded using the SmartDiet questionnaire developed by 'Lipidklinikken Rikshospitalet'. Feces, saliva and blood will be collected analyzed for microbiota and metabolites. Antroprometrics, blood pressure and pulse will be recorded.

In patients undergoing carotid endarterectomy and immunohistochemical analysis will be done.

Study 3: (Comparative cross-sectional study) The aim of this study is to evaluate correlation between the microbiota and microbiota metabolite Levels With other inflammatory markers in blood, as well as known risk factors for stroke and inflammation on imaging modalities (ultrasound, 3-T MRI and PET/CT) .

In this study, 215 patients with ultrasound verified carotid atherosclerosis with or without symptoms of TIA/stroke will be compared to 70 controls.

Patients will undergo investigations with carotid ultrasound, carotid and cerebral MR imaging, blood tests including inflammatory biomarkers. A sub-group of patients will in addition undergo PET/CT imaging of carotid arteries.

Study 4: (Follow up study) The aim of this study is to evaluate the ability of microbiota and microbiota metabolites to predict ischemic stroke in patient With carotid stenosis.

Patients in study 2 and 3 will be followed up after 2 years with repetition of investigations. Findings with serum levels of microbiota metabolites, traditional risk factors and imaging will be correlated to clinical and radiological ischemic events and plaque progression.

Study Type

Observational

Enrollment (Anticipated)

290

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Oslo, Norway
        • Oslo University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

- All patients >18 years with an atherosclerotic carotid stenosis ≥ 50% admitting our department (Dep of Neurology, Rikshospitalet, OUH) as in-patient or out-patient will consecutively be considered for inclusion.

Cooperation With Dep of vascular surgery Akershus University Hospital and Dep of vascular surgery, Aker, OUH, for patients scheduled for thrombendarterectomy.

- Control Group: For study 1: Healthy volonteers For study 2 and 3: Spouses/partners where possible, otherwise matched for age and sex

Description

Inclusion Criteria:

- patients >18 years with an symptomatic og asymptomatic atherosclerotic carotid stenosis ≥ 50% (NASCET criteria)

Exclusion Criteria:

  • active infection
  • current antibiotic treatment
  • autoimmune or autoinflammatory disease
  • malignancies

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Patiens
Patients With symptomatic or asymptomatic carotid stenosis (> 50%, NASCET criteria)
No intervention
Controls
For study 1: Healthy Controls, volunters (mostly blood donors) For study 2 and 3: Spouses/someone living in the same household as the patient.
No intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants With MRI-confirmed acute ischemic stroke related to increased Levels of serum microbiota-metabolites as assessed by blood tests.
Time Frame: 2 years
Blood test (microbiota-metabolites e.g. TMAO) at study inclusion, carotid ultrasound (carotid plaque assessment and degree of stenosis) and cerebral MRI (evidence of stroke) at follow up
2 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants with progression of carotid stenosis related to increased Levels of serum microbiota-metabolites as assessed by blood tests.
Time Frame: 2 years
Blood tests (microbiota metabolites e.g. TMAO) and carotid ultrasound (plaque assessment and degree of stenosis)
2 years
Number of participants With increased Levels of microbiota-metabolites related to Diet Rich in red meat and egg yalk as assessed by 'Smart Diet' questionnaire.
Time Frame: At inclusion
Blood tests (microbiota metabolites, e.g. TMAO), dietary questionnaire ('Smart Diet' developed by the department for endocrinology Rikshospitalet)
At inclusion
Number of participants With increased Levels of microbiota-metabolites related to specific types of microbiota in feces and saliva as assessed by next generation sequencing and 16S RNA.
Time Frame: At inclusion
Blood tests (microbiota metabolites e.g TMAO), fecal samples (Next generation sequencing, 16S RNA), saliva samples (Next generation sequencing 16S RNA)
At inclusion
Number of participants With increased Levels of microbiota-metabolites related to traditional risk factors for ischemic stroke assessed by questionnaire and Medical journal.
Time Frame: At inclusion
Blood tests (microbiota metabolites, e.g. TMAO), questionnaire (Risk factors: hypertension, diabetes mellitus type 2, previous stroke og myocardial infarction, smoking, physical inactivity, Family history)
At inclusion
Number of participants With increased Levels of microbiota-metabolites related to signs of plaque instability on imaging studies assessed by carotid ultrasound, carotid and cerebral MRI and for a subgroup: carotid PET/CT.
Time Frame: At inclusion
Blood tests (microbiota metabolites, e.g. TMAO), carotid ultrasound (carotid plaque assessment, degree of stenosis), carotid and cerebral MRI (evidence of inflammation and stenosis in carotids, stroke), for a subgroup: carotid PET/CT (evidence of inflammation)
At inclusion

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2018

Primary Completion (Anticipated)

December 1, 2024

Study Completion (Anticipated)

December 1, 2024

Study Registration Dates

First Submitted

September 10, 2018

First Submitted That Met QC Criteria

March 16, 2021

First Posted (Actual)

March 18, 2021

Study Record Updates

Last Update Posted (Actual)

April 26, 2022

Last Update Submitted That Met QC Criteria

April 25, 2022

Last Verified

April 1, 2022

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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