- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05820893
Resistant Potato Starch to Alleviate GWI
BCCMA: Targeting Gut-Microbiome in Veterans Deployment Related Gastrointestinal and Liver Diseases; CMA5- Functional Metagenomics in GWI-related Gut Dysfunction
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: Despite medical advancements, Gulf War illness (GWI) treatment remains a major challenge. Gulf war veterans with GWI can experience acute or chronic disorders of diarrhea, nausea, joint pain, muscle pain, general fatigue, sleep problems skin rashes, wheezing, persistent cough, dizziness and headaches. It is estimated 25-32% of the over 700,000 coalition troops deployed report symptoms consistent with GWI, 47% of whom experience gut-related symptoms. Longitudinal studies have shown little to no overall improvement in symptoms over time. Currently there are very limited treatment courses for GWI and even fewer for gut-related symptoms leading to the advisory committee on GWIs call for research leading to effective treatments improving the health of GWVs. Studies have shown that the gut is comprised of diverse bacteria that plays a critical role in the health of an individual. Comprised gut microbiota can lead to serious consequences such as GWI. There is thus a critical need to identify a new treatment that is safe, effective with minimal adverse effect to reduce GWI-associated morbidity. Prebiotics are such an example. Prebiotics are natural fibers derived from carbohydrates and can be beneficial to gut microbiota (good bacterial in the gut). Resistant starches (RS) are dietary fiber prebiotics found naturally in many foods including potatoes, plantains, and legumes. In addition to being highly accessible, RS have been shown to be well tolerated with few adverse reactions. While no studies of RS exist in GWI patients, a meta-analysis of RS in IBD has shown RS to be an effective treatment in both animal and clinical studies where improvements in clinical remission and reduced mucosal damage were found. Furthermore, numerous studies have found RS to reduce inflammation in murine models of colonic inflammation and to modify the intestinal microbiota and associated metabolome in mice and swine.
Objectives: The investigators hypothesize those randomized to the RS prebiotic group will experience a reduction in GWI symptoms following the completion of the trial. The investigators also hypothesize the prebiotic group will have increased concentrations of SCFAs and SCFA-producing bacteria in the gut compared to those in the control group.
Methods: This is a phase II randomized clinical trial in Veterans with GWI experiencing gut symptoms. Subjects will be randomized to either taking a RS prebiotic daily for 4 weeks or to the control group (maintenance of normal diet). Subjects will provide stool and serum samples as well as complete a series of health history and dietary questionnaires.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Nasia Safdar, MD PhD
- Phone Number: (608) 280-7007
- Email: Nasia.Safdar@va.gov
Study Contact Backup
- Name: Ashley E Kates, PhD
- Phone Number: 17535 (608) 256-1907
- Email: ashley.kates@va.gov
Study Locations
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Wisconsin
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Madison, Wisconsin, United States, 53705-2254
- William S. Middleton Memorial Veterans Hospital, Madison, WI
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Principal Investigator:
- Nasia Safdar, MD PhD
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Contact:
- Nasia Safdar, MD PhD
- Phone Number: 608-280-7007
- Email: Nasia.Safdar@va.gov
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Ability to provide informed written consent
- Willing to comply with all study procedures and be available for the duration of the study.
- Ability to take oral medication.
- Willing to provide blood and stool samples
- Meeting the modified Kansas GWI case definition* with gut symptoms endorsed
Aged 45-80 years old
Moderate to severe GWI symptoms lasting at least 6 months in a minimum of three of the six symptom domains (one of which must be fatigue). The symptom domains are:
- Pain (joint pain, muscle pain)
- Gastrointestinal (diarrhea, nausea, vomiting, cramping)
- Respiratory (persistent cough, wheezing)
- Skin (rashes)
- Fatigue (sleep problems, fatigue)
- Neurologic (memory problems, headaches, dizziness, mood changes)
Exclusion Criteria:
- A Known SARS-CoV-2 infection in the last 60 days and/or with a diagnosis of post-acute sequelae of COVID-19 (PASC, sometimes called long COVID) defined as COVID-19 symptoms lasting for greater than 6 months.
- Subjects identified as, or appearing to, lack consent capacity
- Current smokers
- Alcohol abuse (greater than 14 drinks per week for men and 7 drinks per week for women)
- Use of investigational drugs, biologics, or devices within 30 days prior to randomization.
- Individuals who are pregnant, lactating or planning on becoming pregnant during the study.
- Diagnosed inflammatory bowel disease, Crohn's disease, or Celiac's disease
- Hypothyroidism
- Unstable psychiatric illness
- Involvement in another clinical trial
- Previous gastrointestinal surgery (colorectal surgery, gastric bypass, intestinal resection)
- Use of other prebiotics, probiotics (including yogurt containing live probiotics), postbiotics, or other fiber supplements in the last 30 days
- Systemic antibiotics in the last 30 days
- Fecal microbiota transplant in the last 30 days
- Active dysphagia
- Allergies to any of the ingredients in MSPrebiotic
- Individuals with a Kansas criteria exclusionary condition: lupus, multiple sclerosis, schizophrenia, active cancer treatment, physical impairment related to a stroke, uncontrolled Diabetes Mellitus
- Use of anti-diarrheal agents, stool softeners, or immunomodulatory medications in the last 30 days.
- The use of proton pump inhibitors, H2 receptor blockers or any other medication known to suppress gastric acid in the last 30 days.
- Any other factor, condition, or medication not listed above the Investigators believe will affect the response in the gut or the interpretation of results.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Prebiotic arm
Subjects will consume the RS prebiotic daily for 4 weeks.
A dose escalation will be used with subjects taking 4g of the prebiotic for the first 4 days, 7g the next 3 days and the full dose of 10g on day 8.
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MSPrebiotic (MSPrebiotic Inc, Carberry, Manitoba, Canada).
MSPrebiotic is an unmodified resistant starch derived from potatoes (Solanar tuberosum).
It consists of 20% amylose and 80% amylopectin forming granules the stomach and small intestine are unable to digest allowing for absorption in the colon.
MSPrebiotic is consumed by mixing 10g into cold or room temperature foods or beverages; it is not to be heated.
Participants will be instructed to take MSPrebiotic 2 or more hours before or after consuming any medications.
Other Names:
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No Intervention: Standard diet
Subjects randomized to this arm will be asked to maintain their usual diet.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes from baseline to the end of the study period in the composition of the gut microbiome
Time Frame: 2 years
|
The gut microbiome will be assessed using next generation sequencing (shotgun metagenomics)
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2 years
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Changes from baseline to the end of the study period in the concentration of short-chain fatty acids and other metabolites identified in the gut microbiome
Time Frame: 2 years
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The metabolites in the gut will be identified through next-generation sequencing technology and both targeted and untargeted metabolomics.
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2 years
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Improvement in quality of life
Time Frame: 2 years
|
Quality of life will be assessed using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire from baseline to the end of the study period.
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2 years
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Changes in GWI symptoms over the study period
Time Frame: 2 years
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A GWI symptoms assessment tool will be used to determine changes in symptoms from baseline to the end of the study period.
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2 years
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Changes in overall health over the study period
Time Frame: 2 years
|
The Veterans RAND-36 (VR-36) questionnaire will be used to determine changes in overall health and associated quality of life over the study period.
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2 years
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Tolerability of the probiotic defined as discontinuation due to adverse events during the study period
Time Frame: 2 years
|
Assess the tolerability of orally consuming MSPrebiotic by determining the frequency of withdraws from the study due to the occurrence of adverse events.
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2 years
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Collaborators and Investigators
Investigators
- Principal Investigator: Nasia Safdar, MD PhD, William S. Middleton Memorial Veterans Hospital, Madison, WI
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- SPLD-004-22S
- CX002471 (Other Grant/Funding Number: VA Office of Research and Development)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ANALYTIC_CODE
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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