Phase I Clinical Study of Chondroitin Sulfate for Treatment of NEC

A Randomized, Controlled, Double-Blind Phase I Clinical Study of Chondroitin Sulfate Supplementation for Treatment of Necrotizing Enterocolitis

The goal of this phase 1 double blind, randomized controlled trial is to determine the safety of chondroitin sulfate supplementation in the neonates with necrotizing enterocolitis. The main questions the study aims to answer are:

Is chondroitin sulfate safe to administer in the neonatal NEC population, and will it have a beneficial profile in the short term intestinal and long term neurodevelopmental sequelae of NEC? Researchers will compare all cause mortality, progression to surgery, systemic inflammatory markers, and long term neurodevelopmental outcomes in those NEC patients who receive chondroitin sulfate compared to those who receive milk or formula placebo.

Study Overview

• Status: Withdrawn
• Conditions: Necrotizing Enterocolitis; Intestinal Ischemia
• Intervention / Treatment: Drug: Chondroitin sulfate

Detailed Description

Necrotizing Enterocolitis (NEC) is a devastating intra-abdominal emergency that primarily affects premature infants and is characterized by abdominal distention, extreme illness, and intestinal necrosis-with mortality rates that range from 20-30%. Despite earnest research, there have been no significant advances in our ability to treat this disease within the last several decades, making NEC an unmet medical need.

Neurodevelopmental impairment (NDI) is a detrimental sequela in infants with NEC and carries an incidence of approximately 40%. NDI is believed to be a result of the systemic inflammatory response and pathogenic signaling cascades associated with NEC, resulting in white-matter injury, alterations in brain parenchyma, and loss of brain matter volume-which then manifest in later life as cognitive and motor deficits, autism, and cerebral palsy. Novel therapeutic strategies to treat or prevent NEC and its long-term sequelae would have a significant impact on reducing morbidity and mortality in this fragile population.

Our long-term goal is to develop effective methods for the prevention and treatment of NEC and its neurodevelopmental sequelae. In this regard, the use of human breast milk (HM) is an important preventative strategy to reduce the incidence of NEC. In one study, 7.2% of infants receiving formula developed NEC while only 1.2% of infants exclusively being fed breastmilk developed NEC. This would suggest that protective compounds exist in human breastmilk that may prevent NEC. However, despite the beneficial properties of human breastmilk, it's important to note that breast milk has not been shown to eliminate NEC. Therefore, finding protective compounds in HM that could be utilized as a formula additive or breast milk booster would be highly effective in further preventing and treating NEC. A prominent glycosoaminoglycan gaining clinical interest is chondroitin sulfate (CS), which comprises over half of the normal GAG content in HM and is surprisingly nonexistent in most major infant formulas. Additionally, the concentration of CS in HM is higher in preterm mothers than in term mothers, thereby suggesting some evolutionary importance for this compound to preterm infants6.

A review of the prior rigor of research suggests that CS decreases blood lipopolysaccharide (LPS) levels in mice experiencing stress, reduces invasion and translocation of bacteria within the intestine, restores repressed fecal short-chain fatty acids, and alters the intestinal microbiome. We have appreciated beneficial effects of CS in protecting the intestine during experimental NEC. A possible mechanism of action surrounds its modulation of the Th17 immune cell profile. An increase in Th17 cells and intestinal NFĸΒ phosphorylation has long been recognized as contributing molecular factors in NEC. Furthermore, IL-17 is an important effector cytokine of Th17 cells and is involved in the pathogenesis of acute neuroinflammatory conditions.

The overarching goal of this project is to perform a randomized, controlled, double blind phase 1 clinical trial to assess the short- and long-term safety profiles of chondroitin sulfate for the treatment of necrotizing enterocolitis in the neonatal population. Preliminary data from murine and porcine animal models in our lab have shown protection against the intestinal and neurodevelopmental sequelae of NEC. CS has previously been considered a food supplement and therefore is not regulated by the FDA. It has been classified as Generally Recognized as Safe by the FDA and has been used in adult clinical trials without increased safety concerns. We therefore hypothesize that CS will be safe to administer in the neonatal NEC population and will have a beneficial safety profile in the short term intestinal and long term neurodevelopmental sequela of NEC. To test these hypotheses, we propose the following Specific Aims:

1. Assess the short-term safety profile of CS supplementation in the neonatal NEC population and its impact on mortality, progression to surgery, and the systemic inflammatory profile. Adverse events, progression to surgery, and all-cause mortality will be assessed in preterm low birth weight infants with Bell's Stage II NEC. Additionally, the ability of CS to modulate the immune cell profile and systemic inflammatory response will be assessed.
2. Determine the impact of chondroitin sulfate supplementation on neurodevelopmental outcomes in the NEC population as a marker of long-term safety. To assess long-term safety, neurodevelopmental impairment of infants receiving CS will be compared to placebo at both 1- and 2-years following administration. We hypothesize that CS infants would have similar, if not improved NDI compared to placebo.

• Study Type: Interventional
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Riley Hospital for Children

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. NICU patient at Riley Hospital for Children
2. Weight of less than 2500g at time of NEC diagnosis
3. Patient must have a diagnosis of Bell's Stage 2 necrotizing enterocolitis

Exclusion Criteria:

1. Severe cardiac or neurological congenital anomalies
2. Previous history of NEC
3. History of abdominal surgery or other intestinal congenital anomalies
4. Renal failure or renal impairment necessitating dialysis
5. Any end-stage organ disease, infection, or condition, which in the opinion of the Investigator, makes the patient an unsuitable candidate for treatment
6. Receipt of another investigational therapy
7. Informed consent is unable to be obtained from parent or legally authorized representative
8. Patient is a ward of the court system

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Chondroitin sulfate; Neonates with Bell's Stage 2 NEC will receive chondroitin sulfate (20mg/kg/day) dissolved in 1-2 mil of milk or formula for 2 days	Drug: Chondroitin sulfate; Neonates with Bell's Stage 2 NEC will be given chondroitin sulfate (20mg/kg/day) mixed with 1-2 ml of milk or formula for 2 days
Placebo Comparator: Placebo; Neonates with Bell's Stage 2 NEC will receive 1-2 ml of milk or formula placebo for 2 days	Drug: Chondroitin sulfate; Neonates with Bell's Stage 2 NEC will be given chondroitin sulfate (20mg/kg/day) mixed with 1-2 ml of milk or formula for 2 days

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality		14 and 28 days post intervention
Progression to need for surgery	Infants with Stage 2 NEC can progress to stage 3 NEC and require surgery to remove intestinal tissue. This rate will be compared in the intervention and placebo arms	14 and 28 days post intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Systemic inflammatory markers	Blood will be assessed for common inflammatory markers	14 and 28 days post intervention
Neurodevelopmental impairment (NDI)	NDI will be assessed at 1 and 2 years post intervention. eurodevelopmental impairment will be defined as any of the following: moderate to severe cerebral palsy (CP) with Gross Motor Function Classification System level ≥ 2, Bayley-IV cognitive composite score <85, severe bilateral visual impairment consistent with vision <20/200, or permanent hearing loss despite amplification that prevents communication or understanding the examiner	1 and 2 years post intervention

Collaborators and Investigators

• Sponsor: Indiana University

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2025
• Primary Completion (Estimated): December 1, 2028
• Study Completion (Estimated): March 1, 2029

Study Registration Dates

• First Submitted: August 7, 2024
• First Submitted That Met QC Criteria: August 7, 2024
• First Posted (Actual): August 9, 2024

Study Record Updates

• Last Update Posted (Estimated): October 10, 2025
• Last Update Submitted That Met QC Criteria: October 8, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: chondroitin sulfate
• Additional Relevant MeSH Terms: Intestinal Diseases; Digestive System Diseases; Gastrointestinal Diseases; Gastroenteritis; Enterocolitis; Enterocolitis, Necrotizing; Carbohydrates; Glycosaminoglycans; Polysaccharides; Chondroitin; Chondroitin Sulfates
• Other Study ID Numbers: 23893

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Results of the study will be published at completion
• IPD Sharing Time Frame: within 6 months of study completion
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; CSR

Drug and device information, study documents

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