MOTIF@FRESH: Modifying Organisms Transvaginally in Females @ FRESH (MOTIF@FRESH)

The MOTIF@ FRESH trial will assess the safety and efficacy of "vaginal microbiome transplantation" (VMT). Healthy females will be enrolled to donate vaginal fluid which will be processed and transplanted in females with a history of recurrent bacterial vaginosis (BV), treated with antibiotics.

Study Overview

• Status: Not yet recruiting
• Conditions: Recurrent Bacterial Vaginosis (BV)
• Intervention / Treatment: Drug: oral metronidazole; Other: Sterile saline solution; Biological: Vaginal Microbiome Transplantation (VMT)

Detailed Description

The proposed randomized, double-blinded, placebo-controlled trial is to evaluate the safety of vaginal microbiota transplantation (VMT) in women with recurrent bacterial vaginosis (BV). The study is based in South Africa, at the FRESH (Females Rising through Education, Support, and Health) Clinical Research Site (CRS) located in the Umlazi Township of Durban. The aim of the trial is to assess the ability of antibiotic treatment plus VMT to establish a Lactobacillus-dominant vaginal community. The underlying hypothesis is that the VMT will lead to less inflammation and higher prevalence of vaginal Lactobacillus compared to antibiotics alone. The transplant material will be vaginal fluid collected from healthy donors (also known as Donors) using a disposable menstrual cup.

Donors are defined as participants with Nugent scores <4. Over a 16-week period, donors will provide vaginal fluid via softcups (referred to as "donations"). All donations will undergo extensive testing for sexually transmitted infections (STIs) and other infections. Donations that test negative for specified infections will be processed to generate vaginal microbial transplantation (VMT) doses for recipients.

Recipients are defined as participants with Nugent scores ≥4. Because the HPV vaccine is not routinely administered in South Africa, all recipients without documented proof of prior HPV vaccination will receive the HPV vaccine at least 30 days prior to the intervention. The intervention includes the standard of care for bacterial vaginosis in both the U.S. and South Africa: oral metronidazole (MTZ), administered twice daily for seven days. Following completion of the MTZ course, recipients will receive three VMT doses administered over approximately 1.5 weeks. Recipients will be randomized in a 2:1 ratio to receive either VMT or placebo and will be followed for six months post-intervention.

• Study Type: Interventional
• Enrollment (Estimated): 75
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Sarah M Eisa, MPH; Phone Number: 551-689-4016; Email: seisa@mgh.harvard.edu
• Study Contact Backup: Name: Eyerusalem T Alemu, BA; Phone Number: 619-522-4661; Email: ealemu@mgh.harvard.edu

Study Locations

• South Africa
  • Durban, South Africa
    • FRESH Clinic
    • Contact: Thembelihle Dlamini; Phone Number: +27 73 318 9320; Email: lihle.fresh@ragoninsa.org
    • Contact: Sooseela V Pillay; Phone Number: +27 31- 9060394; Email: vanessa.fresh@ragoninsa.org
    • Principal Investigator: Rosie Mngqbisa, MBChB, MPH
    • Sub-Investigator: Funidiswe Chonco, MD
    • Sub-Investigator: Siphesihle R Ngcobo, MD
    • Principal Investigator: Thumbi Ndung'u, PhD

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Premenopausal females between 18 to 25 years of age who are enrolled in the FRESH study
• Nugent score ≥ 4
• Confirmation of use of effective contraceptive method by all study recipient participants (referred to as recipients) of child-bearing potential, which includes use of at least one of the following: Hormonal method, such as birth control pills, patches, injections, vaginal rings, or implants; Barrier method, such as a condom or diaphragm used with a spermicide (a foam, cream, or gel that kills sperm); Intrauterine device (IUD) - non-levonorgestrel containing
• Ability and willingness to give written informed consent.

Exclusion Criteria:

• History of clinically significant vaginal, cervical, or uterine disease including but not limited to cancer of the female reproductive tract, prior hysterectomy, high grade cervical dysplasia (CIN III), or diagnosed with cervicovaginal infection (with the exception of bacterial vaginosis or yeast) within the 30 days prior to the procedure
• Allergy to metronidazole
• Use of investigational therapies or investigational vaccines within 90 days prior to study screening
• Has not received the HPV vaccine and is not willing to be vaccinated
• Metabolic syndrome, e.g. diabetes, pre-diabetes, glucose intolerance
• Use of any immunomodulatory agents within 30 days prior to study enrollment
• Participants taking any of the following medications: systemic steroids (inhaled or nasal steroid therapy is permitted), interleukins, systemic interferons, or systemic chemotherapy
• History of coronary artery disease, myocardial infarction, COPD, chronic renal failure, decompensated cirrhosis, or any other condition that in the opinion of the investigator will compromise ability to participate in the study
• Pap smear result of LSIL, HSIL, AGUS
• Insertion of levonorgestrel-containing IUD within 90 days prior to study enrollment
• Either breastfeeding, pregnant, or trying to conceive within 24 weeks prior to study enrollment; or becomes pregnant during study period

• Use of probiotics and prebiotics (supplements and products, oral or vaginal) within 30 days of the study

  - NOTE: Oral yogurt with live cultures and fermented foods are allowed.

• Routine use of oral antibiotics i.e., daily use for acne, Hiradenitis suppurativa, or regular use for post-coital urinary tract infection prophylaxis within the past 30 days
• Taken non-metronidazole antibiotics in last 30 days
• Taken metronidazole within the last 2 weeks
• BMI > 40

• Positive for any of the STIs listed below or on treatment for any of them.

  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • HIV
  • Trichomonas vaginalis
  • Syphilis
  • Mycoplasma genitalium
• Currently employed at, or professionally affiliated with the FRESH clinical research site, UKZN's HIV Pathogenesis Program (HPP), or the Ragon Institute of Mass General Brigham, MIT and Harvard (referred to as "the Ragon/MGH" in this document).
• Screens positive for TB by symptomatic questionnaire

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Recipient: Placebo; Women in this group will be randomized to receive three doses of sterile saline solution after completing a full course of MTZ	Drug: oral metronidazole; Metronidazole 400 mg PO every 12 hours for 7 days is the concomitant medication. This antibiotic course is the standard Bacterial Vaginosis (BV) treatment which effectively eliminates microbes associated with BV for a limited time.; Other: Sterile saline solution; 1mL of sterile saline solution
Active Comparator: Recipient: Vaginal Microbiome Transplantation (VMT); Women in this group will be randomized to receive three doses of VMT after completing a full course of MTZ	Drug: oral metronidazole; Metronidazole 400 mg PO every 12 hours for 7 days is the concomitant medication. This antibiotic course is the standard Bacterial Vaginosis (BV) treatment which effectively eliminates microbes associated with BV for a limited time.; Biological: Vaginal Microbiome Transplantation (VMT); Vaginal fluid from healthy donors

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluate the safety of VMT	The primary outcome of the study is to evaluate if VMT increases the proportion of women with a Lactobacillus crispatus-dominant microbiota at any time within the 4 weeks after the first dose as measured by sequencing of the microbial community where Lactobacillus crispatus make up > 50% of detected microbes.	for 23 weeks after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine whether VMT will result in a durable change in vaginal microbiota	Secondary outcome will measure Lactobacillus crispatus dominance across follow-up weeks. The hypothesis is that antibiotic plus VMT therapy will increase the proportion of women with a Lactobacillus crispatus-dominant microbiota from 5-10% to 50-60%. The safety, toxicity, and tolerability of VMT will also be assessed via a) follow up pelvic assessments to assess for rash, irritation or infection calls, b) patient symptom questionnaires to assess self-reported symptoms of vulvovaginal discomfort, and c) adverse event reporting.	2, 12, and 24 weeks after intervention
Characterize the host clinical and subclinical mucosal inflammatory response before and after VMT	Additional secondary, exploratory analyses will be done to evaluate mechanisms for increased Lactobacillus prevalence, or lack thereof. This will include measuring proportions of individual Lactobacillus species (e.g., L. crispatus, L. iners, L. jensenii, L. gasseri), assessing vaginal microbial community type, microbial community diversity measures, individual taxa associated with treatment group, and host mucosal inflammatory immune response. (e.g., vaginal concentration of IL1beta, IL1alpha, IL1RA, IL6, IL8, TNFa, IFNg)	24 weeks after intervention

Collaborators and Investigators

• Sponsor: Douglas Kwon
• Collaborators: Massachusetts General Hospital; Bill and Melinda Gates Foundation
• Investigators: Principal Investigator: Caroline Mitchell, MD, MPH, Massachusetts General Hospital; Principal Investigator: Douglas S Kwon, MD, PhD, Ragon Institute of MGB, MIT, and Harvard; Principal Investigator: Krista Dong, MD, Ragon Institute of MGB, MIT, and Harvard

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): February 1, 2028

Study Registration Dates

• First Submitted: April 21, 2026
• First Submitted That Met QC Criteria: April 28, 2026
• First Posted (Actual): May 5, 2026

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 14, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Infections; Genital Diseases, Female; Bacterial Infections; Bacterial Infections and Mycoses; Vaginitis; Vaginal Diseases; Vaginosis, Bacterial; Organic Chemicals; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Azoles; Imidazoles; Nitroimidazoles; Nitro Compounds; Metronidazole
• Other Study ID Numbers: 2026P000260

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
• product manufactured in and exported from the U.S.: No