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FMT for MS Patients (MS-FMT)

24. oktober 2022 opdateret af: Michael Silverman, MD, Lawson Health Research Institute

Fecal Microbial Transplantation for Relapsing Multiple Sclerosis Patients - a Placebo-controlled, Double-blinded, Randomized Trial

This is a placebo-controlled, double-blinded, randomized trial design, whereby all patients are eligible to start an injectable therapy, and then randomized to either placebo or FMT for approximately 1 year.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Fecal Microbiome Transplants: Patients will undergo pretreatment with Amoxicillin/Clavulinate (or matched placebo) for 5 days followed by a bowel cleanse with PEGLYTE. Patients will undergo allogeneic or autologous fecal transplants. Patients will be dosed with FMT oral capsules approximately 48 hours after antibiotic treatment has stopped. Following the FMT capsule treatment on day 1, patients will be administered a repeat oral capsule or placebo dose at 3 weeks. Oral omeprazole or omeprazole placebo will be given 1 hour prior to the baseline and 3 week dose. This will be done to ensure full engraftment of the transplant.

Participants will be seen at baseline, 3 weeks, 6 weeks, 3 months, 6 months and 12 months. A series of neurological tests will be performed for safety measures. In addition to this, MRIs will be completed at baseline, 6 weeks and 12 months. Blood, urine and stool samples will also be collected for data analysis and safety measures.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

34

Fase

  • Fase 2

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 55 år (Voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • 18 - 55 years of age
  • Have an expanded disability status scale (EDSS) of < 6
  • Have a diagnosis of relapsing multiple sclerosis
  • Have evidence of radiographic activity within the 12 months on MRI (new/enlarging T2 lesion or gadolinium enhancing lesion)
  • Eligible to start/starting an injectable DMT
  • Not on a DMT currently and/or not on a DMT in last 6 months
  • Ability to swallow capsules

Exclusion Criteria:

  • Unable to provide informed consent
  • Does not pass the standard MRI screening questionnaire
  • Other disease that can affect GI permeability (such as Inflammatory Bowel Disease, Crohn's disease, ulcerative colitis, indeterminate colitis or microscopic colitis, celiac disease)
  • Expected requirement for antibiotics within 3 months (chronic suppressive therapies, elective prosthetic joint insertion)
  • Toxic megacolon, small bowel ileus
  • Penicillin allergy
  • Omeprazole allergy

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Grundvidenskab
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Autologous Transplants
Biologisk: Fecal Microbial Transplants
Healthy donor stool will be processed and placed into capsules.
Biologisk: Fecal Microbial Transplants
Participants stool will be processed and placed into capsules.
Aktiv komparator: Allogeneic Transplants
Biologisk: Fecal Microbial Transplants
Healthy donor stool will be processed and placed into capsules.
Biologisk: Fecal Microbial Transplants
Participants stool will be processed and placed into capsules.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Changes in T2 Lesions - MRI
Tidsramme: Baseline, 6 weeks, 12 months
Assess the number of new/enlarging/gad enhancing T2 lesions. We will be comparing baseline to 6 weeks and 6 weeks to 12 months.
Baseline, 6 weeks, 12 months

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Blood Brain Barrier - MRI
Tidsramme: Baseline, 6 weeks, 12 months
We will assess the integrity of the blood brain barrier through MRI from baseline to 6 weeks and 6 weeks to 12 months.
Baseline, 6 weeks, 12 months
Neurofilament Light Serum Levels
Tidsramme: Baseline, 6 weeks, 3 months, 12 months

As a biomarker of neuronal damage neurofilament light chain levels will be detected. Peripheral blood will be collected in appropriate tubes at baseline, 6 weeks, 3 months and 12 months and processed for serum.

Once collected all samples will be sent to the University of Ottawa where a Simoa NfL assay will be undertaken on their Simoa Analyzer.

Patients with multiple sclerosis have been shown to have increased intestinal permeability, likely due to a reduction in butyrate-producing bacteria. A decrease in butyrate producing bacteria has been shown to be associated with increased intestinal permeability. Relapsing-remitting MS patients have been shown to have increased intestinal permeability, which may allow dietary and microbial antigens from the intestinal lumen to pass into the blood stream and cause autoimmune responses in MS patients. This may prime the immune system to develop a humoral response to certain bacteria.
Baseline, 6 weeks, 3 months, 12 months
Intestinal Permeability
Tidsramme: Baseline, 6 weeks, 12 months
Small Intestine Permeability: Mannitol/Lactulose administration will be used and urine will be collected to measure small intestine permeability. For small intestine permeability patients will be instructed to drink lactulose solution and collect the urine throughout the night and first thing in the morning. A proper collecting bottle will be provided. Once the urine sample bottle reaches the laboratory University Hospital the total volume will be measured and an aliquot of 30mL total, 10mL in each sterile urine container (no other additives) will be separated and stored at -20C and sent on dry ice to Dr. Meddings laboratory at Calgary, Alberta. All biological material will be transported according to biosafety regulations.
Baseline, 6 weeks, 12 months
IgA Microbiota
Tidsramme: Baseline, 3 weeks, 6 weeks, and 12 months
IgA Microbiota analysis: IgA bound bacteria will be detected and sorted (magnetic beads or flow cytometry) using anti-IgA (pan-IgA, detect monomer and secreted multimer (Miltenyi clone: IS11-8E10). Sorted IgA bound bacteria will be stored, and the DNA extracted in one batch at the end of the study. Changes in the composition of IgA bound bacteria for each patient will be determined using the previously mentioned methods. (Rojas, et al. 2018; Planer, et al. 2016)
Baseline, 3 weeks, 6 weeks, and 12 months
Stool Microbiome
Tidsramme: Baseline, 3 weeks, 6 weeks, 3 months, 6 months, 12 months
Gut microbiota analysis before and after FMT: Toilet paper samples will be collected from patients' at baseline and 1-2 days before each scheduled appointment (Al et al. 2018). Patients will store the toilet paper inside of DNA free plastic bags and keep them at 4 °C in the refrigerator until the time of their appointment (alternatively, the samples can be mailed in to the lab, but one method must be chosen for all of the samples collected). Toilet paper samples will be collected from the FMT donor every time they drop off a stool sample for donation. DNA from the toilet paper samples will be extracted in one batch at the end of the study and sent for Illumina Mi-Seq next-generation sequencing of the V4 region of the 16S rRNA gene. Changes in the composition of gut bacteria will be determined using custom R scripts.
Baseline, 3 weeks, 6 weeks, 3 months, 6 months, 12 months
Metabolomics
Tidsramme: Baseline, 3 weeks, 6 weeks, 3 months, 6 months, 12 months
Metabolomics: Serum will be collected for metabolomic analysis. Metabolomics can be used to identify biomarkers of MS and may provide us with information about which patients are more likely to respond to FMT therapy. Butyrate producing bacteria have been shown to be in lower relative abundance in MS patients and concentrations of short-chain fatty acids in stool and will be investigated before and after FMT.
Baseline, 3 weeks, 6 weeks, 3 months, 6 months, 12 months
Metabolomics
Tidsramme: Baseline, 3 weeks, 6 weeks, 3 months, 6 months, 12 months
Metabolomics: Urine will be collected for metabolomic analysis. Metabolomics can be used to identify biomarkers of MS and may provide us with information about which patients are more likely to respond to FMT therapy. Butyrate producing bacteria have been shown to be in lower relative abundance in MS patients and concentrations of short-chain fatty acids in stool and will be investigated before and after FMT.
Baseline, 3 weeks, 6 weeks, 3 months, 6 months, 12 months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Lawson Health Research Institute

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Forventet)

1. juni 2023

Primær færdiggørelse (Forventet)

1. maj 2025

Studieafslutning (Forventet)

1. august 2025

Datoer for studieregistrering

Først indsendt

11. oktober 2019

Først indsendt, der opfyldte QC-kriterier

1. november 2019

Først opslået (Faktiske)

4. november 2019

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

25. oktober 2022

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

24. oktober 2022

Sidst verificeret

1. oktober 2022

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • MS-FMT 002

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