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CompletedNCT03275467Updated Feb 21, 2020

Faecal Microbiota Transplantation in Patients With Microscopic Colitis

An interventional study of Faecal microbiota transfer (FMT) in Microscopic Colitis, sponsored by Örebro University, Sweden. Completed at 1 site in Sweden. Open to participants aged 18 Years to 65 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2020-02-21.

Sponsored by Örebro University, Sweden · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
10
Allocation
Not applicable
Ages
18 Years to 65 Years
Sex
All
01

Study summary

Microscopic colitis (MC) is a disease with chronic inflammation of the colon that is mostly diagnosed in middle-aged or elderly women. Patients suffer from chronic watery diarrhoea, abdominal pain and weight loss. The aetiology of MC is still unknown but it is hypothesized that MC is caused by a deregulated immune response to a luminal agent in predisposed individuals, and an important role of the intestinal microbiota is suggested.

In the current proof-of-concept study, the effect of faecal microbiota transfer (FMT) in 10 MC patients will be evaluated. FMT consists in the infusion of suspended stool from a healthy donor into the intestine of a patient with the aim to restore a disturbed intestinal microbiota.

Read the detailed description

This will be an intervention pilot study with a 12-week and an optional 6-months follow-up period. It will be investigated if the infusion of suspended stool from healthy donors improves the symptoms of MC patients by restoring their disturbed intestinal microbiota. This procedure is known as faecal microbiota transplantation (FMT).

MC patients (n=10) will be randomised to receive FMT using stool from one of two healthy donors.

At baseline, blood samples and mucosal biopsies will be obtained from the descending colon. In addition, faecal samples will be collected and patients will complete symptom questionnaires. The first FMT will be administered by colonoscopy, FMT 2-3 by enemas. Faecal samples will be collected and questionnaires will be completed at different time points during the study. The patients will be followed-up at 6 weeks, 8 weeks, 12 weeks and 6 months after receiving FMT 1, however, the follow-up after 6 months will be optional. Additional biopsies from the descending colon and blood samples will be collected 6 weeks after the first FMT.

02

Conditions studied

  • Microscopic Colitis
03

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Eligibility criteria

Inclusion criteria for patients:

  1. Signed informed consent
  2. Active MC diagnosis, defined as >3 stools a day from which at least one should be watery
  3. Willingness to stop budesonide treatment during participation in the trial
  4. Age: 18-70 years

Exclusion criteria for patients

  1. Previous complicated gastrointestinal surgery
  2. Malignant disease except non-melanoma skin cancer
  3. Dementia, severe depression, major psychiatric disorder, or other incapacity for adequate cooperation
  4. C. difficile or other current gastroenteritis
  5. Females who are pregnant or breast-feeding
  6. Severe endometriosis
  7. Antimicrobial treatment 4 weeks prior to first screening visit
  8. Antimicrobial prophylaxis (eg. acne, urinary tract infection)
  9. Regular consumption of probiotic products 4 weeks prior to randomization
  10. Recently diagnosed lactose intolerance (less than 6 months prior to first screening visit)
  11. Recently diagnosed coeliac disease (less than 6 months prior to first screening visit)
  12. Regular intake of NSAIDs (non steroidal anti-inflammatory drugs)
  13. Abuse of alcohol or drugs
  14. Any clinically significant disease/condition which in the investigator's opinion could interfere with the results of the trial

Inclusion criteria for donors

  1. Signed informed consent
  2. High-butyrate producing microbiota in faecal samples
  3. Age: 18-65 years

Exclusion criteria for donors

  1. Known organic gastrointestinal disease (e.g. IBD, IBS, chronic diarrhoea or constipation)
  2. First degree relative with IBD
  3. History of or present gastrointestinal malignancy or polyposis
  4. Recent (gastrointestinal) infection (within last 6 months)
  5. History of major gastrointestinal surgery (e.g. gastric bypass)
  6. Eosinophilic disorders of the gastrointestinal tract
  7. Current communicable disease (e.g. upper respiratory tract infection)
  8. Malignant disease and/or patients who are receiving systemic anti-neoplastic agents
  9. Psychiatric diseases (e.g. dementia, depression, schizophrenia, autism, Asperger Syndrome) or other incapacity for adequate cooperation
  10. Chronic neurological/neurodegenerative diseases (e.g. Parkinson's disease, multiple sclerosis)
  11. Autoimmune disease and/or patients receiving immunosuppressive medications
  12. Major relevant allergies (e.g. food allergy, multiple allergies)
  13. Chronic pain syndromes (e.g. fibromyalgia)
  14. Chronic fatigue syndrome
  15. HIV, hepatitis A, B, C or known exposure within the recent 12 months
  16. Obesity (BMI>30) or metabolic syndrome
  17. Antimicrobial treatment or prophylaxis within the last 3 months
  18. Other chronic use of drugs that may affect the microbiome, e.g. proton pump inhibitors
  19. First degree relative with cardiovascular thrombosis before 50 years of age
  20. Females who are pregnant or breast-feeding
  21. Known clinically significant abnormal laboratory values
  22. Participation in high-risk sexual behaviours
  23. Abuse of alcohol or drugs
  24. Tattoo or body piercing within the last 6 months
  25. Travelling in countries with low hygiene or high infection risk for endemic diarrhoea within the last 6 months
  26. Positive stool testing for C. difficile, ova and parasites (e.g. Cyclospora, Isospora, Cryptosporidium), enteric pathogens (e.g. enterohaemorrhagic E. coli, Salmonella, Shigella, Yersinia, Campylobacter, Giarda antigen, amoebas)
  27. Positive stool testing for multiresistant bacteria (e.g. extended-spectrum beta- lactamase (ESBL) producing organisms, multi-resistant Gram-negative bacilli (MRGN) 3 and 4, vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA))
  28. Calprotectin > 50 μg/g of faeces
  29. Positive blood testing for HIV, Hepatitis A, B, C, syphilis, Human T-lymphotropic virus (HTLV), cytomegalovirus (CMV) and Epstein Barr Virus (EBV)
  30. Any clinically significant disease/condition which in the investigator's opinion could interfere with the results of the trial
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
10 participants (actual)

Study arms

  • Experimental
    Faecal microbiota transfer (FMT)

    Suspended stool from a healthy donor

    Other: Faecal microbiota transfer (FMT)

Interventions

  • OtherFaecal microbiota transfer (FMT)

    Suspended stool from a healthy donor

05

What researchers measure

Primary outcomes

  1. Proportion of MC patients in remission six weeks after the first FMT.

    Remission is defined as \<3 stools per day and a mean of less than one watery stool per day.

    Time frame: 6 weeks

Secondary outcomes

  1. Changes in general health and symptom questionnaire scores

    SHS

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  2. Changes in general health questionnaire scores

    SF-36

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  3. Changes in quality of life questionnaire scores

    EG-5D-5L

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  4. Changes in gastrointestinal symptom questionnaire scores

    GSRS

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  5. Changes in hospital and anxiety depression scores

    HADS

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  6. Changes in number and form of bowel movements

    1-week-diaries

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  7. Changes in faecal and mucosal microbiota composition

    16S rRNA-based next generation sequencing

    Time frame: faecal: 6 weeks, 8 weeks, 12 weeks, 6 months; mucosal: 6 weeks

  8. Changes in lymphocyte infiltration

    Immunohistochemistry and flow cytometry

    Time frame: 6 weeks

  9. Changes in subepithelial collagen layer

    Immunohistochemistry

    Time frame: 6 weeks

  10. Changes in immune cell composition of colonic biopsies

    Immunohistochemistry and flow cytometry

    Time frame: 6 weeks

Other outcomes

  1. Changes in inflammation markers in faecal samples such as faecal calprotectin

    Time frame: 6 weeks, 8 weeks, 12 weeks, 6 months

  2. Changes in metabolite profile in faecal samples and blood

    Time frame: faecal: 6 weeks, 8 weeks, 12 weeks, 6 months; blood: 6 weeks

  3. Changes in gene expression in mucosal biopsies

    Time frame: 6 weeks

  4. Changes in barrier function markers in colonic biopsies

    Time frame: 6 weeks

  5. Changes in gene expression of butyrate transporters in colonic biopsies

    Time frame: 6 weeks

  6. Changes in markers of inflammation and intestinal barrier function in blood

    Time frame: 6 weeks

  7. Changes in plasma levels of cardiovascular disease markers and platelet responsiveness and aggregation

    Time frame: 6 weeks

06

Study locations

1 site
  • University Hospital Örebro
    Örebro, Örebro County 70185, Sweden
07

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

08

Registry details

Key details

Study ID
NCT03275467
Lead sponsor
Örebro University, Sweden
Collaborators
Region Örebro County
Responsible party
Robert Brummer (Professor, Örebro University, Sweden) — Principal investigator
First posted
Sep 7, 2017
Start date
Jun 1, 2017
Primary completion
Jun 5, 2019
Completion
Oct 31, 2019
Last update
Feb 21, 2020

Study contacts

Robert J Brummer, Professor, MD
principal investigator · Örebro University, Sweden

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
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