Fecal Microbiota Transplantation (FMT) in the Management of Ulcerative Colitis (UC)

NCT02516384 | Completed Phase 1 DMC

• 1 other identifier: 1404014982
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

Inflammatory bowel disease is a condition caused by gastrointestinal immune system dysregulation and affected by both genetic and environmental factors. Differences in intestinal bacteria exist between IBD patients and healthy controls, but the role of intestinal bacteria in the development and treatment of IBD remains largely unknown. Fecal microbiota transplantation (FMT) is the transfer of gastrointestinal bacteria from a healthy donor to a patient with altered microbial diversity with the intent of restoring a normal bacterial balance. Most studies focus on its use in treating Clostridium difficile (CDI), an infection characterized by dysbiosis. Given the role of dysbiosis in IBD, the investigators hypothesize that FMT may be beneficial in IBD. The purpose of this study is to prospectively examine the safety of FMT in the management of ulcerative colitis (UC).

Conditions

Ulcerative Colitis

Keywords

Fecal Microbiota Transplantation; Ulcerative Colitis

Outcome Measures

Primary Outcomes (1)

• Safety post-FMT as determined by interview for adverse events

  Patient information regarding adverse events and safety of FMT for UC will be collected throughout the study period, including day 0, weeks 1, 2, 4, 6, 12 24, and then every 6 months until 36 months post-FMT. Throughout the study period, patients will be assessed for safety with questions regarding general well-being (such as "how have you been feeling?"), as well as specific questions to evaluate for occurrence of adverse events. Patients will also be questioned regarding stool form and frequency, presence of abdominal pain, fevers and subjective well-being.

  36 months post-FMT

Secondary Outcomes (9)

• Clinical remission

  2, 4 and 12 weeks post fecal microbiota transplantation

• Clinical Response

  2, 4 and 12 weeks post fecal microbiota transplantation

• Progression of disease defined by initiation of anti-TNF agents

  2, 4 and 12 weeks post fecal microbiota transplantation

• Progression of disease defined by increase in dosages of current UC medications

  2, 4 and 12 weeks post fecal microbiota transplantation

• Progression of disease defined by time to colectomy

  up to three year follow-up period post fecal microbiota transplantation

Study Arms (1)

Fecal Microbiota Transplantation

EXPERIMENTAL

Individuals with Ulcerative Colitis will undergo a fecal microbiota transplantation.

Biological: Fecal Microbiota Transplantation

Interventions

Fecal Microbiota Transplantation BIOLOGICAL

We will use fecal microbiota transplantation (FMT), with fecal material obtained from OpenBiome or donor directed, to assess safety (as primary outcome) and efficacy (as secondary outcome) in adult (\>18 year old) patients with active ulcerative colitis (UC).

Fecal Microbiota Transplantation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients with biopsy proven ulcerative colitis (UC), including those with inadequately controlled UC (flare) as defined by failure of standard medical therapy, steroid-dependence, and/or need for escalation of medical care as determined by severity index (Mayo Score), endoscopic or histologic study, and/or medical provider
• Have active disease, defined with a Mayo Score \> 3 and Mayo endoscopic subscore \>1
• Subjects whom the investigator believes can and will comply with the requirements of the protocol
• Able to provide informed written consent.

You may not qualify if:

• Biopsy-proven Crohn's disease or indeterminate colitis
• Acute abdomen or other clinical emergencies requiring emergent management (for example: stricture, bowel obstruction, perforation and/or abscess)
• Primary sclerosing cholangitis (PSC)
• Pregnancy
• Concurrent Clostridium difficile infection or other known infection
• Prior history of fecal microbiota transplantation
• Other causes of diarrhea, including but not limited to tube feeds and medications (for example, kayaxelate, metformin, lactulose, laxatives, magnesium)
• Major congenital defects
• Subjects with recent malignancy in the last 5 years, excluding non-melanoma skin malignancies
• Anaphylactic reactions to any foods
• Any antibiotic use within the last 3 months
• Subject having any other condition that, in the opinion of the investigator, would jeopardize the safety or rights of the participant participating in the study, would make it unlikely for the participant to complete the study, or would confound the study

Sponsors & Collaborators

• Weill Medical College of Cornell University: lead

Study Sites (1)

Weill Cornell Medical College

New York, New York, 10021, United States

Location

Related Publications (15)

• Damman CJ, Miller SI, Surawicz CM, Zisman TL. The microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation? Am J Gastroenterol. 2012 Oct;107(10):1452-9. doi: 10.1038/ajg.2012.93.

  PMID: 23034604 BACKGROUND

• Hanauer SB. Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis. 2006 Jan;12 Suppl 1:S3-9. doi: 10.1097/01.mib.0000195385.19268.68.

  PMID: 16378007 BACKGROUND

• Sartor RB, Muehlbauer M. Microbial host interactions in IBD: implications for pathogenesis and therapy. Curr Gastroenterol Rep. 2007 Dec;9(6):497-507. doi: 10.1007/s11894-007-0066-4.

  PMID: 18377803 BACKGROUND

• Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004 May;126(6):1504-17. doi: 10.1053/j.gastro.2004.01.063.

  PMID: 15168363 BACKGROUND

• Kunde S, Pham A, Bonczyk S, Crumb T, Duba M, Conrad H Jr, Cloney D, Kugathasan S. Safety, tolerability, and clinical response after fecal transplantation in children and young adults with ulcerative colitis. J Pediatr Gastroenterol Nutr. 2013 Jun;56(6):597-601. doi: 10.1097/MPG.0b013e318292fa0d.

  PMID: 23542823 BACKGROUND

• Bennet JD, Brinkman M. Treatment of ulcerative colitis by implantation of normal colonic flora. Lancet. 1989 Jan 21;1(8630):164. doi: 10.1016/s0140-6736(89)91183-5. No abstract available.

  PMID: 2563083 BACKGROUND

• van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, Visser CE, Kuijper EJ, Bartelsman JF, Tijssen JG, Speelman P, Dijkgraaf MG, Keller JJ. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013 Jan 31;368(5):407-15. doi: 10.1056/NEJMoa1205037. Epub 2013 Jan 16.

  PMID: 23323867 BACKGROUND

• Borody TJ, Campbell J. Fecal microbiota transplantation: techniques, applications, and issues. Gastroenterol Clin North Am. 2012 Dec;41(4):781-803. doi: 10.1016/j.gtc.2012.08.008.

  PMID: 23101687 BACKGROUND

• Nagalingam NA, Lynch SV. Role of the microbiota in inflammatory bowel diseases. Inflamm Bowel Dis. 2012 May;18(5):968-84. doi: 10.1002/ibd.21866. Epub 2011 Sep 20.

  PMID: 21936031 BACKGROUND

• Vermeire S JM, Verbeke K, al e. Pilot study on the safety and efficacy of faecal microbiota transplantation in refractory crohn's disease. Gastroenterology 2012, 142:S360.

  BACKGROUND

• Angelberger S LC, Gratzer C, al. e. Fecal transplantation in patients with moderately to severely chronic active ulcerative colitis (UC). ECCO Conference Abstracts 2012:P374

  BACKGROUND

• Kump PK, Grochenig HP, Lackner S, Trajanoski S, Reicht G, Hoffmann KM, Deutschmann A, Wenzl HH, Petritsch W, Krejs GJ, Gorkiewicz G, Hogenauer C. Alteration of intestinal dysbiosis by fecal microbiota transplantation does not induce remission in patients with chronic active ulcerative colitis. Inflamm Bowel Dis. 2013 Sep;19(10):2155-65. doi: 10.1097/MIB.0b013e31829ea325.

  PMID: 23899544 BACKGROUND

• Greenberg A AO, Shelton C, Brandt L. Long-term Follow-up Study of Fecal Microbiota Transplantation (FMT) for Inflammatory Bowel Disease (IBD). Am J Gastroenterol 2013, 108:S540.

  BACKGROUND

• Brandt L AO, Greenberg A, et al. Safety of Fecal Microbiota Transplantation (FMT) in Immunocompromised (Ic) Patients with Inflammatory Bowel Disease (IBD). Am J Gastroenterol 2013, 108:S556.

  BACKGROUND

• Lima SF, Gogokhia L, Viladomiu M, Chou L, Putzel G, Jin WB, Pires S, Guo CJ, Gerardin Y, Crawford CV, Jacob V, Scherl E, Brown SE, Hambor J, Longman RS. Transferable Immunoglobulin A-Coated Odoribacter splanchnicus in Responders to Fecal Microbiota Transplantation for Ulcerative Colitis Limits Colonic Inflammation. Gastroenterology. 2022 Jan;162(1):166-178. doi: 10.1053/j.gastro.2021.09.061. Epub 2021 Oct 2.

  PMID: 34606847 DERIVED

MeSH Terms

Conditions

Colitis, Ulcerative

Interventions

Fecal Microbiota Transplantation

Condition Hierarchy (Ancestors)

Colitis; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Inflammatory Bowel Diseases; Colonic Diseases; Intestinal Diseases

Intervention Hierarchy (Ancestors)

Biological Therapy; Therapeutics

Study Officials

• Carl V Crawford, MD

  Weill Medical College of Cornell University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 29, 2015
• First Posted: August 5, 2015
• Study Start: October 1, 2016
• Primary Completion: December 31, 2016
• Study Completion: January 31, 2017
• Last Updated: February 22, 2018

Record last verified: 2018-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)