Official Title
A Randomized, Double Blind, Placebo-controlled Study to Evaluate the Impact of a Multi-strain Synbiotic on Fecal Metagenomic Stability, Gut Barrier Integrity, and Metabolic Output of the Gut Microbiota
Brief Title
SH-DS01 on Fecal Metagenomic Stability
Protocol ID
NCT04598295
Lead Sponsor
Beth Israel Deaconess Medical Center
Brief Summary
This is a randomized, double blind, Phase 1 study. There will be a 12-week comparison of
the safety of DS-01 versus placebo with a secondary outcome measure of the efficacy in a
cohort of 100 men or women with IBS with constipation. 50 IBS-C or IBS-M patients will
receive DS-01 (Daily Synbiotic, once daily) for 12 weeks, while 50 IBS-C or IBS-M
patients will receive the placebo (once daily). Safety is a paramount concern in the
study design and will be monitored carefully throughout the study. Study subjects will
also receive extensive education on use of the synbiotic.
Detailed Description
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder that
generates a significant health care burden and is the most commonly diagnosed
gastrointestinal condition. Nearly 12% of all patients in the United States seek medical
care in primary care practice for IBS and it accounts for 3.1 million ambulatory care
visits and 5.9 million prescriptions annually.
The pathophysiology of IBS is distinctly broad compared to other gastrointestinal
conditions and includes abnormalities involving motility, visceral sensation, brain-gut
interaction, and distress. Though patients with IBS often have a heterogeneous symptom
profile, the predominant theme is the presence of abdominal pain or discomfort that is
usually relieved by defecation. Host factors such as genetics, immune function, and
psychological status, as well as environmental factors such as stress, recent infection,
or treatment with antibiotics, could predispose to the development of chronic IBS
symptoms. Due to a myriad of contributing factors, a single cause of IBS remains
enigmatic. Despite the urgent need to develop better therapies, the high range of placebo
response has made clinical trials challenging, ranging from 16.0 to 71.4% with a
population-weighted average of 40.2%.
Recent studies have also shown alterations in gut immune response, and a disrupted
intestinal and colonic microbiome in association with IBS. The current working hypothesis
is that abnormal microbiota activate mucosal innate immune responses, which increase
epithelial permeability, activate nociceptive sensory pathways, and dysregulate the
enteric nervous system. Targeting the microbiota and gastrointestinal tract with live
organisms is a promising approach, yet previous trials have yielded limited success due
to empiric strain selection, small population size, and inadequate trial design to
control for a high placebo response.
This protocol aims to assess the impact of a multi-strain consortia of 24 commensal
organisms across 12 species with extensive strain-specific in vivo data, assessing a
range of gastrointestinal symptoms without negatively altering the naive gut microbiota.
High-throughput shotgun DNA sequencing will provide opportunity for '-omics'-based
analyses of the gut microbiota, which can be augmented by the metabolite profiles
resulting from total microbial activity in the gut. Since many of these metabolites are
bioeffector molecules acting upon the host, such analysis can provide a direct measure of
the consequences of microbial activity in the gut and provide a novel integrated data set
for patients with IBS. Recruited subjects will also use a smart-phone application to
report day to day gastrointestinal symptoms, a patient-centric hallmark of this chronic
gut condition.
Probiotics are live microorganisms with a vast array of therapeutic potential for
gastrointestinal disease. Several probiotics strains have shown beneficial outcomes in
constipation-predominant IBS (IBS-C) patients, especially as an adjunct to conventional
treatment. However, a number of controversial issues regarding the roles of probiotics in
pathogenesis of IBS-C remain to be clarified, including precise mechanism of action.
This protocol aims to assess the impact of a mix of 24-beneficial strains on individual
subjects with IBS-C or IBS-M.
Study Period
-
Enrollment Count
48 participants
Eligibility Criteria
Inclusion Criteria:
- Patient must be willing and able to give informed assent/ consent for participation
in the study
- Patient must be willing and able (in the PI's opinion) to comply with all study
requirements.
- Patient must be a premenopausal female or male aged 18 and older.
- Patient must have a documented history of IBS that is not completely controlled by
current IBS drugs.
- Patient must have a score of ≥150 on the IBS-SSS at screening.
- Patient must have no clinically relevant (in the judgment of the PI) abnormal blood
laboratory levels at screening or randomization.
- The clinician will assess eligibility as per the Rome IV criteria (Recurrent
abdominal pain or discomfort at least 1 day/week in the last 3 months associated
with two or more of the following: Improvement with defecation. Onset associated
with a change in frequency of stool).
Exclusion Critieria:
- Patient has clinically significant unstable medical conditions other than IBS.
- Patient has had clinically relevant symptoms or a clinically significant illness in
the four weeks prior to screening or randomization.
- Patient has clinically significant laboratory values (in the PI's opinion).
- Patient is currently using or has in the past used recreational or medicinal
cannabis, or synthetic cannabinoid based medications (including Sativex®) or
supplements (including hemp oil/extracts) within one month prior to study entry and
is unwilling to abstain for the duration for the study.
- Patient has consumed any probiotic product three days prior to screening and/or is
unwilling to abstain from consuming these during the study.
- Intake of antibiotics in the past 1-month (i.e. penicillin, amoxicillin, cephalexin
(Keflex), erythromycin (E-Mycin), clarithromycin (Biaxin), azithromycin (Zithromax),
ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), co-trimoxazole
(Bactrim), trimethoprim (Proloprim), tetracycline (Sumycin or Panmycin), doxycycline
(Vibramycin), gentamicin (Garamycin), or tobramycin (Tobrex). The supplement in the
present study may have a minor interaction with these medications.
- Patient has any known or suspected hypersensitivity to pomegranate, pine, or
mushrooms, or any of the excipients of the Supplement Synbiotic Product (SSP).
- Patients of child bearing potential unless willing to ensure that they use effective
contraception, for example, oral contraception, double barrier, intra-uterine
device, during the study and for three months thereafter.
- Patients who are pregnant, lactating, or planning pregnancy during the course of the
study and for three months thereafter.
- Patients who have been part of a clinical trial involving any investigational
product in the previous six months.
- Any other significant disease or disorder which, in the opinion of the PI, may
either put the patient at risk because of participation in the study, may influence
the result of the study, or affect the patient's ability to participate in the
study.
- Patient has significantly impaired hepatic function at Visit 1 (Alanine
aminotransferase (ALT) >5 × upper limit of normal (ULN) or bilirubin >2 × ULN) OR
the ALT or Aspartate aminotransferase (AST) >3 × ULN and the bilirubin >2 × ULN (or
international normalized ratio >1.5).
- Obesity (BMI > 30)
- Implantable device such as heart pacemaker.
- Patients unwilling to abstain from donation of blood during the study.
- History of inflammatory bowel disease.
- History of diverticulosis.
- History of cardiovascular disease.
- History of kidney/liver/serious infection.
- History of diabetes or other hormone diseases.
- History of abdominal surgery.
- Currently suffering from high blood pressure.
- Following a physical examination, the patient has any abnormalities that, in the
opinion of the investigator would prevent the patient from safe participation in the
study.
- There are plans for the patient to travel outside the USA during the study.
Filters
Irritable Bowel Syndrome
PHASE2
COMPLETED
ADULT
OLDER_ADULT