Investigating the Impact of Faecal Microbiota Transplant on the Clinical Phenome of Patients With Non-alcoholic Fatty Liver Disease and Fibrosis
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Non-Alcoholic Fatty Liver Disease
- Sponsor
- Imperial College London
- Enrollment
- 16
- Locations
- 1
- Primary Endpoint
- Change in gut microbial metabolite composition
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The goal of this pilot experimental medicine interventional study is to explore the degree of transferability of the gut microbiome and associated metabolomic changes in patients with non-alcoholic fatty liver disease (NAFLD) and fibrosis who receive faecal microbiota transplant (FMT). The main questions is aims to answer is:
- To what extent is the gut microbiome transferable from donor to recipient in patients with NAFLD with fibrosis who receive FMT?
- What are the dynamics of how the gut microbiome changes over time in these patients?
- To what degree does the recipient metabolome change in association with this?
Participants will receive up to three capsulised FMT preparations prepared from a donor selected rationally based upon their metabolomic characteristics. They will be asked to attend for serial clinical assessments (including FibroScan and MRE/ MRI-PDFF), and will also be asked to provide serial blood, urine and stool samples for assessment of microbiome and metabolome profiling.
Investigators
Eligibility Criteria
Inclusion Criteria
- •18-75 years of age.
- •Previously-diagnosed NAFLD, with predicted fibrosis based upon non-invasive assessment with FibroScan (i.e. liver stiffness measurement (LSM) \> 8kPa).
- •Raised liver ALT (\> 30IU/l for men, \> 19IU/l for women) or AST (\> 37IU/l for men, \> 31IU/l for women) with negative non-invasive liver screen (including negative screen for viral hepatitis, autoimmune liver disease and metabolic liver disease, and normal echocardiogram within two years in the scenario where congestive hepatopathy may be considered).
- •Able to consent for themselves in English.
Exclusion Criteria
- •Severe or life-threatening food allergy.
- •Pregnant or lactating women; or women trying to conceive.
- •Patients with suspected or confirmed cirrhosis (as assessed by clinical, radiological or histological criteria).
- •Use of particular medications, including:
- •Systemic antibiotics within the six weeks prior to study enrolment.
- •Immunosuppression that may influence risks related to FMT (including - but not limited to: use of corticosteroids within eight weeks of intervention; use of cytotoxic chemotherapy; use of azathioprine, tacrolimus, mycophenolate mofetil and/or immunosuppressive biologic therapy, e.g. infliximab).
- •Use of GLP-1 agonists.
- •Patients not expected to survive the duration of the study's follow-up (six months).
- •Swallowing difficulties that may preclude safe use of FMT capsules, including oral-motor dyscoordination.
- •Alcohol consumption \> 20g/ day.
Outcomes
Primary Outcomes
Change in gut microbial metabolite composition
Time Frame: 24 weeks after initial FMT
Using 1H-NMR and mass spectrometry
Change in faecal microbiome composition
Time Frame: 24 weeks after initial FMT
Using 16S rRNA gene sequencing and shotgun metagenomic sequencing
Secondary Outcomes
- Changes in liver fat on FibroScan(16 weeks after initial FMT)
- Changes in liver fat on MRI(16 weeks after initial FMT)
- Changes in liver stiffness on MRI(16 weeks after initial FMT)
- Changes in liver stiffness on FibroScan(16 weeks after initial FMT)
- Changes in HbA1c(24 weeks after initial FMT)
- Changes in insulin resistance(24 weeks after initial FMT)
- Changes in BMI(24 weeks after initial FMT)
- Changes in lipid metabolism(24 weeks after initial FMT)