Assessment of Cognitive Ability and the Intestinal Microbiome in Individuals With Liver Disease Before and After Investigational Microbiota Restoration Therapeutic
试验速览
- 阶段
- 2 期
- 状态
- 终止
- 入组人数
- 5
- 试验地点
- 1
- 主要终点
- Change in cognitive function at 1 month post-FMT as measured by change in response times on EncephalApp (Stroop test)
研究概览
简要总结
Individuals with cirrhosis are likely to develop overt hepatic encephalopathy for which diagnostic modalities and treatment options are limited. The purpose of this study is to determine if individuals with cirrhosis who experience hepatic encephalopathy would benefit from investigational microbiota restoration therapy due to their inherent cognitive alterations. Analysis for a correlation between changes in microbiome composition and specific blood biomarkers could allow for earlier diagnosis of HE which could then be treated earlier and with novel treatments.
详细描述
The investigators hypothesize that changes in an individual's cognition due to HE-related liver cirrhosis can be stabilized and/or improved through investigational microbiota restoration therapeutic treatment. The main objective of this study is to determine if investigational microbiota restoration therapeutic treatment alters the cognitive function in individuals with cirrhosis who have been previously diagnosed with overt hepatic encephalopathy (HE). Once individuals have one HE episode, they are more likely to experience additional episodes, even after complying with standard of care. The number of HE episodes each study group experiences during the post-treatment follow-up will be compared among treatment groups. It is also anticipated that cognitive improvement will correlate with specific changes in the intestinal microbiota composition of these individuals likely shifting their microbiome away from baseline samples and becoming more like donor samples. Novel blood biomarkers potentially related to episodes of HE will be assessed in individuals before and after treatment.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Care Provider, Investigator)
盲法说明
This is a double-blinded study meaning both Ochsner study staff and participating individuals will not know to which group they are assigned/randomized. A third party will be responsible for providing study participant randomization and recording the exact treatment to which all study participants are assigned.
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Individuals who are male or female and are between the ages of 18 and 70 years.
- •Individuals with a current diagnosis of liver cirrhosis as evidenced by one or more of the following:
- •a. Liver Biopsy
- •OR a clinical suspicion of cirrhosis based on the presence of one or more of the following criteria:
- •Radiologic evidence of varices, cirrhosis or portal hypertension
- •Laboratory evidence of platelet count <100,000 or AST/ALT ratio >1
- •Endoscopic evidence of varices or portal gastropathy
- •Elastography (i.e. Fibroscan)
- •Individuals must have at least one previously documented episode of HE.
- •Individuals must be able to read and write in the English language.
- •Individuals must be able and willing to utilize the electronic device necessary to measure cognitive function without assistance from outside individuals once the training phase has been completed.
- •Individuals must be able to provide valid informed consent prior to any study related procedures.
排除标准
- •Individuals who are color-blind.
- •Individuals actively using psychotropic substances including alcohol.
- •Individuals who are pregnant, breastfeeding, or unwilling to practice birth control during participation in the study. Study individuals are expected to attest to this fact during their participation time. Females who are not surgically sterile or having undergone greater than one year of menopause will receive urine pregnancy tests at screening and initial drug dosing.
- •Presence of TIPS (transjugular intrahepatic portosystemic shunt).
- •Individuals with an active bacterial infection and are taking antibiotics for those infections at time of consent.
- •Individuals with ANC <800 (neutropenia).
- •Individuals with MELD >
- •Individuals with platelet count <35,000/mm
- •Individuals who are immunocompromised due any of the following reasons:
- •HIV infection (CD4 count <200/mm3) or AIDS diagnosis
- •Inherited/primary immunodeficiency disorders
- •Treatment with any anti-neoplastic agent within the last 3 months (excluding locoregional therapy for hepatocellular carcinoma)
- •Treatment with any immunosuppressant medications [including but not limited to monoclonal antibodies to B cells or T cells, anti-TNF agents, glucocorticoids, antimetabolites (azathioprine, 6-mercaptopurine), calcineurin inhibitors (tacrolimus, cyclosporine), mycophenolate mofetil] within the last 3 months
- •Individuals who have previously undergone FMT.
- •Individuals with a history of colorectal cancer (all stages).
- •Individuals with a history of chronic intrinsic GI diseases such as inflammatory bowel disease (ulcerative colitis, Crohn's disease or microscopic colitis), eosinophilic gastroenteritis, celiac disease or irritable bowel syndrome as determined by Rome III criteria.
- •Individuals with a history of colectomy, major gastro-intestinal surgery, or intra-abdominal surgery.
- •Individuals with a history of Clostridium difficile infection six months prior to study enrollment.
- •Individuals with a history of chronic diarrhea.
- •Individuals currently participating in a research trial that involves drug or device intervention.
- •Individuals who are unable to fulfill all study criteria.
- •Individuals that the PI determines are not capable of participating in the research study.
研究组 & 干预措施
pill quantity-matched Placebo
Capsules of inactive compound will be supplied in 8- or 4-capsule blister packets to be taken twice per week for four weeks. Blood and stool samples and cognitive assessments will be collected before treatment and at 1, 3, 6, and 12 months after treatment.
干预措施: Placebo (Biological)
Low dose
Capsules of active drug will be supplied in 4-capsule blister packets to be taken twice per week for four weeks. Blood and stool samples and cognitive assessments will be collected before treatment and at 1, 3, 6, and 12 months after treatment.
干预措施: RBX7455 (Biological)
High dose
Capsules of active drug will be supplied in 8-capsule blister packets to be taken twice per week for four weeks. Blood and stool samples and cognitive assessments will be collected before treatment and at 1, 3, 6, and 12 months after treatment.
干预措施: RBX7455 (Biological)
结局指标
主要结局
Change in cognitive function at 1 month post-FMT as measured by change in response times on EncephalApp (Stroop test)
时间窗: 1 month
Determine whether microbiota restoration therapy improves cognition 1 month after treatment by measuring differences in time scores from EncephalApp. The app times participants in seconds (s) in variations of the Stroop Test. The average (s) across all trials will be reported as well as the difference in (s) between (trial 1)-(trial 5). Longer completion times indicate greater cognitive impairment, while a decrease in completion time from trial 1 to trial 5 indicates learning (cognitive improvement). The scale for this measure is theoretically 0s-500s.
次要结局
- Engraftment of FMT as assessed by change in type and abundance of gut microbiota following shotgun sequencing(1 month to 12 months)
- Change in cognitive function at 3, 6 and 12 months post-FMT as measured by change in response times on EncephalApp (Stroop test)(3 to 12 months)
- Number of HE episodes(1 month to 12 months)