Autism Spectrum Disorder (ASD)Phase 1NCT03426826
The Gut-Brain Study
A Phase 1 study of Autism Spectrum Disorder (ASD) and Gastro-Intestinal Disorder, run by Children's Hospital Los Angeles at 1 site in United States.
Trial summary
The purpose of this study is to find out if transplant of fecal matter (stool), also known as fecal microbiota transplantation (FMT), from a healthy person into the intestines of children and young adults with Autism Spectrum Disorder (ASD). Read more about this study
- Who is it for?
- Ages 5 to 17 years
- Conditions the study is for
- Autism Spectrum Disorder (ASD), Gastro-Intestinal Disorder
- Type of treatment
- Vaccines
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 10 participants
- Where
- 1 siteUnited States
- Study dates
- 15 Aug 2019to Jun 2026
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 5 to 17 years
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- Age: 5-17 who have been diagnosed with non-syndromic ASD-s
- Needs upper GI endoscopy
- Clinical Assessment of ASD
- ADOS validated diagnoses of ASD
- Questionnaires: RBS-2 , KBIT, SRS, Rome III Version (QPGS- RIII), Ped QL, SSP
Who cannot join
- Subjects able to give consent/assent but unwilling to give informed consent/assent
- Prematurity (<36 weeks)
- Pregnancy: testing will be done on FMT day 0 for subjects with childbearing potential
- Subjects with significant renal and liver dysfunction (creatinine > 2 mg/dl and direct bilirubin > 2 mg/dl)
- Subjects with congenital or acquired immunodeficiency, or who are immunosuppressed such as neoplastic disease or organ transplantation), have received or are receiving chemotherapy, or have been diagnosed with HIV.
- Subjects with syndromic disorders of defined genetic cause, and subjects who have severe sensory or motor problems (for example, blindness, deafness, seizures, cerebral palsy)
- Subjects with severe food allergies
Trial locations and contacts
1 site in 1 country.
United States1 site
Children's Hospital Los Angles
Los Angeles, California, 90027
About this study
Official title: Dynamics of Gut Microbiomes in Autism Spectrum Disorder (ASD) Symptoms
The purpose of this study is to find out if transplant of fecal matter (stool), also known as fecal microbiota transplantation (FMT), from a healthy person into the intestines of children and young adults with Autism Spectrum Disorder (ASD).
For this study children between the ages of 5-17years will be recruited over 2 years. Children will be recruited who receive an ASD diagnosis using the gold-standard Autism Diagnosis Observation Schedule -2 (ADOS-2) using module 1, 2 or 3 (none, limited or no moderate expressive language). Children diagnosed with these modules of the ADOS-2 may be at greater risk for GI disorders and rigid-compulsive behaviors. Additional assessment of rigid-compulsive behaviors and social communication will be done using the Repetitive Behavioral Scales-Revised (RBS-R) and Social Responsiveness Scale-2 (SRS-2), respectively. KBIT (the Kaufman Brief Intelligence Test) is used at baseline to obtain patient IQ. Total evaluation time is approximately 90 minutes. Following baseline symptom evaluation, a medical exam will be performed to determine whether each child is expressing specific GI symptoms. In addition, parents will fill out the Questionnaire for Pediatric Gastrointestinal Symptoms- Rome III (QPGS-III). Once an ASD diagnosis is confirmed, FMT treatment will be initiated, which typically occurs within 4-6 weeks of the initial diagnosis. Half 50% of the children (n=5) will receive the equivalent of 50 g of stools from a healthy donor into the jejunum through upper endoscopy and the other 50% off children (n=5) will receive Saline solution as Placebo control through upper endoscopy.
Subjects will have a total of 5 visits within 24 weeks including phone call follow up on Day 7 after FMT.
Read the detailed description
Nearly 1 in 60 children are diagnosed with ASD, a dramatic increase from the start of the 21st century. Although most children with ASD exhibit core social communication deficits, very limited interests, repetitive behaviors and sensory problems, the severity of symptoms and how well each child responds to standard behavioral therapies can vary tremendously from patient to patient. This makes it difficult to enact effective interventions. Other variables also influence the outcomes for ASD patients, including age at first diagnosis, access to care, the quality of treatments and the expertise of interventionists.
Children with ASD also have medical disturbances, which affects their quality of life and compliance in intervention programs. For example, approximately 40 percent of children with ASD have gastrointestinal disturbances (GIDs). Genetics plays a substantial role in risk, but scientists also have determined that non-heritable factors can trigger the expression and severity of ASD symptoms. Clinical research studies from PI laboratories have focused on the gut-brain link that influences ASD symptoms, how a child functions and even responds to interventions .
The investigators hypothesize that children with ASD will tolerate single endoscopic delivery of fecal transplant therapy which will modify their gut microbial profile leading to reduction of repetitive and rigid-compulsive behaviors, based on the Repetitive Behavioral Scales-Revised (RBS-R). Secondary outcomes include improved score in social responsiveness scale and gastrointestinal symptoms . Investigators propose a phase I safety study for the use of FMT in children with Autism Spectrum Disorder.
- Being tested
- FMT versus placebo
- Keywords
- FMT, Gut Microbiome, Fecal Microbiata Transplantation, Autism Spectrum Disorder, 16s rRNA, Gastro-Intestinal Disorder
- Medical subject headings
- Autism Spectrum Disorder, Digestive System Diseases
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
FMT versus placeboBiological
Also called fecal microbial transplant vs placebo
Biological/Vaccine: Fecal Microbial Transplant versus placebo Fecal Transplant via endoscopy.
Other Names:
FMT
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 | Placebo comparator | Placebo Comparator placebo into the jejunum through upper endoscopy. Receives: Biological: FMT versus placebo |
| Arm 2 | Active comparator | Active Comparator: Donor Stool Transplant Arm 2 will get FMT (Fecal Microbial Transplant) with Healthy Donor Stool into the jejunum through upper endoscopy. Receives: Biological: FMT versus placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Primary Outcome Measures, safety and tolerability
The primary Outcome is safety of FMT and also it is measured by any symptom changes in obsessive/compulsive and repetitive behaviors using the RBS-R questionnaire.
Measured: 24 weeks
Secondary outcomes (1)
Secondary Outcome Measures, symptom improvement
Secondary endpoints will include cognitive improvement using language use in a 10 minute interactive session, Social Responsiveness Scale-2. The SRS-2 is newly available (Western Psychological Services). It is a parent 65-item questionnaire that provides a continuous quantitative measure of three DSM domains, including social behavior, communication, and restricted and repetitive behaviors, normed in typically developing (T-score=50, sd=10) and ASD populations. The SRS-2 offers new DSM-5 subscales. The SRS is used in a variety of clinical and research settings. T-scores of 65 correlate highly with an ASD diagnosis, but do not substitute for the ADOS. Changes in SRS T-scores have been used as a measure of social behavior change over time.
Measured: 24 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Feb 2018
- Study start15 Aug 2019
- Primary completionMar 2026 (estimated)
- Study completionJun 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Autism Spectrum Disorder (ASD)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 10 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Children's Hospital Los Angeles
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sonia Michail, MD, Children's Hospital Los Angeles
- Investigators
- Sonia Michail, MD, Principal investigator, Children's Hospital Los AngelesPat Levitt, Ph.D, Principal investigator, Children's Hospital Los Angeles
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03426826
- Sponsor's protocol ID
- CHLA-18-00065
- Status last verified
- Oct 2023
- First submitted
- 2 Feb 2018
- Last updated
- 2 Nov 2023
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Kang DW, Adams JB, Gregory AC, Borody T, Chittick L, Fasano A, Khoruts A, Geis E, Maldonado J, McDonough-Means S, Pollard EL, Roux S, Sadowsky MJ, Lipson KS, Sullivan MB, Caporaso JG, Krajmalnik-Brown R. Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study. Microbiome. 2017 Jan 23;5(1):10. doi: 10.1186/s40168-016-0225-7.
PubMed 28122648Luna RA, Oezguen N, Balderas M, Venkatachalam A, Runge JK, Versalovic J, Veenstra-VanderWeele J, Anderson GM, Savidge T, Williams KC. Distinct Microbiome-Neuroimmune Signatures Correlate With Functional Abdominal Pain in Children With Autism Spectrum Disorder. Cell Mol Gastroenterol Hepatol. 2016 Dec 11;3(2):218-230. doi: 10.1016/j.jcmgh.2016.11.008. eCollection 2017 Mar.
PubMed 28275689Gorrindo P, Williams KC, Lee EB, Walker LS, McGrew SG, Levitt P. Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors. Autism Res. 2012 Apr;5(2):101-8. doi: 10.1002/aur.237.
PubMed 22511450Gorrindo P, Lane CJ, Lee EB, McLaughlin B, Levitt P. Enrichment of elevated plasma F2t-isoprostane levels in individuals with autism who are stratified by presence of gastrointestinal dysfunction. PLoS One. 2013 Jul 3;8(7):e68444. doi: 10.1371/journal.pone.0068444. Print 2013.
PubMed 23844202Yao MD, von Rosenvinge EC, Groden C, Mannon PJ. Multiple endoscopic biopsies in research subjects: safety results from a National Institutes of Health series. Gastrointest Endosc. 2009 Apr;69(4):906-10. doi: 10.1016/j.gie.2008.05.015. Epub 2009 Jan 10.
PubMed 19136110Hamilton MJ, Weingarden AR, Sadowsky MJ, Khoruts A. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012 May;107(5):761-7. doi: 10.1038/ajg.2011.482. Epub 2012 Jan 31.
PubMed 22290405Finegold SM. Therapy and epidemiology of autism--clostridial spores as key elements. Med Hypotheses. 2008;70(3):508-11. doi: 10.1016/j.mehy.2007.07.019. Epub 2007 Sep 29.
PubMed 17904761Finegold SM. State of the art; microbiology in health and disease. Intestinal bacterial flora in autism. Anaerobe. 2011 Dec;17(6):367-8. doi: 10.1016/j.anaerobe.2011.03.007. Epub 2011 Apr 16.
PubMed 21524713
Study at a glance
From the registry record, last updated by the sponsor on 2 Nov 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Dynamics of Gut Microbiomes in Autism Spectrum Disorder (ASD) Symptoms
- ClinicalTrials.gov ID
- NCT03426826
- Acronym / sponsor ID
- CHLA-18-00065
- Keywords
- FMT, Gut Microbiome, Fecal Microbiata Transplantation, Autism Spectrum Disorder, 16s rRNA, Gastro-Intestinal Disorder
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 10 participants (estimated)
- Lead sponsor
- Children's Hospital Los AngelesUniversity, hospital or other
- Study start
- 15 Aug 2019 (actual)
- Primary completion
- Mar 2026 (estimated)
- Study completion
- Jun 2026 (estimated)
- First posted
- 8 Feb 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to find out if transplant of fecal matter (stool), also known as fecal microbiota transplantation (FMT), from a healthy person into the intestines of children and young adults with Autism Spectrum Disorder (ASD).
For this study children between the ages of 5-17years will be recruited over 2 years. Children will be recruited who receive an ASD diagnosis using the gold-standard Autism Diagnosis Observation Schedule -2 (ADOS-2) using module 1, 2 or 3 (none, limited or no moderate expressive language). Children diagnosed with these modules of the ADOS-2 may be at greater risk for GI disorders and rigid-compulsive behaviors. Additional assessment of rigid-compulsive behaviors and social communication will be done using the Repetitive Behavioral Scales-Revised (RBS-R) and Social Responsiveness Scale-2 (SRS-2), respectively. KBIT (the Kaufman Brief Intelligence Test) is used at baseline to obtain patient IQ. Total evaluation time is approximately 90 minutes. Following baseline symptom evaluation, a medical exam will be performed to determine whether each child is expressing specific GI symptoms. In addition, parents will fill out the Questionnaire for Pediatric Gastrointestinal Symptoms- Rome III (QPGS-III). Once an ASD diagnosis is confirmed, FMT treatment will be initiated, which typically occurs within 4-6 weeks of the initial diagnosis. Half 50% of the children (n=5) will receive the equivalent of 50 g of stools from a healthy donor into the jejunum through upper endoscopy and the other 50% off children (n=5) will receive Saline solution as Placebo control through upper endoscopy.
Subjects will have a total of 5 visits within 24 weeks including phone call follow up on Day 7 after FMT.
Detailed description
Nearly 1 in 60 children are diagnosed with ASD, a dramatic increase from the start of the 21st century. Although most children with ASD exhibit core social communication deficits, very limited interests, repetitive behaviors and sensory problems, the severity of symptoms and how well each child responds to standard behavioral therapies can vary tremendously from patient to patient. This makes it difficult to enact effective interventions. Other variables also influence the outcomes for ASD patients, including age at first diagnosis, access to care, the quality of treatments and the expertise of interventionists.
Children with ASD also have medical disturbances, which affects their quality of life and compliance in intervention programs. For example, approximately 40 percent of children with ASD have gastrointestinal disturbances (GIDs). Genetics plays a substantial role in risk, but scientists also have determined that non-heritable factors can trigger the expression and severity of ASD symptoms. Clinical research studies from PI laboratories have focused on the gut-brain link that influences ASD symptoms, how a child functions and even responds to interventions .
The investigators hypothesize that children with ASD will tolerate single endoscopic delivery of fecal transplant therapy which will modify their gut microbial profile leading to reduction of repetitive and rigid-compulsive behaviors, based on the Repetitive Behavioral Scales-Revised (RBS-R). Secondary outcomes include improved score in social responsiveness scale and gastrointestinal symptoms . Investigators propose a phase I safety study for the use of FMT in children with Autism Spectrum Disorder.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Arm 1 | Placebo comparator | Biological: FMT versus placeboPlacebo Comparator placebo into the jejunum through upper endoscopy. |
| Arm 2 | Active comparator | Biological: FMT versus placeboActive Comparator: Donor Stool Transplant Arm 2 will get FMT (Fecal Microbial Transplant) with Healthy Donor Stool into the jejunum through upper endoscopy. |
Who may qualify
- Ages
- 5 to 17 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (5 listed)
- Age: 5-17 who have been diagnosed with non-syndromic ASD-s
- Needs upper GI endoscopy
- Clinical Assessment of ASD
- ADOS validated diagnoses of ASD
- Questionnaires: RBS-2 , KBIT, SRS, Rome III Version (QPGS- RIII), Ped QL, SSP
Key exclusion criteria (7 listed)
- Subjects able to give consent/assent but unwilling to give informed consent/assent
- Prematurity (<36 weeks)
- Pregnancy: testing will be done on FMT day 0 for subjects with childbearing potential
- Subjects with significant renal and liver dysfunction (creatinine > 2 mg/dl and direct bilirubin > 2 mg/dl)
- Subjects with congenital or acquired immunodeficiency, or who are immunosuppressed such as neoplastic disease or organ transplantation), have received or are receiving chemotherapy, or have been diagnosed with HIV.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| FMT versus placeboAlso: fecal microbial transplant vs placeboBiological/Vaccine: Fecal Microbial Transplant versus placebo Fecal Transplant via endoscopy. Other Names: FMT | Biological | Arm 1, Arm 2 |
Primary outcome
Primary Outcome Measures, safety and tolerability
Time frame: 24 weeks
The primary Outcome is safety of FMT and also it is measured by any symptom changes in obsessive/compulsive and repetitive behaviors using the RBS-R questionnaire.
1 secondary outcome
Secondary Outcome Measures, symptom improvement
Time frame: 24 weeks
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Nov 2023.
- Background: PubMed 28122648Kang DW, Adams JB, Gregory AC, Borody T, Chittick L, Fasano A, Khoruts A, Geis E, Maldonado J, McDonough-Means S, Pollard EL, Roux S, Sadowsky MJ, Lipson KS, Sullivan MB, Caporaso JG, Krajmalnik-Brown R. Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study. Microbiome. 2017 Jan 23;5(1):10. doi: 10.1186/s40168-016-0225-7.
- Background: PubMed 28275689Luna RA, Oezguen N, Balderas M, Venkatachalam A, Runge JK, Versalovic J, Veenstra-VanderWeele J, Anderson GM, Savidge T, Williams KC. Distinct Microbiome-Neuroimmune Signatures Correlate With Functional Abdominal Pain in Children With Autism Spectrum Disorder. Cell Mol Gastroenterol Hepatol. 2016 Dec 11;3(2):218-230. doi: 10.1016/j.jcmgh.2016.11.008. eCollection 2017 Mar.
- Background: PubMed 22511450Gorrindo P, Williams KC, Lee EB, Walker LS, McGrew SG, Levitt P. Gastrointestinal dysfunction in autism: parental report, clinical evaluation, and associated factors. Autism Res. 2012 Apr;5(2):101-8. doi: 10.1002/aur.237.
- Background: PubMed 23844202Gorrindo P, Lane CJ, Lee EB, McLaughlin B, Levitt P. Enrichment of elevated plasma F2t-isoprostane levels in individuals with autism who are stratified by presence of gastrointestinal dysfunction. PLoS One. 2013 Jul 3;8(7):e68444. doi: 10.1371/journal.pone.0068444. Print 2013.
- Background: PubMed 19136110Yao MD, von Rosenvinge EC, Groden C, Mannon PJ. Multiple endoscopic biopsies in research subjects: safety results from a National Institutes of Health series. Gastrointest Endosc. 2009 Apr;69(4):906-10. doi: 10.1016/j.gie.2008.05.015. Epub 2009 Jan 10.
- Background: PubMed 22290405Hamilton MJ, Weingarden AR, Sadowsky MJ, Khoruts A. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012 May;107(5):761-7. doi: 10.1038/ajg.2011.482. Epub 2012 Jan 31.
- Background: PubMed 17904761Finegold SM. Therapy and epidemiology of autism--clostridial spores as key elements. Med Hypotheses. 2008;70(3):508-11. doi: 10.1016/j.mehy.2007.07.019. Epub 2007 Sep 29.
- Background: PubMed 21524713Finegold SM. State of the art; microbiology in health and disease. Intestinal bacterial flora in autism. Anaerobe. 2011 Dec;17(6):367-8. doi: 10.1016/j.anaerobe.2011.03.007. Epub 2011 Apr 16.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Sonia Michail, MD principal investigator
Children's Hospital Los Angeles
Pat Levitt, Ph.D principal investigator
Children's Hospital Los Angeles
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study of Autism Spectrum Disorder (ASD) and Gastro-Intestinal Disorder, run by Children's Hospital Los Angeles at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 2 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Primary Outcome Measures, safety and tolerability (time frame: 24 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03426826, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Nov 2023.