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DiarrheaMIRRENCT03596827

The Protective Immune Response to Attenuated Enterotoxigenic Escherichia Coli Infection

A study testing E. coli strain E1392-75-2A dose 1E10 CFU, E. coli strain E1392-75-2A dose 1E9 CFU and E. coli strain E1392-75-2A dose 1E8 CFU in people with Diarrhea, run by NIZO Food Research at 1 site in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The existing diarrhoeagenic Escherichia coli (E. coli) challenge model is already suitable for dietary interventions in its current form, targeted to impact on the immediate clinical symptoms upon E. coli infection. Read more about this study

Who is it for?
Ages 18 to 55 years, men onlyHealthy volunteers can take part
Conditions the study is for
Diarrhea
What is being tested?
E. coli strain E1392-75-2A dose 1E10 CFU, E. coli strain E1392-75-2A dose 1E9 CFU and E. coli strain E1392-75-2A dose 1E8 CFU
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
30 participants
Where
1 siteNetherlands
Study dates
26 Sep 2018to 28 Feb 2019
Phase
Interventional
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 18 to 55 years
  • Men only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • In order to be eligible to participate in this study, a subject must meet all of the following criteria:
  • Male
  • Age between 18 and 55 years.
  • BMI ≥18.5 and ≤30.0 kg/m2.
  • Healthy as assessed by the NIZO health questionnaire.
  • Ability to follow Dutch verbal and written instructions.
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  • Availability of internet connection.
  • Signed informed consent.
  • Willing to accept disclosure of the financial benefit of participation in the study to the authorities concerned.
  • Willing to accept use of all encoded data, including publication, and the confidential use and storage of all data for at least 15 years.
  • Willing to comply with study procedures, including collection of stool and blood samples.
  • Willingness to abstain from high calcium containing products.
  • Willingness to abstain from alcoholic beverages three days before, during and for 4 days after diarrheagenic E. coli challenge.
  • Willingness to abstain from medications that contain acetaminophen, aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs, (OTC) antacids and antimotility agents (eg, loperamide) on the three days before, during and for 4 days after diarrheagenic E. coli challenge.
  • Willingness to abstain from probiotics and prebiotic/fibers starting from runin and during the whole study.
  • Willingness to give up blood donation starting at run-in and during the entire study.

Who cannot join

  • A potential subject who meets any of the following criteria will be excluded from participation in this study:
  • Acute gastroenteritis in the 2 months prior to inclusion
  • Any confirmed or suspected immunosuppressive or immunodeficient condition including human immunodeficiency virus infection (HIV).
  • Disease of the GI tract, liver, gall bladder, kidney, thyroid gland (self-reported), except for appendicitis.
  • History of microbiologically confirmed ETEC or cholera infection within 3 years prior to inclusion.
  • Symptoms consistent with Travelers' Diarrhea concurrent with travel to countries where ETEC infection is endemic (most of the developing world) within 3 years prior to inclusion, OR planned travel to endemic countries during the length of the study.
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  • Vaccination for, or ingestion of cholera within 3 years prior to inclusion, including studies at NIZO.
  • Occupation involving handling of ETEC or Vibrio cholerae currently, or within 3 years prior to inclusion.
  • Vaccination for, or ingestion of ETEC or E coli heat labile toxin, including E. coli challenge studies at NIZO.
  • Evidence of current excessive alcohol consumption (>4 consumptions/day or >20 consumptions/week) or drug (ab)use, and not willing/able to stop this during the study.
  • Known allergy to the following antibiotics: ciprofloxacin, trimethoprim, sulfamethoxazole, and penicillins.
  • Reported average stool frequency of >3 per day or <1 per 2 days.
  • Use of antibiotics, (during 6 months prior to inclusion), norit, laxatives, cholestyramine, antacids H2 receptor antagonists or proton pump inhibitors (during 3 months prior to inclusion).
  • Use of immunosuppressive drugs (e.g. cyclosporine, azathioprine, systemic corticosteroids, antibodies).
  • Vegans.
  • Mental status that is incompatible with the proper conduct of the study.
  • Not having a general practitioner, not allowing disclosure of participation to the general practitioner or not allowing to inform the general practitioner about abnormal results.
  • Participation in any clinical trial including blood sampling and/or administration of substances starting 1 month prior to study start and during the entire study.
  • Personnel that is part of the study team at NIZO, their partner and their first and second degree relatives.

Trial locations and contacts

1 site in 1 country.

Netherlands1 site
  • NIZO Food Research

    Ede, Gelderland, 6718ZB

Other trials in Netherlands

About this study

Official title: The Protective Immune Response to Attenuated Enterotoxigenic Escherichia Coli Infection in Healthy Human Subjects: A Pilot Study

The existing diarrhoeagenic Escherichia coli (E. coli) challenge model is already suitable for dietary interventions in its current form, targeted to impact on the immediate clinical symptoms upon E. coli infection. In order to make the model also suitable for dietary interventions that are aimed at support of the protective response against reinfection, the immune response triggered by the primary infection should be suboptimal. The MIRRE pilot study is set up to determine how much the primary inoculation dose of diarrheagenic E. coli should be lowered in order to result in a reduced protective response upon a secondary infection.

Read the detailed description

The MIRRE pilot study is a randomized, double-blind dose-response, parallel 7 weeks human infection study. Healthy male subjects, 18-55 years of age who fulfil all of the inclusion criteria and none of the exclusion criteria, will be randomly assigned to one of five inoculation dosages of a live attenuated diarrheagenic E. coli strain (n=6 per group). Subjects will be instructed to maintain their usual pattern of physical activity and their habitual food intake, but to reduce and standardize their dietary calcium intake. After a standardized evening meal and an overnight fast, subjects will be orally infected on day 14 and 35 with a live, but attenuated, diarrheagenic E. coli (strain E1392/75-2A; collection NIZO food research). Five groups of 6 subjects will be provided one of the following dosages at day 14: 1E10 CFU (standard dose); 1E9 CFU; 1E8 CFU; 1E7 CFU or 1E6 CFU of the E.coli strain. At study day 35, all subjects will receive a second inoculation of 1E10 CFU of the E.coli strain.

At various time points before and after diarrheagenic E. coli challenges an online diary will be kept to record information on stool consistency, frequency and severity of symptoms, and blood and stool samples are collected to quantify antibody levels and to quantify fecal infection parameters.

The hypothesis of this pilot study is that the E. coli infection dose at primary inoculation determines the outcomes of the protective immune response and the extent of clinical symptoms at a secondary inoculation.Therefore the CFA/II-specific IgG antibody response, in relation to clinical symptoms, is the main outcome.

Conditions
Diarrhea
Being tested
E. coli strain E1392-75-2A dose 1E10 CFU, E. coli strain E1392-75-2A dose 1E9 CFU, E. coli strain E1392-75-2A dose 1E8 CFU, E. coli strain E1392-75-2A dose 1E7 CFU, E. coli strain E1392-75-2A dose 1E6 CFU
Keywords
Diarrhea, Gastroenteritis, Bacterial Infections, Escherichia Coli Infections, E.coli
Medical subject headings
Diarrhea, Gastroenteritis, Bacterial Infections, Escherichia coli Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • E. coli strain E1392-75-2A dose 1E10 CFUBiological

    Diarrhoeagenic E. coli strain E1392/75-2A serotype O6:H16 belongs to Pathogen class 2 . The strain has a deletion of genes encoding the heat-labile (LT) and heat-stable (ST) toxins and can not produce any toxins. However, it continues to express Colonization Factor Antigen II (CFA/II) and provides 75% protection against challenge with an LT, ST, CFA/II strain

  • E. coli strain E1392-75-2A dose 1E9 CFUBiological

    Diarrhoeagenic E. coli strain E1392/75-2A serotype O6:H16 belongs to Pathogen class 2 . The strain has a deletion of genes encoding the heat-labile (LT) and heat-stable (ST) toxins and can not produce any toxins. However, it continues to express Colonization Factor Antigen II (CFA/II) and provides 75% protection against challenge with an LT, ST, CFA/II strain

  • E. coli strain E1392-75-2A dose 1E8 CFUBiological

    Diarrhoeagenic E. coli strain E1392/75-2A serotype O6:H16 belongs to Pathogen class 2 . The strain has a deletion of genes encoding the heat-labile (LT) and heat-stable (ST) toxins and can not produce any toxins. However, it continues to express Colonization Factor Antigen II (CFA/II) and provides 75% protection against challenge with an LT, ST, CFA/II strain

  • E. coli strain E1392-75-2A dose 1E7 CFUBiological

    Diarrhoeagenic E. coli strain E1392/75-2A serotype O6:H16 belongs to Pathogen class 2 . The strain has a deletion of genes encoding the heat-labile (LT) and heat-stable (ST) toxins and can not produce any toxins. However, it continues to express Colonizat

  • E. coli strain E1392-75-2A dose 1E6 CFUBiological

    Diarrhoeagenic E. coli strain E1392/75-2A serotype O6:H16 belongs to Pathogen class 2 . The strain has a deletion of genes encoding the heat-labile (LT) and heat-stable (ST) toxins and can not produce any toxins. However, it continues to express Colonizat

Study groups in NCT03596827
Study groupRoleWhat they receive
1E10 CFU Escherichia coli (E. coli)Active comparatorAt day 14, after a standardized evening meal and overnight fast, subjects receive a single oral dose of 1E10 CFU of the attenuated diarrhoeagenic E. coli strain E1392-75-2A. At day 35, after a standardized evening meal and overnight fast, all subjects receive a second inoculation 1E10 CFU of the diarrhoeagenic E. coli.
Receives: Biological: E. coli strain E1392-75-2A dose 1E10 CFU
1E9 CFU Escherichia coli (E. coli)ExperimentalAt day 14, after a standardized evening meal and overnight fast, subjects receive a single oral dose of 1E9 CFU of the attenuated diarrhoeagenic E. coli strain E1392-75-2A. At day 35, after a standardized evening meal and overnight fast, all subjects receive a second inoculation 1E10 CFU of the diarrhoeagenic E. coli.
Receives: Biological: E. coli strain E1392-75-2A dose 1E9 CFU
1E8 CFU Escherichia coli (E. coli)ExperimentalAt day 14, after a standardized evening meal and overnight fast, subjects receive a single oral dose of 1E8 CFU of the attenuated diarrhoeagenic E. coli strain E1392-75-2A. At day 35, after a standardized evening meal and overnight fast, all subjects receive a second inoculation 1E10 CFU of the diarrhoeagenic E. coli.
Receives: Biological: E. coli strain E1392-75-2A dose 1E8 CFU
1E7 CFU Escherichia coli (E. coli)ExperimentalAt day 14, after a standardized evening meal and overnight fast, subjects receive a single oral dose of 1E7 CFU of the attenuated diarrhoeagenic E. coli strain E1392-75-2A. At day 35, after a standardized evening meal and overnight fast, all subjects receive a second inoculation 1E10 CFU of the diarrhoeagenic E. coli.
Receives: Biological: E. coli strain E1392-75-2A dose 1E7 CFU
1E6 CFU Escherichia coli (E. coli)ExperimentalAt day 14, after a standardized evening meal and overnight fast, subjects receive a single oral dose of 1E6 CFU of the attenuated diarrhoeagenic E. coli strain E1392-75-2A. At day 35, after a standardized evening meal and overnight fast, all subjects receive a second inoculation 1E10 CFU of the diarrhoeagenic E. coli.
Receives: Biological: E. coli strain E1392-75-2A dose 1E6 CFU

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in specific antibody titer

    Serum IgG-CFA/II antibody levels in relation to clinical symptoms at second E.coli inoculation

    Measured: Day 14,21,28 and Day 35,42,49

Secondary outcomes (4)
  1. Change in percentage of faecal wet weight from baseline

    % of faecal wet weight determined by freeze-drying

    Measured: Day 11,12 and Day 15-17. Day 33,34 and 36-38

  2. Change in Stool consistency (Bristol stool scale) from baseline

    Stool consistency for all stools reported by the subjects

    Measured: Day 11-17 and Day 32-38

  3. Change in Stool frequency from baseline

    Stools per day reported by the subjects

    Measured: Day 11-17 and Day 32-38

  4. Change in incidence, duration and severity of Gastro-intestinal symptoms from baseline

    Gastro-intestinal Symptom Rating Scale reported by the subjects in the online diary

    Measured: Day 11-17 and Day 32-38

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Jul 2018
  2. Study start26 Sep 2018
  3. Primary completion13 Nov 2018
  4. Study completion28 Feb 2019

Resources

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 N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Parallel groups
Model description
The MIRRE pilot study is a randomized, double-blind dose-response, parallel human infection study in 30 healthy adults
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
30 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03596827
Sponsor's protocol ID
NL66039.028.18
Acronym
MIRRE
Status last verified
Mar 2019
First submitted
12 Jul 2018
Last updated
20 Mar 2019
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bovee-Oudenhoven IM, Lettink-Wissink ML, Van Doesburg W, Witteman BJ, Van Der Meer R. Diarrhea caused by enterotoxigenic Escherichia coli infection of humans is inhibited by dietary calcium. Gastroenterology. 2003 Aug;125(2):469-76. doi: 10.1016/s0016-5085(03)00884-9.

    PubMed 12891550
  • Ten Bruggencate SJ, Girard SA, Floris-Vollenbroek EG, Bhardwaj R, Tompkins TA. The effect of a multi-strain probiotic on the resistance toward Escherichia coli challenge in a randomized, placebo-controlled, double-blind intervention study. Eur J Clin Nutr. 2015 Mar;69(3):385-91. doi: 10.1038/ejcn.2014.238. Epub 2014 Nov 5.

    PubMed 25369827

Questions about this trial

What is this clinical trial studying?

A study testing E. coli strain E1392-75-2A dose 1E10 CFU, E. coli strain E1392-75-2A dose 1E9 CFU and E. coli strain E1392-75-2A dose 1E8 CFU in people with Diarrhea, run by NIZO Food Research at 1 site in Netherlands.

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 16 inclusion and 19 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: finished, as of the sponsor's last update on 20 Mar 2019. 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 Netherlands. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Change in specific antibody titer (time frame: Day 14,21,28 and Day 35,42,49). 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 NCT03596827, which also lists 2 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 20 Mar 2019.

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