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Alzheimer DiseasePhase 1AMBITIONNCT03998423

Oral Fecal Microbiota Transplant Feasibility Study in Alzheimer's Disease

A Phase 1 study testing Fecal Microbiota Transplant in people with Alzheimer Disease, run by University of Wisconsin, Madison at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The goal of this study is to assess the safety and feasibility of an oral fecal microbiota transplant (FMT) intervention for Alzheimer's disease (AD). Read more about this study

Who is it for?
Ages 45 years and olderHealthy volunteers can take part
Conditions the study is for
Alzheimer Disease
What is being tested?
Fecal Microbiota Transplant
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
5 participants
Where
1 siteUnited States
Study dates
14 Nov 2019to 14 Jul 2020
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 45 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Current enrollment in the Wisconsin ADRC clinical core study (2011-0030), ADCP (26695, MCW IRB), or referred from clinic
  • At least 45 years of age
  • Good general health (other than dementia) with no conditions/medications affecting the gut microbiome (see exclusion criteria below)
  • Willing and able to comply with all study procedures for the duration of the study
  • Able to provide signed and date informed consent form
  • Participant is not pregnant, lactating or of childbearing potential (ie women must be two years post-menopausal or surgically sterile
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  • Males must agree to avoid impregnation of women during and for four weeks after completing study treatment through use of an acceptable method of contraception
  • Able to take oral medications
  • Able to take the test capsule successfully with no signs or symptoms of dysphagia
  • Additional inclusion criteria for participants with Alzheimer's disease:
  • Abnormal memory function documented by neuropsychological testing
  • Wisconsin ADRC (HS IRB# 2015-0030) Consensus Diagnosis Conference indicates probable AD diagnosis as per NINDS/ADRDA criteria for probable AD (for ADRC and ADCP participants only).

Who cannot join

  • Active or previous (within 6 months) participation in an Alzheimer's clinical intervention/trial
  • Significant neurologic disease: Any significant neurologic disease, such as Parkinson's disease, stroke, Huntington's disease, normal pressure hydrocephalus, brain tumor, progressive supranuclear palsy, subdural hematoma, multiple sclerosis, seizure disorder, or other significant deficits (other than Alzheimer's dementia)
  • Alcohol/substance: history of alcohol/substance dependence since joining the cohort
  • Psychiatric disorders: Untreated current axis 1 DSM-V disorder such as major untreated depression, current untreated bipolar 1 disorder, untreated schizophrenia spectrum disorders, or other conditions potentially affecting study adherence.
  • Significant medical illness: any significant systemic illness or unstable medical condition occurring that could affect cognition (other than Alzheimer's). Examples include malignant cancer, chemotherapy, untreated thyroid disease, heart failure, or renal insufficiency.
  • Illiterate, blind, or non-English speaking
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  • Known periodic antibiotic use (i.e. prior to dental appointments)
  • Oral FMT-specific exclusion criteria:
  • Inability (e.g. dysphagia) or unwilling to swallow capsules - assessed using the Eating Assessment Tool (EAT-10) and bedside 3oz water swallow test administered by CRU nurse or study coordinator
  • Active gastrointestinal infection at time of enrollment
  • Known or suspected toxic megacolon and/or known small bowel ileus
  • History of total colectomy or bariatric surgery
  • Concurrent intensive induction chemotherapy, radiation therapy, or biological treatment for active malignancy
  • Unable or unwilling to comply with protocol requirements
  • Expected life expectancy < 6 months
  • Previous FMT or microbiome-based products at any time excluding this study
  • Patients with severe anaphylactic or anaphylactoid food allergy
  • Solid organ transplant recipients ≤ 90 days post-transplant or on active treatment for rejection
  • Immunocompromised/ at risk of CMV/EBV associated disease
  • A condition that would jeopardize the safety or rights of the subject, would make it unlikely for the subject to complete the study, or would confound the results of the study
  • Exclusionary factors affecting the microbiome:
  • Use of systemic antibiotics (intravenous, intramuscular, or oral) in the previous 3 months
  • Oral, intravenous, intramuscular, nasal or inhaled corticosteroids (except PRN use for allergies)
  • Immune stimulating medications
  • Methotrexate or immunosuppressive cytotoxic agents
  • Large doses of commercial probiotics consumed (greater than or equal to 108 cfu or organisms per day). Includes tablets, capsules, lozenges, chewing gum or powders in which probiotic is a primary component (ordinary dietary components such as fermented beverages/milks, yogurts, foods do not apply).
  • Unstable dietary history during the previous month, which is defined as major changes in diet by eliminating or significantly increasing a major good group
  • Major surgery of the GI tract, with the exception of cholecystectomy and appendectomy, in the past five years
  • Major bowel resection at any time
  • Active uncontrolled gastrointestinal disorders or disease including: inflammatory bowel disease including ulcerative colitis (mild-moderate-severe), Crohn's disease (mild-moderate-severe), or indeterminate colitis; irritable bowel syndrome (moderate-severe); persistent, infectious gastroenteritis, colitis or gastritis; persistent or chronic diarrhea of unknown etiology, Clostridium difficile infection (recurrent) or Helicobacter pylori infection (untreated), or chronic constipation

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Wisconsin - Madison

    Madison, Wisconsin, 53792

Other trials in United States

About this study

The goal of this study is to assess the safety and feasibility of an oral fecal microbiota transplant (FMT) intervention for Alzheimer's disease (AD).

Read the detailed description

Studies suggests that microbes, including those derived from the gut, may play a role in the development or progression of AD. Gut microbiome composition among individuals with the Alzheimer's clinical syndrome is reduced in microbial diversity and shows compositional differences relative to control groups. Further, genera identified as more abundant in AD are associated with greater AD pathology while genera identified as less abundant in AD are associated with less AD pathology, as shown using CSF biomarkers.

The goal of this study is to assess the safety and feasibility of an oral fecal microbiota transplant (FMT) intervention.

  • Primary Objective: To assess the safety and feasibility (recruitment, eligibility, enrollment, completion, and follow-up) of an oral FMT intervention in people with and without the Alzheimer's clinical syndrome.
  • Secondary Objective: To demonstrate the effects of FMT on the composition and function of the gut microbiota. To collect preliminary data in order to estimate sample size and other parameters for a larger study.
Being tested
Fecal Microbiota Transplant
Medical subject headings
Alzheimer Disease

What participants receive

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

  • Fecal Microbiota TransplantBiological

    Also called FMT Capsule DE

    Double-encapsulated Fecal Microbiota Transplant Capsules

Study groups in NCT03998423
Study groupRoleWhat they receive
1 dose fecal microbiota transplantExperimentalThis group will receive one dose of Fecal Microbiota Transplant (FMT) at baseline.
Receives: Biological: Fecal Microbiota Transplant
2 doses fecal microbiota transplantExperimentalThis group will will receive one dose of Fecal Microbiota Transplant (FMT) at baseline and a second dose of FMT 8 weeks later.
Receives: Biological: Fecal Microbiota Transplant
3 doses fecal microbiota transplantExperimentalThis group will will receive one dose of Fecal Microbiota Transplant (FMT) at baseline, second dose of FMT at 8 weeks, and a third dose of FMT at 12 weeks.
Receives: Biological: Fecal Microbiota Transplant

What is being measured

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

  1. Safety: Proportion of participants with treatment-related adverse events, serious adverse events, or adverse events of special interest.

    Proportion of participants with treatment-related adverse events, serious adverse events, or adverse events of special interest.

    Adverse events, serious adverse events, or adverse events of special interest, will be evaluated following study procedures using AE and SAE forms, telephone and in person interview, and relevant medical records related to adverse events.

    Measured: 1 year

  2. Feasibility: Participant recruitment rate

    Number of weeks/months needed to meet study group numbers.

    Measured: 1 year

  3. Feasibility: Eligibility

    Proportion of individuals expressing interest who meet inclusion/exclusion criteria.

    Measured: 1 year

  4. Feasibility: Procedures completed.

    Proportion of participants able to complete procedures (including FMT) will be part of feasibility.

    Measured: 1 year

  5. Feasibility: Retention

    Proportion of participants that complete follow up.

    Measured: 1 year

  6. Change in gut composition: Engraftment of fecal microbial transplant as assessed by 16S rRNA sequencing of recipient stool sample

    In order to determine efficacy of fecal transplant, change in composition, i.e. microbial engraftment will be assessed by testing for newly detected operational taxonomic units (OTUs) in the gut microbiome of a participant post-FMT (which were present in the donor but undetected in the participant pre-FMT). This will be assessed via 16S rRNA seq of recipient stool samples pre- and post- FMT.

    Measured: baseline, 8 weeks, 24 weeks, 1 year

Secondary outcomes (17)
  1. Cognition: Change in Montreal Cognitive Assessment (MoCA) score

    The Montreal Cognitive Assessment (MoCA) is a cognitive screening test used for detecting cognitive impairment. MoCA scores range between 0 and 30. Lower scores are indicative of impairment

    Measured: baseline and 1 year

  2. Cognition: Change in results of Repeatable Battery for the Assessment of Neuropsychological Status

    The Repeatable Battery for the Assessment of Neuropsychological Status consists of twelve subtests which give five scores, one for each of the five domains tested (immediate memory, visuospatial/constructional, language, attention, delayed memory). Raw scores on each domain are scaled to account for a person's age. Scaled scores are converted to percentiles which are used to determine a range of performance (impaired, borderline impaired, expected score, high average, superior) and overall cognitive status (impaired/not impaired).

    Measured: baseline and 1 year

  3. Cognition: Change in the results of Trail Making Test Part A and Part B

    The Trail Making Test is a neuropsychological test of visual attention and task switching. It consists of two parts, A and B. Participant is instructed to connect a set of 25 dots as quickly as possible while still maintaining accuracy. The test can provide information about visual search speed, scanning, speed of processing, mental flexibility, as well as executive functioning.

    Results for both TMT A and B are reported as the number of seconds required to complete the task; therefore, higher scores reveal greater impairment.

    Measured: baseline and 1 year

  4. Metabolic/physiological measure: Change in the level of Hemoglobin A1C

    Change in the level of Hemoglobin A1C will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  5. Metabolic/physiological measure: Change in the level of fasting glucose

    Change in the level of fasting glucose will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  6. Metabolic/physiological measure: Change in the level of fasting insulin

    Change in the level of fasting insulin will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  7. Metabolic/physiological measure: Change in the level of C-reactive protein

    Change in the level of C-reactive protein will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  8. Metabolic/physiological measure: Change in the blood lipid profile

    Change in the blood lipid profile will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  9. Metabolic/physiological measure: Change in the blood pressure

    Change in the blood pressure will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  10. Metabolic/physiological measure: Change in body weight

    Change in body weight will be assessed

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  11. Metabolic/physiological measure: Change in the body composition by measuring body fat percentage

    Change in the body composition by measuring body fat percentage

    Measured: baseline and 1 year

  12. Change in insulin resistance indexed by the homeostatic model assessment-insulin resistance (HOMA-IR) method

    Fasting glucose and fasting insulin will be used to calculate HOMA-IR.

    Measured: baseline, 8 weeks, 24 weeks, and 1 year

  13. Change in physical activity as measured by Actigraphy watch

    Actigraphy watch will be worn on the non-dominant wrist was used to record a participant's physical activity (total number of active minutes per day).

    Measured: baseline, 24 weeks, and 1 year

  14. Change in Sleep as measured by Actigraphy watch

    Actigraphy watch will be worn on the non-dominant wrist to estimate sleep duration.

    Measured: baseline, 24 weeks, and 1 year

  15. Change in CSF biomarkers

    Aβ42, Aβ42/Aβ40, phosphorylated tau, total tau, YKL-40

    Measured: baseline and 1 year

  16. Change in serum/plasma metabolites on an average of one week pre and post FMT

    Change in serum/plasma metabolites on an average of one week pre and post FMT

    Measured: baseline, week 8, week 24, and 1 year

  17. Function: Change in total score on the Bristol Activities of Daily Living Scale

    Change in total score on the Bristol Activities of Daily Living Scale. This is a tool used to measure functional ability (ability to independently carry out activities of daily living), and was developed for use with people with dementia. The minimum score is "0". The maximum score is "60". A lower score (better) indicates that a person is independent in their activities of daily living, and a higher score (worse) indicates that the individual is dependent on others.

    Measured: baseline and 1 year

Timeline

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

  1. First posted26 Jun 2019
  2. Study start14 Nov 2019
  3. Primary completion14 Jul 2020
  4. Study completion14 Jul 2020

Why it stopped: SARS-CoV-2 has been detected in fecal material. Although FMT is screened for SARS-CoV-2, the team decided to end the study to minimize risk to participants.

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 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
A single dose of 30 capsules (22.5g) of oral FMT will be given once (week 0), twice (week 0 and week 8), or three times (week 0, week 8, and week 24). Participants are randomly assigned to 1, 2, or 3 doses of FMT.
Masking
None (open label)
Enrolment
5 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03998423
Sponsor's protocol ID
AMBITION
Other IDs
2018-0283, A534255, SMPH/MEDICINE/MEDICINE
Acronym
AMBITION
Status last verified
Jul 2020
First submitted
23 Aug 2018
Last updated
24 Jul 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Vogt NM, Kerby RL, Dill-McFarland KA, Harding SJ, Merluzzi AP, Johnson SC, Carlsson CM, Asthana S, Zetterberg H, Blennow K, Bendlin BB, Rey FE. Gut microbiome alterations in Alzheimer's disease. Sci Rep. 2017 Oct 19;7(1):13537. doi: 10.1038/s41598-017-13601-y.

    PubMed 29051531

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Fecal Microbiota Transplant in people with Alzheimer Disease, run by University of Wisconsin, Madison 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 12 inclusion and 30 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: stopped early, as of the sponsor's last update on 24 Jul 2020. 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. 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?

The study was stopped early (reason given: SARS-CoV-2 has been detected in fecal material. Although FMT is screened for SARS-CoV-2, the team decided to end the study to minimize risk to participants.). 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?

Safety: Proportion of participants with treatment-related adverse events, serious adverse events, or adverse events of special interest. (time frame: 1 year). The study lists 6 primary outcomes in all. 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 NCT03998423, which also lists 1 linked publication.

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 24 Jul 2020.

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