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Rheumatoid ArthritisExpoBiomeNCT04847011

Deciphering the Impact of Exposures From the Gut Microbiome-derived Molecular Complex in Human Health and Disease

A study testing Fasting in people with Rheumatoid Arthritis and Parkinson Disease, run by Andreas Michalsen at 2 sites in Germany.

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 ExpoBiome project will analyze the impact of fasting on patients with Parkinsons's Disease (PD) or rheumatoid arthritis (RA) on a clinical level as well as the effect of fasting on their immune system and gut microbiota. Read more about this study

Who is it for?
Ages 18 to 79 yearsHealthy volunteers can take part
Conditions the study is for
Rheumatoid Arthritis, Parkinson Disease, Healthy
What is being tested?
Fasting
Could I receive a placebo?
No, everyone receives an active treatment
How many people
183 participants
Where
2 sitesGermany
Study dates
21 Apr 2021to 26 Sep 2023
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 79 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • One of the following diagnoses: rheumatoid arthritis (first diagnosis >6 weeks ago and <8 years), parkinson's disease OR healthy volunteer
  • Control ("healthy") individuals must be without any evidence of active, known or treated RA, without any evidence of active, known or treated central nervous system disease, and without a known family history of idiopathic PD
  • Arthritis in at least one joint
  • Control individuals should match the RA or PD individuals as closely as possible, especially their age, sex, and education
  • Present written declaration of consent
  • Consent to specimen collection and specimen use
  • Ability to understand the patient information and willingness to sign the consent form

Who cannot join

  • gout or proven bacterial arthritis
  • Psychiatric illness that limits understanding of the examination protocol (unable to consent)
  • BMI < 18.5
  • Pre-existing/current eating disorders (bulimia nervosa, anorexia nervosa) within the past 5 years.
  • Severe internal diseases (e.g. renal insufficiency with creatinine > 2mg/dl)
  • Participation in another study
Show all 11Show fewer
  • Existing vegan diet or fasting within the past 6 months
  • Pregnancy or breastfeeding
  • Chronic inflammatory bowel disease
  • Use of antibiotics within the past 12 months
  • Presence of anemia

Trial locations and contacts

2 sites in 1 country.

Germany2 sites
  • Charité Hochschulambulanz für Naturheilkunde am Immanuel Krankenhaus

    Berlin, 14109

  • Paracelsus-Elena-Klinik Kassel

    Kassel, Hesse, 34128

Other trials in Germany

About this study

The ExpoBiome project will analyze the impact of fasting on patients with Parkinsons's Disease (PD) or rheumatoid arthritis (RA) on a clinical level as well as the effect of fasting on their immune system and gut microbiota. ExpoBiome will combine metagenomics and other "omics" [meta-transcriptomics, meta-proteomics and (meta-)metabolomics], bioinformatic analyses and biostatistics under a systems biology framework to gain new mechanistic insights into microbiome-immune system interactions in the context of chronic diseases with inflammatory signatures.

Besides a one time crossectional study of healthy participants, patients with RA and PD a longitudinal fasting study with two arms (RA and PD) is planned.

Read the detailed description

The human gut microbiome is a complex ecosystem, which contributes essential functions to human physiology. Changes to the microbiome are associated with several chronic diseases characterised by inflammation, including neurodegenerative and autoimmune diseases. Microbiome-derived effector molecules comprising nucleic acids, (poly)peptides and metabolites are present at high levels in the gut but have so far eluded systematic study. This gap in knowledge is limiting mechanistic understanding of the microbiome's functional impact on chronic diseases such as Parkinson's Disease (PD) and rheumatoid arthritis (RA). Here, for the first time a combination of advanced high-resolution methodologies will be integrated to comprehensively identify the constituents of this molecular complex and their impact on the human immune system. First, a quantitative, integrated multi-omic analysis on microbiome samples collected from healthy individuals and patients with newly diagnosed PD or RA will be performes.

Using contextualised prior knowledge (ExpoBiome Map) and machine learning methods, we will identify microbial molecules associated with condition-specific immunophenotypes. Second, the biomarker signature during a model clinical intervention (therapeutic fasting) will be validated and tracked to predict treatment outcomes. Third, microbes and molecules will be screened in personalised HuMiX gut-on-chip models to identify novel anti-inflammatory compounds. By providing mechanistic insights into the molecular basis of human-microbiome interactions, the project will generate essential new knowledge about causal relationships between the gut microbiome and the immune system in health and disease. By facilitating the elucidation of currently unknown microbiome-derived molecules, it will identify new genes, proteins,metabolites and host pathways for the development of future diagnostic and therapeutic applications.

Being tested
Fasting
Medical subject headings
Arthritis, Rheumatoid, Parkinson Disease

What participants receive

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

  • FastingOther

    Patients undergo a 5-10 day fasting period with a dietary energy supply 350-400kcal per day with fruit and vegetable juices or, if not feasible, an established fasting-mimicking diet of 600-800 kcal according to Longo et al.

Study groups in NCT04847011
Study groupRoleWhat they receive
RA - longitudinal armExperimentalNot described
Receives: Other: Fasting
PD - longitudinal armExperimentalNot described
Receives: Other: Fasting
RA - crosssectional armNo interventionNot described
PD - crossectional armNo interventionNot described
Healthy controls - crosssectional armNo interventionNot described

What is being measured

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

  1. Gut microbiota Characterization

    Molecular typing of the gut microbiota using sequencing and high-throughput analysis from stool samples (metagenomics, metatranscriptomics, metaproteomics, metabolomics)

    Measured: Change over baseline to 12 months

Secondary outcomes (48)
  1. Resting blood pressure

    Measured: Change over baseline to 12 months

  2. Heart rate

    Measured: Change over baseline to 12 months

  3. Abdominal circumference

    Measured: Change over baseline to 12 months

  4. Waist to Hip Ratio

    Measured: Change over baseline to 12 months

  5. Body Mass Index (kg/m2)

    Measured: Change over baseline to 12 months

  6. Disease Activity Score 28 (DAS-28-CRP)

    Change from Baseline in the DAS-28-CRP, range from 2.0 to 10.0 while higher values meaning a higher disease activity and below of 2.6 meaning remission

    Measured: Change over baseline to 12 months

  7. Health Assessement Questionnaire (HAQ)

    Change from Baseline in the HAQ, range from 0 to 3 while higher values meaning a higher grade of disability

    Measured: Change over baseline to 12 months

  8. Simplified Disease Activity Index Score (SDAI)

    Change from Baseline in the SDAI, range from 0 to 86 with assumed range from 0.1 to 10mg/dL for CRP. Higher values mean a higher disease activity and below of 34 meaning remission.

    Measured: Change over baseline to 12 months

  9. Hannover Functional Ability Questionnaire (Funktionsfragebogen Hannover, FFbH-R)

    Change from Baseline in the FFbH-R, range from 0 to 100 % while higher values meaning a higher grade of functional capacity

    Measured: Change over baseline to 12 months

  10. MDS-UPDRS

    Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale part I, II, IV (MDS-UPDRS part I, II, IV). Total score range: 0-260 (including the MDS-UPDRS part III), including 4 subcategories. Subcategories are summed to compute the total score. A lower score means a better outcome.

    Measured: Change over baseline to 12 months

  11. Parkinson's Disease Sleep Scale-2 (PDSS-2)

    The Parkinson's Disease Sleep Scale 2 (PDSS-2) is designed to assess nocturnal disability in Parkinson's disease. The PDSS-2 is a 15 question analog scale that ranks answers from 0 - 4, with 4 being worse. (Question 1 is an exception, where 4 is better and 0 is worse). In addition to an overall assessment of sleep disability three aspects of sleep problems can be obtained; disturbed sleep (total of questions 1-3, 8 and 14), PD-specific nocturnal motor symptoms (total of questions 4-6, 12 and 13), and PD-specific nocturnal symptoms (Total of questions 7, 9-11 and 15).

    Measured: Change over baseline to 12 months

  12. Parkinson's Disease Questionnaire-39 (PDQ-39)

    The 39 question Parkinson's Disease Questionnaire (PDQ-39) is a patient-reported rating scale for quality of life in Parkinson's disease. Respondents affirm if they have experienced problems due to their disease using a five point scale from never (0 points) to always (4 points, or worse) in doing common activities. The PDQ-39 is comprised of 8 domains: mobility, emotion, activities of daily living, cognition, stigma, social support, communication, bodily discomfort. Total possible range of scores = 0 - 156, with higher scores representing worse severity.

    Measured: Change over baseline to 12 months

  13. Non-motor symptoms questionnaire (NMSQ)

    The non-motor symptoms (NMS) questionnaire can be given to people affected by Parkinson's in order to aid health and social care professionals to assess their non-motor symptoms.The non-motor symptoms questionnaire is a 30-point, patient-based questionnaire used to determine the non-motor symptoms experienced by the patient during the past month. The points should be totalled to give a score out of 30. A score of under 10 is mild, 10-20 moderate and over 20, severe.

    Measured: Change over baseline to 12 months

  14. Non Motor Symptoms Scale (NMSS)

    The Non-Motor Symptoms Scale (NMSS) measures the frequency and severity of a range of non-motor symptoms in Parkinson's Disease, through 30 questions grouped into 9 domains: cardiovascular, sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, gastro-intestinal tract, urinary, sexual function, and miscellaneous (pain, taste/smell, weight change, excessive sweating). Severity is rated on a scale from 0 (none) to 3 (severe). Frequency is rated on a scale from 1 (rarely) to 4 (very frequent). Item scores are calculated as the product of severity and frequency; the total score is obtained by summing the item scores. The NMSS total score ranges from 0 to 360 with a lower score indicating fewer symptoms. A negative change from baseline indicates improvement in symptoms (reduced score).

    Measured: Change over baseline to 12 months

  15. Stress questionnaire (Cohen Perceived Stress Scale, CPSS)

    Change from Baseline in the CPSS, range from 0 to 4 in each item. Scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1 \& 4 = 0) to the positively stated items and then summing across all scale items, higher values meaning a higher grade of perceived stress.

    Measured: Change over baseline to 12 months

  16. Quality of Life questionnaire (WHO-5)

    Change from Baseline in the WHO-5, range from 0 to 100 %, higher values meaning a higher grade of well-being

    Measured: Change over baseline to 12 months

  17. Hospital Anxiety and Depression Scale (HADS)

    Assessing full scale, range 0-42, lower score meaning a better outcome

    Measured: Change over baseline to 12 months

  18. Mood questionnaire (Profile of Mood States, POMS)

    Change from Baseline in Emotional Distress will be measured using the German Version of the Profile of Mood States (ASTS) short version (19 items, 7-point Likert scale; 0=not at all, 6=extremely). Lower scores indicate more stable mood profiles.

    Measured: Change over baseline to 12 months

  19. Sociodemographic Measurements

    Age, gender, education level, household income, employment status, marital status, language spoken, complete family history, current and previous illness and co-morbidities, and current medications

    Measured: Baseline

  20. Behavioral Factors

    Physical inactivity, coffee, health promoting activities via Likert Scales, range from 0 to 5 while higher values meaning a higher grade of agreement

    Measured: Change over baseline to 12 months

  21. Dietary Behaviour

    Modified FFQ recording dietary behaviour such as mealtimes, frequency of food intake, food preferences, fasting experiences

    Measured: Change over baseline to 12 months

  22. Behavioral Factors: alcohol consumption

    Number of alcoholic beverages on average per week in the last month

    Measured: Change over baseline to 12 months

  23. Behavioral Factors: smoking

    Smoking status in packyears

    Measured: Baseline

  24. Expectation questions

    For fasting on a 5-point likert scale from 1 (nothing at all) to 5 (very strong)

    Measured: Baseline

  25. Differential blood count

    Measured: Change over baseline to 12 months

  26. Hepatic transaminases (GPT, GOT) and Gamma glutamyl transpeptidase (y-GT)

    GPT in units per liter (U/L) GOT (U/L) y-GT (U/L)

    Measured: Change over baseline to 12 months

  27. Bilirubine (total, direct, indirect in mg/dL)

    Measured: Change over baseline to 12 months

  28. Total protein in grams per liter (g/L)

    Measured: Change over baseline to 12 months

  29. Albumine in grams per liter (g/L)

    Measured: Change over baseline to 12 months

  30. Creatinine in µmol per liter (µmol/L)

    Measured: Change over baseline to 12 months

  31. Estimated glomerular filtration rate (eGFR) in milliliter per minute (mL/min)

    Measured: Change over baseline to 12 months

  32. Alcalic Phosphatase in units per liter (U/L)

    Measured: Change over baseline to 12 months

  33. Urea in milligrams per deciliter (mg/dL)

    Measured: Change over baseline to 12 months

  34. Blood lipids and fasting glucose

    • triglycerides (mmol/L)
    • total cholesterol (mmol/L)
    • LDL (mmol/L)
    • HDL (mmol/L)
    • fasting glucose (mmol/L)

    Measured: Change over baseline to 12 months

  35. HbA1C (mmol/mol Hb, %)

    Measured: Change over baseline to 12 months

  36. TSH (mU/L)

    Measured: Change over baseline to 12 months

  37. IGF-1 (ng/mL)

    Measured: Change over baseline to 12 months

  38. Insulin (mU/L)

    Measured: Change over baseline to 12 months

  39. High sensitive CrP (mg/L)

    Evaluate change in hs-CrP levels in participants with RA

    Measured: Change over baseline to 12 months

  40. Rheumatoid factor (RF, IgM) (U/mL)

    Evaluate RF status in participants with RA

    Measured: Baseline

  41. Anti-cyclic citrullinated peptide (ACPA) (U/mL)

    Evaluate change in ACPA levels in participants with RA

    Measured: Change over baseline to 12 months

  42. Zonulin (ng/mL)

    Measured: Change over baseline to 12 months

  43. Fatty acid binding protein 2 (FABP2) (pg/mL)

    Measured: Change over baseline to 12 months

  44. Plasma Calprotectin (µg/g)

    Measured: Change over baseline to 12 months

  45. Fecal Calprotectin (µg/g)

    Measured: Change over baseline to 12 months

  46. Phenotyping of immune cells

    Determination of cytometric parameters that indicate changes in cell activation or quantitative changes in the absolute and/or relative size of subpopulations (e.g. classical/intermediate/non-classical monocytes, naïve and memory T-cells, B-cell differentiation to plasmablasts/-cells) Gene expression analysis of immune cells with Affymetrix whole genome microarrays and RNAseq to search for transcriptional patterns and markers that help to identify relevant immune cell (sub-)populations, which are not yet included in the cytometric phenotyping screen

    Measured: Change over baseline to 12 months

  47. Urine metabolomics (10 ml midstream urine)

    Measured: Change over baseline to 12 months

  48. Oral microbiota analysis in saliva

    Measured: Change over baseline to 12 months

Timeline

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

  1. First posted15 Apr 2021
  2. Study start21 Apr 2021
  3. Primary completion26 Sep 2023
  4. Study completion26 Sep 2023

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
Health services research
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
183 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04847011
Sponsor's protocol ID
ExpoBiome
Acronym
ExpoBiome
Status last verified
Jan 2024
First submitted
14 Apr 2021
Last updated
29 Jan 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: It is not yet known if there will be a plan to make IPD available.

Publications

  • Hansen B, Laczny CC, Aho VTE, Frachet-Bour A, Habier J, Ostaszewski M, Michalsen A, Hanslian E, Koppold DA, Hartmann AM, Steckhan N, Mollenhauer B, Schade S, Roomp K, Schneider JG, Wilmes P. Protocol for a multicentre cross-sectional, longitudinal ambulatory clinical trial in rheumatoid arthritis and Parkinson's disease patients analysing the relation between the gut microbiome, fasting and immune status in Germany (ExpoBiome). BMJ Open. 2023 Aug 18;13(8):e071380. doi: 10.1136/bmjopen-2022-071380.

    PubMed 37597865

Questions about this trial

What is this clinical trial studying?

A study testing Fasting in people with Rheumatoid Arthritis and Parkinson Disease, run by Andreas Michalsen at 2 sites in Germany.

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 7 inclusion and 11 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 29 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Germany. 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?

Gut microbiota Characterization (time frame: Change over baseline to 12 months). 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 NCT04847011, 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 29 Jan 2024.

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