Pilot Study of Gut Commensals in Antiphospholipid Syndrome

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2013 by Yale University
Sponsor:
Collaborator:
Hospital for Special Surgery, New York
Information provided by (Responsible Party):
Martin Kriegel, Yale University
ClinicalTrials.gov Identifier:
NCT01787305
First received: February 3, 2013
Last updated: July 17, 2013
Last verified: July 2013
  Purpose

The purpose of this study is to explore if certain commensals within the gut microbiota (the collection of all microbes that live inside the gut) correlate with autoantibodies in the autoimmune clotting disorder called antiphospholipid syndrome. The study hypothesis is that particular commensals induce the autoantibodies (immune molecules that bind to self structures) and thus correlate with the level of immune cells and antibodies that are self-reactive. Participants are patients with antiphospholipid syndrome and individuals who have tested positive on a prior blood test for anti-beta2-glycoprotein I antibodies or those that have tested negative for antiphospholipid antibodies in their blood, but had a clotting event or a health problem that puts them at risk to form blood clots.


Condition
Antiphospholipid Syndrome (APS)

Study Type: Observational
Study Design: Observational Model: Case Control
Official Title: Longitudinal Study of the Fecal Microbiome in Persistently Anti-β2 Glycoprotein-I Positive Individuals and Patients With Antiphospholipid Syndrome

Resource links provided by NLM:


Further study details as provided by Yale University:

Primary Outcome Measures:
  • Change in autoantibody levels [ Time Frame: Baseline ] [ Designated as safety issue: No ]
    Certain gut bacteria will correlate with anti-β2GPI autoantibody titers in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects

  • Change in autoantibody levels [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
    Certain gut bacteria will correlate with anti-β2GPI autoantibody titers in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects

  • Change in autoantibody levels [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
    Certain gut bacteria will correlate with anti-β2GPI autoantibody titers in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects


Secondary Outcome Measures:
  • Change in autoreactive T cell frequencies [ Time Frame: Baseline ] [ Designated as safety issue: No ]
    Certain gut bacteria will correlate with β2GPI-reactive CD4+ T-cells in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects.

  • Change in autoreactive T cell frequencies [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]
    Certain gut bacteria will correlate with β2GPI-reactive CD4+ T-cells in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects.

  • Change in autoreactive T cell frequencies [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
    Certain gut bacteria will correlate with β2GPI-reactive CD4+ T-cells in anti-β2GPI-positive subjects that are lower or absent in aPL-negative subjects.


Biospecimen Retention:   Samples With DNA

Whole Blood Serum Stool DNA?


Estimated Enrollment: 40
Study Start Date: February 2013
Estimated Study Completion Date: July 2014
Estimated Primary Completion Date: February 2014 (Final data collection date for primary outcome measure)
Detailed Description:

Antiphospholipid syndrome (APS) is an autoimmune disorder in which people are at risk to form blood clots. Having a positive antiphospholipid antibody (aPL) test does not mean the person has APS; but a small number of people do develop APS. These antibodies can also occur in otherwise healthy people. We believe certain bacteria in the gut may cause these antibodies to be produced.

Current treatments in APS target the blood clotting system and the goal is to prevent future blood clots. Many patients require this therapy for their entire life. If an persistent trigger can be found within the gut microbiota, it may help in developing other treatments. This study is being conducted at two centers, Yale University School of Medicine in New Haven, CT, and The Hospital for Special Surgery in Manhattan, New York. We expect to enroll a total of 40 subjects in this study at these study sites.

Visits will be as follows:

Visit 1: Initial screening visit: Review of medical records and questionnaire completion.

Visit 2 (one month after initial visit) & Visit 3 (2 months after initial visit): Questionnaire relating to any changes that may have taken place since recruitment. Brief physical examination by the study doctor.

Overall participation: Over a period of 8 weeks.

Sample Collection:

At each study visit, a sample of blood will be obtained (approximately 6.5 tablespoons of whole blood) via one needle stick.

A take-home stool sample collection kit will be provided. Stool samples will be obtained within 24 hours before or after blood collection and delivered (or mailed) to a study site. 2 kits will be provided at the initial visit, 1 kit will be provided at the follow up visit at month 1.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population

Yale New Haven Hospital and affiliated outpatient clinics Hospital for Special Surgery and affiliated outpatient clinics

Criteria

Inclusion Criteria:

  • 18-70 years of age
  • One of the following groups below:

Group 1a: Persistently positive anti-β2GPI on Coumadin (n: 10) Group 1b: Persistently positive anti-β2GPI not on Coumadin (n: 10) Group 2a: Negative aPL on Coumadin (n: 10) Group 2b: Negative aPL not on Coumadin (n: 10) Persistently positive aβ2GPI will be defined as anti-β2GPI immunoglobulin G (IgG)/IgM/IgA ≥ 40 SGU/SMU at two separate time points at least 12 weeks apart.

Negative aPL will be defined as negative Lupus anticoagulant test, aCL IgG/IgM/IgA, and anti-β2GPI IgG/IgM/IgA within 12 months of the study entry.

Exclusion Criteria:

  • Any autoimmune diseases including systemic lupus erythematosus/SLE (defined by ACR criteria >4/11), Rheumatoid Arthritis, Spondylarthropathy, Inflammatory Muscle Disease, and Sarcoidosis

    o Lupus like disease (ACR < 4/11) is not an exclusion criterion

  • Steroid use greater than 10 mg/d prednisone or equivalent 30 days prior to enrollment
  • Any immunosuppressive drug use within 3 months prior to screening (mycophenolate mofetil, azathioprine, methotrexate, leflunomide, rituximab, cyclophosphamide, intravenous immunoglobulin, plasmapheresis).
  • Ongoing chronic infection (viral, bacterial or fungal) including known HIV, Hepatitis B/C
  • Acute infection receiving any antibiotics within 30 days prior to screening
  • Acute thrombosis within 2 days prior to screening
  • Major gastrointestinal surgery less than 5 years prior to enrollment (with the exception of appendectomy)
  • Any Gastrointestinal bleeding history
  • Inflammatory Bowel Disease diagnosed by biopsy
  • Celiac Disease diagnosed by biopsy
  • Bulimia or anorexia nervosa
  • Probiotics (greater than estimated 10^9 cfu or organisms per day) within 30 days prior to enrollment (with the exception of fermented beverages, milks or yogurts).
  • Morbid obesity (BMI ≥ 40)
  • Diabetes Mellitus Type I or II on medical therapy
  • Malignancy within one year prior to screening (with the exception of non-metastatic squamous or basal cell skin carcinomas and cervical carcinoma if received curative surgical treatment)
  • Known alcohol abuse
  • Pregnancy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01787305

Contacts
Contact: Martin A Kriegel, MD PhD 203-737-8326 Martin.Kriegel@yale.edu

Locations
United States, Connecticut
Yale University School of Medicine; Yale-New Haven Hospital Recruiting
New Haven, Connecticut, United States, 06511
Contact: Martin A Kriegel, MD PhD    203-737-7420    martin.kriegel@yale.edu   
Contact: Martin A Kriegel, MD PhD    203-737-8326      
Principal Investigator: Martin A Kriegel, MD PhD         
Sponsors and Collaborators
Yale University
Hospital for Special Surgery, New York
Investigators
Principal Investigator: Martin A Kriegel, MD PhD Yale University
  More Information

No publications provided

Responsible Party: Martin Kriegel, Assistant Professor of Immunobiology and Medicine (Rheumatology), Yale University
ClinicalTrials.gov Identifier: NCT01787305     History of Changes
Other Study ID Numbers: 1210010962
Study First Received: February 3, 2013
Last Updated: July 17, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Yale University:
microbiome
commensals
autoantibodies
autoreactive T cells

Additional relevant MeSH terms:
Syndrome
Antiphospholipid Syndrome
Disease
Pathologic Processes
Autoimmune Diseases
Immune System Diseases

ClinicalTrials.gov processed this record on October 16, 2014