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The Gut-Brain Study

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ClinicalTrials.gov Identifier: NCT03426826
Recruitment Status : Recruiting
First Posted : February 8, 2018
Last Update Posted : January 30, 2019
Sponsor:
Information provided by (Responsible Party):
Sonia Michail, MD, Children's Hospital Los Angeles

Brief 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).

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.


Condition or disease Intervention/treatment Phase
Autism Spectrum Disorder (ASD) Gastro-Intestinal Disorder Biological: FMT versus placebo Phase 1

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 Type : Interventional  (Clinical Trial)
Estimated Enrollment : 10 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Dynamics of Gut Microbiomes in Autism Spectrum Disorder (ASD) Symptoms
Estimated Study Start Date : January 2019
Estimated Primary Completion Date : March 2022
Estimated Study Completion Date : June 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Placebo Comparator: Arm 1
Placebo Comparator placebo into the jejunum through upper endoscopy.
Biological: FMT versus placebo

Biological/Vaccine: Fecal Microbial Transplant versus placebo Fecal Transplant via endoscopy.

Other Names:

FMT

Other Name: fecal microbial transplant vs placebo

Active Comparator: Arm 2
Active Comparator: Donor Stool Transplant Arm 2 will get FMT (Fecal Microbial Transplant) with Healthy Donor Stool into the jejunum through upper endoscopy.
Biological: FMT versus placebo

Biological/Vaccine: Fecal Microbial Transplant versus placebo Fecal Transplant via endoscopy.

Other Names:

FMT

Other Name: fecal microbial transplant vs placebo




Primary Outcome Measures :
  1. 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.


Secondary Outcome Measures :
  1. Secondary Outcome Measures, symptom improvement [ Time Frame: 24 weeks ]
    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.



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Ages Eligible for Study:   5 Years to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age: 5-17 who have been diagnosed with non-syndromic ASD-s
  2. Needs upper GI endoscopy
  3. Clinical Assessment of ASD
  4. ADOS validated diagnoses of ASD
  5. Questionnaires: RBS-2 , KBIT, SRS, Rome III Version (QPGS- RIII), Ped QL, SSP

Exclusion Criteria:

  1. Subjects able to give consent/assent but unwilling to give informed consent/assent
  2. Prematurity (<36 weeks)
  3. Pregnancy: testing will be done on FMT day 0 for subjects with childbearing potential
  4. Subjects with significant renal and liver dysfunction (creatinine > 2 mg/dl and direct bilirubin > 2 mg/dl)
  5. 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.
  6. Subjects with syndromic disorders of defined genetic cause, and subjects who have severe sensory or motor problems (for example, blindness, deafness, seizures, cerebral palsy)
  7. Subjects with severe food allergies


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03426826


Contacts
Contact: Sonia Michail, MD 323-361-1353 sonia.michail@hotmail.com
Contact: Riddhi Parsana, MS 323-361-7699 rparsana@chla.usc.edu

Locations
United States, California
Children's Hospital Los Angles Recruiting
Los Angeles, California, United States, 90027
Contact: Sonia Michail, MD    323-361-1353    sonia.michail@hotmail.com   
Contact: Riddhi Parsana, MS    323-361-7699    rparsana@chla.usc.edu   
Sponsors and Collaborators
Children's Hospital Los Angeles
Investigators
Principal Investigator: Sonia Michail, MD Children's Hospital Los Angeles
Principal Investigator: Pat Levitt, Ph.D Children's Hospital Los Angeles

Publications:

Responsible Party: Sonia Michail, MD, Physician /Professor of Clinical Pediatrics, Children's Hospital Los Angeles
ClinicalTrials.gov Identifier: NCT03426826     History of Changes
Other Study ID Numbers: APP-18-00409
First Posted: February 8, 2018    Key Record Dates
Last Update Posted: January 30, 2019
Last Verified: January 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Sonia Michail, MD, Children's Hospital Los Angeles:
FMT
Gut Microbiome
Fecal Microbiata Transplantation
Autism Spectrum Disorder
16s rRNA
Gastro-Intestinal Disorder

Additional relevant MeSH terms:
Disease
Autistic Disorder
Autism Spectrum Disorder
Child Development Disorders, Pervasive
Intestinal Diseases
Digestive System Diseases
Gastrointestinal Diseases
Pathologic Processes
Neurodevelopmental Disorders
Mental Disorders