Fecal Microbiota Transplantation for Diabetes Mellitus Type II in Obese Patients

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

The incidence of obesity has dramatically increased during the last three decades, leading to a significant increase of obesity-related morbidity, including type 2 diabetes mellitus (T2DM) that is characterized by resistance of target tissues to insulin action. T2DM obese patients may be treated by medications or by bariatric surgery. Both alternatives have limitations due to incomplete resolution of the diseases, high cost or potential procedural related morbidity. An increasing body of evidence points to a role of the enteric microbiota in the pathogenesis of obesity-related insulin resistance. In addition to that, the gut microbiota is directly affected by the diet composition. Studies in T2DM mice carrying human gut germs, demonstrated special interactions between the gut microbiota and the host, creating a typical microbiota composition which changes significantly following diet change from a western diet, rich with sugar, to a vegetarian diet rich with fibers. This rapid alternations in the microbiota composition has also shown in humans, after changing from western to high fiber diet. A change in diet life style may lead to an improvement in T2DM symptoms such as decrease in visceral adipose tissue.

Condition or disease	Intervention/treatment	Phase
Diabetes Mellitus, Type 2; Obesity	Procedure: gastroscopy; Drug: Fecal Microbiota Transplantation; Other: high fat low fiber diet; Other: sham diet; Other: low fat high fiber diet	Phase 2

Detailed Description:

Study design:

30 Patients will undergo 2 FMT's from a lean donor and will be randomized into 3 types of diet groups:

1. low fat high fiber diet (20% fat)
2. no change in fat intake (sham diet)
3. high fat low fiber diet (40-45% fat)

The treating physicians and the patients will be blinded for the diet arm. Before and after FMT, patients will be assessed after an overnight fast (and before taking medications) for weight, anthropometric measures, questionnaires (dietary, general health, antibiotic and probiotic exposure, oral diabetes medication quantity, and other drug exposure), blood and stool.

The investigators hypothesize that fecal microbial transplantation from a lean donor to T2DM obese patients, with the combination of low fat high fiber diet, will alter the gut microbiota composition to decrease insulin resistance through microbiota dependent metabolic and immunologic effects.

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	30 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Double (Participant, Investigator)
Primary Purpose:	Treatment
Official Title:	Fecal Microbiota Transplantation for Diabetes Mellitus Type II in Obese Patients
Study Start Date :	April 2016
Estimated Primary Completion Date :	January 2018

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Active Comparator: FMT from a lean donor+ high fat diet; Patients will undergo FMT (Fecal Microboita Transplantation) from a lean donor twice during study through a gastroscopy: at time 0; after 6 weeks Patient will start high fat low fiber diet 2 weeks before first FMT and continue on consuming the same diet 9 weeks after the first FMT. Patient will be followed up by a nutritionist through the the study.	Procedure: gastroscopy; as detailed in arm description Drug: Fecal Microbiota Transplantation; as detailed in arm description Other: high fat low fiber diet; as detailed in arm description
Sham Comparator: FMT from a lean donor+ sham diet; Patients will undergo FMT (Fecal Microboita Transplantation) from a lean donor twice during study through a gastroscopy: at time 0; after 6 weeks Patient will start sham diet (no change in fat/fiber consumption) 2 weeks before first FMT and continue on consuming the same diet 9 weeks after the first FMT. Patient will be followed up by a nutritionist through the the study.	Procedure: gastroscopy; as detailed in arm description Drug: Fecal Microbiota Transplantation; as detailed in arm description Other: sham diet; as detailed in arm description
Active Comparator: FMT from lean donor+ low fat diet; Patients will undergo FMT (Fecal Microboita Transplantation) from a lean donor twice during study through a gastroscopy: at time 0; after 6 weeks Patient will start low fat high fiber diet 2 weeks before first FMT and continue on consuming the same diet 9 weeks after the first FMT. Patient will be followed up by a nutritionist through the the study.	Procedure: gastroscopy; as detailed in arm description Drug: Fecal Microbiota Transplantation; as detailed in arm description Other: low fat high fiber diet; as detailed in arm description

Outcome Measures

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Primary Outcome Measures :

1. 30% decrease in insulin resistance [ Time Frame: 6 weeks after first FMT ]
   Lean donor FMT will result in 30% decrease in insulin resistance that will be further enhanced after a second FMT. These will be meditated by an alteration of intestinal microbiota
2. 40% decrease in insulin resistance compared to baseline [ Time Frame: 12 weeks after second FMT ]

Secondary Outcome Measures :

1. Decreased use of diabetes medications [ Time Frame: Week 6 and 12 post FMT ]
2. Improvement in anthropometric measures and in metabolic indices [ Time Frame: week 6 and 12 post FMT ]
   At least 5% decrease in waist to hip ratio and in total body weight
3. Maintenance of an improved insulin resistance [ Time Frame: 28 weeks post FMT ]
   Insulin resistance at 28 weeks will be in the range (+5% to -5%) of the value achieved at week 12.
4. Maintenance of altered of enteric microbiota in the three diet groups [ Time Frame: 6, 12, 28 weeks post FMT ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 65 Years (Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

• 30≤BMI

• A diagnosis of T2DM (≥3 months) and one of the following:

  1. Fasting glucose level≥126mg/dL and/ or
  2. A stable dose of anti-diabetic drugs for ≥2 weeks and/or
  3. HbA1C≥6.5
• Access to a smart phone supporting the research application for tracking food consumption.

Exclusion Criteria:

• participation in other clinical trial
• incapable of signing an informed consent
• pregnancy or breast feeding
• Antibiotic treatment within the prior 3 months or predicted antibiotic treatment
• insulin medications
• drugs or alcohol addiction
• immune mediated diseases
• type 1 diabetes and latent autoimmune diabetes of adults
• systemic disease
• ischemic heart disease
• probiotics consumption
• a new or unstable treatment with anti diabetic medications

Patients will also be excluded if:

• treated by systemic antibiotic during the study
• will not be compliant with the diet

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Contacts

Contact: Nitsan Maharshak, MD	972-3-6972488	nitsanm@tlvmc.gov.il

Locations

Israel
Department of Gastroentherology	Recruiting
Tel Aviv, Israel, 64239
Contact: Nitsan Maharshak, MD 972-3-6972488 nitsanm@tlvmc.gov.il
Principal Investigator: Nitsan Maharshak, MD
Sub-Investigator: Zamir Halpern, Prof.
Sub-Investigator: Nethaniel Cohen, MD
Sub-Investigator: Meirav Ben-Yehoyada, PHD
Sub-Investigator: Iddo Bar Yishay, MD
Sub-Investigator: Ronnie Baruch, B.Sc Nut
Sub-Investigator: Eran Segal, Prof.

Sponsors and Collaborators

Tel-Aviv Sourasky Medical Center

Investigators

Principal Investigator:	Nitsan Maharshak, MD	Tel Aviv Medical Center

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Tel-Aviv Sourasky Medical Center
ClinicalTrials.gov Identifier:	NCT02346669 History of Changes
Other Study ID Numbers:	TASMC-14-NM-447-CTIL
First Posted:	January 27, 2015
Last Update Posted:	June 9, 2016
Last Verified:	June 2016

Keywords provided by Tel-Aviv Sourasky Medical Center:

Microbiota; Diabetes Mellitus, Type 2; Obesity

Additional relevant MeSH terms:

Diabetes Mellitus; Diabetes Mellitus, Type 2; Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases