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Beginning Assessment of Cutaneous Treatment Efficacy of Roseomonas in Atopic Dermatitis

Primary Purpose

Atopic Dermatitis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Roseomonas mucosa
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Atopic Dermatitis focused on measuring Lyophilized Biotherapeutic, Microbiome, Probiotic, Commensal Gram-negative Bacteria, Staphylococcus Aureus, Transepidermal Water Loss, Allergic Diseases

Eligibility Criteria

3 Years - 99 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

Inclusion Criteria for Young Adults and Adults with AD (Part 1)

  1. Age 16+ years
  2. SCORAD of at least 10
  3. Have a clinical diagnosis of AD with active involvement of the antecubital fossa
  4. Willing to allow storage of blood for future research
  5. No history of other skin disease
  6. Initiated or attempted standard of care therapy at least 6 months prior to enrollment
  7. Must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) when engaging in sexual activities that can result in pregnancy. The effects of CGN live biotherapy on the developing human fetus are unknown. Adequate contraception must be used consistently, beginning before the first dose and lasting for the duration of study participation. Participants of childbearing potential must have a negative pregnancy test result before they receive CGN live biotherapy. During the course of the study, if a participant becomes pregnant or suspects they are pregnant, then they should inform the study staff and their primary care physician immediately.

Inclusion Criteria for Children with AD (Part 2)

  1. Age 3-16 years
  2. SCORAD of at least 10
  3. Have a clinical diagnosis of AD with active involvement of the antecubital fossa
  4. Willing to allow storage of blood and bacterial swabs for future research
  5. Initiated or attempted standard of care therapy at least 6 months prior to enrollment
  6. Participants who have begun menstruating must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) when engaging in sexual activities that can result in pregnancy.

EXCLUSION CRITERIA:

  1. Presence of an indwelling venous or arterial catheter
  2. Individuals living with anyone with a diagnosed immunodeficiency, cardiac valvular disease, and/of indwelling catheter
  3. Precence of allergies to aimkacin, ciprofloxacin, gentamicin, levofloxacin, and tobramycin (which would preclude treatment of any unexpected infection)
  4. History of cardiac valvular disease
  5. Any history of grade 2 or higher neutropenia or leukopenia
  6. Clinical suspicion of immunodeficiency, liver disorder, kidney disorder, and/or HIV
  7. Pregnant or breastfeeding
  8. Any history of anti-TNF treatment
  9. Inability to demonstrate proper bacteria administration procedure despite coaching and training
  10. Use of fluoroquinolone or aminoglycoside antibiotics within 2 weeks of enrollment
  11. Any condition that, in the opinion of the investigator, contraindicates participation in this Study

Co-enrollment guidelines: Co-enrollment in other trials is restricted, other than enrollment on observational studies or those evaluating the use of a licensed medication. Study staff should be notified of co-enrollment as it may require the approval of the investigator.

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

1

Arm Description

Vials of lyophilized R mucosa (10"3, 10"4, or 10"5 CFU)

Outcomes

Primary Outcome Measures

A 50% reduction in antecubital-specific SCORing Atopic Dermatitis (SCORAD) with no adverse events related to product use. Frequency of solicited adverse events, unsolicited adverse events, serious adverse events, and death.

Secondary Outcome Measures

A 30% improvement in the quality of life as measured by the validated Children's Dermatology Life Quality Index (CDLQI)
A 30% improvement in the quality of life as measured by the validated Family Dermatology Life Quality Index (FDLQI)

Full Information

First Posted
January 11, 2017
Last Updated
November 26, 2019
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT03018275
Brief Title
Beginning Assessment of Cutaneous Treatment Efficacy of Roseomonas in Atopic Dermatitis
Official Title
Beginning Assessment of Cutaneous Treatment Efficacy of Roseomonas in Atopic Dermatitis Phase I/II
Study Type
Interventional

2. Study Status

Record Verification Date
October 2019
Overall Recruitment Status
Completed
Study Start Date
April 20, 2017 (Actual)
Primary Completion Date
October 11, 2019 (Actual)
Study Completion Date
October 11, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

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

5. Study Description

Brief Summary
Background: Atopic dermatitis (AD) is a skin disease also called eczema. It is common in children and sometimes gets better on its own. However, chronic AD may cause asthma, food allergies, eye infections, and sleep problems. The cause of AD might be related to bacteria that live on the skin. Researchers want to see if introducing bacteria, R mucosa, from healthy skin onto the skin of someone with AD helps treat the disease. Objective: To test the safety and activity of R mucosa for treating AD. Eligibility: Part 1: People ages 18 and older with AD Part 2: Children ages 3-17 with AD Design: Participants will be screened with: Medical history Physical exam Examination of their AD Blood and urine tests At the baseline visit, participants will have blood tests and photos taken of their skin. They will get a supply of R mucosa and a memory aid to track their doses and record how they are feeling. Part 2 participants guardians will complete questionnaires about their child s AD. Part 1 participants will spray R mucosa on their arm twice per week for 6 weeks. Part 2 guardians will spray it on their child s arm twice per week for 16 weeks. Participants will have follow-up visits to repeat some baseline tests and review their memory aid: Part 1: Six weeks after the baseline visit Part 2: Four times over 16 weeks; then 2 or 3 times for 1 year Participants will be called or emailed to discuss how they are feeling: Part 1: About 30 days after their last visit Part 2: About every 10 days between visits
Detailed Description
The underlying pathology of atopic dermatitis (AD) consists of defective skin barrier function, susceptibility to Staphylococcus aureus skin infection, and immune imbalance. There is currently no cure for AD. Preclinical data in a mouse model of AD suggest that commensal Gram-negative bacteria (CGN), such as Roseomonas mucosa, from a healthy source can relieve symptoms of AD and have antimicrobial effects. In this study, we will first evaluate the safety of R mucosa-based biotherapy in adults with AD (age 18+ years; part 1), and then evaluate the safety and activity of R mucosa-based biotherapy in children (ages 3-17 years) with AD (parts 2A and 2B). In part 1, participants will receive twice-weekly doses of CGN biotherapy for 6 weeks, with dose escalations at 2 and 4 weeks. In part 2, participants will receive twice-weekly doses of CGN biotherapy for 4 months, with possible dose escalations at 4 and 8 weeks (part 2A only). Starting at 12 weeks for both parts 2A and 2B, dosing frequency may be increased to every other day. Participants in part 1 will be contacted 30 10 days after end of treatment for assessment of safety. Participants in parts 2A and 2B will also be followed for up to 1 year after the end of treatment for evaluation of long-term activity and safety. This will be the first study to test cutaneous live biotherapeutic products for AD. We hypothesize that altering the strains of CGN on the skin of people with AD will improve the patient s clinical outcome. We do not expect serious toxicities because R mucosa is rarely pathogenic; reported cases of bacteremia have typically been associated with percutaneous catheters in immunocompromised patients, who are excluded from this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Atopic Dermatitis
Keywords
Lyophilized Biotherapeutic, Microbiome, Probiotic, Commensal Gram-negative Bacteria, Staphylococcus Aureus, Transepidermal Water Loss, Allergic Diseases

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
31 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
Vials of lyophilized R mucosa (10"3, 10"4, or 10"5 CFU)
Intervention Type
Biological
Intervention Name(s)
Roseomonas mucosa
Intervention Description
R mucosa grown in Hank's balanced salt solution. Bacteria is washed, quantitated spectrophotometrically, suspended in 10%-15% sucrose, and lyophilized.
Primary Outcome Measure Information:
Title
A 50% reduction in antecubital-specific SCORing Atopic Dermatitis (SCORAD) with no adverse events related to product use. Frequency of solicited adverse events, unsolicited adverse events, serious adverse events, and death.
Time Frame
4 weeks, 8 weeks, 12 weeks, 16 weeks, 8 months, 12 months, and 16 months
Secondary Outcome Measure Information:
Title
A 30% improvement in the quality of life as measured by the validated Children's Dermatology Life Quality Index (CDLQI)
Time Frame
4 weeks, 8 weeks, 12 weeks, 16 weeks, 8 months, 12 months, and 16 months
Title
A 30% improvement in the quality of life as measured by the validated Family Dermatology Life Quality Index (FDLQI)
Time Frame
4 weeks, 8 weeks, 12 weeks, 16 weeks, 8 months, 12 months, and 16 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Inclusion Criteria for Young Adults and Adults with AD (Part 1) Age 16+ years SCORAD of at least 10 Have a clinical diagnosis of AD with active involvement of the antecubital fossa Willing to allow storage of blood for future research No history of other skin disease Initiated or attempted standard of care therapy at least 6 months prior to enrollment Must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) when engaging in sexual activities that can result in pregnancy. The effects of CGN live biotherapy on the developing human fetus are unknown. Adequate contraception must be used consistently, beginning before the first dose and lasting for the duration of study participation. Participants of childbearing potential must have a negative pregnancy test result before they receive CGN live biotherapy. During the course of the study, if a participant becomes pregnant or suspects they are pregnant, then they should inform the study staff and their primary care physician immediately. Inclusion Criteria for Children with AD (Part 2) Age 3-16 years SCORAD of at least 10 Have a clinical diagnosis of AD with active involvement of the antecubital fossa Willing to allow storage of blood and bacterial swabs for future research Initiated or attempted standard of care therapy at least 6 months prior to enrollment Participants who have begun menstruating must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) when engaging in sexual activities that can result in pregnancy. EXCLUSION CRITERIA: Presence of an indwelling venous or arterial catheter Individuals living with anyone with a diagnosed immunodeficiency, cardiac valvular disease, and/of indwelling catheter Precence of allergies to aimkacin, ciprofloxacin, gentamicin, levofloxacin, and tobramycin (which would preclude treatment of any unexpected infection) History of cardiac valvular disease Any history of grade 2 or higher neutropenia or leukopenia Clinical suspicion of immunodeficiency, liver disorder, kidney disorder, and/or HIV Pregnant or breastfeeding Any history of anti-TNF treatment Inability to demonstrate proper bacteria administration procedure despite coaching and training Use of fluoroquinolone or aminoglycoside antibiotics within 2 weeks of enrollment Any condition that, in the opinion of the investigator, contraindicates participation in this Study Co-enrollment guidelines: Co-enrollment in other trials is restricted, other than enrollment on observational studies or those evaluating the use of a licensed medication. Study staff should be notified of co-enrollment as it may require the approval of the investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ian A Myles, M.D.
Organizational Affiliation
National Institute of Allergy and Infectious Diseases (NIAID)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20109729
Citation
Boguniewicz M, Leung DY. Recent insights into atopic dermatitis and implications for management of infectious complications. J Allergy Clin Immunol. 2010 Jan;125(1):4-13; quiz 14-5. doi: 10.1016/j.jaci.2009.11.027.
Results Reference
background
PubMed Identifier
27478874
Citation
Myles IA, Williams KW, Reckhow JD, Jammeh ML, Pincus NB, Sastalla I, Saleem D, Stone KD, Datta SK. Transplantation of human skin microbiota in models of atopic dermatitis. JCI Insight. 2016 Jul 7;1(10):e86955. doi: 10.1172/jci.insight.86955.
Results Reference
background
PubMed Identifier
25419479
Citation
Bantz SK, Zhu Z, Zheng T. The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma. J Clin Cell Immunol. 2014 Apr;5(2):202. doi: 10.4172/2155-9899.1000202.
Results Reference
background

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Beginning Assessment of Cutaneous Treatment Efficacy of Roseomonas in Atopic Dermatitis

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