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Metagenomic and Metabolomic Reconstitution of Gut Microbiota After Broad Spectrum Antibiotic Therapy

Primary Purpose

Antibiotic Side Effect, Antibiotic-associated Diarrhea, Antibiotic-induced Dysbiosis

Status
Completed
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Ciprofloxacin + Metronidazole
SH-DS01
Placebo
Sponsored by
Seed Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Antibiotic Side Effect focused on measuring Gut microbiome, Dysbiosis, Antibiotic therapy, Rationally-defined consortia, Short-chain fatty acids, Gut metabolome, Metagenomic sequencing, Ciproflozacin, Metronidazole, Probiotic Therapy

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Males & Females 18-55 years of age, inclusive
  2. BMI of 18.5 - 29.9 kg/m2, inclusive
  3. Waist circumference < 102 cm in males or < 88 cm in females
  4. Female participant is not of child-bearing potential, defined as females who have undergone a sterilization procedure (e.g. hysterectomy, bilateral oophorectomy, bilateral tubal ligation, total endometrial ablation) Or, Females of child-bearing potential must have a negative baseline urine pregnancy test and agree to use a medically approved method of birth control for the duration of the study. All hormonal birth control must have been in use for a minimum of three months.
  5. Healthy as determined by laboratory results, medical history, and physical exam by QI
  6. Agrees to abstain from use of fermented foods or beverages with live bacteria or products containing active cultures for the duration of the study
  7. Agrees to avoid alcoholic beverages and drugs containing alcohol during antibiotic treatment period and for at least one day after (days 0-8)
  8. Agrees to avoid high caffeine intake (no more than 1 cup of coffee or 300 mg of caffeine/day) during antibiotic treatment period of the study (days 0-7)
  9. Agrees to refrain from intake of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) during antibiotic treatment period of the study (days 0-7) and 72 hours prior to prior to lactulose and mannitol test
  10. Agrees to refrain from using drugs and supplements containing aluminum, magnesium, sorbitol and/or mannitol 72 hours prior to lactulose and mannitol test.
  11. Agrees to comply with all study procedures
  12. Agrees to maintain current level of physical activity throughout the study

Exclusion Criteria:

  1. Women who are pregnant, breast feeding, or planning to become pregnant during the trial
  2. Allergy or sensitivity to antibiotics (Ciprofloxacin, Metronidazole), Lactulose or Mannitol, or investigational product's active or inactive ingredients
  3. Use of antibiotics or antifungals within three months prior to enrollment, including topical antibiotics or antifungals.
  4. Clinically significant abnormal laboratory results at screening as assessed by the QI
  5. Use of PPIs and H2-antagonists
  6. Use of tobacco products
  7. Type I or type II diabetes mellitus or treatment with anti-diabetic medication
  8. Unstable metabolic diseases or chronic diseases as assessed by the QI
  9. Self-reported current or pre-existing thyroid condition.
  10. Unstable hypertension. Treatment on a stable dose of medication for at least 3 months will be considered by the QI
  11. Current or history of any significant diseases of the gastrointestinal tract that may impact study outcomes as assessed by the QI
  12. Significant cardiovascular event in the past 6 months. If the event occurred greater that 6 months ago and if on stable medication may be included after assessment by the QI on a case by case basis
  13. Major surgery in the past 3 months or individuals who have planned surgery during the course of the trial. Participants with minor surgery will be considered on a case-by-case basis by the QI
  14. Self-reported an autoimmune disease or an immune-compromised state
  15. Self-reported HIV-, Hepatitis B- and/or C-positive diagnosis
  16. History of or current diagnosis with kidney and/or liver diseases as assessed by the QI on a case-by-case basis, with the exception of history of kidney stones symptom free for 6 months
  17. Self-reported medical or neuropsychological condition and/or cognitive impairment that, in the QI's opinion, could interfere with study participation
  18. Self-reported blood/bleeding disorder. To be confirmed by the QI on a case by case basis
  19. Cancer in the five years prior to enrollment, except skin cancers completely excised with no chemotherapy or radiation with a follow up that is negative. Volunteers with cancer in full remission for more than five years after diagnosis are acceptable following case by case assessment by QI.
  20. Clinically significant illness in the four weeks prior to randomization
  21. Current use of prescribed medications listed in Section 7.3.1
  22. Current use of over-the-counter medications, supplements, foods and/or drinks listed in Section 7.3.2
  23. Current use of any probiotic, prebiotic and symbiotic product unless willing to undergo a 4-week washout and abstain from consuming such products during the study.
  24. Medical use of cannabinoid products
  25. Use of any cannabinoid products (including synthetics) within one month of study entry
  26. Alcohol or drug abuse within the last 12 months
  27. High alcohol intake (>2 per day or a total of >10 standard drinks per week)
  28. Blood donation 30 days prior to screening, during the study, or a planned donation within 30-days of the last study visit
  29. Participation in other clinical research trials 30 days prior to screening
  30. Any other active or unstable medical condition, that, in the opinion of the QI, may adversely affect the participant's ability to complete the study or its measures or pose significant risk to the participant

Sites / Locations

  • KGK Science

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Placebo Comparator

Active Comparator

Placebo Comparator

Arm Label

Broad Spectrum Antibiotic Therapy + Microbial Consortia

Broad Spectrum Antibiotic Therapy + Placebo

No Antibiotic Therapy + Microbial Consortia

No Antibiotic Therapy + Placebo

Arm Description

Outcomes

Primary Outcome Measures

Change in microbiota composition at 3 months as assessed by whole genome shotgun sequencing.
Microbiota composition will be identified through fecal samples for total genomic DNA extraction in participants supplemented with SH-DS01 and with or without antibiotics.

Secondary Outcome Measures

Difference in serum LPS-binding protein (LBP) at Day 7.
As a measure of intestinal barrier integrity in response to antibiotic therapy.
Difference in the Intestinal Permeability Assessment (IPA) at Day 7 as measured by Lactulose/mannitol testing.
As a measure of intestinal barrier integrity in response to antibiotic therapy.
Metabolomic profile of stool samples.
As assessed by untargeted metabolomics on whole stool samples.
Number of participants with improved Antibiotic-Associated Gastrointestinal Function
As assessed by daily symptom tracking software of stool quality, regularity, ease of expulsion, bloating, flatulence, and intestinal transit time.

Full Information

First Posted
November 19, 2019
Last Updated
October 24, 2022
Sponsor
Seed Health
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1. Study Identification

Unique Protocol Identification Number
NCT04171466
Brief Title
Metagenomic and Metabolomic Reconstitution of Gut Microbiota After Broad Spectrum Antibiotic Therapy
Official Title
A Randomized, Double-blind, Placebo-controlled Study to Determine the Efficacy of a Multi-strain Synbiotic (SH-DS01) to Restore Gut Barrier Integrity and Gut Microbiota Composition After Antibiotic Administration.
Study Type
Interventional

2. Study Status

Record Verification Date
October 2022
Overall Recruitment Status
Completed
Study Start Date
August 12, 2020 (Actual)
Primary Completion Date
September 7, 2022 (Actual)
Study Completion Date
September 7, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Seed Health

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
In the United States, healthcare providers prescribe over 270 million antibiotic prescriptions each year. While antibiotics have transformed medicine and methods of treating life-threatening bacterial infection, broad spectrum antibiotics also induce disruption of resident gut microbial communities by altering both composition and function. This disruption of microbial community dynamics has been demonstrated at the taxonomic level, yet the extent of functional disruptions to microbial metabolic output and host cells remains understudied in humans. This study explores the impact of a broad spectrum antibiotic cocktail on microbial communities throughout the gastrointestinal tract, and the impact of a defined, multi-strain consortia of probiotic organisms following antibiotic exposure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Antibiotic Side Effect, Antibiotic-associated Diarrhea, Antibiotic-induced Dysbiosis, Antibiotic-induced Epithelial Barrier Disintegrity
Keywords
Gut microbiome, Dysbiosis, Antibiotic therapy, Rationally-defined consortia, Short-chain fatty acids, Gut metabolome, Metagenomic sequencing, Ciproflozacin, Metronidazole, Probiotic Therapy

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
46 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Broad Spectrum Antibiotic Therapy + Microbial Consortia
Arm Type
Active Comparator
Arm Title
Broad Spectrum Antibiotic Therapy + Placebo
Arm Type
Placebo Comparator
Arm Title
No Antibiotic Therapy + Microbial Consortia
Arm Type
Active Comparator
Arm Title
No Antibiotic Therapy + Placebo
Arm Type
Placebo Comparator
Intervention Type
Other
Intervention Name(s)
Ciprofloxacin + Metronidazole
Intervention Description
Participants will be instructed to take 1 capsule of Ciprofloxacin (500mg) twice daily for 7 days and 1 capsule of Metronidazole (500mg) thrice daily for 7 days. Antibiotics should be taken at least 2 hours before or 6 hours after mineral supplements containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamin preparations with zinc.
Intervention Type
Other
Intervention Name(s)
SH-DS01
Intervention Description
SH-DS01 is a rationally defined microbial consortia consisting of 24 strains across 12 species, with polyphenolic and phenolic prebiotic bioactive compounds. Participants will be instructed to take 2 capsules daily for the duration of the trial.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo capsules for SH-DS01 will contain rice flour matched for color and texture in an identical outer capsule shell. Participants will be instructed to take 2 capsules daily for the duration of the trial.
Primary Outcome Measure Information:
Title
Change in microbiota composition at 3 months as assessed by whole genome shotgun sequencing.
Description
Microbiota composition will be identified through fecal samples for total genomic DNA extraction in participants supplemented with SH-DS01 and with or without antibiotics.
Time Frame
Baseline- Days 91
Secondary Outcome Measure Information:
Title
Difference in serum LPS-binding protein (LBP) at Day 7.
Description
As a measure of intestinal barrier integrity in response to antibiotic therapy.
Time Frame
Baseline- Days 91
Title
Difference in the Intestinal Permeability Assessment (IPA) at Day 7 as measured by Lactulose/mannitol testing.
Description
As a measure of intestinal barrier integrity in response to antibiotic therapy.
Time Frame
Baseline- Days 91
Title
Metabolomic profile of stool samples.
Description
As assessed by untargeted metabolomics on whole stool samples.
Time Frame
Baseline- Days 91
Title
Number of participants with improved Antibiotic-Associated Gastrointestinal Function
Description
As assessed by daily symptom tracking software of stool quality, regularity, ease of expulsion, bloating, flatulence, and intestinal transit time.
Time Frame
Baseline- Days 91

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Males & Females 18-55 years of age, inclusive BMI of 18.5 - 29.9 kg/m2, inclusive Waist circumference < 102 cm in males or < 88 cm in females Female participant is not of child-bearing potential, defined as females who have undergone a sterilization procedure (e.g. hysterectomy, bilateral oophorectomy, bilateral tubal ligation, total endometrial ablation) Or, Females of child-bearing potential must have a negative baseline urine pregnancy test and agree to use a medically approved method of birth control for the duration of the study. All hormonal birth control must have been in use for a minimum of three months. Healthy as determined by laboratory results, medical history, and physical exam by QI Agrees to abstain from use of fermented foods or beverages with live bacteria or products containing active cultures for the duration of the study Agrees to avoid alcoholic beverages and drugs containing alcohol during antibiotic treatment period and for at least one day after (days 0-8) Agrees to avoid high caffeine intake (no more than 1 cup of coffee or 300 mg of caffeine/day) during antibiotic treatment period of the study (days 0-7) Agrees to refrain from intake of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) during antibiotic treatment period of the study (days 0-7) and 72 hours prior to prior to lactulose and mannitol test Agrees to refrain from using drugs and supplements containing aluminum, magnesium, sorbitol and/or mannitol 72 hours prior to lactulose and mannitol test. Agrees to comply with all study procedures Agrees to maintain current level of physical activity throughout the study Exclusion Criteria: Women who are pregnant, breast feeding, or planning to become pregnant during the trial Allergy or sensitivity to antibiotics (Ciprofloxacin, Metronidazole), Lactulose or Mannitol, or investigational product's active or inactive ingredients Use of antibiotics or antifungals within three months prior to enrollment, including topical antibiotics or antifungals. Clinically significant abnormal laboratory results at screening as assessed by the QI Use of PPIs and H2-antagonists Use of tobacco products Type I or type II diabetes mellitus or treatment with anti-diabetic medication Unstable metabolic diseases or chronic diseases as assessed by the QI Self-reported current or pre-existing thyroid condition. Unstable hypertension. Treatment on a stable dose of medication for at least 3 months will be considered by the QI Current or history of any significant diseases of the gastrointestinal tract that may impact study outcomes as assessed by the QI Significant cardiovascular event in the past 6 months. If the event occurred greater that 6 months ago and if on stable medication may be included after assessment by the QI on a case by case basis Major surgery in the past 3 months or individuals who have planned surgery during the course of the trial. Participants with minor surgery will be considered on a case-by-case basis by the QI Self-reported an autoimmune disease or an immune-compromised state Self-reported HIV-, Hepatitis B- and/or C-positive diagnosis History of or current diagnosis with kidney and/or liver diseases as assessed by the QI on a case-by-case basis, with the exception of history of kidney stones symptom free for 6 months Self-reported medical or neuropsychological condition and/or cognitive impairment that, in the QI's opinion, could interfere with study participation Self-reported blood/bleeding disorder. To be confirmed by the QI on a case by case basis Cancer in the five years prior to enrollment, except skin cancers completely excised with no chemotherapy or radiation with a follow up that is negative. Volunteers with cancer in full remission for more than five years after diagnosis are acceptable following case by case assessment by QI. Clinically significant illness in the four weeks prior to randomization Current use of prescribed medications listed in Section 7.3.1 Current use of over-the-counter medications, supplements, foods and/or drinks listed in Section 7.3.2 Current use of any probiotic, prebiotic and symbiotic product unless willing to undergo a 4-week washout and abstain from consuming such products during the study. Medical use of cannabinoid products Use of any cannabinoid products (including synthetics) within one month of study entry Alcohol or drug abuse within the last 12 months High alcohol intake (>2 per day or a total of >10 standard drinks per week) Blood donation 30 days prior to screening, during the study, or a planned donation within 30-days of the last study visit Participation in other clinical research trials 30 days prior to screening Any other active or unstable medical condition, that, in the opinion of the QI, may adversely affect the participant's ability to complete the study or its measures or pose significant risk to the participant
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gregor Reid, PhD
Organizational Affiliation
Lawson Health Research Institute, St. Joseph's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
KGK Science
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5R8
Country
Canada

12. IPD Sharing Statement

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Metagenomic and Metabolomic Reconstitution of Gut Microbiota After Broad Spectrum Antibiotic Therapy

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