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Epigenetic Effects in Children With Cow's Milk Allergy Treated With Different Formulas (EPICMA II)

Primary Purpose

Cow Milk Allergy

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
EHCF+LGG
RHF
SF
EHWF
AAF
Sponsored by
Federico II University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cow Milk Allergy

Eligibility Criteria

6 Months - 12 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • children with cow's milk allergy

Exclusion Criteria:

  • Concomitant chronic systemic diseases,
  • congenital cardiac defects,
  • active tuberculosis,
  • autoimmune diseases,
  • immunodeficiency,
  • chronic inflammatory bowel diseases,
  • celiac disease,
  • cystic fibrosis,
  • metabolic diseases,
  • malignancy,
  • chronic pulmonary diseases,
  • malformations of the gastrointestinal tract,
  • suspected eosinophilic esophagitis or eosinophilic enterocolitis,
  • suspected food-protein-induced enterocolitis syndrome,
  • suspected cow's milk protein-induced anaphylaxis,
  • still on exclusion diet with one of the study formulas or with another dietary regimen because of cow's milk allergy,
  • other food allergies.

Sites / Locations

  • Pediatric OfficeRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

EHCF + LGG

RHF

EHWF

AAF

SF

Arm Description

Extensively hydrolyzed casein formula plus Lactobacillus rhamnosus GG

Extensively hydrolyzed rice formula

Extensively hydrolyzed protein formula

Amino acid based formula

Soy formula

Outcomes

Primary Outcome Measures

Epigenetic modifications in cytokines genes
Serum levels (pg/ml) of FOXP3 in children with cow's milk allergy
Epigenetic modifications in cytokines genes
Methylation rate (%) of FOXP3 in children with cow's milk allergy

Secondary Outcome Measures

microRNAs modifications
Expression of miR-125b miR-146 miR-155 miR-29a/b miR-27 miR-128 let-7 family miR-21 miR-126 miR-145 miR-106a miR-375 miR-193a
Concentration of metagenomic characteristics of the intestinal microbiota
evaluation of composition of gut microbiota
Concentration of metabolomic characteristics of the intestinal microbiota
evaluation of function of gut microbiota
The rate of patients with immune tolerance acquisition to cow's milk protein
Rate of patients with acquisition of tolerance to cow milk protein (rate of patients with outgrown cow's milk allergy)
Epigenetic modifications in cytokines genes
Methylation rate (%) of interleukin IL-4, IL-5, IL-13, IL-10, IFN-γ, FoxP3, GATA3, T-bet, TGF-β, IL-17, IL-25, IL-12, IL-22, IL-6, IL-23 children with cow's milk allergy
Epigenetic modifications in cytokines genes
Serum levels (pg/ml) of interleukin IL-4, IL-5, IL-13, IL-10, IFN-γ, FoxP3, GATA3, T-bet, TGF-β, IL-17, IL-25, IL-12, IL-22, IL-6, IL-23 in children with cow's milk allergy

Full Information

First Posted
November 29, 2019
Last Updated
September 7, 2023
Sponsor
Federico II University
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1. Study Identification

Unique Protocol Identification Number
NCT04184700
Brief Title
Epigenetic Effects in Children With Cow's Milk Allergy Treated With Different Formulas
Acronym
EPICMA II
Official Title
Epigenetic Effects Involved in Children With Cow's Milk Allergy: A Possible Effect of Hypoallergenic Formulas
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 10, 2019 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
January 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Federico II University

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
Lactobacillus GG (LGG) is able to exert long lasting effects in children with atopic disorders. Nutramigen LGG accelerates tolerance acquisition in infants with cow's milk allergy. The mechanisms of these effects are still largely undefined. The effect of LGG could be related at least in part by the immunoregulatory role played by LGG. This probiotic can balance the generation of cytokines possibly involved in IgE- or non-IgE-mediated cow's milk allergy Interleulkin (IL)-4, IL-5, IL-10, IFN-γ , TGF-β, and TNF-Υ), which can contribute to modulation of inflammatory processes. The investigators have demonstrated that children with IgE-mediated CMA produce significantly higher level of IL-4 and IL-13 in response to cow's milk protein, and that tolerance is associated with a marked reduction of IL-13 production and a concomitant increased frequency of IFN-γ releasing cells. Epigenetics studies the heritable (and potentially reversible) changes of the genome inherited from one cell generation to the next which alter gene expression but do not involve changes in primary DNA sequences, highlighting the complexity of the inter-relationship between genetics and nutrition. There are three distinct, but closely interacting, epigenetic mechanisms (histone acetylation, DNA methylation, and non-coding microRNAs) that are responsible for modifying the expression of critical genes associated with physiologic and pathologic processes. The profile of epigenetic modifications associated with Th lineage commitment, coupled with the sensitivity of the early developmental period, has led to speculation that factors that disrupt these pathways may increase the risk of allergic diseases. Specifically, effects on DNA methylation and endogenous histone deacetylase inhibitors acting on specific pathways (Th1 and T regulatory cell differentiation) may favour Th2-associated allergic differentiation. MicroRNAs are another structural components of an epigenetic mechanism of post-transcriptional regulation of messenger RNA translation. It has been recently identified a specific Th2-associated microRNA (miR-21) that is critical for the regulation of Th cell polarization. It has been previously demonstrated an inverse DNA methylation pattern of cytokines involved in Th2 response (IL-4, IL-5) compared with cytokines involved in Th1 response (IL-10, INF- y) in children with CMA acquiring oral tolerance, with the most pronounced effects in those treated with Nutramigen LGG.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cow Milk Allergy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
InvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
EHCF + LGG
Arm Type
Experimental
Arm Description
Extensively hydrolyzed casein formula plus Lactobacillus rhamnosus GG
Arm Title
RHF
Arm Type
Active Comparator
Arm Description
Extensively hydrolyzed rice formula
Arm Title
EHWF
Arm Type
Active Comparator
Arm Description
Extensively hydrolyzed protein formula
Arm Title
AAF
Arm Type
Active Comparator
Arm Description
Amino acid based formula
Arm Title
SF
Arm Type
Active Comparator
Arm Description
Soy formula
Intervention Type
Dietary Supplement
Intervention Name(s)
EHCF+LGG
Intervention Description
Extensively hydrolyzed casein formula containing Lactobacillus rhamnosus GG
Intervention Type
Dietary Supplement
Intervention Name(s)
RHF
Intervention Description
Rice hydrolysed formula
Intervention Type
Dietary Supplement
Intervention Name(s)
SF
Intervention Description
Soy formula
Intervention Type
Dietary Supplement
Intervention Name(s)
EHWF
Intervention Description
extensively hydrolysed whey formula
Intervention Type
Dietary Supplement
Intervention Name(s)
AAF
Intervention Description
amino acid based formula
Primary Outcome Measure Information:
Title
Epigenetic modifications in cytokines genes
Description
Serum levels (pg/ml) of FOXP3 in children with cow's milk allergy
Time Frame
12 months
Title
Epigenetic modifications in cytokines genes
Description
Methylation rate (%) of FOXP3 in children with cow's milk allergy
Time Frame
12 months
Secondary Outcome Measure Information:
Title
microRNAs modifications
Description
Expression of miR-125b miR-146 miR-155 miR-29a/b miR-27 miR-128 let-7 family miR-21 miR-126 miR-145 miR-106a miR-375 miR-193a
Time Frame
12 months
Title
Concentration of metagenomic characteristics of the intestinal microbiota
Description
evaluation of composition of gut microbiota
Time Frame
12 months
Title
Concentration of metabolomic characteristics of the intestinal microbiota
Description
evaluation of function of gut microbiota
Time Frame
12 months
Title
The rate of patients with immune tolerance acquisition to cow's milk protein
Description
Rate of patients with acquisition of tolerance to cow milk protein (rate of patients with outgrown cow's milk allergy)
Time Frame
12 months
Title
Epigenetic modifications in cytokines genes
Description
Methylation rate (%) of interleukin IL-4, IL-5, IL-13, IL-10, IFN-γ, FoxP3, GATA3, T-bet, TGF-β, IL-17, IL-25, IL-12, IL-22, IL-6, IL-23 children with cow's milk allergy
Time Frame
6 and 12 months
Title
Epigenetic modifications in cytokines genes
Description
Serum levels (pg/ml) of interleukin IL-4, IL-5, IL-13, IL-10, IFN-γ, FoxP3, GATA3, T-bet, TGF-β, IL-17, IL-25, IL-12, IL-22, IL-6, IL-23 in children with cow's milk allergy
Time Frame
6 and 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Months
Maximum Age & Unit of Time
12 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: children with cow's milk allergy Exclusion Criteria: Concomitant chronic systemic diseases, congenital cardiac defects, active tuberculosis, autoimmune diseases, immunodeficiency, chronic inflammatory bowel diseases, celiac disease, cystic fibrosis, metabolic diseases, malignancy, chronic pulmonary diseases, malformations of the gastrointestinal tract, suspected eosinophilic esophagitis or eosinophilic enterocolitis, suspected food-protein-induced enterocolitis syndrome, suspected cow's milk protein-induced anaphylaxis, still on exclusion diet with one of the study formulas or with another dietary regimen because of cow's milk allergy, other food allergies.
Facility Information:
Facility Name
Pediatric Office
City
Naples
ZIP/Postal Code
80100
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Roberto Berni Canani, MD, Ph
Phone
00390817462680
Email
berni@unina.it

12. IPD Sharing Statement

Plan to Share IPD
No

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Epigenetic Effects in Children With Cow's Milk Allergy Treated With Different Formulas

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