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WHNRC (Western Human Nutrition Research Center) Fiber Intervention Study

Primary Purpose

Inflammation, Vaccine, Intestinal Permeability

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Inulin
Maltodextrin
Ty21a Typhoid Fever Vaccine
Sponsored by
USDA, Western Human Nutrition Research Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Inflammation focused on measuring Gastrointestinal Health, Intestinal Permeability, Vaccine Response, Inflammation, Ty21a Typhoid Vaccine, Typhoid Fever, Microbiome, Bifidobacterium

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Body Mass Index (BMI) 18.5 - 30.9 kg/m2
  2. inadequate total dietary fiber intake defined as:

    • Females 18 - 30 years old, less than 28 g/day
    • Females 31 - 50 years old, less than 25 g/day
    • Males 18 - 30 years old, less than 34 g/day
    • Males 31 - 50 years old, less than 31 g/day

Exclusion Criteria:

  1. blood pressure greater than or equal to 140/90 mmHg
  2. has HIV/AIDS or another disease that affects the immune system
  3. has any kind of cancer
  4. inability to lift 30 pounds with assistance (for transporting refrigerated stool containers)
  5. decline to take an HIV blood test
  6. pregnant or lactating women
  7. refusal to take a pregnancy test
  8. female subjects: refusal to use a method of birth control 1 week prior to the administration of the vaccine, 1 week during the vaccine, and 1 week after the vaccine
  9. allergy to vaccine components, i.e. thimerosal and enteric-coated capsules
  10. allergy to oral typhoid vaccine
  11. use of anti-inflammatory medications, i.e. nonsteroidal anti-inflammatory drugs (NSAID), aspirin, 3 or more times per month
  12. use of sulfonamides or antibiotics 3 months prior to the receipt of Ty21a vaccine.
  13. use of anti-hypertensive drugs, i.e. beta blockers, diuretics, calcium channel blockers
  14. use of anti-malaria drugs, i.e. mefloquine, chloroquine, and proguanil
  15. use of drugs that affects the immune system, i.e. immunosuppressants, immune-modifying drugs, corticosteroids, i.e. cortisone, prednisone, methylprednisolone, for 2 weeks or longer
  16. use of biologics, i.e. Lantus, Remicade, Rituxan, Humira, Herceptin, Avastin, Lucentis, Enbrel for 2 weeks or longer
  17. undergoing cancer treatment with radiation or drugs
  18. greater than 10 years residence in a typhoid-endemic area
  19. receipt of typhoid vaccine in the last 5 years
  20. receipt of any vaccine two weeks prior to receipt of Ty21a vaccine
  21. individuals at increased risk of developing complications from a live, bacterial vaccine
  22. history of typhoid fever
  23. history of primary immune deficiency or autoimmune disease
  24. history of acute or chronic gastrointestinal (GI) disorder, i.e. Crohn's disease, irritable bowel syndrome, gastric ulcer
  25. diarrheal illness (defined as passing 3 or more abnormally loose or watery stool in a 24 hour period) or persistent vomiting 2 weeks prior to the study
  26. history of chronic illnesses, i.e. diabetes, cardiovascular disease, cancer, gastrointestinal malabsorption or inflammatory diseases, kidney disease, autoimmune disorders, HIV, liver disease, including hepatitis B and C
  27. asthma if taking medication on a daily basis
  28. recent surgery (within 3 months)
  29. history of GI surgery
  30. recent hospitalization (within 3 months)
  31. fever (within 2 weeks)
  32. unwillingness to discontinue probiotic, prebiotic, or other supplements (except Recommended Dietary Allowance-level vitamin and mineral supplements), fiber supplements, or food and beverage products containing inulin, chicory root fiber, or maltodextrin during the study
  33. not having at least one arm vein suitable for blood drawing
  34. unwilling or uncomfortable with blood draws and stool collections
  35. regular blood or blood product donation and refusal to suspend donation
  36. current participation in another research study
  37. unable to fast for 12-16 hours
  38. have fewer than 3 bowel movements per week
  39. consuming one or more servings of added-inulin foods per day over the past month

Sites / Locations

  • USDA, ARS, Western Human Nutrition Research CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Inulin and Ty21a Vaccine

Maltodextrin and Ty21a Vaccine

Arm Description

Participants will consume 12 grams/day of inulin for 3 weeks before the administration of the Ty21a vaccine, 1 week during the vaccine, and 1 week after the vaccine for a total of 5 weeks.

Participants will consume 12 grams/day of maltodextrin (control) for 3 weeks before the administration of the Ty21a vaccine, 1 week during the vaccine, and 1 week after the vaccine for a total of 5 weeks.

Outcomes

Primary Outcome Measures

Change in vaccine-specific antibody-secreting cell response to oral Ty21a typhoid vaccination using the standard 4-dose regimen
Measurement of baseline level (Day 26; before first vaccine dose) and post-vaccine, antibody response, Immunoglobulin G (IgG), Immunoglobulin M (IgM) and IgA, 7 and 9 days after the first vaccine dose using the antibody-in-lymphocyte-supernatant (ALS) assay to identify antibody-secreting cells in blood. Two antigens will be used: Ty21a outer membrane protein and lipopolysaccharide from Salmonella Typhi.

Secondary Outcome Measures

Change in vaccine-specific serum antibody response to typhoid vaccination
Measurement of baseline level (Day 26; before first vaccine dose) and post-vaccine (28 d after first vaccine dose) antibody levels (IgG, IgM, IgA)
Change in vaccine-specific fecal IgA antibody levels from typhoid vaccination
Measurement of baseline level (Day 26; before first vaccination dose) and change in fecal antibody levels
Change in plasma cytokines as markers of systemic inflammation
Measurement of plasma cytokines, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and IL-1beta
Change in plasma acute phase proteins and adhesion molecules
Measurement of acute phase reactants, such as C-reactive protein (CRP) and serum amyloid-A (SAA), and intercellular adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1) and vascular endothelial cell adhesion molecule-1 (VCAM-1)
Change in a plasma marker of lipopolysaccharide (LPS) exposure
Measurement of plasma LPS-binding protein using an ELISA.
Change in blood monocyte subsets
Monocyte subsets will be analyzed using flow cytometry.
Change in plasma short chain fatty acids (SCFA)
Plasma SCFA will be measured using liquid chromatography-mass spectrometry (LC-MS).
Change in urinary lactulose and D-mannitol
Measurement of lactulose to mannitol ratio, an indicator of intestinal permeability, in urine
Change in fecal microbiome
Measurement of relative abundance of colonic bacteria using DNA isolated from stool.
Change in fecal mRNA
Total RNA, and specifically, messenger ribonucleic acid (mRNA), will be analyzed from preserved stools.
Change in stool consistency and frequency
Measurement of stool consistency using the Bristol stool scale, a medical tool used to classify stool forms into 7 categories, and frequency via self-report in diaries.
Change in GI symptoms
Measurement of GI symptoms using a 10-symptom health questionnaire with degree of discomfort ranked in one of four categories (0 absent, 1 mild, 2 moderate, or 3 severe; PMID: 9301412)
Change in fecal pH
Measurement of fecal pH using a standard pH meter.
Change in fecal calprotectin
Measurement of calprotectin will be done by ELISA
Change in fecal SCFA
Measurement of SCFA will be done by gas chromatography-mass spectrometry (GC-MS.)
Change in fecal metabolites
Measurement of bile acids and other metabolites will be measured
Change in fecal secretory total immunoglobulin A (sIgA)
Measurement of total fecal sIgA using ELISA.

Full Information

First Posted
August 24, 2020
Last Updated
November 29, 2022
Sponsor
USDA, Western Human Nutrition Research Center
Collaborators
University of Minnesota
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1. Study Identification

Unique Protocol Identification Number
NCT04543877
Brief Title
WHNRC (Western Human Nutrition Research Center) Fiber Intervention Study
Official Title
WHNRC (Western Human Nutrition Research Center) Fiber Intervention Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
September 27, 2022 (Actual)
Primary Completion Date
September 30, 2024 (Anticipated)
Study Completion Date
September 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
USDA, Western Human Nutrition Research Center
Collaborators
University of Minnesota

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to determine if adding dietary fiber, such as inulin, to a diet that does not have enough fiber would raise the levels of potentially beneficial bacteria, such as Bifidobacterium, in the gut. There is evidence to suggest that these microbes can affect gut health and immune response, including to vaccines. The investigators will examine how inulin in the diet (compared to the maltodextrin control) (1) causes changes in the composition and function of the gut microbes, (2) reduces gut inflammation and gut leakiness caused by the vaccine, (3) increases immune response to vaccination, and (4) changes the expression of important adhesion molecules on the surface of white blood cells. Intestinal and whole-body responses will be measured in all participants.
Detailed Description
Inulin, a dietary fiber supplement, is known to increase gut levels of potentially beneficial bacteria, including Bifidobacterium that are indigenous to gut microbiomes. Our underlying hypothesis is that the commensal microbiome, including Bifidobacterium, in the proximal colon or distal ileum affects the environment of draining lymph nodes and can thus modulate immune responses, including to vaccines. In the current study, participants will consume 12 grams/day inulin or maltodextrin (control) for 3 weeks before the administration of the Ty21a typhoid fever vaccine, 1 week during the vaccine, and 1 week after the vaccine. Vaccine response will be measured by counting T cells and immunoglobulin G (IgG) or immunoglobulin A (IgA)-secreting plasma cells specific for Ty21a. Gut permeability will be measured at baseline, and before and after the vaccine administration. Systemic inflammation and immune activation will be measured by analyzing blood for markers of inflammation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Inflammation, Vaccine, Intestinal Permeability, Typhoid Fever
Keywords
Gastrointestinal Health, Intestinal Permeability, Vaccine Response, Inflammation, Ty21a Typhoid Vaccine, Typhoid Fever, Microbiome, Bifidobacterium

7. Study Design

Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Inulin and Ty21a Vaccine
Arm Type
Experimental
Arm Description
Participants will consume 12 grams/day of inulin for 3 weeks before the administration of the Ty21a vaccine, 1 week during the vaccine, and 1 week after the vaccine for a total of 5 weeks.
Arm Title
Maltodextrin and Ty21a Vaccine
Arm Type
Placebo Comparator
Arm Description
Participants will consume 12 grams/day of maltodextrin (control) for 3 weeks before the administration of the Ty21a vaccine, 1 week during the vaccine, and 1 week after the vaccine for a total of 5 weeks.
Intervention Type
Dietary Supplement
Intervention Name(s)
Inulin
Other Intervention Name(s)
Orafti GR
Intervention Description
Consume 12 grams/day of inulin for 5 weeks (Day 9 - 43).
Intervention Type
Dietary Supplement
Intervention Name(s)
Maltodextrin
Other Intervention Name(s)
Maltrin M100
Intervention Description
Consume 12 grams/day of maltodextrin for 5 weeks (Day 9 - 43).
Intervention Type
Biological
Intervention Name(s)
Ty21a Typhoid Fever Vaccine
Other Intervention Name(s)
Vivotif
Intervention Description
All participants will receive the vaccine. One capsule is swallowed on alternate days, e.g. days 30, 32, 34, and 36 for a total of 4 capsules.
Primary Outcome Measure Information:
Title
Change in vaccine-specific antibody-secreting cell response to oral Ty21a typhoid vaccination using the standard 4-dose regimen
Description
Measurement of baseline level (Day 26; before first vaccine dose) and post-vaccine, antibody response, Immunoglobulin G (IgG), Immunoglobulin M (IgM) and IgA, 7 and 9 days after the first vaccine dose using the antibody-in-lymphocyte-supernatant (ALS) assay to identify antibody-secreting cells in blood. Two antigens will be used: Ty21a outer membrane protein and lipopolysaccharide from Salmonella Typhi.
Time Frame
Day 26, 37, and 39
Secondary Outcome Measure Information:
Title
Change in vaccine-specific serum antibody response to typhoid vaccination
Description
Measurement of baseline level (Day 26; before first vaccine dose) and post-vaccine (28 d after first vaccine dose) antibody levels (IgG, IgM, IgA)
Time Frame
Day 26 and 58
Title
Change in vaccine-specific fecal IgA antibody levels from typhoid vaccination
Description
Measurement of baseline level (Day 26; before first vaccination dose) and change in fecal antibody levels
Time Frame
Day 26, 39, and 58
Title
Change in plasma cytokines as markers of systemic inflammation
Description
Measurement of plasma cytokines, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and IL-1beta
Time Frame
Day 8, 26, 37, 39, and 58
Title
Change in plasma acute phase proteins and adhesion molecules
Description
Measurement of acute phase reactants, such as C-reactive protein (CRP) and serum amyloid-A (SAA), and intercellular adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1) and vascular endothelial cell adhesion molecule-1 (VCAM-1)
Time Frame
Day 8, 26, 37, 39, and 58
Title
Change in a plasma marker of lipopolysaccharide (LPS) exposure
Description
Measurement of plasma LPS-binding protein using an ELISA.
Time Frame
Day 8, 26, 37, 39, and 58
Title
Change in blood monocyte subsets
Description
Monocyte subsets will be analyzed using flow cytometry.
Time Frame
Day 8, 26, 37, 39, and 58
Title
Change in plasma short chain fatty acids (SCFA)
Description
Plasma SCFA will be measured using liquid chromatography-mass spectrometry (LC-MS).
Time Frame
Day 8, 26, 37, 39, and 58
Title
Change in urinary lactulose and D-mannitol
Description
Measurement of lactulose to mannitol ratio, an indicator of intestinal permeability, in urine
Time Frame
Day 8, 26, and 37
Title
Change in fecal microbiome
Description
Measurement of relative abundance of colonic bacteria using DNA isolated from stool.
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in fecal mRNA
Description
Total RNA, and specifically, messenger ribonucleic acid (mRNA), will be analyzed from preserved stools.
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in stool consistency and frequency
Description
Measurement of stool consistency using the Bristol stool scale, a medical tool used to classify stool forms into 7 categories, and frequency via self-report in diaries.
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in GI symptoms
Description
Measurement of GI symptoms using a 10-symptom health questionnaire with degree of discomfort ranked in one of four categories (0 absent, 1 mild, 2 moderate, or 3 severe; PMID: 9301412)
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in fecal pH
Description
Measurement of fecal pH using a standard pH meter.
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in fecal calprotectin
Description
Measurement of calprotectin will be done by ELISA
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in fecal SCFA
Description
Measurement of SCFA will be done by gas chromatography-mass spectrometry (GC-MS.)
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in fecal metabolites
Description
Measurement of bile acids and other metabolites will be measured
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65
Title
Change in fecal secretory total immunoglobulin A (sIgA)
Description
Measurement of total fecal sIgA using ELISA.
Time Frame
Period 1: Days 1-7; Period 2: Days 16-25; Period 3: Days 26-36; Period 4: Days 37-43; Period 5: Days 58-65

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Body Mass Index (BMI) 18.5 - 30.9 kg/m2 inadequate total dietary fiber intake defined as: Females 18 - 30 years old, less than 28 g/day Females 31 - 50 years old, less than 25 g/day Males 18 - 30 years old, less than 34 g/day Males 31 - 50 years old, less than 31 g/day Exclusion Criteria: blood pressure greater than or equal to 140/90 mmHg has HIV/AIDS or another disease that affects the immune system has any kind of cancer inability to lift 30 pounds with assistance (for transporting refrigerated stool containers) decline to take an HIV blood test pregnant or lactating women refusal to take a pregnancy test female subjects: refusal to use a method of birth control 1 week prior to the administration of the vaccine, 1 week during the vaccine, and 1 week after the vaccine allergy to vaccine components, i.e. thimerosal and enteric-coated capsules allergy to oral typhoid vaccine use of anti-inflammatory medications, i.e. nonsteroidal anti-inflammatory drugs (NSAID), aspirin, 3 or more times per month use of sulfonamides or antibiotics 3 months prior to the receipt of Ty21a vaccine. use of anti-hypertensive drugs, i.e. beta blockers, diuretics, calcium channel blockers use of anti-malaria drugs, i.e. mefloquine, chloroquine, and proguanil use of drugs that affects the immune system, i.e. immunosuppressants, immune-modifying drugs, corticosteroids, i.e. cortisone, prednisone, methylprednisolone, for 2 weeks or longer use of biologics, i.e. Lantus, Remicade, Rituxan, Humira, Herceptin, Avastin, Lucentis, Enbrel for 2 weeks or longer undergoing cancer treatment with radiation or drugs greater than 10 years residence in a typhoid-endemic area receipt of typhoid vaccine in the last 5 years receipt of any vaccine two weeks prior to receipt of Ty21a vaccine individuals at increased risk of developing complications from a live, bacterial vaccine history of typhoid fever history of primary immune deficiency or autoimmune disease history of acute or chronic gastrointestinal (GI) disorder, i.e. Crohn's disease, irritable bowel syndrome, gastric ulcer diarrheal illness (defined as passing 3 or more abnormally loose or watery stool in a 24 hour period) or persistent vomiting 2 weeks prior to the study history of chronic illnesses, i.e. diabetes, cardiovascular disease, cancer, gastrointestinal malabsorption or inflammatory diseases, kidney disease, autoimmune disorders, HIV, liver disease, including hepatitis B and C asthma if taking medication on a daily basis recent surgery (within 3 months) history of GI surgery recent hospitalization (within 3 months) fever (within 2 weeks) unwillingness to discontinue probiotic, prebiotic, or other supplements (except Recommended Dietary Allowance-level vitamin and mineral supplements), fiber supplements, or food and beverage products containing inulin, chicory root fiber, or maltodextrin during the study not having at least one arm vein suitable for blood drawing unwilling or uncomfortable with blood draws and stool collections regular blood or blood product donation and refusal to suspend donation current participation in another research study unable to fast for 12-16 hours have fewer than 3 bowel movements per week consuming one or more servings of added-inulin foods per day over the past month
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ellen Bonnel, PhD
Phone
530-752-4184
Email
ellen.bonnel@usda.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Yuriko Adkins, PhD
Phone
530-752-9469
Email
yuriko.adkins@usda.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Danielle Lemay, PhD
Organizational Affiliation
USDA, ARS, Western Human Nutrition Research Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Charles Stephensen, PhD
Organizational Affiliation
USDA, ARS, Western Human Nutrition Research Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mary Kable, PhD
Organizational Affiliation
USDA, ARS, Western Human Nutrition Research Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
USDA, ARS, Western Human Nutrition Research Center
City
Davis
State/Province
California
ZIP/Postal Code
95616
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ellen Bonnel, PhD
Phone
530-752-4184
Email
ellen.bonnel@usda.gov
First Name & Middle Initial & Last Name & Degree
Yuriko Adkins, PhD
Phone
530-752-9469
Email
yuriko.adkins@usda.gov

12. IPD Sharing Statement

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WHNRC (Western Human Nutrition Research Center) Fiber Intervention Study

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