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Fecal Transplant for Alopecia Areata

Primary Purpose

Alopecia Areata

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
fecal transplant
placebo
Sponsored by
Tel-Aviv Sourasky Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alopecia Areata focused on measuring Alopecia Areata, Fecal transplant, Microbiome

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

AA patients with:

  • Acute disease that appeared in the last 3 months.
  • Recurrence of AA in the last 3 months, in a patient who had remission for at least one year.
  • At least one patch of hair loss on the scalp and / or the beard, or with a widespread disease such as total loss of the hair over the entire scalp (alopecia totalis).
  • In case of a single alopetic patch, the patch must be equal or bigger than 2 cm in diameter.
  • All patients will be diagnosed by two separate dermatologist, or one dermatologist with the support of classical finding on skin biopsy.

Exclusion Criteria:

  1. Patients who were treated with systemic corticosteroids / corticosteroids injection one year prior the study.
  2. Patients who were treated with topical corticosteroids two weeks prior the study.
  3. Patients who were treated with immunosuppressing medications or biological treatments one year prior the study.
  4. Patients who were treated with systemic antibiotics of any kind 3 months prior the study.
  5. Patient who were treated with topical antibiotics one months prior the study.
  6. Patients who were treated with probiotics one months prior the study.
  7. Patients with alopecia universalis (total loss of all body, scalp and facial hair).
  8. Patients with bowel disease or an active infection including clostridium difficile.
  9. Pregnant and breastfeeding women.
  10. Childrenbelow the age of 18.
  11. Malignant disease in the past 5 years.
  12. Patient with any infectious disease that require antibiotics during the study period.

In any case a patient would like to withdraw from the study, for any reason, all samples will be destroyed immediately, and the patient will stop his participant in the study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    fecal transplant

    placebo

    Arm Description

    Healthy donors will be selected by the fecal transplant unit, in Tel-Aviv medical center. The treatment will be given in the form of fecal capsule. Each capsule will contain a double capsule with 2 layers to ensure that the fecal material will be contained. The treatments will include 30 capsules for the first treatment, that will be taken in two consecutive days, each day 15 capsules. The second, third and fourth treatments will all include 15 fecal capsules. There will be 2 weeks intervals between each treatment.

    Placebo capsule that can not be differentiate from the focal transplant capsule will be given in the same interval as the fecal transplant procedure written above.

    Outcomes

    Primary Outcome Measures

    Severity alopecia tool score - SALT score I
    The SALT score I (Olsen, 2004) is a global severity score that captures percentage hair loss. The scalp area is divided into 4 quadrants - Left (L) Right (R) Back (B) Top (T). Photographs taken of the four views of the scalp. The percentage of hair loss in any one of the four views (areas) of the scalp = the percentage hair loss X percent surface area of the scalp in that area. left side view = ALOPECIA% x 18% right side view = ALOPECIA% x 18% top of scalp = ALOPECIA% x 40% back of scalp = ALOPECIA% x 24% The SUM of all equals the score. (possible score range: 0-100)
    Alopecia Areata Progression Index, AAPI
    formula for the total AAPI score (possible score range: 0-600). The scalp area is divided into 4 quadrants - Left (L) Right (R) Back (B) Top (T) using the Olsen/Canfield tool. The percent alopecic area (%AA) and score of hair loss activity (SL) is determined in each quadrant. The %AA is defined as the percentage of alopecic area in each compartment. SL is calculated as the sum of the results of hair pull tests (2 = positive, excessive, i.e. >20% of grasped hairs; 1 = positive, not excessive, 10-20%; 0 = negative, <10%) and the magnification findings associated with hair loss activity such as exclamation mark hairs, broken hairs and black dots (4 = ≥50%, 2 = <50%, 0 = 0%) in each quadrant. The total AAPI score is calculated by the following formula: [%AA(L) × SL(L) × 0.18] + [%AA(R) × SL(R) × 0.18] + [%AA(T) × SL(T) × 0.4] + [%AA(B) × SL(B) × 0.24]. (possible score range: 0-600)
    patient assessment.
    <25% regrowth. 25%<x<50% regrowth. 50%<x<70%regrowth. >75% regrowth. 100% regrowth.

    Secondary Outcome Measures

    Full Information

    First Posted
    March 1, 2021
    Last Updated
    April 3, 2021
    Sponsor
    Tel-Aviv Sourasky Medical Center
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04833179
    Brief Title
    Fecal Transplant for Alopecia Areata
    Official Title
    Fecal Transplant for Alopecia Areata
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2021
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    May 2021 (Anticipated)
    Primary Completion Date
    April 2024 (Anticipated)
    Study Completion Date
    April 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Tel-Aviv Sourasky Medical Center

    4. Oversight

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

    5. Study Description

    Brief Summary
    the investigators intend to analyze the microbiome in the diseased areas, healthy skin and fecal samples. In addition, the investigators plan to evaluate how the fecal transplant can influence the severity of the disease and hair growth, all in hope that fecal transplant can help to treat or even cure AA. This may help dermatologists in the future and expand the treatment options for AA.
    Detailed Description
    Alopecia areata (AA) is a common autoimmune disease that triggers non scarring hair loss in different severities. Usually the hair loss will be contained to the scalp and / or beard, but in some cases, there will be total hair loss from the entire scalp (alopecia totalis), or complete loss of all body, facial and scalp hair (alopecia universalis). AA is an autoimmune disease that produces an inflammation surrounding the hair follicles, this leads to temporary hair loss. In cases the disease become chronic, the immune system attack may lead to a permanent hair loss. This common hair disease has a significant impact on the patient's quality of life, it can cause impairment on the patient's confidence, self-esteem, lead to depression and more. Lately two patients with AA and clostridium difficile infection were treated with fecal transplantation for their infection (Rebello et al. 2017). After the transplant a significant improvement was notice in hair growth. These 2 cases raised the option that a fecal transplant may have an additional effect on the autoimmune reaction against the hair follicle in AA. the investigators intend to analyze the microbiome in the diseased areas, healthy skin and fecal samples. In addition, the investigators plan to evaluate how the fecal transplant can influence the severity of the disease and hair growth, all in hope that fecal transplant can help to treat or even cure AA. This may help dermatologists in the future and expand the treatment options for AA.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Alopecia Areata
    Keywords
    Alopecia Areata, Fecal transplant, Microbiome

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Model Description
    110 patients with alopecia areata. Prior the beginning of the study all subjects will undergo: Complete physical examination Clinical image of involved locations will be taken Estimating the severity of the disease Microbiome samples Blood sample The patients with AA will undergo randomization into two groups. Group 1 - the subjects will receive a complete fecal transplant course. Group 2 - the subjects will receive placebo.
    Masking
    ParticipantCare ProviderInvestigator
    Allocation
    Randomized
    Enrollment
    110 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    fecal transplant
    Arm Type
    Experimental
    Arm Description
    Healthy donors will be selected by the fecal transplant unit, in Tel-Aviv medical center. The treatment will be given in the form of fecal capsule. Each capsule will contain a double capsule with 2 layers to ensure that the fecal material will be contained. The treatments will include 30 capsules for the first treatment, that will be taken in two consecutive days, each day 15 capsules. The second, third and fourth treatments will all include 15 fecal capsules. There will be 2 weeks intervals between each treatment.
    Arm Title
    placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo capsule that can not be differentiate from the focal transplant capsule will be given in the same interval as the fecal transplant procedure written above.
    Intervention Type
    Biological
    Intervention Name(s)
    fecal transplant
    Intervention Description
    Healthy donors will be selected by the fecal transplant unit, in Tel-Aviv medical center. All donors will undergo a screening process that will include a detailed medical history, blood work and fecal tests. Only after passing the screening, the donor will be added to the groups of donors that will participant in this study. The treatment will be givenin the form of fecal capsule. Each capsule will contain a double capsule with 2 layers to ensure that the fecal material will be contained. The treatments will include 30 capsules for the first treatment, that will be taken in two consecutive days, each day 15 capsules. The second, third and fourth treatments will all include 15 fecal capsules. There will be 2 weeks intervals between each treatment.
    Intervention Type
    Other
    Intervention Name(s)
    placebo
    Intervention Description
    placebo
    Primary Outcome Measure Information:
    Title
    Severity alopecia tool score - SALT score I
    Description
    The SALT score I (Olsen, 2004) is a global severity score that captures percentage hair loss. The scalp area is divided into 4 quadrants - Left (L) Right (R) Back (B) Top (T). Photographs taken of the four views of the scalp. The percentage of hair loss in any one of the four views (areas) of the scalp = the percentage hair loss X percent surface area of the scalp in that area. left side view = ALOPECIA% x 18% right side view = ALOPECIA% x 18% top of scalp = ALOPECIA% x 40% back of scalp = ALOPECIA% x 24% The SUM of all equals the score. (possible score range: 0-100)
    Time Frame
    up to1 year after fecal transplantation
    Title
    Alopecia Areata Progression Index, AAPI
    Description
    formula for the total AAPI score (possible score range: 0-600). The scalp area is divided into 4 quadrants - Left (L) Right (R) Back (B) Top (T) using the Olsen/Canfield tool. The percent alopecic area (%AA) and score of hair loss activity (SL) is determined in each quadrant. The %AA is defined as the percentage of alopecic area in each compartment. SL is calculated as the sum of the results of hair pull tests (2 = positive, excessive, i.e. >20% of grasped hairs; 1 = positive, not excessive, 10-20%; 0 = negative, <10%) and the magnification findings associated with hair loss activity such as exclamation mark hairs, broken hairs and black dots (4 = ≥50%, 2 = <50%, 0 = 0%) in each quadrant. The total AAPI score is calculated by the following formula: [%AA(L) × SL(L) × 0.18] + [%AA(R) × SL(R) × 0.18] + [%AA(T) × SL(T) × 0.4] + [%AA(B) × SL(B) × 0.24]. (possible score range: 0-600)
    Time Frame
    up to1 year after fecal transplantation
    Title
    patient assessment.
    Description
    <25% regrowth. 25%<x<50% regrowth. 50%<x<70%regrowth. >75% regrowth. 100% regrowth.
    Time Frame
    up to1 year after fecal transplantation

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    90 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: AA patients with: Acute disease that appeared in the last 3 months. Recurrence of AA in the last 3 months, in a patient who had remission for at least one year. At least one patch of hair loss on the scalp and / or the beard, or with a widespread disease such as total loss of the hair over the entire scalp (alopecia totalis). In case of a single alopetic patch, the patch must be equal or bigger than 2 cm in diameter. All patients will be diagnosed by two separate dermatologist, or one dermatologist with the support of classical finding on skin biopsy. Exclusion Criteria: Patients who were treated with systemic corticosteroids / corticosteroids injection one year prior the study. Patients who were treated with topical corticosteroids two weeks prior the study. Patients who were treated with immunosuppressing medications or biological treatments one year prior the study. Patients who were treated with systemic antibiotics of any kind 3 months prior the study. Patient who were treated with topical antibiotics one months prior the study. Patients who were treated with probiotics one months prior the study. Patients with alopecia universalis (total loss of all body, scalp and facial hair). Patients with bowel disease or an active infection including clostridium difficile. Pregnant and breastfeeding women. Childrenbelow the age of 18. Malignant disease in the past 5 years. Patient with any infectious disease that require antibiotics during the study period. In any case a patient would like to withdraw from the study, for any reason, all samples will be destroyed immediately, and the patient will stop his participant in the study.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Efrat Bar-Ilan, MD
    Phone
    +972-54-8186226
    Email
    efratbarilan@gmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Liat Samueluv, MD
    Organizational Affiliation
    Vice chair, Department of Dermatology Tel Aviv Sourasky Medical center, Israel
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Fecal Transplant for Alopecia Areata

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