FMT in Uncomplicated Diverticulitis
Primary Purpose
Diverticulitis, Uncomplicated Diverticular Disease
Status
Not yet recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Fecal Microbiota Transplantation (FMT)
Sponsored by
About this trial
This is an interventional treatment trial for Diverticulitis
Eligibility Criteria
Recipient Inclusion Criteria:
- Age >18
- One or more prior episode(s) of uncomplicated diverticulitis, as confirmed by imaging and clinical symptoms.
- Eligible for surgical resection
Recipient Exclusion Criteria:
- Subjects <18 years of age
- Patients with active diverticulitis flare
- Evidence of complicated diverticulitis (diverticulitis with abscess/phlegmon, bleeding, stricture, fistula or perforation) on imaging
- Prior fecal transplant
- Patients unable to provide informed consent
- Pregnant and/or breastfeeding women
- Prisoners
- Students
- Prior small or large bowel obstruction within the past year
- Prior major gastrointestinal or intra-abdominal surgery
- Any major illness or condition that may substantially increase risks to the recipient based on the investigator's judgment.
- Sexually active women who adhere to natural family planning alone
Donor Inclusion Criteria:
- Adult patients ≥18 years old
- Colonoscopy screening as recommended by the American Cancer Society. However, it is to be noted that only recipients will undergo colonoscopy for receipt of FMT as part of the study, not donors. We will only ensure that the prospective donor follows the recommended guidelines for screening colonoscopy, which are to begin at the age of 45. If the donor does not meet such guidelines, s/he will not be allowed to proceed as a donor. If a donor is not yet eligible to undergo screening colonoscopy (i.e., younger than 45), this will not be required of him/her."
- Able to provide informed consent
Donor Exclusion Criteria:
- History of diverticulitis
- Recent COVID-19 infection, confirmed or suspected exposure to COVD-19 within the past eight weeks. Such subjects will be excluded irrespective of negative COVID nasopharyngeal test.
Risk of infectious agent
- Known exposure to HIV, syphilis, or viral hepatitis (within the previous 12 months)
- High-risk sexual behaviors including sexual contact with anyone with HIV/AIDS or hepatitis, men who have sex with men, sex for drugs or money
- Use of illicit intravenous (IV) drug use
- Tattoo or body piercing within 6 months
- Incarceration within previous 12 months
- Known current communicable disease (e.g., COVID 19, Influenza, STDs, HIV/AIDS, Hepatitis B and C)
- Risk factors for variant Creutzfeldt-Jacob disease to prevent potential transmission of abnormal/pathologic prions (cellular proteins), which are the basis of this disease.
- Receipt of blood transfusion from country other than the United States of America (USA) and Canada in the previous 6 months
Individuals who are at a higher risk for colonization with multi-drug resistant organisms (MDRO):
- Health care workers
- Persons who have been hospitalized or discharged from long-term care facilities in the past 30 days
- Persons who regularly attend outpatient medical or surgical clinics
- Persons who have engaged in medical tourism in the past 30 days
Gastrointestinal comorbidities
- History of inflammatory bowel disease
- History of celiac disease
- History of irritable bowel syndrome, idiopathic chronic constipation, or chronic diarrhea
- History of gastrointestinal malignancy
Other
- Antibiotic use within the preceding 90 days
- Ingestion of a potential allergen (e.g., nuts) where recipient has a known allergy to this agent within the past 30 days
- Systemic autoimmunity (e.g., multiple sclerosis, connective tissue disease)
- Chronic pain syndromes (e.g., chronic fatigue syndrome, fibromyalgia)
- Fever, defined as temperature of 100 F or 38.7C, on the day of stool donation. Potential donors will be allowed to re-screen within 1 week if febrile on the day of stool donation. .
- Sexually active women who adhere to natural family planning alone as method of contraception
- Prisoners
- Students
- Pregnant women
Sites / Locations
- UMASS Memorial Medical Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
FMT cohort
Arm Description
This will be a single-arm pilot study of patients with uncomplicated diverticulitis. All subjects enrolled as recipients will undergo FMT via colonoscopy.
Outcomes
Primary Outcome Measures
Number of diverticular flares/attacks since FMT
After FMT, recipients/participants will be asked to report the number of diverticulitis episodes they have experienced since FMT
Number of emergency room visits and hospitalizations due to diverticulitis since FMT
After FMT, recipients/participants will be asked to report the number of times (if any) they presented to the emergency room or were hospitalized due to diverticulitis.
Number of courses of antibiotics required for the treatment of diverticulitis since FMT
After FMT, recipients/participants will be asked to report whether they required any antibiotics due to diverticulitis
Necessity for surgery
After FMT, recipients/participants will be asked to report whether they required surgery to treat diverticulitis
Secondary Outcome Measures
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05373784
Brief Title
FMT in Uncomplicated Diverticulitis
Official Title
Outcomes of Fecal Microbiota Transplantation (FMT) in Uncomplicated Diverticulitis: A Pilot Study
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
June 30, 2023 (Anticipated)
Primary Completion Date
August 15, 2024 (Anticipated)
Study Completion Date
November 30, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Justin Maykel
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Fecal Microbiota Transplantation (FMT) is an established treatment for Clostridium difficile (C. diff) infection refractory to medical management. As C. diff infection usually arises due to significant disturbances in the gut microbiome, FMT is typically performed to restore a healthy microbiome among affected patients who have failed other treatments. Diverticulitis is a major, and often recurrent, source of morbidity in the U.S for which antibiotics and surgical resection constitute the only treatment options to date. Although alterations of the intestinal microbiome have also been shown among patients with diverticular disease, research on FMT in diverticulitis is sparse. The intended goal of this project is to determine the feasibility, effectiveness and safety of FMT in the treatment of uncomplicated diverticulitis, using clinical outcomes and microbiome analyses.
Detailed Description
This study aims to assess the safety and efficacy of fecal microbiota transplantation (FMT) in treating uncomplicated diverticulitis. FMT will be delivered via colonoscopy using donor stool. Upon enrollment, patients or intended recipients will be asked to identify a potential donor. Donors will undergo a series of serologic, stool and COVID-19 testing to ensure that they meet inclusion and exclusion criteria prior to stool donation.
Recipients will undergo FMT via Colonoscopy at UMASS Memorial Medical Center and will be monitored for one hour after the procedure to ensure they are not experiencing any adverse events. They will receive a phone call 24 hours and 2 weeks after their procedure to ensure that they are at their baseline health. Recipients follow-up visits will occur at one month, 3 month, 6 months and 1 year post FMT.
Baseline stool samples will be collected from both donors and recipients for baseline metagenomic sequencing. Recipient stool samples will be obtained weekly for the first month, then at 3 months, 6 months and 1 year. Microbiome analyses will also performed on recipient all stool samples post FMT to assess for successful engraftment of donor's microbiota onto the recipient's.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diverticulitis, Uncomplicated Diverticular Disease
7. Study Design
Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Model Description
This will be a pilot study of 10 patients with a diagnosis of uncomplicated diverticulitis who will undergo FMT.
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
FMT cohort
Arm Type
Experimental
Arm Description
This will be a single-arm pilot study of patients with uncomplicated diverticulitis. All subjects enrolled as recipients will undergo FMT via colonoscopy.
Intervention Type
Biological
Intervention Name(s)
Fecal Microbiota Transplantation (FMT)
Intervention Description
Fecal microbiota transplantation (FMT) involves administering fecal material from a healthy individual into the gastrointestinal tract of another individual. This is currently an accepted method of treatment for recurrent colitis secondary to Clostridium difficile infection refractory to antibiotics/medical management. FMT can be delivered via capsule endoscopy or via colonoscopy. In this study, it will be administered via colonoscopy.
Primary Outcome Measure Information:
Title
Number of diverticular flares/attacks since FMT
Description
After FMT, recipients/participants will be asked to report the number of diverticulitis episodes they have experienced since FMT
Time Frame
1 year
Title
Number of emergency room visits and hospitalizations due to diverticulitis since FMT
Description
After FMT, recipients/participants will be asked to report the number of times (if any) they presented to the emergency room or were hospitalized due to diverticulitis.
Time Frame
1 year
Title
Number of courses of antibiotics required for the treatment of diverticulitis since FMT
Description
After FMT, recipients/participants will be asked to report whether they required any antibiotics due to diverticulitis
Time Frame
1 year
Title
Necessity for surgery
Description
After FMT, recipients/participants will be asked to report whether they required surgery to treat diverticulitis
Time Frame
1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Recipient Inclusion Criteria:
Age >18
One or more prior episode(s) of uncomplicated diverticulitis, as confirmed by imaging and clinical symptoms.
Eligible for surgical resection
Recipient Exclusion Criteria:
Subjects <18 years of age
Patients with active diverticulitis flare
Evidence of complicated diverticulitis (diverticulitis with abscess/phlegmon, bleeding, stricture, fistula or perforation) on imaging
Prior fecal transplant
Patients unable to provide informed consent
Pregnant and/or breastfeeding women
Prisoners
Students
Prior small or large bowel obstruction within the past year
Prior major gastrointestinal or intra-abdominal surgery
Any major illness or condition that may substantially increase risks to the recipient based on the investigator's judgment.
Sexually active women who adhere to natural family planning alone
Donor Inclusion Criteria:
Adult patients ≥18 years old
Colonoscopy screening as recommended by the American Cancer Society. However, it is to be noted that only recipients will undergo colonoscopy for receipt of FMT as part of the study, not donors. We will only ensure that the prospective donor follows the recommended guidelines for screening colonoscopy, which are to begin at the age of 45. If the donor does not meet such guidelines, s/he will not be allowed to proceed as a donor. If a donor is not yet eligible to undergo screening colonoscopy (i.e., younger than 45), this will not be required of him/her."
Able to provide informed consent
Donor Exclusion Criteria:
History of diverticulitis
Recent COVID-19 infection, confirmed or suspected exposure to COVD-19 within the past eight weeks. Such subjects will be excluded irrespective of negative COVID nasopharyngeal test.
Risk of infectious agent
Known exposure to HIV, syphilis, or viral hepatitis (within the previous 12 months)
High-risk sexual behaviors including sexual contact with anyone with HIV/AIDS or hepatitis, men who have sex with men, sex for drugs or money
Use of illicit intravenous (IV) drug use
Tattoo or body piercing within 6 months
Incarceration within previous 12 months
Known current communicable disease (e.g., COVID 19, Influenza, STDs, HIV/AIDS, Hepatitis B and C)
Risk factors for variant Creutzfeldt-Jacob disease to prevent potential transmission of abnormal/pathologic prions (cellular proteins), which are the basis of this disease.
Receipt of blood transfusion from country other than the United States of America (USA) and Canada in the previous 6 months
Individuals who are at a higher risk for colonization with multi-drug resistant organisms (MDRO):
Health care workers
Persons who have been hospitalized or discharged from long-term care facilities in the past 30 days
Persons who regularly attend outpatient medical or surgical clinics
Persons who have engaged in medical tourism in the past 30 days
Gastrointestinal comorbidities
History of inflammatory bowel disease
History of celiac disease
History of irritable bowel syndrome, idiopathic chronic constipation, or chronic diarrhea
History of gastrointestinal malignancy
Other
Antibiotic use within the preceding 90 days
Ingestion of a potential allergen (e.g., nuts) where recipient has a known allergy to this agent within the past 30 days
Systemic autoimmunity (e.g., multiple sclerosis, connective tissue disease)
Chronic pain syndromes (e.g., chronic fatigue syndrome, fibromyalgia)
Fever, defined as temperature of 100 F or 38.7C, on the day of stool donation. Potential donors will be allowed to re-screen within 1 week if febrile on the day of stool donation. .
Sexually active women who adhere to natural family planning alone as method of contraception
Prisoners
Students
Pregnant women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Justin A Maykel, MD
Phone
508-334-8195
Email
justin.maykel@umassmemorial.org
First Name & Middle Initial & Last Name or Official Title & Degree
Alexandra M Onyiego, MD
Phone
508-334-8195
Email
alexandra.onyiego@umassmemorial.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Justin A Maykel, MD
Organizational Affiliation
UMass Chan Medical School
Official's Role
Principal Investigator
Facility Information:
Facility Name
UMASS Memorial Medical Center
City
Worcester
State/Province
Massachusetts
ZIP/Postal Code
01605
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Justin A Maykel, MD
Phone
508-334-8195
Email
justin.maykel@umassmemorial.org
First Name & Middle Initial & Last Name & Degree
Alexandra M Onyiego, MD
Phone
508-334-8195
Email
alexandra.onyiego@umassmemorial.org
12. IPD Sharing Statement
Plan to Share IPD
No
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FMT in Uncomplicated Diverticulitis
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