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LGG Supplementation in Patients With AUD and ALD (AUD+ALD)

Primary Purpose

Alcohol Use Disorder, Alcohol-associated Liver Disease

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
: Placebo for Probiotic
Lactobacillus Rhamnosus GG
Sponsored by
University of Louisville
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alcohol Use Disorder focused on measuring AUD, ALD, AH, TLFB, LTDH, AUDIT, WHO Drinking Level Reduction Criteria, MELD, ALT, AST, ABIC, Total Bilirubin, Heavy Drinking, Drinking Pattern, AUD Domains, Albumin

Eligibility Criteria

21 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Breath alcohol concentration (BAC) equal to 0.00 when the participant signs the informed consent document.
  2. Age between 21 and 65 years old (inclusive).
  3. Willingness to receive trial treatment.
  4. Ability to provide informed consent
  5. Understanding that this is not an alcohol treatment study.
  6. Heavy drinking. Men must consume ≥ 20 and women ≥ 14 standardized alcoholic beverages a week for the past 3 months.
  7. Diagnosis of Alcohol Use Disorder using DSM V criteria.
  8. 50 <AST<400 U/L; AST > ALT; and ALT < 200 U/L; total bilirubin > 1.2 mg/dL
  9. Model for End-Stage Liver Disease: 12 ≤ (MELD) ≤19.
  10. Good health as confirmed by medical history, physical examination, ECG, laboratory tests and vital signs except for liver injury and AUD related history.
  11. Provide contact information for someone who may be able to contact the subject in case of a missed appointment.
  12. . Females of child-bearing potential must not be pregnant and must be using birth control

Exclusion Criteria:

  1. Current (last 12 months) DSM V diagnosis of dependence on any psychoactive substance other than alcohol or nicotine,
  2. Positive urine drug screen at baseline for any illegal substance other than marijuana,
  3. History of hospitalization for alcohol intoxication delirium, alcohol withdrawal delirium or seizure,
  4. Participation in any research study for alcoholism treatment within 3 months prior to signing the informed consent,
  5. Pharmacological treatment with naltrexone, acamprosate, topiramate, or disulfiram within 1 month prior to randomization,
  6. Lifetime diagnosis based on DSM-V criteria of schizophrenia, bipolar disorder, or other psychosis, eating disorders; current or past year diagnosis of major depression
  7. In the investigators' opinion, moderate to severe risk of suicide (e.g., active plan, or recent attempt in last 6 months),
  8. Current use of psychotropic medications that cannot be discontinued,
  9. Clinically significant medical abnormalities (apart from moderate ALD, MELD≤19),
  10. Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) >10, at screening for more than 3 days,
  11. Serious medical diseases, such as cancer, liver cirrhosis, pancreatitis, severe alcohol associated hepatitis, heart chronic failure, chronic kidney failure, chronic intestinal diseases (e.g., Crohn's disease), chronic neurological disorders (e.g., tardive dyskinesia, epilepsy, Parkinson's disease)
  12. History of clinically significant hypotension (e.g., history of lipotimia and/or syncopal episodes)
  13. History of adverse reactions to needle puncture,
  14. Obesity (BMI ≥ 33.0 kg/m2),
  15. Pregnancy; incarceration; inability to provide consent
  16. Signs of systemic infection: Fever > 38o C, positive blood or ascites cultures, on appropriate antibiotic therapy for > 3 days within 3 days of inclusion
  17. Acute gastrointestinal bleeding requiring > 2 units blood transfusion within the previous 2 weeks
  18. Undue risk from immunosuppression: Positive HBsAg; positive skin PPD skin test or history of treatment for tuberculosis; known HIV infection

Sites / Locations

  • University of Louisville HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Placebo Comparator: Placebo for Probiotic

Active Comparator: Lactobacillus Rhamnosus GG

Arm Description

Placebo capsule that matches the probiotic capsule in appearance will be given once daily for 180 days.

Dietary supplement capsule (Lactobacillus Rhamnosus GG) will be given once daily for 180 days.

Outcomes

Primary Outcome Measures

By lowering heavy drinking to meet the criteria on the responder definitions of abstinence, no heavy drinking days, WHO 1-level, and WHO 2-level reduction
Timeline Followback for past 180 days [Unit: numerical frequency], AUDIT [Unit: numerical frequency], monthly drinking questionnaire [Unit: numerical frequency]).
By reducing relapse episodes to minimal/absent incident level
(Unit: incident frequency).
By showing a significant positive effect on one or more of the underlying neurobehavioral domains.
Questionnaires: reward (reasons for heavy drinking questionnaire or RHDQ [Unit: numerical frequency]), craving (Penn Alcohol Craving Scale or PACS, [Unit: numerical frequency]; and obsessive compulsive drinking scale or OCDS [Unit: numerical frequency]), withdrawal (Clinical Institute Withdrawal Assessment Alcohol Scale Revised [CIWA-AR] or CIWA-AR [Unit: numerical frequency]), and reinforcement effects (Desires for Alcohol Questionnaire or DAQ [Unit: numerical frequency]).
By lowering a biochemical marker of alcohol intake
PeTH (Unit: μmol/L)

Secondary Outcome Measures

By significantly improving liver related and clinical markers
Liver markers: Aspartate transaminases or AST (Unit: IU/L), Alanine Transaminases or ALT (Unit: IU/L), Albumin (Unit: g/dL), Total bilirubin (Unit: mg/dL), Creatinine (Unit: mg/dL), and INR (Unit: numerical), AST:ALT ratio (numerical unit), Prothrombin Time or PT (Unit: seconds). Clinical marker: Model For End-Stage Liver Disease or MELD ([=0.957 × ln(Cr) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643]. Unit: numerical), Maddrey's Discriminant Function for Alcoholic Hepatitis or Maddrey DF ([=4.6 * (Pt's PT - Control PT) + TBili]. Unit: numerical). Laboratory markers: K18M65 and K18M30 (Unit for both: IU/L).
By substantially improving the overall health as assessed by the patient reported outcomes
Quality of Life or QOL scale [Unit: numerical frequency], Drinker inventory of consequences or DrInC [unit: numerical frequency].
By lowering frequency and intensity of treatment/disease based adverse effects (AE).
Incident frequency of AE [Unit: numerical], Severity Scale (AE/SAE (Unit: 1-5).

Full Information

First Posted
November 9, 2021
Last Updated
May 11, 2023
Sponsor
University of Louisville
Collaborators
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
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1. Study Identification

Unique Protocol Identification Number
NCT05178069
Brief Title
LGG Supplementation in Patients With AUD and ALD
Acronym
AUD+ALD
Official Title
Lactobacillus Rhamnosus GG: A Novel Probiotic Therapy for Treating Alcohol Use Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 1, 2022 (Actual)
Primary Completion Date
August 31, 2026 (Anticipated)
Study Completion Date
February 28, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Louisville
Collaborators
National Institute on Alcohol Abuse and Alcoholism (NIAAA)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
To test the efficacy of 6-month LGG compared to placebo in treating Alcoholic Use Disorder (AUD) and liver injury in Alcoholic Hepatitis (AH). And to evaluate the effects of LGG treatment compared to placebo on therapeutic-mechanistic markers of the gut-brain axis and pro-inflammatory activity in patients with AUD and moderate AH
Detailed Description
Aim. 1: To test the efficacy of 6-month LGG compared to placebo in treating AUD: (1a) by lowering heavy drinking (1b) by reducing relapse episodes to minimal/absent incident level; (1c) by showing a significant positive effect on one or more of the underlying neurobehavioral domain, and (1d) by lowering a biochemical marker of alcohol intake. Aim. 2: To test if 6-month LGG treatment compared to placebo will improve the symptoms and liver injury in AH: (2a) by significantly improving liver related tests (AST, ALT, AST:ALT, albumin, bilirubin and INR; K18M65 and K18M30) and clinical severity/prognostic markers (MELD, Maddrey); (2b) by substantially improving the overall health as assessed by the patient reported outcomes (Quality of Life [QOL] scale, and drinker inventory of consequences [DrInC]); and (2c) by lowering frequency and intensity of treatment/disease based adverse effects (AE). Aim. 3: To evaluate the effects of LGG treatment compared to placebo on therapeutic-mechanistic markers of gut-brain axis and pro-inflammatory activity in patients with AUD and moderate AH: (3a) by identifying the blood biomarkers of gut-barrier dysfunction and endotoxemia, and inflammation; (3b) by determining the therapeutic targets of LGG involved in the gut-brain axis of AUD using LC-MS metabolomic fecal assays (candidate markers of gut-dysfunction associated neurotransmitters); and (3c) by validating the efficacy of LGG treatment vs. placebo to lower inflammation using an ex-vivo design.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alcohol Use Disorder, Alcohol-associated Liver Disease
Keywords
AUD, ALD, AH, TLFB, LTDH, AUDIT, WHO Drinking Level Reduction Criteria, MELD, ALT, AST, ABIC, Total Bilirubin, Heavy Drinking, Drinking Pattern, AUD Domains, Albumin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Time by treatment study.
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Placebo Comparator: Placebo for Probiotic
Arm Type
Placebo Comparator
Arm Description
Placebo capsule that matches the probiotic capsule in appearance will be given once daily for 180 days.
Arm Title
Active Comparator: Lactobacillus Rhamnosus GG
Arm Type
Active Comparator
Arm Description
Dietary supplement capsule (Lactobacillus Rhamnosus GG) will be given once daily for 180 days.
Intervention Type
Drug
Intervention Name(s)
: Placebo for Probiotic
Other Intervention Name(s)
Dummy capsule
Intervention Description
Capsule manufactured without active ingredients.
Intervention Type
Dietary Supplement
Intervention Name(s)
Lactobacillus Rhamnosus GG
Other Intervention Name(s)
Culturelle
Intervention Description
Probiotic nutritional supplement; Lactobacillus Rhamnosus G
Primary Outcome Measure Information:
Title
By lowering heavy drinking to meet the criteria on the responder definitions of abstinence, no heavy drinking days, WHO 1-level, and WHO 2-level reduction
Description
Timeline Followback for past 180 days [Unit: numerical frequency], AUDIT [Unit: numerical frequency], monthly drinking questionnaire [Unit: numerical frequency]).
Time Frame
180 days
Title
By reducing relapse episodes to minimal/absent incident level
Description
(Unit: incident frequency).
Time Frame
180 days
Title
By showing a significant positive effect on one or more of the underlying neurobehavioral domains.
Description
Questionnaires: reward (reasons for heavy drinking questionnaire or RHDQ [Unit: numerical frequency]), craving (Penn Alcohol Craving Scale or PACS, [Unit: numerical frequency]; and obsessive compulsive drinking scale or OCDS [Unit: numerical frequency]), withdrawal (Clinical Institute Withdrawal Assessment Alcohol Scale Revised [CIWA-AR] or CIWA-AR [Unit: numerical frequency]), and reinforcement effects (Desires for Alcohol Questionnaire or DAQ [Unit: numerical frequency]).
Time Frame
180 days
Title
By lowering a biochemical marker of alcohol intake
Description
PeTH (Unit: μmol/L)
Time Frame
180 days
Secondary Outcome Measure Information:
Title
By significantly improving liver related and clinical markers
Description
Liver markers: Aspartate transaminases or AST (Unit: IU/L), Alanine Transaminases or ALT (Unit: IU/L), Albumin (Unit: g/dL), Total bilirubin (Unit: mg/dL), Creatinine (Unit: mg/dL), and INR (Unit: numerical), AST:ALT ratio (numerical unit), Prothrombin Time or PT (Unit: seconds). Clinical marker: Model For End-Stage Liver Disease or MELD ([=0.957 × ln(Cr) + 0.378 × ln(bilirubin) + 1.120 × ln(INR) + 0.643]. Unit: numerical), Maddrey's Discriminant Function for Alcoholic Hepatitis or Maddrey DF ([=4.6 * (Pt's PT - Control PT) + TBili]. Unit: numerical). Laboratory markers: K18M65 and K18M30 (Unit for both: IU/L).
Time Frame
180 days
Title
By substantially improving the overall health as assessed by the patient reported outcomes
Description
Quality of Life or QOL scale [Unit: numerical frequency], Drinker inventory of consequences or DrInC [unit: numerical frequency].
Time Frame
180 days
Title
By lowering frequency and intensity of treatment/disease based adverse effects (AE).
Description
Incident frequency of AE [Unit: numerical], Severity Scale (AE/SAE (Unit: 1-5).
Time Frame
180 days
Other Pre-specified Outcome Measures:
Title
To determine the therapeutic-mechanistic markers of gut-brain axis, pro-inflammatory activity in AUD
Description
By identifying the blood biomarkers of gut-barrier dysfunction and endotoxemia as assessed by: LPS [Unit: EU/ml], LBP [Unit: ng/ml], sCD14 [Unit: x 10^6 pg/ml]. Serum Inflammation markers: IL1β, IL33, IL18, IL17, IL22, TNFα [Units for all: pg/ml]. By determining the therapeutic targets of LGG involved in the gut-brain axis of AUD using LC-MS metabolomic fecal assays (candidate markers of gut-dysfunction associated neurotransmitters): Gamma Aminobutyric Acid or GABA [Unit: pmoles/ml], hexyl-2-methyl butyrate or HMBA (Unit: mmol/L), serotonin (Unit: ng/mL), dopamine (Unit: ng/ml), acetylcholine (Unit: nmol/L), tryptophan (Unit: umol/L), and short-chain fatty acids (Unit: mmol/L). Units can be relative in intensity (as fold-change). By validating the efficacy of LGG treatment vs. placebo to lower inflammation using an ex-vivo design: Candidate WBC type derived Inflammation markers: IL1β, IL33, IL18, IL17, IL22, TNFα [Units for all: pg/ml].
Time Frame
180 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Breath alcohol concentration (BAC) equal to 0.00 when the participant signs the informed consent document. Age between 21 and 65 years old (inclusive). Willingness to receive trial treatment. Ability to provide informed consent Understanding that this is not an alcohol treatment study. Heavy drinking. Men must consume ≥ 20 and women ≥ 14 standardized alcoholic beverages a week for the past 3 months. Diagnosis of Alcohol Use Disorder using DSM V criteria. 50 <AST<400 U/L; AST > ALT; and ALT < 200 U/L; total bilirubin > 1.2 mg/dL Model for End-Stage Liver Disease: 12 ≤ (MELD) ≤19. Good health as confirmed by medical history, physical examination, ECG, laboratory tests and vital signs except for liver injury and AUD related history. Provide contact information for someone who may be able to contact the subject in case of a missed appointment. . Females of child-bearing potential must not be pregnant and must be using birth control Exclusion Criteria: Current (last 12 months) DSM V diagnosis of dependence on any psychoactive substance other than alcohol or nicotine, Positive urine drug screen at baseline for any illegal substance other than marijuana, History of hospitalization for alcohol intoxication delirium, alcohol withdrawal delirium or seizure, Participation in any research study for alcoholism treatment within 3 months prior to signing the informed consent, Pharmacological treatment with naltrexone, acamprosate, topiramate, or disulfiram within 1 month prior to randomization, Lifetime diagnosis based on DSM-V criteria of schizophrenia, bipolar disorder, or other psychosis, eating disorders; current or past year diagnosis of major depression In the investigators' opinion, moderate to severe risk of suicide (e.g., active plan, or recent attempt in last 6 months), Current use of psychotropic medications that cannot be discontinued, Clinically significant medical abnormalities (apart from moderate ALD, MELD≤19), Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) >10, at screening for more than 3 days, Serious medical diseases, such as cancer, liver cirrhosis, pancreatitis, severe alcohol associated hepatitis, heart chronic failure, chronic kidney failure, chronic intestinal diseases (e.g., Crohn's disease), chronic neurological disorders (e.g., tardive dyskinesia, epilepsy, Parkinson's disease) History of clinically significant hypotension (e.g., history of lipotimia and/or syncopal episodes) History of adverse reactions to needle puncture, Obesity (BMI ≥ 33.0 kg/m2), Pregnancy; incarceration; inability to provide consent Signs of systemic infection: Fever > 38o C, positive blood or ascites cultures, on appropriate antibiotic therapy for > 3 days within 3 days of inclusion Acute gastrointestinal bleeding requiring > 2 units blood transfusion within the previous 2 weeks Undue risk from immunosuppression: Positive HBsAg; positive skin PPD skin test or history of treatment for tuberculosis; known HIV infection
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Suman K Jha, MBBS
Phone
773-997-5461
Email
sumankumar.jha@louisville.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Steve Mahanes
Phone
502-852-1388
Email
steve.mahanes@louisville.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Vatsalya Vatsalya, MD PhD
Organizational Affiliation
Department of Medicine, University of Louisville
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Craig J McClain, MD
Organizational Affiliation
Department of Medicine, University of Louisville
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Evan J. Winrich, M.D.
Organizational Affiliation
Department of Medicine, University of Louisville
Official's Role
Study Director
Facility Information:
Facility Name
University of Louisville Hospital
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Vatsalya Vatsalya, MD, PgD, MSc, MS, FRSM
Phone
502-952-8928
Email
v0vats01@louisville.edu
First Name & Middle Initial & Last Name & Degree
Steve Mahanes
Phone
5028521388
Email
steve.mahanes@louisville.edu

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Data is shared through NIMH NDA portfolio
IPD Sharing Time Frame
2028 -2030 year
IPD Sharing Access Criteria
Application to NIAAA for getting the dataset
Citations:
PubMed Identifier
33306505
Citation
McClain CJ, Vatsalya V, Mitchell MC. Keratin-18: Diagnostic, Prognostic, and Theragnostic for Alcohol-Associated Hepatitis. Am J Gastroenterol. 2021 Jan 1;116(1):77-79. doi: 10.14309/ajg.0000000000001042.
Results Reference
background
PubMed Identifier
32106390
Citation
Gala KS, Vatsalya V. Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope. Cells. 2020 Feb 25;9(3):524. doi: 10.3390/cells9030524.
Results Reference
background
PubMed Identifier
31811953
Citation
Vatsalya V, Cave MC, Kong M, Gobejishvili L, Falkner KC, Craycroft J, Mitchell M, Szabo G, McCullough A, Dasarathy S, Radaeva S, Barton B, McClain CJ. Keratin 18 Is a Diagnostic and Prognostic Factor for Acute Alcoholic Hepatitis. Clin Gastroenterol Hepatol. 2020 Aug;18(9):2046-2054. doi: 10.1016/j.cgh.2019.11.050. Epub 2019 Dec 4.
Results Reference
background
PubMed Identifier
30766965
Citation
Zhou Y, Vatsalya V, Gobejishvili L, Lamont RJ, McClain CJ, Feng W. Porphyromonas gingivalis as a Possible Risk Factor in the Development/Severity of Acute Alcoholic Hepatitis. Hepatol Commun. 2018 Dec 14;3(2):293-304. doi: 10.1002/hep4.1296. eCollection 2019 Feb.
Results Reference
background
PubMed Identifier
28774194
Citation
Gowin JL, Sloan ME, Stangl BL, Vatsalya V, Ramchandani VA. Vulnerability for Alcohol Use Disorder and Rate of Alcohol Consumption. Am J Psychiatry. 2017 Nov 1;174(11):1094-1101. doi: 10.1176/appi.ajp.2017.16101180. Epub 2017 Aug 4.
Results Reference
background
PubMed Identifier
26209857
Citation
Vatsalya V, Gowin JL, Schwandt ML, Momenan R, Coe MA, Cooke ME, Hommer DW, Bartlett S, Heilig M, Ramchandani VA. Effects of Varenicline on Neural Correlates of Alcohol Salience in Heavy Drinkers. Int J Neuropsychopharmacol. 2015 Jul 25;18(12):pyv068. doi: 10.1093/ijnp/pyv068.
Results Reference
background
PubMed Identifier
33374263
Citation
Vatsalya V, Gala KS, Hassan AZ, Frimodig J, Kong M, Sinha N, Schwandt ML. Characterization of Early-Stage Alcoholic Liver Disease with Hyperhomocysteinemia and Gut Dysfunction and Associated Immune Response in Alcohol Use Disorder Patients. Biomedicines. 2020 Dec 24;9(1):7. doi: 10.3390/biomedicines9010007.
Results Reference
background
PubMed Identifier
32963470
Citation
Vatsalya V, Kong M, Marsano LM, Kurlawala Z, Chandras KV, Schwandt ML, Ramchandani VA, McClain CJ. Interaction of Heavy Drinking Patterns and Depression Severity Predicts Efficacy of Quetiapine Fumarate XR in Lowering Alcohol Intake in Alcohol Use Disorder Patients. Subst Abuse. 2020 Sep 9;14:1178221820955185. doi: 10.1177/1178221820955185. eCollection 2020.
Results Reference
background
Links:
URL
https://reporter.nih.gov/search/zmJAfR_IOkGNjlHYcbLx0w/project-details/10191836
Description
Details of the Study at NIH Reporter
URL
https://louisville.edu/medicine/departments/medicine/divisions/gimedicine/faculty/vatsalya-lab
Description
Clinical Laboratory for the Intervention Development of AUD and Organ-Injury

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LGG Supplementation in Patients With AUD and ALD

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