Oral Fecal Microbiota Transplantation in Pediatric Ulcerative Colitis
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Fecal Microbiota Transplantation by Stool capsules, Fecal Microbiota Transplantation by Intra-rectal enemas.
- Who it may be relevant to
- Registry conditions: Pediatric Ulcerative Colitis in Remission. Basic parameters: 8 years — 17 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- France
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Pilot Study of a New Technique of Oral Fecal Transplantation Using Frozen Stool Capsules for the Maintenance Treatment of Pediatric Ulcerative Colitis.
Overview
The purpose of this study is to evaluate whether FMT by frozen stool capsules in pediatric UC patients in remission after corticosteroid treatment, can modify their dysbiotic gut microbiota by increasing the richness of their microbiota at 6 months.
Detailed description
Ulcerative colitis (UC) is characterized by chronic inflammation of the colon of undetermined origin. Their incidence is increasing dramatically in the paediatric population.
Pediatric-onset inflammatory bowel disease (IBD) is characterized by a greater severity than adult IBD. Although great progress has been made in recent years, the pathogenesis of IBD is not fully elucidated. During UC, an imbalance in the composition of gut microbiota, called "dysbiosis", has been identified. This dysbiosis is notably characterized by an increased proportion of pro-inflammatory microorganisms and a decreased proportion of anti-inflammatory microorganisms. The current treatments used in IBD mainly target the immune system through immunosuppressants, and help to shorten flairs and prevent recurrences, but there is no curative treatment.
From a therapeutic point of view, the correction of this dysbiosis is thus an attractive approach. Until now, efficacy of microbiome-based therapies such as probiotics or antibiotics has been disappointing in IBD. Fecal microbiota transplantation (FMT) consists of the administration of fecal material from a donor into the intestinal tract of a recipient to change their microbiota composition and restore healthy conditions. FMT has been successfully used for many years for the treatment of Clostridioides difficile infection. Recent studies seem to show a benefit of FMT in UC.
The investigator's main hypothesis is that the replacement of a dysbiotic microbiota by a 'healthy' microbiota by FMT can modify the richness of UC patient's microbiota and has a positive impact on the disease course.
Once steroid-induced remission will be achieved, patients will be included and randomised to receive either FMT by frozen stool capsules or enemas. They will receive 3 doses at 0, 1 and 2 months. They will be followed for one year with stool samples collected every 3 months. Clinical and laboratory data will be collected.
Interventions
- Drug Fecal Microbiota Transplantation by Stool capsules
After colon cleansing using PolyEthylen glycol, the patient will have a colonoscopy under general anaesthesia. The patient will then receive orally FMT (frozen stools capsules prepared from healthy donor feces). - Drug Fecal Microbiota Transplantation by Intra-rectal enemas
After colon cleansing using Polyethylen glycol, the patient will have a colonoscopy under general anaesthesia. The patient will then receive first FMT (frozen preparation of stools) by infusion in caecum during colonoscopy and the second and third doses by enemas.
Primary outcome measures
- Success of FMT with frozen stool capsules defined by an increase in the richness of the recipient's microbiota at 6 months. [Time frame: 6 months after the first Fecal Microbiota Transplantation (FMT)]
Secondary outcome measures (12)
- Success of FMT with frozen stool capsules defined by an increase in the richness of the recipient's microbiota at 12 months [Time frame: 12 months after the first FMT]
- Success of FMT by stool enema defined by an increase in the richness of the recipient's microbiota at 6 and 12 months [Time frame: 6 and 12 months after the first FMT]
- Success of FMT with frozen stool capsules on the change of recipient dysbiotic microbiota at 6 and 12 months [Time frame: 6 and 12 months after the first FMT]
- Success of FMT by enema on the change of recipient dysbiotic microbiota at 6 and 12 months [Time frame: 6 and 12 months after the first FMT]
- Success of FMT with frozen stool capsules on the richness and change of mucosal microbiota at 12 months [Time frame: 12 months]
- Success of FMT by enema on the richness and change of mucosal microbiota at 12 months [Time frame: 12 months]
- Success of FMT with frozen stool capsules on the change of mucosal recipient dysbiotic microbiota at 6 and 12 months [Time frame: 6 and 12 months after the first FMT]
- Success of FMT by enema on the change of mucosal recipient dysbiotic microbiota at 6 and 12 months [Time frame: 6 and 12 months after the first FMT]
- FMT with frozen stool capsules Feasibility [Time frame: At inclusion, 1 and 2 months after each FMT]
- FMT by enema Feasibility [Time frame: At inclusion, 1 and 2 months after each FMT]
- Ulcerative colitis clinical relapse [Time frame: 6 and 12 months]
- Ulcerative colitis Endoscopic relapse [Time frame: 12 months]
Eligibility criteria
Inclusion Criteria for patients:
- Patient aged 8 to 17 years old
- Ulcerative colitis (UC), whatever the extent, except isolated proctitis (<5 cm), diagnosed for more than 3 months according to the usual clinical, biological and endoscopic criteria
- Moderate active UC defined by a PUCAI score > 35 and responding to corticosteroid treatment with a PUCAI score <10 at enrollment
- Treatment of UC (5-ASA, immunosuppressants, biotherapies) stable for more than 3 months
- Patient able to swallow test capsules
- For girls of childbearing age:
- To have a negative blood (or urine) pregnancy test
- To agree to use a reliable contraceptive method from visit 1 until the end of the research
- Patient with health insurance
- Informed written consent form signed by both parents or by the person (s) with parental authority
Exclusion Criteria for patients:
- isolated proctitis (<5 cm)
- Being on enteral nutrition
- Have received antibiotic or antifungal treatment in the 4 weeks prior to enrollment
- Having a Clostridioides difficile infection in the 4 weeks prior to enrollment;
- Being pregnant or breastfeeding, or have a positive pregnancy test;
- Have a contraindication to colonoscopy or general anaesthesia
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
France · 3 centers
- Department of gastroenterology, Armand Trousseau Hospital — Paris
- Department of Pediatric Gastroenterology, Hepatology and Nutrition - Necker - Enfants Mala — Paris
- Department of Pediatric Gastroenterology, Robert Debré Hospital — Paris
Identifiers
NCT: NCT05202990 · APHP180572 · 2024-518044-20-00