Gut Microbial Transplantation in Pediatric Inflammatory Bowel Diseases
Condition: Inflammatory Bowel Disease (IBD)
MeSH terms: Intestinal Diseases; Inflammatory Bowel Diseases
Intervention: Gut Microbial Transplantation
Intervention description: Each participant received Gut Microbial Transplantation (GMT) as retention enema over a period of 1 hour (60mL enema every 15 minutes) daily for 5 days. Although 240mL of GMT solution was prepared for each participant, the final administered dose was dependent on the subject's comfort and willingness to proceed with the next enema, which was assessed after each enema infusion. Subjects were monitored for 30 minutes after GMT for any immediate adverse events and discharged.
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 20.0
Sex: All
Minimum age: 7 Years
Maximum age: 21 Years
Healthy volunteers: No
Keywords: ulcerative colitis, gut microbial transplantation

Summary:

      Inflammatory bowel disease (IBD) is a chronic, debilitating, relapsing inflammatory disorder
      affecting the gastrointestinal tract which does not have a medical cure. IBD consists of 2
      different forms: Crohn's Disease (CD) and Ulcerative Colitis (UC). In the last 2 decades, Gut
      Microbial Transplantation (GMT), also known as fecal transplantation, has been used as a
      treatment option for Clostridium difficile colitis and UC. The literature supports strong
      evidence for the plausibility of using GMT for patients with IBD associated colitis,
      especially for patients with UC.

      This research will be conducted in the Helen DeVos Children's Hospital (HDVCH) Pediatric
      gastrointestinal outpatient clinic. A pilot study of ten patients will be conducted to
      evaluate if GMT improves clinical symptoms in patients with IBD. Patients with IBD colitis
      (UC and CD with colonic involvement only) will be approached for GMT as a treatment option
      for their disease. Each subject will undergo 5 sessions (1 session/day, and not necessarily
      on consecutive days) of GMT within a period of 10 days. Post treatment evaluation will be
      done at their regularly scheduled clinic follow up.

      Healthy donors >18 years of age will be chosen by the family, inclusive of immediate family
      members and friends. Donors will be required to complete a screening questionnaire, provide
      medical history, and undergo blood and stool tests.
    

Eligibility criteria:

        Participant Inclusion Criteria:

          1. Children ages >7 and ≤21 years of age with established diagnosis of Inflammatory Bowel
             Disease (IBD) colitis (patient with ulcerative colitis (UC) or patients with crohn's
             disease (CD) with colonic involvement only)

          2. Have clinical disease (mild to moderate disease: 10≤ Pediatric Ulcerative Colitis
             Activity Index (PUCAI) <65)

          3. Have stable disease activity and therapy for two months prior to Gut Microbial
             Transplantation (GMT) procedure.

        Participant Exclusion Criteria:

          1. Fulminant colitis

          2. Indication or scheduled for surgery

          3. Pregnancy

          4. Use of probiotic supplements during the study period (subjects who have stopped use of
             probiotic supplements will be eligible as long as they stop taking it 2 weeks prior to
             Day 1 of GMT)

          5. anemia (hemoglobin < 6.0 g/dL) in last one month

          6. Graft versus host disease (GVHD)

          7. Severely immunocompromised - defined as

               1. History of opportunistic infection (tuberculosis, Pneumocystis jirovecii or
                  systemic fungal infections) in last one year or

               2. Neutropenia: Absolute neutrophil count (ANC) <500

          8. Major intra-abdominal surgery within 90 days prior to Day 1 of GMT

          9. Administration of any investigational drug within 30 days prior to Day 1 of GMT.

         10. Have received infliximab or other tumor necrosis factor (TNF) inhibitors within 2
             months prior to Day 1 of GMT or are expected to receive such therapy within 1 month
             post final GMT.

        Donor Inclusion Criteria

          1. Based on patient's and parents'/guardian's decision

          2. Will be chosen from immediate adult (≥18 years) family members or close friends

          3. Should have negative or normal results on screening tests (as explained in donor
             exclusion criteria below)

        Donor Exclusion Criteria (adopted from guidelines provided by American Association of Blood
        Bank Donor History Questionnaire and American Gastroenterological Association)

          1. Positive or abnormal screening test to include:

               1. Hepatitis A Immunoglobulin M (IgM) antibody

               2. Hepatitis B antibody panel suggestive of infection (HBc IgM, HBs Ag, HBs Ab)

               3. Hepatitis C antibody Level

               4. Cytomegalovirus (CMV) IgM antibody

               5. Ebstein Barr Virus (EBV) viral capsid antigen (VCA) IgM antibody

               6. Syphilis Immunoglobulin G (IgG) Ab Screen

               7. Human Immune Deficiency Virus (HIV) I & II enzyme-linked immunosorbent assay
                  (ELISA) screen

               8. Stool i) Fungal smear ii) Stool cultures to exclude Salmonella, Shigella,
                  Escherichia Coli, Campylobacter, Yersinia, Vibrio, Listeria iii) Clostridium
                  difficile toxin assay iv) Ova and parasite screen for Giardia and Cryptosporidium

          2. History of metabolic syndrome or gastric bypass surgery

          3. History of GI conditions: IBD, irritable bowel syndrome, chronic abdominal pain, GI
             Malignancy, blood in stool or diarrhea in the last 4 weeks before enrollment

          4. Antibiotic or probiotic use within 3 months before enrollment and for the duration of
             the donation

          5. Positive response on screening questionnaire to any of the following:

               1. History of active malignancy or any cancer within the last 5 years (excluding
                  basal cell carcinoma of the skin)

               2. Family history of Creutzfeld-Jacob disease

               3. Corneal or dural transplant

               4. History of high risk sexual behavior (e.g. sexual contact with HIV/acquired
                  immune deficiency syndrome (AIDS) positive, hepatitis positive partner, men who
                  have sex with men, sex for drugs or money)

               5. History of signs of sexually transmitted infections such as genital ulcerations,
                  anogenital herpes, anogenital warts, cancroids or syphilitic lesions

               6. Use of illicit drugs

               7. Travel within the last 6 months to areas of the world where diarrheal illnesses
                  are endemic

               8. History or signs of immunosuppression i) History of any immunosuppressant
                  medication(s) within the last 6 months or history of opportunistic infection(s)
                  in past 1 year ii) Signs of immunosuppression such as:

               1. Oral thrush

               2. Disseminated lymphadenopathy