A Trial of Bile Acid Supplementation in Patients With Multiple Sclerosis

Study Overview
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Brief Summary
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This study aims to identify the safety and tolerability of bile acid supplementation in patients with progressive Multiple Sclerosis (MS). Participants will also be assessed for an impact of the bile acid on their immune system and gut microbiome. Half of the participants will receive the bile acid tauroursodeoxycholic acid (TUDCA) and half will receive placebo. The investigators believe participants who take TUDCA will have normalization of blood bile acid levels, a normalization of abnormal immune response and a normalization of the gut microbiome.

Official Title
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A Phase 1/2 Trial of Tauroursodeoxycholic Acid Supplementation in Progressive MS Patients

Conditions
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Progressive Multiple Sclerosis

Intervention / Treatment
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* Drug: Tauroursodeoxycholic Acid
* Drug: Placebo oral capsule


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of Progressive MS based on Lublin Criteria Low bile acid levels identified using targeted metabolomics analysis On the same therapy for the past 6 months and not expected to switch therapy in the next 6 months No relapse in the past 3 months Exclusion Criteria: No previous history of liver disease or cholecystectomy No stage IV/V chronic kidney disease or other severe metabolic derangements (e.g. poorly controlled thyroid disease or diabetes) BMI < 15 kg/m2 and BMI > 40 kg/m2 Female patients who are pregnant or nursing, or not willing to use contraception Chronic antibiotic use Corticosteroid treatment within the past 30 days Known history of other neuroinflammatory, neurodegenerative or systemic autoimmune disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TUDCA Treatment<br>Tauroursodeoxycholic acid (Taurolite) 250 mg four capsules by mouth, twice daily for 16 weeks. | Drug: Tauroursodeoxycholic Acid<br>* Participants will be given 1 gram of Tauroursodeoxycholic acid twice daily in the form of four 250mg capsules.<br>* Other names: Taurolite;|
| Placebo Comparator: Placebo oral capsule<br>Placebo oral capsule four capsules by mouth, twice daily for 16 weeks. | Drug: Placebo oral capsule<br>* Participants will be given four capsules of the placebo twice daily.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With at Least One Treatment-related Adverse Event | Safety and tolerability will be assessed based on treatment-related adverse events in the two arms. | 16 weeks | 
| Number of Total Treatment-related Adverse Events | Safety and tolerability will be assessed based on treatment-related adverse events in the two arms. | 16 weeks | 
| Incidence of Treatment-related Adverse Events (AE) | Safety and tolerability will be assessed based on treatment-related adverse events in the two arms. AE incidence will be measured as total number of events per 1000 exposure years. | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Fasting Bile Acid Levels in Plasma | The change of targeted bile acid levels over the course of 16 weeks (duration of the study) is reported. Bile acid levels (ng/mL) were log transformed before analysis to approximate normal distribution. Units are log(levels) per 16 weeks. Values are derived from linear mixed-effects models. | Baseline to 16 weeks | 
| Change in Microbiome Alpha-diversity Measured by Shannon Index at the End of the Study | Change in Shannon index of the gut microbiota between baseline and end of study (16 weeks). Shot-gun metagenomic sequencing in first morning stool specimen was utilized to derive the microbiome composition. Higher values of the index indicate more diversity in the microbial community. The minimum value the Shannon index can take is 0 (no diversity). There is no upper limit to the index. | Baseline to 16 weeks | 
| Change in Flow Cytometric Assessments of Peripheral Blood Mononuclear Cells (PBMCs) | Change in flow cytometric assessments over the course of 16 weeks (duration of the study). Cells are expressed as ratios of their parent types. Units reported as change in the ratio per 16 weeks. Values are derived from linear mixed-effects models. | Baseline to 16 weeks | 
| Change in Quality of Life Based on Multiple Sclerosis Quality of Life (MSQOL)-54 Instrument | Change in physical and mental health scores as assessed using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument over the course of 16 weeks (duration of the study). This 54-item instrument generates 12 subscales along with two summary scores, and two additional single-item measures. Two summary scores - physical health and mental health - are derived from a weighted combination of scale scores. Higher scores suggest a better quality of life. Scores can range from 0 to 100. | Baseline to 16 weeks |