Confirmatory Efficacy Trial of a Gluten-Free Diet in a Subgroup of Persons With Schizophrenia Who Have High Levels of IgG Anti-Gliadin Antibodies (AGA IG)

Study Overview
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Brief Summary
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This study purpose is to conduct a confirmatory double-blind randomized controlled trial in an inpatient setting of the effects of a tightly controlled gluten-free diet (GFD) to improve negative symptoms in people with schizophrenia or schizoaffective disorder who have antibodies to gliadin (AGA IgG). As part of the project investigators will also confirm outcomes such as cognitive symptoms, changes in peripheral and central inflammation as well as gut/blood brain barrier permeability.

Detailed Description
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This study is a randomized double blind clinical trial being funded by NIMH. Investigators will need to enroll 40 cases with AGA IgG positivity in order to present a powered and convincing result about the efficacy of gluten withdrawal in the subpopulation of persons with schizophrenia with elevated AGA IgG levels. Investigators will recruit a minimum 50 to ensure they are well powered without question, and to account for dropouts. Investigators will use a battery of measures of peripheral and central inflammation as well as gut permeability at baseline and endpoint to confirm the relationship of these outcomes to changes in AGA IgG and symptom changes in the clinical trial. Investigators will test negative symptoms as a primary outcome but will test changes in other symptom domains such as positive symptoms. After the completion of the 5 week confirmatory study, investigators will discharge participants and follow them for 8 weeks in their own environment to test the maintenance of the effect following the stringent GFD, and provide education on gluten free shopping, cooking and eating.

Official Title
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Confirmatory Double-Blind Placebo-Controlled Efficacy Trial of a Gluten-Free Diet in a Subgroup of Persons With Schizophrenia Who Have High Levels of IgG Anti-Gliadin Antibodies (AGA IG)

Conditions
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Schizophrenia, Gluten Sensitivity, Schizo Affective Disorder

Intervention / Treatment
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* Other: Gluten Flour in Protein Shake
* Other: Rice Flour in Protein Shake


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: DSM-IV/DSM 5 diagnosis of schizophrenia or schizoaffective disorder Positive for antibodies to gliadin (IgG > 20 U) SANS total score ≥ 20 and the affective flattening or alogia global item ≥ 3 Age 18- 64 years Same antipsychotic for at least 4 weeks Ability to consent determined by a score of 10 or greater on the Evaluation to Sign Consent. Exclusion Criteria: Persons already on gluten free diets Positivity to tissue transglutaminase (tTg) antibodies or known history of Celiac Disease Pregnant or lactating females Medical condition whose pathology or treatment could alter the presentation or treatment of schizophrenia or significantly increase the risk associated with the proposed treatment protocol Meets DSM-5 criteria for alcohol or substance use disorder (other than nicotine) within the last month Gluten ataxia, as measured by the Brief Ataxia Rating Scale Additional exclusion for those participating in optional imaging component: Non-removable ferromagnetic metal on or within the body Current claustrophobia Inability to lie supine for 1.5 hours

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 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
Interventional Model Description: Randomized double blind trial
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Gluten<br>30 grams of gluten flour daily in protein shake | Other: Gluten Flour in Protein Shake<br>* 15 Grams Gluten Flour BID<br>|
| Placebo Comparator: Placebo<br>30 grams of rice flour daily in protein shake | Other: Rice Flour in Protein Shake<br>* 15 Grams Rice Flour BID<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Negative symptom change as defined by difference in Scale for the Assessment of Negative Symptoms (SANS) score | This will be measured by the difference in Scale for the Assessment of Negative Symptoms (SANS) score from baseline to week 5. | 5 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in cognitive function as measured by change in MATRICS Consensus Cognitive Battery (MCCB) | This will be measured by the difference in MATRICS Consensus Cognitive Battery (MCCB) scores from baseline to week 5 | 5 weeks |