The Impact of Cranberries On the Microbiome and the Brain in Healthy Ageing sTudy (COMBAT)

Study Overview
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Brief Summary
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Tremendous progress has been made in characterizing the interactions between the central nervous system and the gastrointestinal tract. This concept of a gut-brain axis suggests that influencing bacteria in the gut is a promising approach for developing new ways of benefiting brain function. This is particularly relevant for an ageing population for which cognitive decline is a common symptom and can be an indicator for the development of neurodegenerative conditions such as dementia. There is good evidence already that nutrition can delay the development of cognitive decline in ageing, in particular for ageing-sensitive brain regions such as the medial temporal lobe, however this has been little explored for cranberry intake. Cranberries are high in plant-derived nutrients called polyphenols, which have been suggested to promote brain function and protect against disease-causing mechanisms. In the proposed project we will pioneer work to investigate the impact of cranberry intake on gut bacteria and how it relates to cognitive performance in ageing and associated regions in the brain. This study is being conducted by Chief Investigators Dr David Vauzour and Prof Michael Hornberger at the University of East Anglia. Sixty participants (i.e. n=30 control and treatment groups) aged 50-80 years old, with no memory complaints will be recruited for this 12-week double-blind placebo-controlled parallel intervention of cranberry flavonoids. Freeze-dried cranberry or a matched placebo will be taken twice daily for the duration of the trial. Blood, urine and faecal samples will be collected for microbiome, DNA, biochemical and nutritional analysis. Participants will also undergo cognitive testing, as well as MRI scanning to detect changes in brain physiology.

Official Title
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The Impact of Cranberries on the Microbiome and the Brain in Healthy Ageing: A Feasibility Intervention

Conditions
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Aging, Cognitive Decline

Intervention / Treatment
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* Dietary Supplement: Freeze-Dried Cranberry Powder
* Dietary Supplement: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged between 50 and 80 years old. Willing and able to provide written informed consent. Fluent in written and spoken English. Normal or corrected to normal vision and hearing. Understands and is willing and able to comply with all study procedures. Exclusion Criteria: Diagnosis of any form of dementia or significant neurological condition. Significant memory complaints. Past history or MRI evidence of brain damage, including significant trauma, stroke, learning difficulties or serious neurological disorder, including a loss of consciousness for more than 24 hours. Currently smoking or ceased smoking less than 6 months ago. Chronic fatigue syndrome, liver disease, diabetes mellitus, or gall bladder abnormalities. History of alcohol or drug dependency. Clinically diagnosed psychiatric disorder. Existing diagnosed gastrointestinal disorders likely to impact on absorption of flavonoids. Known allergy to the intervention supplement. Any significant medical condition likely to affect participation. Currently a participant or have been a participant in any other study involving an investigational product within the last 4 weeks. Uncontrolled hypertension (systolic blood pressure >140mmHg, diastolic blood pressure >90mmHg). Major cardiovascular event, such as myocardial infarction, within the last 12 months. On a stable prescription of blood pressure lowering medication or non-steroidal anti-inflammatory drugs. for fewer than 2 months. Prescribed anti-coagulant/blood thinning medication (eg. warfarin). Taking flavonoid containing supplements (and unwilling to cease intake during, and 1 month preceding the trial) or unwilling to maintain existing intake of other supplements. High flavonoid intake defined as > 15 portions of flavonoid rich foods per day Are currently taking medication or supplements which have a significant impact on the outcome measures. In addition, any participants with claustrophobia will not be invited to participate in the neuroimaging component of the study. Likewise for metal implants, e.g. pacemaker that precludes MRI.

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Double-blind placebo-controlled parallel intervention
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active Cranberry Study Food<br> | Dietary Supplement: Freeze-Dried Cranberry Powder<br>* Freeze-dried cranberry powder (or matched placebo), approximating 500mg active flavonoids per day, taken twice daily for 12 weeks.<br>|
| Placebo Comparator: Placebo Study Food<br> | Dietary Supplement: Placebo<br>* Placebo food powder matched for taste, colour, energy and macronutrient content to the active cranberry powder.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gut microflora speciation and metabolism | Measured in faecal and serum samples. | 12 weeks | 
| Change in volumes of hippocampus and other key brain structures | Structural magnetic resonance imaging | 12 weeks | 
| Change in cerebrovascular blood flow | Measured using spectroscopy | 12 weeks | 
| Change in global cognition | Global cognition to be measured using the Addenbrooke's Cognitive Examination - III, from 0-100, with higher scores indicating better global cognitive performance. | 12 weeks | 
| Change in spatial navigation abilities | The Supermarket Test, with outcomes including accurate reporting of starting direction, and accurate indication of end position and direction. | 12 weeks | 
| Change in executive function and attention | Trail Making Test, with scores including time taken to complete and number of errors made. | 12 weeks | 
| Change in memory performance | The Rey Complex Figure Test, with outcomes including time taken to complete copy, accuracy out of a possible 36 of copy and accuracy out of 36 of 3-minute recall. | 12 weeks | 
| Change in spatial navigation abilities | SeaHero Quest Test, with outcomes including time taken to complete, accuracy of path taken and number of errors made. | 12 weeks | 
| Change in executive function and attention | Digit Span Backwards, scored out of a possible 14 for numbers recited backwards in the correct order. | 12 Weeks | 
| Change in presence of circulating inflammatory biomarkers (hs-CRP) | Blood samples analysed for presence of inflammatory cytokines | 12 weeks | 
| Change in circulating biomarkers of neuronal functioning and cognitive decline (BDNF) | Blood samples analysed for presence of circulating biomarkers of neural function | 12 weeks | 
| Change in circulating biomarkers of lipid metabolism (total-, HDL-, LDL-cholesterol) | Blood samples analysed for presence of circulating biomarkers of lipid metabolism | 12 weeks | 
| Change in circulating biomarkers of lipid metabolism (triglycerides) | Blood samples analysed for presence of circulating biomarkers of lipid metabolism | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in energy expenditure and sleep | Actigraphs to be used to measure changes in activity and sleep patterns of participants. | 12 weeks | 
| Genetics related to neurodegenerative disease | Blood samples to be analysed for genes associated with neurodegenerative disease and dementia (eg. C9ORF72, APOE-4) | Baseline | 
| Biomarkers of gut permability and endotoxemia (LPS) | Blood serum/plasma samples to be analysed for presence of lipopolysaccharide (LPS) as a biomarker of gut permability and possible endotoxemia | 12 weeks | 
| Levels of sunlight exposure | Self-reported levels of daily sunlight exposure to be measured using a brief questionnaire | Baseline, Follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cognition, Ageing, Nutrition, Microbiome, Flavonoids