Fecal Microbial Transplant (FMT) for Sjogrens Syndrome

Study Overview
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Brief Summary
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This is an open label study to evaluate the effect of Fecal Microbiota Transplantation (FMT) on the gut microbiome and Systemic parameters.

Official Title
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Fecal Microbial Transplant for Sjogrens Syndrome

Conditions
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Sjogren's Syndrome

Intervention / Treatment
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* Drug: FMP-30


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Positive diagnosis of Sjogrens syndrome, defined by meeting two or more of the following three criteria: Positive serum anti-SS-A/Ro and/or anti-SS-B/La (or positive rheumatoid factor and ANA ≥ 1:320) Labial salivary gland biopsy exhibiting focal lymphocytic sialadenitis with a focus score ≥ focus/4 mm2 Keratoconjunctivitis sicca with ocular staining score ≥ 3 (assuming that individual is not currently using daily eye drops for glaucoma, and has not had corneal surgery or cosmetic eyelid surgery in the last 5 years) Or by both of the following: Positive antibodies to one of the early markers of Sjogrens Syndrome: Anti-salivary gland protein 1 (SP1) Anti-carbonic anhydrase 6 (CA6) Parotid secretory protein (PSP) Ocular staining score ≥ 3 Age ≥ 18 years at time of enrollment Able to provide signed and dated informed consent Women of child childbearing potential in sexual relationships with men must use an acceptable method of contraception§ from 30 days prior to enrollment until 4 weeks after completing study treatment. Males must agree to avoid impregnation of women during and for four weeks after completing study treatment through use of an acceptable method of contraception*. Includes, but is not limited to, barrier with additional spermicidal foam or jelly, intrauterine device, hormonal contraception (started at least 30 days prior to study enrollment), intercourse with men who underwent vasectomy. Includes, but is not limited to, barrier with additional spermicidal foam or jelly and vasectomy. Participant exclusion criteria Exclusion Criteria: Inability to provide informed consent and/or unable or unwilling to comply with protocol requirements. Antibiotics for at least 2 weeks prior to FMT. Active infection for >15 days: bacteremia, urinary tract infection, pneumonia or abdominal collection. Known or suspected toxic megacolon and/or known small bowel ileus. Previous FMT Major gastrointestinal surgery (e.g. significant bowel resection) within 3 months before enrollment. This does not include appendectomy or cholecystectomy. History of total colectomy or bariatric surgery. Antibiotics for the treatment of an active infection or anticipated antibiotic use during trial duration. Concurrent intensive induction chemotherapy, radiation therapy or biological treatment for active malignancy. Expected life expectancy < 6 months Patients with a history of severe anaphylactic or anaphylactoid food allergy. Solid organ transplant patients ≤ 90 days post-transplant or on active treatment for rejection. Neutropenia (<500 neutrophils/mL) or other severe immunosuppression. Patients on monoclonal antibodies to B and T cells, anti-tumor necrosis factor, glucocorticoids, antimetabolites, calcineurin inhibitors may be enrolled after consultation with their medical doctor. Renal failure (GFR <30 or dialysis) Human immunodeficiency virus+ controlled or not well controlled on antiretroviral therapy Regular probiotic supplement use within prior 2 weeks to enrollment Pregnancy or inability/unwillingness to use contraceptives. A condition that would jeopardize the safety or rights of the subject, would make it unlikely for the subject to complete the study, or would confound the results of the study. Exclusion on the discretion of the PI.

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: FMT for Sjogrens<br>FMT- active ingredient coming from participant's screening stool | Drug: FMP-30<br>* FMP-30 containing frozen human fecal microbiota administered as (3) units of FMP30 enema on Day 0 and Week1<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with reported adverse events (AEs) and serious adverse events (SAEs) | As an evaluation of the safety of FMT, the number of participants with reported AEs and SAEs will be collected. All occurrences of AEs and SAEs, regardless of relatedness to FMT, will be reported and assessed by the clinician using the NIH CTCAE. | 7 months | 
| Number of participants with stable microbiome engraftment | Engraftment will be analyzed via the Jensen-Shannon divergence (JSD). The engraftment scores will be the ratio between the donors and recipients at the bacterial genus level. Participants who successfully engraft will more closely resemble the donor microbial profile on JSD analysis. | month 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in dry eye symptoms | Dry eye symptoms will be measured by the Ocular Surface Disease Index (OSDI) Scale 0-100 Continuous with higher scores representing greater dry eye symptoms | baseline, 1 week, 1 month, 3 months | 
| Change in dry eye symptoms | Dry eye symptoms will be measured by the Dry Eye Questionnaire 5 (DEQ5) Scale Range 0-22 Continuous with a higher number representing greater symptomatology of dry eye | baseline, 1 week, 1 month, 3 months | 
| Change in diversity of bacterial communities | This will be captured via high-throughput 16S gene sequencing using DNA extracted from stool specimens in study participants. The Shannon diversity index will be used as our primary measure of diversity. | Pre FMT, 3 months post FMT | 
| Change in system immune profiles as measured by T cell populations | System immune profiles will be evaluated by completing a comprehensive immuno-phenotypic profile from blood samples evaluating T cell populations including Th1, Th17, and T regulatory cells. | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Change in ocular and systemic symptoms as measured by the quality of life SF-12 Questionnaire | Ranges 0-100 with higher scores representing a better quality of life | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Change in self-reported ocular pain as assessed by the Numerical Rating Scale(NRS) | NRS Scoring Ranges from 0-10 with 0=no pain sensation and 10=the most intense eye pain imaginable | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Change in self-reported ocular pain as assessed by the Short-form McGill Pain Questionnaire(SFM-PQ) | SFM-PQ Scoring Ranges from 0-45 with zero to 45 with a higher score indicating more server eye pain | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Change in self-reported ocular pain as assessed by the Neuropathic Pain Symptom Inventory (NPSI) | NPSI Scoring Ranges from 0-100 with the higher score indicating the worse pain imaginable. | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Depression as assessed by the Patient Health Questionnaire-9 (PHQ-9) | PHQ-9 scoring Ranges from 0-27 with the higher score indicating a greater degree of depression | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Depression as assessed by the Symptom Checklist 90 for Depression (SCL-90 Depression) | SCL-90 Depression scoring ranges from 0-4 with the higher score indicating a greater degree of depression. | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 
| Anxiety as assessed by the Symptom Checklist 90 for Anxiety (SCL-90 Anxiety) | SCL-90 Anxiety scoring ranges from 0-4 with the higher score indicating a greater degree of anxiety. | Pre-FMT, 1 Week, 1 Month, 3 months post FMT | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dry Eye, Auto-Immune Disorder