Probiotics for Vascular Inflammation in Metabolic Syndrome

Study Overview
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Brief Summary
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Subjects with metabolic syndrome are known to possess chronic low-level inflammation. Furthermore, such individuals are at risk of developing atherosclerosis in coronary and other vascular beds. In particular, subjects with metabolic syndrome, prediabetes and type II diabetes mellitus were shown to possess vascular inflammation in carotid atherosclerosis as demonstrated using FDG-PET. In the current pilot proposal, the investigators wish to study the impact of 3-month probiotic supplementation on vascular and systemic inflammation in subjects with metabolic syndrome in the context of a randomized, placebo-controlled, pilot trial.

Official Title
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Probiotics for Vascular Inflammation in Metabolic Syndrome (PROMISE): a 12-Week Pilot Study, Randomized,Double-Blinded, Placebo-Controlled Trial

Conditions
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Metabolic Syndrome

Intervention / Treatment
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* Dietary Supplement: Probiotic supplement
* Dietary Supplement: Placebo supplement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female age > 50 years Presence of MetS as defined according to recent updated criteria (13): Presence of at least three of five criteria, namely abdominal obesity (waist circumference cut-off) depending on the recently published ethnic-based variations (14), triglycerides > 1.70 mmol/l, decreased HDL-cholesterol (< 1.0 mmol/l in men and < 1.3 mmol/l in women), systolic blood pressure > 130 mmHg or diastolic blood pressure > 85 mmHg, and FPG > 5.6 mmol/l. Willingness to complete questionnaires, records, and diaries associated with the study and to complete all clinic visits. Willingness to discontinue consumption of fermented foods or probiotics (e.g. yoghourts, with live, active cultures or supplements). Able to provide informed consent. Exclusion Criteria: Concurrent consumption of fermented foods or probiotics (e.g. yoghourts, with live, active cultures or supplements). Subjects will be eligible for participation, however, after a two-week washout period Overt or documented vascular disease (coronary heart disease, cerebrovascular disease, or peripheral vascular disease). Participants suffering from dementia (mini mental state examination) or depression (geriatric depression scale). Concurrent statin therapy. (Statins have been shown to reduce vascular inflammation as measured by FDG-PET-see section 9.1). Color blind Concurrent antibiotic therapy. However, screened participants would be eligible to participate two weeks after completing their course of antibiotics (wash-out period). Known to be pregnant or breast-feeding or planning on becoming pregnant in the next 18 months. Women of childbearing potential not using effective contraception. Acceptable methods of birth control includes: Hormonal contraceptives including combined oral contraceptives, hormone birth control patch, vaginal contraceptive ring, injectable contraceptives, or hormonal implants; Intrauterine devices (IUD) or Intrauterine system (IUS); Tubal ligation; Vasectomy of partner; Double barrier method (use of physical barrier by both partners, e.g. male condom and diaphragm, male condom and cervical cap). Positive pregnancy test in women of childbearing potential. Allergy to milk, soy, or yeast. Use of another investigational product within 3 months of the screening visit. Claustrophobia Patient with pacemaker Patient with BMI greater than 40 kg/m2 Immune disorder. Drug and alcohol abuse Current use of NSAIDs Liver and kidney disorders Bleeding/blood disorder

Ages Eligible for Study
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Minimum Age: 50 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Probiotics arm<br>The active comparator arm will be of a 12-week probiotic supplement regimen (one capsule daily, containing 20 x 109 CFU of Bifidobacterium animalis ssp. Lactis Lafti®B94 and Lactobacillus plantarum R1012) | Dietary Supplement: Probiotic supplement<br>* Probiotic supplement once daily (xyz) for 12 weeks<br>|
| Placebo Comparator: Placebo arm<br>The placebo comparator arm will be of a 12-week placebo supplement regimen. | Dietary Supplement: Placebo supplement<br>* Placebo supplement once daily for 12 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome is to evaluate the change on vascular inflammation (measured by FDG-PET), so as to test the hypothesis that probiotic treatment reduces vascular inflammation in comparison to placebo. | PET-CT scan of the carotid arteries and ascending thoracic aorta will be performed 2 hours post I.V. The participant will be injected with 18F-FDG. | At baseline and following 12 weeks of probiotic supplementation or placebo. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mesure of High-sensitivity C-reactive protein (hs-CRP) a systemic inflammatory marker. | Change with hs-CRP | At baseline and following 12 weeks of probiotic supplementation or placebo. | 
| Mesure of Tumor necrosis factor alpha (TNF-α) a systemic inflammatory marker. | Change with TNF-α | At baseline and following 12 weeks of probiotic supplementation or placebo. | 
| Mesure of Matrix metallopeptidase 9 (MMP-9) | Change with MMP-9 | At baseline and following 12 weeks of probiotic supplementation or placebo. | 
| Cognitive function at rest by a standard pen-paper battery test. | Cognitive functions will be measured at rest with a pen-paper battery test by a neuropsychologist. The investigators will measure change of score to the cognitive tests. | At baseline and following 12 weeks of probiotic supplementation or placebo. | 
| Intestinal microbiota community composition | To evaluate the impact on intestinal microbiota community composition | At baseline and following 12 weeks of probiotic supplementation or placebo. |