Intestinal Microbiome Composition in Infants With Biliary Atresia (BA)

Study Overview
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Brief Summary
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A prospective observational study in infants with biliary atresia and controls to determine whether the composition of the intestinal microbiome is specific for biliary atresia will be conducted. The hypothesis of the study is infants with biliary atresia have a unique microbiome signature at the time of diagnosis and changes in population dynamics occur during disease progression. The microbiome will be determined at diagnosis and at well-defined time points during the natural history of the disease.

Detailed Description
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Biliary atresia, the most common cause of neonatal cholestasis, results from a fibrosing and inflammatory obstruction of extrahepatic bile ducts of unknown etiology. Infants with neonatal cholestasis will be enrolled at the time of diagnosis. Those that undergo exploratory laparotomy and are diagnosed with biliary atresia will form the biliary atresia. The development of the normal bacterial flora is a dynamic process that varies in early postnatal ages and may be influenced by disease states. To control for age differences, the composition of the microbiome in subjects with other causes of neonatal liver diseases (non-biliary atresia or disease-controls) and age-matched healthy subjects (normal controls) will be determined. Subjects with biliary atresia will be enrolled at diagnosis, at which time a stool sample and a 2 mL blood sample will be obtained. Thereafter, a stool sample will be obtained at 3±1 months after hepatoportoenterostomy (HPE) and at 24±6 months of age. A stool sample and a 2 ml blood sample will also be obtained if/when subjects are admitted to the hospital for an evaluation and treatment of presumed infection (example: ascending cholangitis) and at the time of liver transplantation. Similar samples will also be obtained from healthy subjects (normal controls) and patients diagnosed with other cholestatic syndromes (non-biliary atresia or disease-controls) at ages that match those of subjects with biliary atresia. Samples will be used for bacterial DNA isolation, which will be used for bacterial and mammalian gene sequencing using next-generation sequencing methods, followed by statistical analysis to identify unique microbiome compositions or alterations that are associated with particular disease (biliary atresia or non-BA controls) or clinical outcomes including response to HPE, ascending cholangitis and progression of liver disease.

Official Title
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Intestinal Microbiome Composition in Infants With Biliary Atresia

Conditions
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Biliary Atresia, Intrahepatic Cholestases, Normal Controls

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: -Birth to 5 months Disease state: Must meet either (a), (b), or (c) for eligibility. a) Biliary atresia: Conjugated hyperbilirubinemia (serum direct bilirubin > 1mg/dL) AND demonstration of obstruction of extra hepatic bile ducts by examination of histological sections of extra hepatic bile ducts b) Neonatal cholestasis secondary to other causes of liver disease: Diagnosis of liver disease caused by syndromes of intrahepatic cholestasis with or without hyperbilirubinemia c) Normal controls: No acute or chronic liver related illness Signed informed consent/assent Exclusion Criteria: Evidence of multi-organ system failure (e.g. combined liver and kidney failure) For subjects < 5 months old, treatment with antibiotics prior to enrollment into study

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 2 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Biliary atresia<br>Biliary atresia is an obstructive cholangiopathy of infancy. It is the most common cause of neonatal cholestasis and the most frequent indication for liver transplantation in children. Patients with biliary atresia have conjugated hyperbilirubinemia (serum direct bilirubin > 1mg/dL) AND are scheduled for/undergo exploratory laparotomy for diagnosis and Kasai portoenterostomy for surgical treatment of BA. | |
| Non-BA=disease controls<br>All infants with other cholestatic syndromes (except biliary atresia) will be eligible for study enrollment in disease controls/non-biliary atresia. This involves the diagnosis of liver diseases caused by syndromes of intrahepatic cholestasis with or without hyperbilirubinemia. | |
| Normal<br>All healthy infants with no acute or chronic liver related illness. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in intestinal microbiome signature. | Change in intestinal microbiome signature at the time of diagnosis of biliary atresia (up to 3 months of age/ at HPE) as compared with disease control and normal. | Through study completion, an average of 24 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Microbiome signature and serum direct/ conjugated bilirubin. | Correlation between the microbiome signature and normalization of serum direct/ conjugated bilirubin 3months after HPE. | Through study completion, an average of 24 months. | 
| Microbiome signature and survival at 1 yr of age. | Correlation between the microbiome signature and survival with the native liver at 1 yr of age. | Through study completion, an average of 36 months. | 
| Microbiome signature and survival at 2 yr of age. | Correlation between the microbiome signature and survival with the native liver at 2 yr of age. | Through study completion, an average of 48 months. | 
| Microbiome signature and ascending cholangitis. | Change in intestinal microbiome signature specific for ascending cholangitis up to and include 2 yr of age. | Through study completion, an average of 48 months. | 
| Change in microbiome signature and liver transplant. | Change in microbiome signature specific for end-stage liver disease (liver transplant) up to and include 2 yr of age.. | Through study completion, an average of 48 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Microbiome