Evaluating the Safety and Efficacy of Oral Encapsulated Microbiota Transplantation Therapy in Peanut Allergic Patients

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

37 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-06-08

Study Completion Date

2027-03-01

Brief Summary

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This is a phase II trial that aims at evaluating the safety and tolerability of oral encapsulated fecal microbial transplantation therapy (MTT) in peanut allergic patients. In this research the investigators would like to learn more about ways to treat peanut allergies. The primary objective for Part A is to evaluate whether MTT with antibiotic pretreatment can increase the threshold of peanut reactivity during a double-blind placebo-controlled food challenge from \<=100 mg peanut protein to 300 mg after 28 days of MTT /placebo therapy and 4 months post therapy initiation. The primary objective for Part B is to evaluate whether MTT with antibiotic pretreatment can lead to sustained unresponsiveness (SU) defined as tolerating the same dose of peanut protein administered during a food challenge at baseline and 12 weeks after OIT cessation.

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Detailed Description

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Part A is a This is a phase II randomized double-blind placebo-controlled arm trial that aims at evaluating the efficacy and safety and tolerability of microbial transplantation therapy (MTT) in peanut allergic patients. After reacting to \<=100 mg peanut protein during initial DBPCFC, patients will be randomized to receive either oral Vancomycin and Neomycin or placebo/placebo for 7 days. Patients will then come to the Experimental and Therapeutic Unit (ETU) to receive orally 5 capsules of MTT or placebo under medical supervision. Patients will then take 5 capsules of MTT or placebo the next day then 2 capsules daily for 26 days. Patients will return to the ETU to undergo a second DBPCFC within 2 weeks of end of MTT/placebo treatment and 4 months post MTT initiation. They will return to the ETU for an exit visit 6 months after end of treatment. Gut microbiota will be analyzed serially using state-of-the-art 16SRNA sequencing prior to transplantation, then at 4 weeks, 4-month, and 6 months post transplantation. Immunological biomarkers and mechanistic studies will be performed on blood taken at baseline, second DBPCFC visit and exit visit. Adverse events will be monitored carefully throughout the study.

Part B is an open label phase II arm that aims at evaluating the role of MTT in sustained unresponsiveness. Patients who are on maintenance peanut oral immunotherapy (OIT) for a year will be enrolled. They will undergo an open label oral food challenge (OFC) to determine their threshold tolerated dose, after which they will start a week of antibiotics (Vancomycin and Neomycin). Patients will receive their 4 oral capsules of MTT under medical supervision, take another 4 capsules the next day then will start 2 capsules per day for a total of 12 weeks of MTT therapy , all while continuing maintenance peanut OIT. At the end of this course, patients will undergo another open label OFC to evaluate for any change in their tolerated dose . Subjects will then stop OIT and MTT for 12 weeks and will come back for a third OFC to evaluate for any change in their tolerated dose. An exit visit will occur 6 months post end of treatment.

Gut microbiota will be analyzed serially using state-of-the-art 16SRNA sequencing at baseline, post antibiotics (and prior to MTT initiation), then at 4, 8, 12, 16, 20 and 24 weeks post MTT initiation. Immunological biomarkers and mechanistic studies will be performed on blood taken at baseline, second and third OFC and exit visit. Adverse events will be monitored carefully throughout the study.

Conditions

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Allergy, Peanut Peanut Allergy Peanut Hypersensitivity Peanut-Induced Anaphylaxis Food Allergy Food Allergy Peanut

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

All individuals enrolled in Part A of the study patients will be randomized on a 1:1 ratio to receive either MTT with antibiotics (arm 1) or placebo/placebo (arm 2). The unblinding will occur at the end of the study.

All individuals enrolled to Part B of the study (arm 3) will receive open label MTT and antibiotics.

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Double blind

Study Groups

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PART A: antibiotic / MTT

Study subjects randomized to the experimental arm will receive oral antibiotics for 7 days as a way to modulate the composition of the gastrointestinal microbiota.

Upon completion of oral antibiotics, subjects randomized to the experimental arm will be administeredf MTT under medical supervision. Subjects will be monitored and then discharged. Subjects will be instructed to take MTT capsules daily for 27 days.

Group Type EXPERIMENTAL

Microbial Transplantation Therapy

Intervention Type BIOLOGICAL

Participants randomized to the MTT/antibiotic arm of PART A will be administered oral MTT capsules over the course of 28 days.

Participant enrolled on PART B will be administered oral MTT capsules over the course of 28 days.

Antibiotic

Intervention Type DRUG

Participants randomized to the MTT/antibiotic arm of PART A will receive oral antibiotics for 7 days prior to the MTT administration visit.

Participant enrolled on PART B will receive oral antibiotics for 7 days prior to the MTT administration visit.

PART A: placebo / placebo

Study subjects randomized to the placebo arm will receive oral placebo capsules instead of oral antibiotics, for 7 days, at the same frequency and capsule amount per dose.

Upon completion of 7 days of placebo (matching the antibiotics given in the experimental arm), subjects randomized to the placebo arm will be administered capsules of placebo (matching the MTT capsules given in the experimental arm) under medical supervision. Subjects will be monitored and then discharged. Subjects will be instructed to take placebo capsules daily for 27 days.

Group Type ACTIVE_COMPARATOR

Placebo (in place of MTT)

Intervention Type OTHER

Participants randomized to the placebo arm of PART A will be administered oral placebo capsules in place of MTT over the course of 28 days.

Placebo (in place of antibiotics)

Intervention Type OTHER

Participants randomized to the placebo arm of PART A will receive oral placebo in place of antibiotics for 7 days prior to the MTT administration visit.

PART B: open label antibiotic / MTT

In Part B will enroll 13 participants who are peanut allergic and are on maintenance peanut oral immunotherapy (OIT). Participants will undergo an open label food challenge (OFC) up to 2,000 mg peanut protein. These participants will be pre-treated with open label oral Vancomycin and Neomycin over 7 days prior to receiving open label MTT. This part of the study is not randomized or double blind.

Group Type OTHER

Microbial Transplantation Therapy

Intervention Type BIOLOGICAL

Participants randomized to the MTT/antibiotic arm of PART A will be administered oral MTT capsules over the course of 28 days.

Participant enrolled on PART B will be administered oral MTT capsules over the course of 28 days.

Antibiotic

Intervention Type DRUG

Participants randomized to the MTT/antibiotic arm of PART A will receive oral antibiotics for 7 days prior to the MTT administration visit.

Participant enrolled on PART B will receive oral antibiotics for 7 days prior to the MTT administration visit.

Oral Immunotherapy (OIT)

Intervention Type OTHER

Participant enrolled on PART B will be on maintenance peanut oral immunotherapy (OIT) for their clinical care.

Interventions

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Microbial Transplantation Therapy

Participants randomized to the MTT/antibiotic arm of PART A will be administered oral MTT capsules over the course of 28 days.

Participant enrolled on PART B will be administered oral MTT capsules over the course of 28 days.

Intervention Type BIOLOGICAL

Antibiotic

Participants randomized to the MTT/antibiotic arm of PART A will receive oral antibiotics for 7 days prior to the MTT administration visit.

Participant enrolled on PART B will receive oral antibiotics for 7 days prior to the MTT administration visit.

Intervention Type DRUG

Placebo (in place of MTT)

Participants randomized to the placebo arm of PART A will be administered oral placebo capsules in place of MTT over the course of 28 days.

Intervention Type OTHER

Placebo (in place of antibiotics)

Participants randomized to the placebo arm of PART A will receive oral placebo in place of antibiotics for 7 days prior to the MTT administration visit.

Intervention Type OTHER

Oral Immunotherapy (OIT)

Participant enrolled on PART B will be on maintenance peanut oral immunotherapy (OIT) for their clinical care.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Develop dose limiting symptoms to peanut during a DPBCFC conducted in accordance with PRACTALL (Practical Issues in Allergology, Joint United States/European Union Initiative) guidelines at 1 mg, 3 mg, 10 mg, 30 mg, or 100 mg peanut protein (Part A only).
2. Has a positive SPT to peanut (≥3mm) and/or a positive peanut-specific IgE \>0.35kU/L (Part A only).
3. For asthmatic patients, has a Spirometry or Peak Flow with Measurement of FEV1\>=80% of predicted
4. Has a negative urine hCG test if a female participant.
5. Agrees to use an acceptable single-barrier form of birth control from enrollment through the exit DBPCFC study visit if female of childbearing potential and sexually active. An example of a single-barrier method of contraception includes condoms or oral contraceptives. Acceptable methods of birth control include implants, injectables, combined oral contraceptives, some intrauterine contraceptive devises (IUDs), sexual abstinence, a vasectomized partner, the contraceptive patch, the contraceptive ring, and condoms.
6. Able to swallow 2 empty capsules size 00.
7. Able to give informed assent and guardian willing to give informed consent.
8. Willing and able to participate in the study requirements, including study visits, food challenges, serial stool collection
9. Willing to undergo telephone or email follow-up to assess for safety and adverse events.
10. Subject has been on maintenance peanut oral immunotherapy for at least a year (part B only).

Exclusion Criteria

1. Patients with a history of severe anaphylaxis to any food (hypotension requiring vasopressor support, hypoxia requiring mechanical ventilation, or neurological compromise)
2. For Part A, patients with current diagnosis of an IgE mediated reactions to food (excluding allergic reactions to peanut, tree nuts, egg and milk, provided that MTT does not contain traces of these food estimated to be above the LOAEL in 5 capsules combined, and excluding oral allergy syndrome, and excluding other foods that the MTT donor avoided)
3. For Part B, patients with current diagnosis of an IgE mediated reactions to food (excluding allergic reactions to peanut, tree nuts, egg and milk, provided that MTT does not contain traces of tree nuts, egg and milk estimated to be above the LOAEL in 4 capsules, and excluding oral allergy syndrome, excluding the food that the patient is undergoing immunotherapy to, and excluding other foods that the MTT donor avoided).
4. Patients with chronic illness other than controlled asthma that is mild intermittent, mild- persistent or moderate persistent, mild eczema and allergic rhinitis. Exceptions can be made per PI discretion if illness is not expected to affect allergies or treatment.
5. Recurrent or chronic infections necessitating frequent systemic (including oral) antibiotic administration.
6. Patients on chronic systemic immunosuppressive therapies.
7. Patients who are diagnosed with active, chronic urticaria.
8. Patients who have received peanut oral immunotherapy within the past 6 months (Part A only).
9. Patients who are on the up-dosing phase of aeroallergen immunotherapy or patients who have received Omalizumab or dupilumab therapy within the past 6 months.
10. Women who are pregnant or breast feeding or planning to get pregnant during the time of the study.
11. Sexually active female patients who refuse to use contraception from enrollment through the third DBPCFC study visit
12. Patient with GI conditions including inflammatory bowel disease, eosinophilic esophagitis, food protein induced enterocolitis, uncontrolled reflux despite medication, uncontrolled chronic constipation despite medication, esophageal dysmotility, swallowing dysfunction, delayed gastric emptying syndromes, pill esophagitis or history of aspiration pneumonia within 3 months prior to screening.
13. Patient with current rheumatologic conditions. Exceptions can be made per PI discretion if illness is not expected to affect allergies or treatment.
14. Patients with neutropenia \<1000 cells/uL
15. Patients participating or planning to participate in the next 6 months in interventional research trials. Exceptions can be made per PI discretion.
16. Patients who have received systemic corticosteroids therapy for 1 week or more over the past 60 days.
17. Patient with an allergy to Vancomycin or Neomycin or any component to the capsules.

Minimum Eligible Age

12 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No