Aging, Frailty
Conditions
Keywords
Aging, Frailty, Microbiome, Treatment, Fecal Microbiota Transplantation
Brief summary
A severe public health issue facing global population is aging. Increasing preclinical and clinical data indicate the contribution of gut microbiome on aging and aging-related diseases such as cardiovascular disease, Alzheimer Disease, and diabetes. Interventions on microbiota are developed including prebiotics, probiotics, and fecal microbial transplantation (FMT). FMT via oral capsules also advances in recent with limited safety concerns compared with invasive routes. A hypothesis is thus raised that gut microbiome intervention via oral FMT can be a potential safe approach to encourage healthy aging, with multiple aspects evaluated for clinical phenotype of frailty, anthropometric measurement, cognitive function, cardiovascular aging, physical function, living activity, hippocampal volume, telomere length, cognitive biomarkers, inflammatory biomarkers, altered microbial composition and metabolites.
Detailed description
Objective: To explore the effect, safety and underlying mechanisms of gut microbiome intervention via FMT on aging. Study Design: A multi-center, randomized, blinded, placebo-controlled pilot study. Data quality control and statistical analysis: The investigators have invited professional statistic analysts to assist analyzing data and a third party to supervise data quality. Ethics: The Ethics Committee of Fuwai Hospital approved this study. Informed consents before patient enrollment are required.
Interventions
BIOLOGICALFMT capsules
FMT capsules containing extensively screened donor stool.
OTHERPlacebo capsules
Placebo capsules that do not contain donor stool or any active drug.
Sponsors
Chinese Academy of Medical Sciences, Fuwai Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
70 Years to 85 Years
Healthy volunteers
Yes
Inclusion criteria
1. Age 70-85 years. 2. Patients with informed consent after thorough explanation.
Exclusion criteria
1. Participants of other clinical trials; 2. Antibiotics or probiotics usage within last 4 weeks; 3. Severe hepatic or renal diseases ((ALT \>3 times the upper limit of normal value, or end stage renal disease on dialysis or eGFR \<30 mL/min/1.73 m2, or serum creatinine \>2.5 mg/dl \[\>221 μmol/L\]); 4. History of large atherosclerotic cerebral infarction or hemorrhagic stroke (not including lacunar infarction and transient ischemic attack \[TIA\]); 5. Hospitalization for myocardial infarction within last 6 months; Coronary revascularization (PCI or CABG) within last 12 months; Planned for PCI or CABG in the next 6 months; 6. NYHA class III-IV heart failure; Hospitalization for chronic heart failure exacerbation within last 6 months; 7. Severe valvular diseases; Potential for surgery or percutaneous valve replacement within the study period; 8. Dilated cardiomyopathy; Hypertrophic cardiomyopathy; Rheumatic heart disease; Congenital heart disease; 9. History of dementia, Parkinson's disease, intracranial infection, intracranial tumor, schizophrenia, anxiety, depression; 10. History of neurosurgical operation; 11. History of gastrointestinal tumor, gastrointestinal surgery, inflammatory bowel disease; Hospitalization for peptic ulcer disease exacerbation within last 6 months or anticipated hospitalization for peptic ulcer disease the next 6 months; 12. Hypertension with uncontrolled blood pressure ≥180/110mmHg; 13. Diabetes Mellitus with uncontrolled fasting glucose level ≥200mg/dl (11.1mmol/L), or HbA1C\>8%; 14. Addicted to alcohol; Use of medication influencing cognitive function(i.e., antihistamine, antipsychotic); 15. General anesthesia within last 3 months; 16. Other severe diseases influencing the entry or survival of participants, such as malignant tumor or acquired immune deficiency syndrome, life expectancy \<1 year; 17. Impaired verbal communication who are incapable of providing their own informed consent, or incapable of self-care; 18. Special diet influencing microbiota (i.e. vegetarian); 19. Other conditions inappropriate for recruitment according to the investigators.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of participants with reduced frailty score at week 96 follow-up | week 96 | Frailty score via CHS criteria of five frailty components, compared with baseline |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of participants with reduced frailty score at week 24 follow-up | week 24 | Frailty score via CHS criteria of five frailty components, compared with baseline |
| Proportion of participants with reduced frailty score at week 48 follow-up | week 48 | Frailty score via CHS criteria of five frailty components, compared with baseline |
| Proportion of participants with reduced frailty score at week 72 follow-up | week 72 | Frailty score via CHS criteria of five frailty components, compared with baseline |
| Change from baseline in Frailty score | week 12, week 24, week 48, week 72, week 96, compared with baseline | Frailty score via CHS criteria of five frailty components, ranging from 0 to 5, with higher score indicating worse outcome |
| Change from baseline in telomere length | week 48, week 96 | Change from baseline in telomere length |
| Change from baseline in Cognitive assessment via Mini Mental State Examination(MMSE) | week 24, week 48, week 72, week 96, compared with baseline | MMSE (Mini Mental State Examination) ranging from 0 to 30, with lower score indicating worse outcome |
| Change from baseline in Cognitive assessment via Montreal Cognitive Assessment(MoCA) | week 24, week 48, week 72, week 96, compared with baseline | MoCA (Montreal Cognitive Assessment) ranging from 0 to 30, with lower score indicating worse outcome |
| Change from baseline in Hippocampal volumes | week 48, week 96 | Hippocampal volumes evaluated by Magnet Resonance Imaging |
| Change from baseline in cognitive biomarkers | week 12, week 24, week 48, week 72, week 96 | plasma levels of cognitive biomarkers for BDNF、tau、Aβ-40、Aβ42 |
| Change from baseline in inflammatory biomarkers | week 12, week 24, week 48, week 72, week 96 | plasma levels of inflammatory biomarkers for hs-C-reactive protein (hs-CRP)、 interleukin 6(IL-6)、interleukin 1 β(IL-1 β) 、interleukin10 (IL-10)、tumor necrosis factor α(TNF-α) |
| Change from baseline in Intestinal Microbiota Composition Pre- and Post-intervention via Metagenomic Analysis | week 12, week 24, week 48, week 72, week 96 | Change in Intestinal Microbiota Composition Pre- and Post-intervention (FMT or Placebo) via Metagenomic Analysis, stratified by: 1. Randomisation 2. Change in Office SBP |
| Change from baseline in Intestinal Microbiota Function assessed by KEGG Orthology (KO) Pre- and Post-intervention via Metagenomic Analysis | week 12, week 24, week 48, week 72, week 96 | Change in Intestinal Microbiota Function assessed by KEGG Orthology (KO) Pre- and Post-intervention (FMT or Placebo) via Metagenomic Analysis, stratified by: 1. Randomisation 2. Change in Office SBP |
| Proportion of participants with reduced frailty score at week 12 follow-up | week 12 | Frailty score via CHS criteria of five frailty components, compared with baseline |
| Change from baseline in Ankle-Brachial Blood Pressure Index(ABI) | week 48, week 96 | Change for ABI as an objective measurement of arterial insufficiency based on the ratio of ankle systolic pressure to brachial systolic pressure. |
| Change from baseline in Pulse wave velocity(PWV) | week 48, week 96 | Change for Pulse wave velocity(PWV) |
| Number of Participants with Adverse Events (AEs) as a Measure of Safety | week 12, week 24, week 48, week 72, week 96 | Number of Participants with Adverse Events (AEs) as a Measure of Safety |
| Change from baseline in Body Mass Index (BMI) | week 4, week 8, week 12, week 24, week 48, week 72, week 96 | Change for Body Mass Index |
| Change from baseline in office SBP | week 4, week 8, week 12, week 24, week 48, week 72, week 96 | change for office systolic blood pressure(SBP) |
| Change from baseline in office DBP | week 4, week 8, week 12, week 24, week 48, week 72, week 96 | change for office diastolic blood pressure(DBP) |
| Change from baseline in Blood Lipid Level | week 12, week 24, week 48, week 96 | Change for Blood Lipid Level (Total Cholesterol, Total Triglyceride, Low Density Lipoprotein Cholesterol, High Density Lipoprotein Cholesterol) |
| Change from baseline in blood fasting glucose level | week 12, week 24, week 48, week 96 | Change for blood fasting glucose level |
| Change from baseline in blood HbA1c level | week 12, week 24, week 48, week 96 | Change for blood glycosylated hemoglobin, type A1C (HbA1c) level |
| Change from baseline in physical function assessment via 6MWT | week 12, week 24, week 48, week 72, week 96 | 6-minute walking test(6MWT) |
| Change from baseline in daily function assessment via Activity of Daily Living (ADL) | week 12, week 24, week 48, week 72, week 96 | Activity of Daily Living (ADL) ranging from 0 to 100, with lower score indicating worse outcome |
| Change from baseline in Plasma Metabolite Composition Pre- and Post-intervention via Metabolomic Analysis | week 12, week 24, week 48, week 72, week 96 | Change in Plasma Metabolite Composition Pre-and Post-intervention (FMT or Placebo) via Metabolomic Analysis |
Countries
China
Contacts
Primary ContactLuyun Fan, MD,PhD
Backup ContactJun Cai, MD,PhD
Outcome results
None listed