FOCUSED: A Clinical Trial of Fecal Microbiota Transplantation in a Population With Obsessive-compulsive Disorder
Study Details
Study Description
Brief Summary
Obsessive-compulsive disorder (OCD) is a psychiatric condition marked by recurrent intrusive thoughts (obsessions) and ritualistic behaviors aimed at reducing distress (compulsions). While there exist a number of medications to treat this illness, half of those who need them either do not respond or can not tolerate current medications because of side effects. Therefore, there is an urgent need to develop new ways to treat this illness. One of the areas being explored as a potential option is based on what is now known as a strong link between the bacteria that live in our gut and the brain. Research has shown that a fecal transplant of the gut bacteria from healthy donors is able to improve health outcomes for people with depression and the investigators now want to expand this into OCD, given a known link between this condition and bacterial infection. To do this the investigators will use both the standard methods of bacterial identification via stool analysis, which looks at large bowel changes, and compare it to the Small Intestine Microbiome Aspiration (SIMBA) system, a small capsule that when swallowed allows a fluid sample to be collected from the participants' small intestine. This work will help the investigators assess the benefits of fecal transplant in OCD, and more importantly, identify how transplant changes the system, utilizing a novel technology to move the field forward.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: FMT capsule + SIMBA Capsule adults with OCD who are being treated with an approved first line treatment for OCD medication will be assigned to receive FMT capsules as an adjunct treatment. |
Combination Product: FMT Capsule + SIMBA Capsule
Participants in this arm will receive FMT capsules in addition to their usual treatment. participants will also be administered SIMBA sample collection capsules.
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Outcome Measures
Primary Outcome Measures
- Adverse Events [0-13 weeks]
Reported Adverse events
- Toronto Side Effects Scale (TSES) [0-13 weeks]
Changes in the Toronto Side Effects Scale (TSES). TSES a 32-item instrument used to evaluate the incidence, frequency, and severity of the central nervous system (CNS), gastrointestinal (GI), and sexual side effects.
Secondary Outcome Measures
- Global function/overall improvement (Quick Inventory of Depressive Symptomatology-Self-Report (QIDS)) [0-13 weeks]
Quick Inventory of Depressive Symptomatology-Self-Report (QIDS). is a 16-item questionnaire that rates depression symptoms via self-assessment. Toral score is calculated but summing the scores of each of the 16 different questions. 0-5 Normal, 6-10 mild depression, 11-15 Moderate depression, 16-20 Severe depression and >21 is considered very severe depression.
- Global function/overall improvement (The General Anxiety Disorder-7 scale (GAD-7)) [0-13 weeks]
The General Anxiety Disorder-7 scale (GAD-7). The 7-item tool is used to screen and assess for generalized anxiety. Score 0-4: Minimal Anxiety, Score 5-9: Mild Anxiety, Score 10-14: Moderate Anxiety and Score greater than 15: Severe Anxiety
- Global function/overall improvement (Positive and Negative Affect Schedule (PANAS)) [0-13 weeks]
Positive and Negative Affect Schedule (PANAS). The PANAS is a self-report questionnaire that consists of two 10-item scales and measures both positive and negative emotions for participants. The total score is calculated by finding the sum of the 10 positive items, and then the 10 negative items. Scores range from 10 - 50 for both sets of items. higher score indicates more positive or negative affect respectively.
- Global function/overall improvement (Patient Health Questionnaire-9(PHQ9)) [0-13 weeks]
Patient Health Questionnaire-9(PHQ9). The PHQ9 is used for screening and measuring the severity of depressive symptoms. The total score is the sum the numbers of all the checked responses under each heading. Cut off scores are: 0 - 4 None, 5 - 9 Mild, 10 - 14 Moderate, 15 - 19 Moderately Severe and 20 - 27 Severe.
- OCD symptoms (Y-BOCS) [0-13 weeks]
Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Total scores range from 0 to 40. 0-7 indicates subclinical symptoms, 8-15 mild symptoms, 16-23 moderate symptoms, 24-31 severe symptoms and 32-40 extreme symptoms
- OCD symptoms (TOCS) [0-13 weeks]
Toronto Obsessive-Compulsive Scale (TOCS). TOCS is a 21 item self-reported questionnaire that assesses several major symptom dimensions in OCD. A total score is calculated by adding each score of the 21 items, and dimension scores are calculated by averaging the sum of item scores within each dimension.
- Next generation fecal, Urine, Blood and saliva sequencing [0-13 weeks]
analysis of Fecal, urine, blood and saliva samples
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adults who have a primary diagnosis of OCD
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on a stable appropriate dose of (SSRI) treatment for at least 12 weeks prior to Baseline
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insufficient response to current SSRI treatment indicated by persistence of symptoms.
Exclusion Criteria:
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Participant meets Diagnostic criteria for substance use, eating disorder, schizophrenia, or schizoaffective disorder
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Suicidality
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regular intake of antibiotics, prebiotics, or probiotics
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Clinically diagnosed with IBD, Crohn's disease, Ulcerative colitis, or Celiac disease
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Immune suppression
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intestinal obstruction
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Oropharyngeal dysphagia or other swallowing disorder
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< 2 bowel movements per week
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Breastfeeding, pregnant or seeking to get pregnant during the course of this study
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | University of Calgary, TRW building | Calgary | Alberta | Canada | T2N 4Z6 |
Sponsors and Collaborators
- Valerie Taylor
- Nimble Science Ltd.
- University of Calgary
Investigators
- Principal Investigator: Valere Taylor, MD,PhD,FRCPC, Professor, Head of Department
Study Documents (Full-Text)
None provided.More Information
Publications
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- Dickerson FB, Stallings C, Origoni A, Katsafanas E, Savage CL, Schweinfurth LA, Goga J, Khushalani S, Yolken RH. Effect of probiotic supplementation on schizophrenia symptoms and association with gastrointestinal functioning: a randomized, placebo-controlled trial. Prim Care Companion CNS Disord. 2014;16(1):PCC.13m01579. doi: 10.4088/PCC.13m01579. Epub 2014 Feb 13.
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- Girard SA, Bah TM, Kaloustian S, Lada-Moldovan L, Rondeau I, Tompkins TA, Godbout R, Rousseau G. Lactobacillus helveticus and Bifidobacterium longum taken in combination reduce the apoptosis propensity in the limbic system after myocardial infarction in a rat model. Br J Nutr. 2009 Nov;102(10):1420-5. doi: 10.1017/S0007114509990766. Epub 2009 Jun 29.
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- Grace E, Shaw C, Whelan K, Andreyev HJ. Review article: small intestinal bacterial overgrowth--prevalence, clinical features, current and developing diagnostic tests, and treatment. Aliment Pharmacol Ther. 2013 Oct;38(7):674-88. doi: 10.1111/apt.12456. Epub 2013 Aug 20.
- Liu HN, Wu H, Chen YZ, Chen YJ, Shen XZ, Liu TT. Altered molecular signature of intestinal microbiota in irritable bowel syndrome patients compared with healthy controls: A systematic review and meta-analysis. Dig Liver Dis. 2017 Apr;49(4):331-337. doi: 10.1016/j.dld.2017.01.142. Epub 2017 Jan 21.
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- Luna RA, Foster JA. Gut brain axis: diet microbiota interactions and implications for modulation of anxiety and depression. Curr Opin Biotechnol. 2015 Apr;32:35-41. doi: 10.1016/j.copbio.2014.10.007. Epub 2014 Nov 21.
- Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, Bisson JF, Rougeot C, Pichelin M, Cazaubiel M, Cazaubiel JM. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011 Mar;105(5):755-64. doi: 10.1017/S0007114510004319. Epub 2010 Oct 26.
- O'Hara AM, Shanahan F. The gut flora as a forgotten organ. EMBO Rep. 2006 Jul;7(7):688-93. doi: 10.1038/sj.embor.7400731.
- Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, Logan AC. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Gut Pathog. 2009 Mar 19;1(1):6. doi: 10.1186/1757-4749-1-6.
- Sullivan A, Nord CE. Probiotics and gastrointestinal diseases. J Intern Med. 2005 Jan;257(1):78-92. doi: 10.1111/j.1365-2796.2004.01410.x.
- Wlodarska M, Kostic AD, Xavier RJ. An integrative view of microbiome-host interactions in inflammatory bowel diseases. Cell Host Microbe. 2015 May 13;17(5):577-91. doi: 10.1016/j.chom.2015.04.008.
- Zhong L, Shanahan ER, Raj A, Koloski NA, Fletcher L, Morrison M, Walker MM, Talley NJ, Holtmann G. Dyspepsia and the microbiome: time to focus on the small intestine. Gut. 2017 Jun;66(6):1168-1169. doi: 10.1136/gutjnl-2016-312574. Epub 2016 Aug 3. No abstract available.
- NIM-FMT/OCD-2022