Crohn's disease is a chronic and relapsing inflammatory bowel disease. Many data show that the intestinal flora is involved in the disease and it has been show that patients with Crohn's disease exhibit an abnormal fecal flora that might play a role in inflammation. The purpose of this study is to determine the effect of the fecal flora transplantation on Crohn's disease.
Introduction : Crohn's disease (CD) is an relapsing inflammatory bowel disease relatively frequent. Its prevalence is about 1 for 700 in France, affecting predominantly young adults. Its treatment is based on immunosuppressants that might be associated with potentially severe complications such as infection and cancers. Moreover, these treatments are expensive. The gut microbiota being involved in the disease pathogenesis, it can be considered as a potential therapeutic target. CD pathogenesis remains poorly understood but involves an inappropriate immune response toward an unbalanced gut microbiota (called dysbiosis) in predisposed hosts. The complete replacement of a dysbiotic microbiota by a "healthy" one is thus an attractive strategy. Fecal transplantation (FT) has been used with success for a long time in the context of Clostridium difficile. Hypothesis : Fecal transplantation allow the replacement of a dysbiotic microbiota by a " healthy " one with favorable impact on CD evolution. Primary endpoint : In CD patient with colonic or ileo-colonic involvement put in remission with corticosteroids, Evaluate if FT can modify a dysbiotic fecal microbiota to be closer of the one of a healthy donor. Methodology For the Receiver : Once corticoid-induced remission will be achieved, the patient will be included and randomised to receive either FT or sham transplantation during a colonoscopy. The patient will be evaluated at week 2, 6, 10, 14, 18 and 24. At week 6, a colonoscopy will be performed. For the Donor : Donors will be recruited by poster advertising. When a receiver will be included, 3 donors will be contacted to attend an inclusion visit including physical examination as well as blood and stool screening for pathogen. The 3 donors will then come the day of the FT to donate their stool.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
24
Fecal microbiota (50-100g of stool from donor resuspended in 250-350ml of physiological serum and filtered) given by infusion in coecum during colonoscopy
250-350ml of physiological serum given by infusion in coecum during colonoscopy
Gastroenterology department, Saint Antoine Hospital
Paris, France
FT success defined by : Sorensen's index [receiver 6 weeks after FT vs donor] > Sorensen's index [receiver 6 weeks after FT vs receiver before FT]) with Sorensen's index [receiver 6 weeks after FT vs donor] ≥ 0.6.
In other words, FT success is reached if the fecal microbiota of the receiver 6 weeks after FT is closer of the fecal microbiota of the donor that of the receiver before FT. Fecal microbiota composition will be assessed by 454 pyrosequencing (16S RNA) and microbiota comparison will be done using Sorensen's index.
Time frame: 6 weeks after FT
FT feasibility
evaluate the feasibility of the FT procedure (frequency of evaluable patients in each group)
Time frame: 6 weeks after FT
Clinical relapse rate in the 24 weeks following FT procedure
Clinical relapse defined by a Crohn's disease activity index (CDAI) \> 220 points, or by a CDAI between 150 and 220 with an increase \>70 compared with baseline, or by the need of surgery or to start a medical treatment for CD.
Time frame: 24 weeks following FT
Effect of FT compared to sham transplantation on CRP
Effect of FT compared to sham transplantation on CRP level.
Time frame: 6 weeks after FT
Effect of FT compared to sham transplantation on Leukocytes level
Effect of FT compared to sham transplantation on: Leukocytes level
Time frame: 6 weeks after FT
Effect of FT compared to sham transplantation on fecal calprotectin
Effect of FT compared to sham transplantation on: fecal calprotectin
Time frame: 6 weeks after FT
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Effect of FT compared to sham transplantation on Crohn's Disease Endoscopic Index of Severity
Effect of FT compared to sham transplantation on: Crohn's Disease Endoscopic Index of Severity
Time frame: 6 weeks after FT
Effect of FT compared to sham transplantation on fecal microbiota composition
Effect of FT compared to sham transplantation on: fecal microbiota composition
Time frame: 6 weeks after FT
Effect of FT compared to sham transplantation on lymphocytes population in blood
Effect of FT compared to sham transplantation on: lymphocytes population in blood
Time frame: 6 weeks after FT
Effect of FT compared to sham transplantation on lymphocytes population in colon
Effect of FT compared to sham transplantation on: lymphocytes population in colon.
Time frame: 6 weeks after FT
Effect of FT compared to sham transplantation on colon transcriptomics
Effect of FT compared to sham transplantation on: colon transcriptomics.
Time frame: 6 weeks after FT