Investigator initiated, randomised, placebo-controlled, double-blind, multi-centre primary intervention study to assess whether daily administration of B. infantis EVC001 from age 7 days to 6 weeks (+14 days) until age 12 months (+ 14 days) to children with elevated genetic risk for type 1 diabetes reduces the cumulative incidence of beta-cell autoantibodies in childhood.
The GPPAD-04 SINT1A study will evaluate whether early, regular supplementation with a daily dose of a probiotic can reduce the risk of developing beta-cell autoimmunity in children identified by GPPAD-02 as being genetically predisposed to developing type 1 diabetes. Children will be enrolled at age 7 days to 6 weeks (+14 days) and the study product (B. infantis EVC001 or Placebo) will be administered orally once per day from enrollment until age 12 months (+14 days). The hypotheses is that administration of B. infantis may have a positive influence on the intestinal flora and thus have a regulating effect on the immune system. The study is designed to investigate whether pathogenic immune reactions as in type 1 diabetes but also in other diseases, such as celiac disease, can be reduced and if the disease can be prevented. Children will be followed until age 3.5 - 6.5 years (2.5 - 5.5 years after end of treatment). Throughout the study data will be collected by regular study visits, phone calls with the families and electronic questionaires. Blood samples will be collected to investigate glucose, HbA1c, beta-cell autoantibodies, transglutaminase antibodies, vaccine responses, genetic susceptibility and mechanistic markers. Stool samples will be collected for further assessments such as colonization,microbiome, pH and calprotectin. Exploratory outcomes (allergy, vaccine responses, stool microbiome, blood metabolomics, stool pH and calprotectin or site specific ancillary measurements) may be assessed or in part assessed on a portion of the participants after unblinding the study. They may not necessarily be included in the primary outcome analysis and publication. GPPAD is committed to sharing of data in compliance with all applicable European and GPPAD Consortium Member State, Data Protection and Privacy Protection laws, rules and regulations. Pseudonymized data of the GPPAD-04 SINT1A study will be available to the scientific community after the publication of the trial analysis, which is anticipated in 2028. The SINT1A data will be available upon request.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
1,149
Activated B. infantis EVC001; Bifidobacterium longum subsp. infantis; 8 x 109 colony forming units (CFU) per day
Lactose identical in appearance and taste to the active supplement
University Hospitals Leuven Faculty of Medicine, Catholic University of Leuven
Leuven, Belgium
Universitätsklinikum Carl Gustav Carus Technische Universität Dresden
Dresden, Germany
AUF DER BULT, Kinder- und Jugendkrankenhaus
Hanover, Germany
Persistent confirmed multiple beta-cell autoantibodies
Persistent confirmed multiple beta-cell autoantibodies is defined as confirmed IAA, confirmed GADA, confirmed IA-2A, or confirmed ZnT8A in two consecutive samples, AND a confirmed second antibody from these four antibodies in one sample. The primary outcome is the elapsed time from the random treatment assignment to the first confirmed autoantibody positive sample used in defining the persistent confirmed multiple beta-cell autoantibody positive status. Diabetes in the absence of multiple beta-cell autoantibodies is also considered as a primary outcome endpoint, and in this case, the date of diagnosis is the time of the end point.
Time frame: Through study completion, up to 6.5 years
Persistent confirmed beta-cell autoantibodies
Any persistent confirmed beta-cell autoantibody, defined as at least one confirmed autoantibody in two consecutive samples, including IAA, GADA, IA-2A or ZnT8A
Time frame: Through study completion, up to 6.5 years
Diabetes
Criteria for T1D onset are, as defined by the American Diabetes Association (ADA), based on glucose testing, or the presence of unequivocal hyperglycaemia with acute metabolic decompensation (diabetic ketoacidosis).
Time frame: Through study completion, up to 6.5 years
Transglutaminase antibodies
Transglutaminase antibodies defined as persistent in two consecutive samples
Time frame: Through study completion, up to 6.5 years
Respiratory infection rate
Respiratory infection rate in first year of life during supplementation
Time frame: 1 year
Measurement of Safety parameters
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Institute of Diabetes Research, Helmholtz Zentrum Munich, Germany, and Forschergruppe Diabetes, Technical University Munich (TUM), School of Medicine, Klinikum rechts der Isar
Munich, Germany
Department of Paediatrics Medical University of Warsaw
Warsaw, Poland
Lund University, Skane University Hospital SUS
Malmö, Sweden
University Department of Paediatrics, Cambridge Biomedical Campus
Cambridge, United Kingdom
Royal Victoria Infirmary, Newcastle upon Tyne
Newcastle, United Kingdom
Adverse Events and Serious Adverse Events will be captured until 30 days after the last administration of the food product. Local and systemic adverse effects will be elicited by direct questioning of the participant or parent. Systemic effects will be sought by questioning about any untoward symptoms or signs, and graded as mild, moderate, severe, life-threatening or death according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 5.0.
Time frame: from Baseline until 30 days after end of supplementation