The gut microbiota provides an intestinal biological barrier against pathogens and has a pivotal role in the maintenance of intestinal homeostasis and modulation of the host immune system. The gut microbiota in a dysbiotic state has increasingly been implicated in the pathogenesis and progression of numerous diseases. However, whether dysbiosis reflects changes caused by the disease itself, or should be considered as a driving step in the pathogenesis, is not always understood. Dysbiosis results in the disturbance of several metabolic pathways that influence immunological and mechanical processes both in and outside the intestine, and it impairs colonization resistance. These processes may be reverted by fecal microbiota transplantation (FMT). FMT is a type of treatment that relies on transferring the microbiota that targets and corrects intestinal dysbiosis. FMT is based on collecting stool from healthy donors and - after preparation - administering the material to an individual with a specific disease. In summary, a subset of the symptoms associated with COVID-19 during the initial phase are intestinal complications, such as vomiting or diarrhea. Detecting these symptoms might not only lead to slowdown in transmission but also open the door to novel treatments that could reduce the severity of COVID-19.There is a positive correlation between severity of patient condition and level of proinflammatory cytokines (cytokine storm) in group of patients with COVID 19. Though numerous studies have been published on FMT for the treatment of certain diseases, there are only scarce studies on FMT for the treatment of SARS-CoV-2. Antiviral mechanism depended on the gut-lung axis was intimately proved in case of flu virus. The same dependency is observed in SARS CoV2 as well. That seems, good condition of intestinal microbiota could impact on antiviral effects and inhibits replication of virus. This leads to inhibit progress of inflammatory process in lung tissue. Silencing of inflammatory process through reestablish right influence of gut-lung axis could be fundamental meaning in arresting of cytokines storm and development of ARDS in patients with COVID-19. The scientist rationale definitely argue a clear need to studies of gut wellbeing in COVID 19 and using FMT to reduce development of COVID 19. According to our knowledge FeMToCOVID will be the first clinical trial with using of FMT in COVID 19. We postulate FMT in the beginning of cytokine storm during CIVUD-19 may act as an immunomodulation and stop the progression of the disease.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
366
The FMT will be administered orally in double cover, gastro-resistant, enteric release capsules in 60g dose (about 30-50 frozen capsules).
Double cover, gastro-resistant, enteric release capsules with lactose (about 30-50 frozen capsules)
The standard COVID 19 pharmacological treatment
Incidence of adverse events after administration of IMP in the phase II/III
The incidence of adverse events up to day 30 after administration of the product in the safety pilot group
Time frame: 30 days
Percentage of patients requiring escalation of oxygen therapy in non-invasive and invasive methods in phase III
Percentage of patients in the study and control groups requiring escalation of oxygen therapy in non-invasive methods (increasing FiO2 and / or the use of HFNOT and / or other non-invasive methods, e.g. CPAP) and / or invasive ventilation, ventilator therapy and / or hospitalization in the intensive care unit (corresponding to disease exacerbation at grade 5-7 on the COVID-19 Performance Status scale)
Time frame: 100 days
Mortality during hospitalization, up to 14, 30, 60 and 100 days of observation in the study and control groups,
Time frame: 14, 30, 60, 100 days
The number of complications secondary to COVID-19 (bacterial, fungal infections, sepsis, septic shock, multi-organ failure) by the 30th day of observation;
Time frame: 30 days
COVID-19 Performance Status score during hospitalization from randomization to discharge from hospital or death, and to day 14 and 30 of observation in the study and control groups
Time frame: 14, 30 days
The maximum degree of COVID-19 disease severity assessed in the COVID-19 Performance Status scale during hospitalization (until discharge from hospital or death)
Time frame: until discharge or death
NEWS (National Early Warning Score) 2 scores during hospitalization from randomization to discharge from hospital or death in the study and control groups
Time frame: until discharge or death
Assessment of the number of patients who were not able to take all capsules despite the lack of swallowing disorders in the initial evaluation,
Time frame: hospitalization
The number of days with fever (temperature above 38.0°C) up to the 30th day of observation in the study and control groups,
Time frame: 30 days
Number of hospitalization days up to the 30th day of observation in the study and control groups
Time frame: 30 days
Number of days of stay in the intensive care unit until the 30th day of observation in the study and control groups
Time frame: 30 days
Number of days of mechanical ventilation in convalescents up to the 30th day of observation in the study and control groups (if applicable)
Time frame: 30 days
The number of days of non-invasive ventilation in convalescents up to the 30th day of observation in the study and control groups (if applicable)
Time frame: 30 days
Number of days of passive oxygen therapy in convalescents up to the 30th day of observation in the study and control groups (if applicable)
Time frame: 30 days
Safety of treatment up to day 100 of follow-up in the study and control and pilot groups (type, frequency, severity of adverse events [AE])
Time frame: 100 days
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