This is a phase II trial that aims at evaluating the safety and tolerability of oral encapsulated fecal microbial transplantation therapy (MTT) in peanut allergic patients. In this research the investigators would like to learn more about ways to treat peanut allergies. The primary objective for Part A is to evaluate whether MTT with antibiotic pretreatment can increase the threshold of peanut reactivity during a double-blind placebo-controlled food challenge from \<=100 mg peanut protein to 300 mg after 28 days of MTT /placebo therapy and 4 months post therapy initiation. The primary objective for Part B is to evaluate whether MTT with antibiotic pretreatment can lead to sustained unresponsiveness (SU) defined as tolerating the same dose of peanut protein administered during a food challenge at baseline and 12 weeks after OIT cessation.
Part A is a This is a phase II randomized double-blind placebo-controlled arm trial that aims at evaluating the efficacy and safety and tolerability of microbial transplantation therapy (MTT) in peanut allergic patients. After reacting to \<=100 mg peanut protein during initial DBPCFC, patients will be randomized to receive either oral Vancomycin and Neomycin or placebo/placebo for 7 days. Patients will then come to the Experimental and Therapeutic Unit (ETU) to receive orally 5 capsules of MTT or placebo under medical supervision. Patients will then take 5 capsules of MTT or placebo the next day then 2 capsules daily for 26 days. Patients will return to the ETU to undergo a second DBPCFC within 2 weeks of end of MTT/placebo treatment and 4 months post MTT initiation. They will return to the ETU for an exit visit 6 months after end of treatment. Gut microbiota will be analyzed serially using state-of-the-art 16SRNA sequencing prior to transplantation, then at 4 weeks, 4-month, and 6 months post transplantation. Immunological biomarkers and mechanistic studies will be performed on blood taken at baseline, second DBPCFC visit and exit visit. Adverse events will be monitored carefully throughout the study. Part B is an open label phase II arm that aims at evaluating the role of MTT in sustained unresponsiveness. Patients who are on maintenance peanut oral immunotherapy (OIT) for a year will be enrolled. They will undergo an open label oral food challenge (OFC) to determine their threshold tolerated dose, after which they will start a week of antibiotics (Vancomycin and Neomycin). Patients will receive their 4 oral capsules of MTT under medical supervision, take another 4 capsules the next day then will start 2 capsules per day for a total of 12 weeks of MTT therapy , all while continuing maintenance peanut OIT. At the end of this course, patients will undergo another open label OFC to evaluate for any change in their tolerated dose . Subjects will then stop OIT and MTT for 12 weeks and will come back for a third OFC to evaluate for any change in their tolerated dose. An exit visit will occur 6 months post end of treatment. Gut microbiota will be analyzed serially using state-of-the-art 16SRNA sequencing at baseline, post antibiotics (and prior to MTT initiation), then at 4, 8, 12, 16, 20 and 24 weeks post MTT initiation. Immunological biomarkers and mechanistic studies will be performed on blood taken at baseline, second and third OFC and exit visit. Adverse events will be monitored carefully throughout the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
37
Participants randomized to the MTT/antibiotic arm of PART A will be administered oral MTT capsules over the course of 28 days. Participant enrolled on PART B will be administered oral MTT capsules over the course of 28 days.
Participants randomized to the MTT/antibiotic arm of PART A will receive oral antibiotics for 7 days prior to the MTT administration visit. Participant enrolled on PART B will receive oral antibiotics for 7 days prior to the MTT administration visit.
Participants randomized to the placebo arm of PART A will be administered oral placebo capsules in place of MTT over the course of 28 days.
Participants randomized to the placebo arm of PART A will receive oral placebo in place of antibiotics for 7 days prior to the MTT administration visit.
Participant enrolled on PART B will be on maintenance peanut oral immunotherapy (OIT) for their clinical care.
Boston Children's Hospital
Boston, Massachusetts, United States
RECRUITINGPART A: Changes in threshold of peanut reactivity during DBPCFC (<=100 mg to 300 mg peanut protein)
PART A: Changes in threshold of peanut reactivity during DBPCFC after 28 days of MTT from \<=100 mg to 300 mg peanut protein and 4 months post therapy initiation.
Time frame: 4 months post MTT
PART B: Achievement of sustained unresponsiveness after 12 weeks of MTT
PART B: Achievement of sustained unresponsiveness after 12 weeks of MTT therapy combined with peanut OIT followed by 12 weeks therapy cessation
Time frame: 12 weeks
PART A: Changes in threshold of peanut reactivity during DBPCFC (<=100 mg to 600 mg peanut protein)
PART A: Changes in threshold of peanut reactivity during DBPCFC after 28 days of MTT from \<=100 mg to 600 mg peanut protein and 4 months post therapy initiation.
Time frame: 4 months post MTT
PART A & B: Adverse Events
PART A \& B: MTT Treatment emergent adverse events
Time frame: 8 months
PART A & B: Changes in Skin Test Wheal Size and IgE level
PART A \& B: Changes in skin test peanut specific wheal size, peanut-specific IgE level over time
Time frame: 8 months
PART A & B: Changes in Gut Microbial Composition
PART A \& B: Changes in gut microbial composition and persistence of that change over time
Time frame: 8 months
PART A & B: Changes in Biomarkers
PART A \& B: Changes in biomarkers including RoRgt+Treg cells and Th2 helper cells frequencies after MTT therapy
Time frame: 8 months
PART B: Change in the tolerated dose during OFC after 12 weeks days of MTT
PART B: Change in the tolerated dose during OFC after 12 weeks days of MTT therapy combined with OIT compared to baseline.
Time frame: 12 weeks
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