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Non Alcoholic SteatohepatitisPhase 2SYNCHNCT05821010

Synbiotics and Fecal Microbiota Transplantation to Treat Non-Alcoholic Steatohepatitis

A Phase 2 study testing Lyophilized fecal microbiota transplantation capsules, A. soehngenii and Pasteurized A. muciniphila in people with Non Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) at 1 site in Netherlands.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The goal of this clinical trial is to investigate the therapeutic potential of A. soehngenii and pasteurized A. muciniphila combined with B. animalis subsp. lactis and fructo-oligosaccharides with and without conditioned vegan lyophilized fecal microbiota transplantation capsules to reduce NASH in patients with… Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Lyophilized fecal microbiota transplantation capsules, A. soehngenii and Pasteurized A. muciniphila
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
48 participants
Where
1 siteNetherlands
Study dates
17 Mar 2023to 20 Aug 2026
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • biopsy-proven NASH obtained up to 32 weeks before screening: SAF Steatosis score ≥1, Activity ≥2, Fibrosis <4; 50% of participants should at least have NASH fibrosis stage 1, 2 or 3 according to the NASH CRN fibrosis staging system based on tandem reading of two expert liver pathologists
  • fluency in Dutch or English
  • participants should be able to understand the information and give informed consent

Who cannot join

  • Current or history of significant alcohol consumption for a period of more than 3 consecutive months within 1 year before screening (significant alcohol consumption is defined as more than 2 international units/day for females and more than 3 international units/day for males, on average; 1 international unit contains ±14 grams of alcohol)
  • liver cirrhosis or hepatocellular carcinoma
  • hepatitis B and/or C
  • auto-immune hepatitis
  • Wilson's disease
  • primary sclerosing cholangitis
Show all 24Show fewer
  • primary biliary cholangitis
  • alpha-1-antitripsine deficiency and hemochromatosis
  • history of liver transplant, current placement on a liver transplant list
  • use of pre-, pro- or synbiotics
  • use of systemic antibiotics 3 month prior to randomization
  • use of tamoxifen, methotrexate or amiodarone
  • prior or planned bariatric surgery
  • active GLP-1 receptor agonist treated diabetes mellitus
  • bleeding disorder
  • International normalized ratio (INR) of prothrombin time >1.4 or platelet count <100 109/L at screening
  • anti-platelet/coagulant therapy use which cannot be temporarily discontinued
  • any major cardiovascular event within 6 months prior to screening (e.g. myocardial infarction, cerebrovascular accident)
  • prolonged compromised immunity (e.g. recent cytotoxic chemotherapy, HIV-infection with a CD4 count < 240)
  • active or prior history of invasive malignancy (except for curatively treated in situ carcinomas [e.g., cervix] or non-melanoma skin cancer) unless a complete remission was achieved
  • surgery scheduled for the trial duration period, except for minor surgical procedures, in the opinion of the investigator
  • pregnant or nursing women
  • any condition which, in the investigator's opinion, might jeopardize participants' safety or compliance with the protocol
  • participation in another concomitant clinical trial.

Trial locations and contacts

1 site in 1 country.

Quinten Augustijn, MD contact

+31205661267

q.j.augustijn@amsterdamumc.nl

Netherlands1 site, 1 recruiting
  • Amsterdam UMC

    Amsterdam, North Holland, 1105AZ

    Q.J.J. Augustijn, MD, +315661267, q.j.augustijn@amsterdamumc.nl

    Recruiting

Other trials in Netherlands

About this study

The goal of this clinical trial is to investigate the therapeutic potential of A. soehngenii and pasteurized A. muciniphila combined with B. animalis subsp. lactis and fructo-oligosaccharides with and without conditioned vegan lyophilized fecal microbiota transplantation capsules to reduce NASH in patients with fibrotic NASH. The main questions to answer are:

  1. Can NASH be treated by altering the gut microbiota using LFMT capsules?
  2. Can NASH be treated using a syntrophic cocktail of synbiotics and will these strains strengthen the effect of FMT?
  3. What are the underlying mechanism by which the aforementioned treatments attenuate NASH?

Participants will be treated with FMT-capsules or placebo, and all participants will receive a cocktail of 3 strains of probiotics and one type of prebiotic.

Read the detailed description

Main objective To investigate the therapeutic potential of A. soehngenii and pasteurized A. muciniphila combined with B. animalis subsp. lactis and fructo-oligosaccharides with and without conditioned vegan lyophilized fecal microbiota transplantation (LFMT) capsules to reduce NASH in patients with NASH and NASH-fibrosis.

Secondary objective To investigate the mechanisms of A. soehngenii and pasteurized A. muciniphila combined with B. animalis subsp. lactis and FOS with and without conditioned vegan LFMT capsules in reducing NASH in patients with NASH and NASH-fibrosis.

Study design:

Double-blind randomized placebo-controlled intervention study.

Study population:

Patients between age 18-75 years with biopsy-proven NASH obtained up to 32 weeks before screening based on tandem reading of two expert liver pathologists: SAF Steatosis score ≥1, Activity ≥2, Fibrosis <4; 50% of participants should at least have NASH fibrosis stage 1, 2 or 3 according to the NASH CRN fibrosis staging system.

Intervention:

Recipient participants From day -3 before the first FMT until completion of the study, all recipient participants will receive an oral daily single dose of 5 g FOS. Subsequently, participants will be randomized to lean donor FMT capsules (donors conditioned with WholeFiber) or placebo (blinded design)1.

At baseline (day 0) and at week 8 (day 56) and week 16 (day 112) participants will ingest 21 LFMT or placebo capsules. The study visits will be 8 weeks apart, although a margin of -3 days to +3 days is implemented to take participants schedule and availability into account. In addition, participants will daily take 2 capsules of LFMT or placebo during the whole study period (24 weeks).

The investigators have previously observed that gut microbiota composition in the recipient is affected up to 8-12 weeks after donor FMT1, so this time window ensures a stable donor gut microbiota composition during the study.

During the 24-week intervention period, all participants will take daily doses of 109 A. soehngenii CH-106 cells (dosage based on previous studies including toxicology study)2,3, 1010 B. animalis subsp. lactis BLC1 (a well-studied strain marketed as a probiotic by Sacco SRL) and 3x1010 pasteurized A. muciniphila ATCC BAA-835T cells (dosage based on EFSA approval and obtained from A-Mansia Biotech).

Percutaneous liver biopsies will be performed as a part of screening when participants are theoretically eligible for participation, unless a liver biopsy has been performed in the previous 36 weeks. A tandem-read by two liver pathologists blinded to any other result will determine if patients will be included in the study. At 24 weeks, another liver biopsy will be performed to examine the effect of the FMT, which will also be reviewed by two liver pathologists (again blinded to any other result). The NASH-CRN classification will be assessed on H\&E slides, for steatosis, inflammation and ballooning, and with a Sirius red-stained slide for evaluation of fibrosis. RNA for RNA-sequencing will be isolated.

Differential gene expression will be assessed over time (baseline and 24 weeks) and by treatment allocation (vegan donor FMT versus placebo).

Feces will be collected at baseline, and after week 2, 8, 10, 16, 18, and 24, in order to investigate the changes in gut microbiome. Also, markers of gut barrier function will be assessed.

Blood will be collected at baseline and at 8, 16 and 24 weeks to investigate common liver enzymes, indicators of glycemic control, lipids, and general and more NASH-specific inflammation parameters.

A multiparametric MRI of liver (MRI-PDFF, MR elastography, corrected T1) and of visceral and subcutaneous fat will be performed at baseline and after 24 weeks to estimate visceral and subcutaneous adipose tissue depot volume, hepatic fat content as well as hepatic fibrosis and inflammation.

Continuous glucose measurements will be performed at home using portable devices, during a consecutive period of 1 week (7 days) in the week before baseline, week 1, 9, 17 and 25.

Being tested
Lyophilized fecal microbiota transplantation capsules, Placebo capsules, A. soehngenii, Pasteurized A. muciniphila, B. animalis subsp. lactis
Medical subject headings
Non-alcoholic Fatty Liver Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Lyophilized fecal microbiota transplantation capsulesCombination product

    Oral administration (capsule)

  • Placebo capsulesCombination product

    Oral administration (capsule)

  • A. soehngeniiDietary supplement

    Oral administration (capsule)

  • Pasteurized A. muciniphilaDietary supplement

    Oral administration (capsule)

  • B. animalis subsp. lactisDietary supplement

    Oral administration (capsule)

  • Fructo-oligosaccharidesDietary supplement

    Oral administration (dissolved in water)

Study groups in NCT05821010
Study groupRoleWhat they receive
LFMT-capsulesExperimentalLFMT-capsules. 3 times bulk, and further continuous administration. This arm is also treated pre- and probiotics.
Receives: Combination Product: Lyophilized fecal microbiota transplantation capsules; Dietary Supplement: A. soehngenii; Dietary Supplement: Pasteurized A. muciniphila; Dietary Supplement: B. animalis subsp. lactis; Dietary Supplement: Fructo-oligosaccharides
PlaceboPlacebo comparatorPlacebo-capsules. 3 times bulk, and further continuous administration. This arm is also treated pre- and probiotics.
Receives: Combination Product: Placebo capsules; Dietary Supplement: A. soehngenii; Dietary Supplement: Pasteurized A. muciniphila; Dietary Supplement: B. animalis subsp. lactis; Dietary Supplement: Fructo-oligosaccharides

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Liver histology

    Alteration of liver histology in subjects with NASH and fibrosis stage 0-3, with an alteration defined as change of steatohepatitis by ≥1 SAF-A point, or a change in ≥ 1 stage liver fibrosis.

    Measured: baseline and after 24 weeks

Secondary outcomes (19)
  1. MRI

    MRI-PDFF, MR elastography, corrected T1

    Measured: baseline and after 24 weeks

  2. Fibroscan

    CAP and LSM

    Measured: baseline and after 24 weeks

  3. Liver enzymes (blood)

    alanine amino transferase (ALT), aspartate amino transferase (AST), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP))

    Measured: baseline and after 24 weeks; 8 and 16 weeks for safety.

  4. Immunological data

    leukocytes, monocytes, CRP, Il-1(β), Il-6, Il-11, Il-17, Il-32, TNF-α, IFN-γ, other inflammatory markers),

    Measured: baseline and after 24 weeks

  5. Plasma lipids

    plasma lipids (LDL, HDL, triglycerides, total cholesterol),

    Measured: baseline and after 24 weeks

  6. Gut metabolites (in blood)

    short chain fatty acids (i.e. propionate, butyrate, acetate), lactate, ethanol,

    Measured: baseline and after 24 weeks

  7. Glycemic control

    Continuous glucose monitoring (4x 7 consecutive days), HOMA-IR

    Measured: 5 weeks during study period

  8. albumin, kreatinine, hemoglobin (blood)

    albumin, kreatinine, hemoglobin (blood)

    Measured: baseline, 8, 16 and 24 weeks

  9. NAFLD NASH related endocrinological and metabolic outcome parameters

    FGF-21, adiponectin, leptin, lipopolysaccharides, estrogen, vitamin B12, folate acid, zonulin, and other metabolomic and lipidomic outcomes.

    Measured: Baseline and 24 weeks

  10. Microbiome readouts

    microbiome read outs (composition, engraftment, strain tracking) and metabolites, fecal SCFA-composition, and fecal albumine.

    Measured: baseline and after 24 weeks, and 5 times in between.

  11. Body weight

    Body weight measured without shoes, in kilograms

    Measured: baseline and after 24 weeks

  12. Height

    Height measured without shoes, in cm

    Measured: baseline

  13. BMI

    Body mass index, calculated from height and weight kg/m^2 (kg per meters squared)

    Measured: baseline and after 24 weeks

  14. Waist circumference

    Measured just cranial of the spina iliaca anterior superior, in cm

    Measured: baseline and after 24 weeks

  15. Percentage body fat

    Measured with a biometric device, as a percentage.

    Measured: baseline and after 24 weeks

  16. Demographics and (medical) history

    Sex, age, ethnicity, height, weight, comorbidities (e.g. diabetes), smoking, alcohol intake, medication use, polypharmacy (defined as chronic use of ≥ 5 different medications)

    Measured: baseline and 24 weeks

  17. Quality of life with CDLQ-NASH

    quality of life with NAFLD/NASH-specific (CDLQ-NAFLD)) questionnaire.

    Measured: baseline and after 24 weeks

  18. Quality of life with SF36 questionnaire.

    quality of life (general (SF36) questionnaire.

    Measured: baseline and after 24 weeks

  19. Food diary

    5x 10 days, daily caloric intake, daily fat and sugar consumption

    Measured: around the visits 0, 8, 16, 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Apr 2023
  2. Study start17 Mar 2023
  3. Primary completion20 Feb 2026 (estimated)
  4. Study completion20 Aug 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized placebo-controlled trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
48 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05821010
Sponsor's protocol ID
NL81001.018.22
Acronym
SYNCH
Status last verified
Aug 2024
First submitted
8 Mar 2023
Last updated
27 Aug 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Augustijn QJJ, Grefhorst A, de Groen P, Wortelboer K, Seegers JFM, Gul IS, Suenaert P, Verheij J, de Vos WM, Herrema H, Nieuwdorp M, Holleboom AG. Randomised double-blind placebo-controlled trial protocol to evaluate the therapeutic efficacy of lyophilised faecal microbiota capsules amended with next-generation beneficial bacteria in individuals with metabolic dysfunction-associated steatohepatitis. BMJ Open. 2025 Jan 9;15(1):e088290. doi: 10.1136/bmjopen-2024-088290.

    PubMed 39788762

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Lyophilized fecal microbiota transplantation capsules, A. soehngenii and Pasteurized A. muciniphila in people with Non Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease, run by Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) at 1 site in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 27 Aug 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Quinten Augustijn, MD (+31205661267, q.j.augustijn@amsterdamumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Liver histology (time frame: baseline and after 24 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05821010, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Aug 2024.

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