Understanding the Role of Gut Microbiota in Hyperphagia in Prader-Willi Syndrome

Obesity Clinical Trial

— PWSGUT  

Official title:

Understanding the Role of Gut Microbiota in Hyperphagia in Prader-Willi Syndrome

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05541003
• Other study ID #: Pro2022000828
• Status: Completed
• Phase: Phase 2
• Start date: January 6, 2023
• Est. completion date: May 30, 2023

Study information

• Verified date: February 2024
• Source: Rutgers, The State University of New Jersey
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study aims to use a high-fiber supplementation, an intervention known to create shifts in the gut microbiota towards a healthier structure, to explore the relationship between gut microbiota, appetite control and feeding behavior in PWS patients.

Description:

This study is recruiting PWS patients aged 18-35 years who have not received growth hormone treatment in the previous 6 months. Study candidates will be recruited from Robert Wood Johnson. Participants will attend a baseline visit at the Center for Advanced Human Brain Imaging Research (CAHBIR) at Rutgers University, during which functional magnetic resonance imaging (fMRI) coupled with a meal test will be performed to assess peripheral and central feeding pathways (7, 8). fMRI scans will be performed during resting state to assess functional connectivity of feeding related networks, with a specific focus on connectivity between the hypothalamus, insula, anterior cingulate, ventromedial/orbitofrontal prefrontal cortex and amygdala (9, 10). Activation to food (vs non-food) images will be assessed to index responsivity to appetitive feeding networks including the above regions and the ventral striatum using paradigms that have previously been found to be sensitive to trait and state in multiple studies (11-13). Thereafter participants will consume a liquid meal (525 kcal; Ensure Plus, Abbott). fMRI will be repeated immediately after the meal. Participants will obtain laboratory work coupled with a meal test to assess satiety hormones and inflammatory markers. Fasting blood draw will be taken, and the participants will consume a liquid meal (525 kcal; Ensure Plus, Abbot) followed by blood draws at 30, 60, 120, 180 and 240 min post-meal. Upon completion of baseline testing and providing a fecal sample, participants will consume NBT-NM108 (a mixture of inulin, Fibersol-2, and brans of oat, wheat, corn and sorghum; Notitia Biotechnologies) daily for 4 weeks. At the completion of the 4-week intervention, all sampling and testing will be repeated as per baseline. At baseline and end of intervention, participants will be interviewed with appetite and physical activity questionnaires (Appendix C and G) and requested to complete a 24-h food recall using MyFitnessPal, a mobile health app on their phone.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. completion date: May 30, 2023
• Est. primary completion date: May 29, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 35 Years

Eligibility

Inclusion Criteria:

• Aged between 18-35 (inclusive)
• Confirmed PWS with genetic testing
• No growth hormone treatment in the previous 6 months
• Body weight < 300 lbs.

Exclusion Criteria:

• History of other gastrointestinal disorders such as small intestinal bacterial overgrowth, celiac disease, inflammatory bowel disease, or irritable bowel syndrome.
• Pregnancy or breastfeeding
• Prior gastrointestinal or bariatric surgery
• Immunocompromised e.g., cancer treatment, bone marrow/organ transplant, immune deficiency, poorly controlled HIV/AIDS, prolonged use of steroids or other immunosuppressant medications
• Antibiotic administration in the previous 30 days
• Participation in other weight-loss programs in the previous 3 months.
• Administration of pre/probiotic supplements or antibiotics.
• Growth hormone administration in the previous 6 months
• Must have access to a smartphone, tablet, computer, or other qualifying internet-enabled device and be able to follow instructions.
• Individuals who are not proficient in English
• Contraindications for MRI scanning, including Ferrous material implanted in or on the body, including flakes or filings, surgical clips, bullets, or electrical devices such as a pacemaker, or nonremovable ferrous jewelry (fillings in teeth and permanent retainers are permitted). Individuals with surgical pins or plates above the neck are excluded. Surgical pins or plates below the neck are exclusions, except when the material is fixed to bone, and considered acceptable by the Reference Manual for Magnetic Resonance Safety. Implants and Devices, 2020 Edition. Almost all recent orthopedic implants are made of materials that are not ferromagnetic and therefore are safe for scanning, and even though some screws are still made of ferromagnetic materials these are firmly screwed into bone. In cases where the material is unknown or deemed unsafe for scanning by the Reference Manual for Magnetic Resonance Safety. Implants and Devices, the participant will be excluded. History of eye injury involving metallic materials, shavings in eyes, or welding without a face mask. Lead/iron tattoos and tattoos performed by a nonprofessional artist if the pigment material is unknown. Claustrophobia (history of significant anxiety in closed places).
• Back problem that would prevent the subject from laying still comfortably for up to 60 minutes.

Related Conditions & MeSH terms

• Hyperphagia
• Obesity
• Prader-Willi Syndrome
• Syndrome

Intervention

Drug:
• NBT-NM108
All patients will consume NBT-NM108 in the form of 2 muffins daily.

Locations

Country	Name	City	State
United States	Robert Wood Johnson University Hospital	New Brunswick	New Jersey

Sponsors (1)

Lead Sponsor	Collaborator
Rutgers, The State University of New Jersey

Country where clinical trial is conducted

United States, 

References & Publications (7)

Dykens EM, Maxwell MA, Pantino E, Kossler R, Roof E. Assessment of hyperphagia in Prader-Willi syndrome. Obesity (Silver Spring). 2007 Jul;15(7):1816-26. doi: 10.1038/oby.2007.216. — View Citation

Fieldstone A, Zipf WB, Sarter MF, Berntson GG. Food intake in Prader-Willi syndrome and controls with obesity after administration of a benzodiazepine receptor agonist. Obes Res. 1998 Jan;6(1):29-33. doi: 10.1002/j.1550-8528.1998.tb00311.x. — View Citation

Holland AJ, Treasure J, Coskeran P, Dallow J, Milton N, Hillhouse E. Measurement of excessive appetite and metabolic changes in Prader-Willi syndrome. Int J Obes Relat Metab Disord. 1993 Sep;17(9):527-32. — View Citation

Martinez Michel L, Haqq AM, Wismer WV. A review of chemosensory perceptions, food preferences and food-related behaviours in subjects with Prader-Willi Syndrome. Appetite. 2016 Apr 1;99:17-24. doi: 10.1016/j.appet.2015.12.021. Epub 2015 Dec 20. — View Citation

Proffitt J, Osann K, McManus B, Kimonis VE, Heinemann J, Butler MG, Stevenson DA, Gold JA. Contributing factors of mortality in Prader-Willi syndrome. Am J Med Genet A. 2019 Feb;179(2):196-205. doi: 10.1002/ajmg.a.60688. Epub 2018 Dec 19. — View Citation

Purtell L, Sze L, Loughnan G, Smith E, Herzog H, Sainsbury A, Steinbeck K, Campbell LV, Viardot A. In adults with Prader-Willi syndrome, elevated ghrelin levels are more consistent with hyperphagia than high PYY and GLP-1 levels. Neuropeptides. 2011 Aug;45(4):301-7. doi: 10.1016/j.npep.2011.06.001. Epub 2011 Jul 1. — View Citation

Zhang C, Yin A, Li H, Wang R, Wu G, Shen J, Zhang M, Wang L, Hou Y, Ouyang H, Zhang Y, Zheng Y, Wang J, Lv X, Wang Y, Zhang F, Zeng B, Li W, Yan F, Zhao Y, Pang X, Zhang X, Fu H, Chen F, Zhao N, Hamaker BR, Bridgewater LC, Weinkove D, Clement K, Dore J, Holmes E, Xiao H, Zhao G, Yang S, Bork P, Nicholson JK, Wei H, Tang H, Zhang X, Zhao L. Dietary Modulation of Gut Microbiota Contributes to Alleviation of Both Genetic and Simple Obesity in Children. EBioMedicine. 2015 Jul 10;2(8):968-84. doi: 10.1016/j.ebiom.2015.07.007. eCollection 2015 Aug. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Gut microbiota composition	Network analysis will be employed to identify guild-level structure in the gut microbiota. When supplemented with dietary fiber, gut bacteria exhibited co-abundance patterns and formed genome interaction groups (GIGs) or "guilds" (an ecological group in which members exploit an environmental resource in a similar way and show co-abundant behavior).	Weeks 0
Primary	Gut microbiota composition	Network analysis will be employed to identify guild-level structure in the gut microbiota. When supplemented with dietary fiber, gut bacteria exhibited co-abundance patterns and formed genome interaction groups (GIGs) or "guilds" (an ecological group in which members exploit an environmental resource in a similar way and show co-abundant behavior).	Week 4
Secondary	Weight	Weight in lbs	Week 0
Secondary	Weight	Weight in lbs	Week 1
Secondary	Weight	Weight in lbs	Week 2
Secondary	Weight	Weight in lbs	Week 3
Secondary	Weight	Weight in lbs	Week 4
Secondary	Ghrelin level	fasting and post-prandial hormone level measured in mg/dl	Week 0 and week 4
Secondary	Ghrelin level	fasting and post-prandial hormone level measured in mg/dl	Week 4
Secondary	Insulin level	fasting and post-prandial hormone level measured in mg/dl	Week 0 and week 4
Secondary	Insulin level	fasting and post-prandial hormone level measured in mg/dl	Week 4
Secondary	Glucose level	fasting and post-prandial hormone level measured in mg/dl	Week 0 and week 4
Secondary	Glucose level	fasting and post-prandial hormone level measured in mg/dl	Week 4
Secondary	Functional MRI	functional MRI in the resting state and post-prandial state to assess functional connectivity of feeding related networks, with a specific focus on connectivity between the hypothalamus, insula, anterior cingulate, ventromedial/orbitofrontal prefrontal cortex and amygdala. The output is an image of brain activation.	Week 0
Secondary	Functional MRI	functional MRI in the resting state and post-prandial state to assess functional connectivity of feeding related networks, with a specific focus on connectivity between the hypothalamus, insula, anterior cingulate, ventromedial/orbitofrontal prefrontal cortex and amygdala. The output is an image of brain activation.	Week 4
Secondary	24 hour dietary recall	24 hour dietary recall recorded in MyFitnessPal application measured in kcal. It is anticipated that the calorie count decreases from week 0 to week 4.	Week 0 and week 4
Secondary	24 hour dietary recall	24 hour dietary recall recorded in MyFitnessPal application measured in kcal. It is anticipated that the calorie count decreases from week 0 to week 4.	Week 4
Secondary	Hyperphagia questionnaire	Appetite behavior measured by questionnaire measured by likert scale. The scores should improve from week 0 to week 4. Higher scores indicate worse hyperphagia. Lowest score is 13 and highest score is 65.	Week 0 and week 4
Secondary	Hyperphagia questionnaire	Appetite behavior measured by questionnaire measured by likert scale. The scores should improve from week 0 to week 4. Higher scores indicate worse hyperphagia. Lowest score is 13 and highest score is 65.	Week 4