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Design and rationale of the INSYTE study: a randomised, placebo controlled study to test the efficacy of a synbiotic on liver fat, disease biomarkers and intestinal microbiota in non-alcoholic fatty liver disease

Design and rationale of the INSYTE study: a randomised, placebo controlled study to test the efficacy of a synbiotic on liver fat, disease biomarkers and intestinal microbiota in non-alcoholic fatty liver disease
Design and rationale of the INSYTE study: a randomised, placebo controlled study to test the efficacy of a synbiotic on liver fat, disease biomarkers and intestinal microbiota in non-alcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of fat-related conditions ranging from simple fatty liver, to non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis. There is growing evidence that NAFLD is a multisystem disease, affecting several extra-hepatic organs and regulatory pathways. Furthermore, since the gut and liver are linked anatomically via the portal vein, disturbances of the gut microbiota (dysbiosis) can affect the liver. Objectives: In patients with NAFLD, we are testing the effects of a synbiotic which is the combination of a prebiotic (fructooligosaccharides; 4 g/day) and a probiotic (Bifidobacterium animalis subsp. lactis BB-12 at a minimum of 10 billion CFU/day) on a) liver fat percentage, b) NAFLD fibrosis algorithm scores, c) gut microbiota composition. Additionally, there will be several hypothesis-generating secondary outcomes to understand the metaorganismal pathways that influence the development and progression of NAFLD, type 2 diabetes, and cardiovascular risk. Design: In a randomised double-blind placebo-controlled trial, 104 participants were randomised to 10–14 months intervention with either synbiotic (n = 55) or placebo (n = 49). Recruitment was completed in April 2017 and the last study visit will be completed by April 2018. Methods: Change in gut microbiota composition will be assessed using 16S ribosomal RNA gene sequencing. Change in mean liver fat percentage will be quantified by magnetic resonance spectroscopy (MRS). In addition, change in liver fat severity will be measured using two NAFLD fibrosis algorithm scores. The INSYTE study was approved by the local ethics committee (REC: 12/SC/0614) and is registered at www.clinicaltrials.gov as NCT01680640.

Bifidobacterium animalis, Cardiovascular disease, Fructo-oligosacharide, Gut microbiota, NAFLD: non-alcoholic fatty liver disease, Nutrition, Prebiotic, Probiotic, Synbiotic, Type 2 diabetes
1551-7144
113-123
Scorletti, Eleonora
42bb0659-ac67-4a73-bf36-a881fe6c1563
Afolabi, Paul R.
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Miles, Elizabeth A.
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Smith, Debbie E.
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Almehmadi, Amal
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Alshathry, Albandri
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Moyses, Helen E.
56434d9c-870f-4539-a66a-c791add44f67
Clough, Geraldine F.
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Wright, Mark
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Patel, Janisha
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Bindels, Laure
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Delzenne, Nathalie M.
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Calder, Philip C.
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Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Scorletti, Eleonora
42bb0659-ac67-4a73-bf36-a881fe6c1563
Afolabi, Paul R.
757e7f01-664c-493e-bc51-c6a2c933dc22
Miles, Elizabeth A.
20332899-ecdb-4214-95bc-922dde36d416
Smith, Debbie E.
a6a58ace-63d0-4b8f-a91b-403d035528db
Almehmadi, Amal
3721de0d-a04b-4741-af38-0c294f0076af
Alshathry, Albandri
6a08246a-7d46-4baa-83dc-81424b337e92
Moyses, Helen E.
56434d9c-870f-4539-a66a-c791add44f67
Clough, Geraldine F.
9f19639e-a929-4976-ac35-259f9011c494
Wright, Mark
43325ef9-3459-4c75-b3bf-cf8d8dac2a21
Patel, Janisha
2939f10e-7439-4969-8ab7-ee1498b77b99
Bindels, Laure
22d81581-a9aa-4bf0-941b-42a65a40c9a4
Delzenne, Nathalie M.
88794fd8-0986-4816-b7cd-d85f8e81c269
Calder, Philip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c

Scorletti, Eleonora, Afolabi, Paul R., Miles, Elizabeth A., Smith, Debbie E., Almehmadi, Amal, Alshathry, Albandri, Moyses, Helen E., Clough, Geraldine F., Wright, Mark, Patel, Janisha, Bindels, Laure, Delzenne, Nathalie M., Calder, Philip C. and Byrne, Christopher D. (2018) Design and rationale of the INSYTE study: a randomised, placebo controlled study to test the efficacy of a synbiotic on liver fat, disease biomarkers and intestinal microbiota in non-alcoholic fatty liver disease. Contemporary Clinical Trials, 71, 113-123. (doi:10.1016/j.cct.2018.05.010).

Record type: Article

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) represents a spectrum of fat-related conditions ranging from simple fatty liver, to non-alcoholic steatohepatitis (NASH), fibrosis and cirrhosis. There is growing evidence that NAFLD is a multisystem disease, affecting several extra-hepatic organs and regulatory pathways. Furthermore, since the gut and liver are linked anatomically via the portal vein, disturbances of the gut microbiota (dysbiosis) can affect the liver. Objectives: In patients with NAFLD, we are testing the effects of a synbiotic which is the combination of a prebiotic (fructooligosaccharides; 4 g/day) and a probiotic (Bifidobacterium animalis subsp. lactis BB-12 at a minimum of 10 billion CFU/day) on a) liver fat percentage, b) NAFLD fibrosis algorithm scores, c) gut microbiota composition. Additionally, there will be several hypothesis-generating secondary outcomes to understand the metaorganismal pathways that influence the development and progression of NAFLD, type 2 diabetes, and cardiovascular risk. Design: In a randomised double-blind placebo-controlled trial, 104 participants were randomised to 10–14 months intervention with either synbiotic (n = 55) or placebo (n = 49). Recruitment was completed in April 2017 and the last study visit will be completed by April 2018. Methods: Change in gut microbiota composition will be assessed using 16S ribosomal RNA gene sequencing. Change in mean liver fat percentage will be quantified by magnetic resonance spectroscopy (MRS). In addition, change in liver fat severity will be measured using two NAFLD fibrosis algorithm scores. The INSYTE study was approved by the local ethics committee (REC: 12/SC/0614) and is registered at www.clinicaltrials.gov as NCT01680640.

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INSYTE protocol paper final - Accepted Manuscript
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Accepted/In Press date: 18 May 2018
e-pub ahead of print date: 19 May 2018
Published date: 1 August 2018
Keywords: Bifidobacterium animalis, Cardiovascular disease, Fructo-oligosacharide, Gut microbiota, NAFLD: non-alcoholic fatty liver disease, Nutrition, Prebiotic, Probiotic, Synbiotic, Type 2 diabetes

Identifiers

Local EPrints ID: 422305
URI: http://eprints.soton.ac.uk/id/eprint/422305
ISSN: 1551-7144
PURE UUID: 53c629d5-f5b9-4ac8-8efb-a836f73e1a3a
ORCID for Paul R. Afolabi: ORCID iD orcid.org/0000-0002-0553-1578
ORCID for Elizabeth A. Miles: ORCID iD orcid.org/0000-0002-8643-0655
ORCID for Geraldine F. Clough: ORCID iD orcid.org/0000-0002-6226-8964
ORCID for Philip C. Calder: ORCID iD orcid.org/0000-0002-6038-710X
ORCID for Christopher D. Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 20 Jul 2018 16:31
Last modified: 18 Mar 2024 05:18

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Contributors

Author: Eleonora Scorletti
Author: Paul R. Afolabi ORCID iD
Author: Debbie E. Smith
Author: Amal Almehmadi
Author: Albandri Alshathry
Author: Helen E. Moyses
Author: Mark Wright
Author: Janisha Patel
Author: Laure Bindels
Author: Nathalie M. Delzenne

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