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Pilot Project: The Amplicon and Metatranscriptomic Study of Intra and Extra Intestinal Microbiome in Non-infectious Uveitis Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT04126850
Recruitment Status : Not yet recruiting
First Posted : October 15, 2019
Last Update Posted : October 17, 2019
Information provided by (Responsible Party):
Ratna Sitompul, Fakultas Kedokteran Universitas Indonesia

Brief Summary:
This study aimed to discover the composition on the microbiome in several sites of the human body; and to find out the difference in microbiome composition on ocular fluid, blood, and feces before and after therapy in uveitis patient with history of autoimmune disease (Behcet and Vogt-Koyanagi-Harada) and idiopathic uveitis

Condition or disease
Autoimmune Uveitis Behçet Disease Vogt-Koyanagi-Harada Disease Idiopathic Uveitis Noninfectious Panuveitis Anterior Uveitis Idiopathic Posterior Uveitis Intermediate Uveitis

Detailed Description:

Gut microbiome has been widely studied around the globe, and it is convinced that the gut microbiome plays an essential role in many human diseases. In a published review showed the presence of microbes in blood from a patient who suffered from non-communicable disease. The microbes present in dormant or not-immediately-culturable states as if blood is a 'sterile' environment. It was argued that the difficulty of culturing microbes from the blood was coming from the limited understanding of suitable growth/isolation media for the microbes to be cultured. This limitation can be overcome by the sequenced-based methods for detecting non-proliferating microbes. The presence of microbes in blood also can be observed by ultrastructural (microscopic) methods. Through the microscopic observations, it was witnessing the presence of coccus and bacillus shaped bacteria that present proximity to (Red Blood Cell) RBCs in sample blood patients with Alzheimer's or Parkinson's Disease. The presence of microbes in the places other than their normal location state by term 'atopobiosis'. The presence of microbes in blood suspected as a result of translocation between the gut to the blood.

Therefore, according to the current knowledge of microbiome association and the human diseases, we are eager to conduct a pilot project that gives a comprehensive picture of the association between the microbiome and uveitis disease partially non-infectious and idiopathic uveitis. We will investigate microbiome profiling in the intestinal and extra-intestinal of uveitis patients before and after treatment to see whether any alteration of microbial abundance at two distinct clinical conditions partially in uveitis patients with history of autoimmune disease (Behcet and Vogt-Koyanagi-Harada) and idiopathic uveitis. Another objective of this study is to explore any pathogenic microorganism that present in uveitis patients samples conducted by a sequenced-based method.

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Study Type : Observational
Estimated Enrollment : 10 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Pilot Project: The Amplicon and Metatranscriptomic Next-generation Sequencing of Samples From Intra and Extra-intestinal Microbiome in Non-infectious Uveitis Patients to Decipher Possibility Uveitis Pathogenesis
Estimated Study Start Date : November 1, 2019
Estimated Primary Completion Date : July 30, 2020
Estimated Study Completion Date : July 30, 2020

Primary Outcome Measures :
  1. Differential abundant taxonomic groups bacterial [ Time Frame: 0, 6 weeks ]
    The primer used in this amplicon study is targeted to 16S rRNA gene region V3-V4 to detect bacterial diversity in the samples. The sequencing will be generated by Illumina according to standard protocol. Prior filter is conducted using Prinseq-lite, then chimeric sequences remove using Usearch61 and left over the high quality reads. The (operational taxonomic unit) OTU is picked using bioinformatic tool (Quantitative Insights Into Microbial Ecology - QIIME). Taxonomic classification for de novo OTUs clustering will be generated using open source software package for bioinformatics data processing. Shanon diversity, Simpson index will be examined for calculating alpha diversity. And then we will do identification of differential abundant taxonomic groups. And do analysis correlation network between bacterial genera among two clinical condition (before and after received oral steroid) relatively to health control.

Secondary Outcome Measures :
  1. Detection pathogenic microorganism in samples [ Time Frame: 0, 6 weeks ]
    In this study we are going to use IDseq Portal, a novel bioinformatics platform that designed for detection of microbes from metagenomic data. This analysis will be applied in all types samples (stool, blood, and aqueous humor). We expect to find any specific microbiome (bacterial/fungal/virus) signature in samples patient uveitis.

Biospecimen Retention:   Samples With DNA
  • Feces
  • Blood
  • Aqueous humor

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Non-infectious and idiopathic uveitis patients registered from November 2019 at Cipto Mangunkusumo Hospital, Indonesia.

Inclusion Criteria:

  • New patient registered at Cipto Mangunkusumo Hospital since November 2019
  • Patient diagnosed with non-infectious uveitis (with Behcet, VKH history)
  • Patient idiopathic uveitis (proven to have negative result by available etiological uveitis work-ups)
  • Minimum age: 18 years old
  • Experience active inflammation in the past 180 days and or during patient registration following Standard Uveitis Nomenclature (SUN) guidelines, in at least:

    • equal and or more than 2+ anterior chamber cells
    • equal and or more than 2+ vitreous haze and/or
    • active retinal/choroidal lesions

Exclusion Criteria:

  • patients had taken probiotics supplement or antibiotics 3 months before sample collection
  • or who experience prolonged diarrhea or constipation
  • or undergone gastrointestinal surgery
  • having any form of malignancy
  • having a systemic disease such as hypertension, obesity, inflammatory bowel disease, or diabetes.
  • Disagree to sign informed consent
  • Uveitis is proven to be an infectious origin
  • Pregnant patient
  • Loss to follow up patient

Healthy volunteers are recruited for this study after giving consent with the following inclusion criteria:

  • age: 18-50 years old (Man/Woman)
  • having no health complaints or symptoms
  • not in any long term medications
  • having no history of allergy
  • willing to cooperate in the study
  • state of complete physical, mental and social well being

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04126850

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Contact: Ratna Sitompul, Professor +628118009911
Contact: Rina La Distia Nora, PhD +62811198910

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RSUPN dr. Cipto Mangunkusumo (Cipto Mangunkusumo Hospital)
Jakarta Pusat, Jakarta, Indonesia, 10320
Contact: RSCM Kirana    +622131902885   
Contact: Divisi IIM RSCM Kirana    +6285781170297   
Sponsors and Collaborators
Fakultas Kedokteran Universitas Indonesia
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Principal Investigator: Ratna Sitompul, Professor RSUPN dr. Cipto Mangunkusumo Hospital (RSCM)
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Responsible Party: Ratna Sitompul, Prof. Dr. dr. Ratna Sitompul, SpM(K), Fakultas Kedokteran Universitas Indonesia Identifier: NCT04126850    
Other Study ID Numbers: 19-05-0624
First Posted: October 15, 2019    Key Record Dates
Last Update Posted: October 17, 2019
Last Verified: October 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Ratna Sitompul, Fakultas Kedokteran Universitas Indonesia:
Autoimmune Uveitis
Vogt-Koyanagi-Harada Disease
Behçet Disease
Idiopathic Uveitis
Additional relevant MeSH terms:
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Behcet Syndrome
Uveomeningoencephalitic Syndrome
Uveitis, Anterior
Uveitis, Posterior
Uveitis, Intermediate
Pars Planitis
Uveal Diseases
Eye Diseases
Mouth Diseases
Stomatognathic Diseases
Vascular Diseases
Cardiovascular Diseases
Hereditary Autoinflammatory Diseases
Genetic Diseases, Inborn
Skin Diseases, Genetic
Skin Diseases
Skin Diseases, Vascular
Iris Diseases
Choroid Diseases
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Autoimmune Diseases
Immune System Diseases